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Inspection on 29/10/08 for Oakfield Nursing Home

Also see our care home review for Oakfield Nursing Home for more information

This inspection was carried out on 29th October 2008.

CSCI found this care home to be providing an Good service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The needs of people were thoroughly assessed before they moved into the home, to ensure that the staff team could provide the care and support required. Once admitted to the home people`s needs were recorded on the plans of care, showing clearly how they were to be best met, so that staff were fully aware of what each individual required and so that people`s health, personal and social care needs were fully met. Those living at the home were treated with respect, their privacy and dignity being maintained at all times. Good nutritional, pressure and incontinence care was provided, which involved a range of external professionals, ensuring that people living at the home received appropriate health care. The management of medicines was good, so that people were adequately protected against medication errors. The daily routines within the home were flexible and people living there were offered a variety of choices throughout the day. Visitors were made very welcome to the home and residents were able to access an independant person to act on their behalf, if they so wished. Activities were provided in accordance with the needs of people living at Oakfield and religious needs were appropriately met. The management of meal times was good. The menu provided a choice of nutritious food and people were allowed to eat at their own pace, so that the dining experience was enjoyable for them. Special diets were provided, as was required, and the meals served looked appetising to aid in nutrition. The sweet trolley was a feast of delightful, homemade hot and cold puddings, which people thoroughly enjoyed and looked forward to selecting. Complaints were well managed and people living at the home were adequately safeguarded from abusive situations. The environment was warm, comfortable and homely, providing pleasant surroundings for people to live in. The control of infection was good, so that those living at the home were protected from infectious diseases.

What has improved since the last inspection?

At the last key inspection one recommendation was made, which no longer stands and so this has been removed.

What the care home could do better:

