CARE HOMES FOR OLDER PEOPLE
Oakfield Nursing Home Lancaster Road Forton Nr Preston Lancashire PR3 OBL Lead Inspector
Mrs Christine Marshall Unannounced Inspection 21st November 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Oakfield Nursing Home Address Lancaster Road Forton Nr Preston Lancashire PR3 OBL 01524 792194 01524 792666 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Portland Care Services Limited Mrs Leonie Bull Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28), Physical disability (28) of places Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The home shall not accommodate more than 28 service users in total at any one time. The service should, at all times, employ a suitably qualified and experienced Manager who is registered with the NCSC. 6th May 2005 Date of last inspection Brief Description of the Service: Oakfield Nursing Home is situated in Forton, on the A6 road to Lancaster. It is registered for 28 residents who need nursing care. There are 26 single bedrooms, of which 18 have en-suite facilities, and 1 double room. Bedrooms and lounge and dining areas are nicely furnished and there are pleasant garden areas. There are trained nurses on duty 24 hours a day and good levels of staff in place. Mrs Leonie Bull is the registered manager of the home and Mr Anthony Bull is the administrator. The home is owned by Mr Hadyn Hughes of Portland Care Services Ltd. Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second of two unannounced inspection visits, scheduled from 1st April 2005 to 31st March 2006. The inspection took place over a full morning and was carried out by the home’s designated lead inspector. The inspector undertook a full tour of the home, including bedrooms, lounge and dining areas and bathrooms. The policies and procedures for the management of the home were examined, as were staff recruitment and training files. Comment cards were handed out to the residents and when returned, were all very positive and indicated that everyone is satisfied with the care that they receive. The inspector spoke privately with three of the residents, and had group discussions with several other people living at the home. There were two visiting relatives available during the inspection visit. The registered manager, administrator, the deputy manager and three care staff spoke with the inspector. The manager and staff were welcoming and co-operative with the inspector throughout the visit. What the service does well:
Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 6 The home is committed to the training and development of care staff and is a registered training centre. Daily routines for the people living at Oakfield are as flexible as they can be and designed to meet the residents’ individual needs. Carers are very friendly and the residents spoken to said that the staff were all very helpful, caring and considerate. Comments from the residents included“There is no place like home, but this is the next best thing.” “The staff are just perfect, no complaints at all.” ‘’The food is good.’’ “I enjoy the food.” Visiting relatives told the inspector that they were more than happy with the care at the home. What has improved since the last inspection? What they could do better:
The registered provider must forward a monthly monitoring visit report to the CSCI. This will show that the management of the homeis being monitored and will ensure that good practice is maintained. Proof of identity must be obtained for each member of staff’s recruitment file. This will make sure that each person working at the home is recognised and that the checks for the security and the safety of the people living at the home can be carried out robustly.
Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 7 Criminal Records Bureau (CRB) disclosure records must have the name, reference number and date of disclosure recorded before they are shredded. These disclosures are necessary for the protection of the people living at the home and details must be available for any visiting inspector or person of authority to see. It is the policy of the Commission for Social Care Inspection (CSCI) that managers should undertake a relevant training programme that is equivalent to the Registered Managers Award, so that managers are updated and aware of all aspects of management in care. Although the registered manager, Mrs Bull has been managing nursing homes for thirty years, thirteen of these at Oakfield, and has proved herself to be competent, she is reluctant to undertake the Registered Managers Award. Discussion with the Commission are to be arranged in respect of this. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X No judgement is made. EVIDENCE: All of these standards were assessed on the previous inspection visit and each was met. Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 & 10 There are basically safe systems of medicating in the home; however, the recording of medicines that are received into the home needs to be reviewed to ensure that residents are given their drugs safely. Residents’ privacy and dignity is an integral part of the care offered at Oakfield. EVIDENCE: Most aspects of the medication system are safe and satisfactory. Tablets, medicines and creams are stored properly and records of the drug fridge temperature, and the medication room temperature are recorded daily. However, current Medication Administration Record (MAR) sheets were examined and these show that all medicines records are handwritten. The inspector advised that this in itself is satisfactory, but that these records must be signed by the person writing the instructions and witnessed by a
Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 11 second person, to make sure that the records have the correct drug, dosage and times of administering. Also, the receipt of medication into the home is not fully recorded in that there is no record of the amount of tablets or medicine that is received from the supplying chemist. Again the inspector advised that this must be recorded to make sure that there is an audit trail of drugs and to ensure that there is no room for misuse of medicines and tablets. Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 & 14 The manager and the staff support the residents in exercising choice and control over their lives. Social activities, family contact, privacy and dignity are daily considerations for each resident who lives at the home. EVIDENCE: The home offers activities such as dominoes, reminiscence and manicures for the residents. A mobile library visits the home regularly. Religious ministers also visit the home regularly. Residents who were able said that they preferred just have quiet time rather than organised entertainment or activities: They also said that they had full choice of what they wanted to do in their daily routines. Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 13 The inspector spoke to a number of residents an each one said that they enjoyed having their relatives visit and that they were always welcomed by the staff at the home. Two visiting relatives told the inspector that they were always welcomed at the home and had a very good relationship with everyone there. Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X No judgement has been made. EVIDENCE: Each of these standards was assessed on the previous inspection visit and all were met Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 & 24 A safe and comfortable environment is provided for the residents. Bedrooms are furnished and decorated to suit the individuals’ tastes and preferences, meaning people are living in homely surroundings. EVIDENCE: The inspector visited some of the resident’s bedrooms and noted that each room was personalised and comfortable. There are two lounge areas and a dining area that are comfortable and homely. Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 16 There are plans to extend the home and this will then bring the home into compliance with the National Minimum Standards communal and recreational space. The manager assured the inspector that any resident who wishes to have a safety lock fitted to their door would be given that facility. All new residents are offered this and the new extension will provide safety locks on all newly registered bedrooms. Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 The home provides adequate levels of staff to ensure that the service users needs are met. The training programmes that are available at the home make sure that the staff are qualified and competent to care for the residents. Staff recruitment files need to have proof of identity recorded. EVIDENCE: The list of staff on duty showed that there are good levels of nurses, carers and domestic staff on duty at the home. The inspector spoke to carers and the domestic staff, who were very helpful and showed that there is a good mix of people in place. National Vocational Qualifications (NVQ) and staff training programs are in place; 50 of carers have already achieved the NVQ award. Residents who were able told the inspector that they never had to wait very long for the carers to help them and that they were happy with the levels of staff on duty. Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 18 Staff recruitment files contained most of the necessary information that is required, however there were not photographs as proof of identity on every file; the administrator Mr Bull is addressing this as a matter of priority. Induction and training programmes are in place and staff confirmed that they were given regular training. Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 A qualified and experienced person, who is registered with the Commission for Social Care Inspection, manages the home; the residents’ welfare is protected through good management. However some issues in respect of management qualifications and monitoring visits have been identified. EVIDENCE: The registered manager Mrs Leoni Bull is a Registered Nurse and a National Vocational Qualifications (NVQ) assessor. She has managed the home for 13 years and has proved herself competent. However Mrs Bull is not undertaking the Registered Managers Award. Discussions in respect of this are to be arranged. Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 20 There is a quality monitoring system in place, however the registered provider Mr Hughes does not produce a monthly report for the Commission, which is a requirement under the Care Homes Regulations 2001. The inspector is to contact Mr Hughes in respect of this. Examination of the home’s safety certificates confirmed that the residents are protected through regular health and safety maintenance visits. Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X 2 X X X 3 X X STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Are there any outstanding requirements from the last
Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 22 inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13.2 Requirement The amount of tablets and medicines received into the home must be recorded. Two signatures must accompany any handwritten drug instructions of the MAR sheets. Proof of identity must be evident in the form of a photograph in staff recruitment files. The registered manager must enrol on a Registered Managers Award course. Monthly monitoring visit report must be forwarded to the CSCI. Timescale for action 09/01/06 2 3 4 OP29 OP31 OP33 18 10 26 09/01/06 28/02/06 09/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Oakfield Nursing Home DS0000006066.V267690.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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