Hand written entries on the Medication Administration Records could have been signed, witnessed and countersigned to reduce the possibility of transcription errors. Recruitment practices could have been better to ensure that those employed were fit to care for vulnerable people. References sought could have included a space for the referree to enter the date to show that they were obtained before employment commenced. Crimimal Record Bureau disclosures and POVA checks could have always been obtained before people started to work at the home. The home could continue to work towards 50% of care staff achieving a National Vocational Qualification in care, so that more of the work force is qualified to supervisenewer carers and to provide the care required by the people living at the home. The manager of the home could work towards obtaining the Registered Managers Award, so that she will have achieved a recognised management qualification. The views of stakeholders in the community could now be sought as to how the goals for the people living at the home are met and feedback could be obtained from staff as to what it is like working at the home.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oakfield Nursing Home Lancaster Road Forton Nr Preston Lancashire PR3 0BL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vivienne Morris     Date: 2 9 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Oakfield Nursing Home Lancaster Road Forton Nr Preston Lancashire PR3 0BL 01524792194 01524792666 fitdog@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Leonie Bull Type of registration: Number of places registered: Portland Care Services Limited care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care Home with Nursing - Code N To Service Users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Physical Disability - Code PD The maximum number of Service Users who can be accommodated is: 28 Date of last inspection Brief description of the care home Oakfield Nursing Home is situated in Forton, on the A6 road to Lancaster. It is currently 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 is wheelchair access to the home and there is a passenger lift in place. There are Care Homes for Older People Page 4 of 30 Over 65 28 0 0 28 Brief description of the care home 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. Mr Hadyn Hughes of Portland Care Services Ltd owns the home. At the time of this visit, (21/8/06) the information given to the Commission showed that the fees for care at the home are #465.00 per week, with added expenses for hairdressing, newspapers and chiropody. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. The site visit to Oakfield Nursing Home formed part of the inspection process and was conducted over one day in October 2008. It was unannounced, which means that the managers, staff and people living at the home did not know it was going to take place. During the course of the site visit, discussions took place with those living at the home, as well as relatives and staff. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation was viewed and all communal areas were seen. Care Homes for Older People Page 6 of 30 Comment cards were received from six people who were living at the home and two staff members and their feedback is reflected throughout this report. Every year the provider completes a self-assessment (AQAA), which gives information to the Commission about how the home is meeting outcomes for the people using the service and how the quality of service provided is monitored. We observed the activity within the home and tracked the care of three people during the site visit, not to the exclusion of other residents. The total key inspection process focussed on the outcomes for people living at the home and involved gathering information about the service over a period of time. The Commission for Social Care Inspection received some information about this service shortly before our site visit, which was looked at during our visit to the home and which found that one of the care home regulations was not being consistently met. What the care home does well: What has improved since the last inspection? What they could do better: Hand written entries on the Medication Administration Records could have been signed, witnessed and countersigned to reduce the possibility of transcription errors. Recruitment practices could have been better to ensure that those employed were fit to care for vulnerable people. References sought could have included a space for the referree to enter the date to show that they were obtained before employment commenced. Crimimal Record Bureau disclosures and POVA checks could have always been obtained before people started to work at the home. The home could continue to work towards 50 of care staff achieving a National Vocational Qualification in care, so that more of the work force is qualified to supervise Care Homes for Older People Page 8 of 30 newer carers and to provide the care required by the people living at the home. The manager of the home could work towards obtaining the Registered Managers Award, so that she will have achieved a recognised management qualification. The views of stakeholders in the community could now be sought as to how the goals for the people living at the home are met and feedback could be obtained from staff as to what it is like working at the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are thoroughly assessed before they are admitted to the home to ensure that the staff team can deliver the appropriate care. Evidence: The care of three people living at Oakfield Nursing Home was tracked during this site visit to the service. We looked at the care records of all three people, which showed that the needs of each person had been thoroughly assessed by the home before they were admitted, so that the managers were confident that the staff team could fully meet each persons individual needs. The information recorded gave a clear picture of peoples personal, health and social histories, so that staff were able to discuss with them things that mattered to them. The registered manager told us that the needs of people wishing to move into the home were consistently assessed before they were admitted, the only exception being Care Homes for Older People Page 11 of 30 Evidence: in an isolated emergency situation, when an assessment of needs would be conducted as soon as practicable following admission. The admission procedure was undertaken in accordance with the admission policy available at the home and those responsible for undertaking the pre-admmission assessments were fully aware of how to gather the relevant information about people before they moved into the home. We received comment cards from six people who use the service and all six said that they received enough information about Oakfield before they moved in, so that they could decide if it was the right place for them to live. One relative added, we visited several homes and felt that Oakfield was definitely the best place for mum. We asked if people had received a contract and of the six who returned comment cards five said that they had, showing that they had been given a copy of the terms and conditions of the home. When asked what the service does well, the registered manager told us, we aim to help people to exercise the opportunity to select from a range of options in all aspects of their lives. She gave some good examples of how this was achieved. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are fully met, their privacy and dignity being respected at all times and the management of medications is good. Evidence: The assessed needs of people whose care was tracked were recorded within the plans of care and clear guidance was provided for staff as to how these needs were to be met. The care plans were supported by a risk management framework, so that any potential risks to the health or personal care of people living at the home were identified and strategies were implemented to minimize the risk factor. The plans of care were well written documents, having been reviewed each month or more regularly, if needed and changes in care needs were reflected well, so that staff were made aware of the current needs of people in their care. The records showed that good continence, nutritional and pressure care was provided to those requiring it and that, where necessary a wide range of external professionals were involved in the care of people living at the home, ensuring that health care needs were being Care Homes for Older People Page 13 of 30 Evidence: consistently met. The registered manager told us that regular meetings were held between a variety of professionals involved in the care of those living at the home and that relatives were invited to these meetings, should they wish to attend, so that they could have some input into the care of their loved one. People spoken to told us that they were more than happy with the care provided and they felt that all their care needs were being met. One person commented, the staff are very caring and look after me well and another said, I am very happy living here and the staff are all very nice. When asked what the service does well, the registered manager wrote on the homes self-assessment, we draw on expert professional guidelines for the services the home provides. We produce with each patient, regularly update, and thoroughly implement a patients plan of care, based on an initial and then continuing assessment. We seek to meet or arrange for appropriate professionals to meet the health care needs of each patient. We establish and carry out careful procedures for the administration of medicines. We take steps to safeguard peoples privacy and dignity in all aspects of the delivery of personal and health care. Comment cards were received from two members of staff. One of these people felt that they always had the right support, experience and knowledge to meet the differing needs of people who use the service. The other member of staff indicated that they sometimes have this support, experience and knowledge. One person wrote, peoples wishes are respected, including their privacy and beliefs. When asked what the service does well, one member of staff wrote on the comment card, it treats each resident as an individual with respect and dignity. Confidentiality is maintained. All six people who use the service who submitted comment cards said that they always receive the care and support that they need, including medical care. A relative wrote on the comment card on behalf of one of these people, we have never found the staff anything but caring and attentive. All six residents indicated that staff listen to them and act on what they say. One relative added to the comment card, mum seems to be very well looked after. She went through a phase of not eating well and all the staff seemed concerned and alert to the fact by encouraging energy drinks and another relative commented, it was very traumatic finding a place for mother, but we are all very pleased with Care Homes for Older People Page 14 of 30 Evidence: Oakfield. We know mum is well cared for and she is looked after. The management of medications was good, so that people living at the home were safeguarded against medication errors. However, handwritten entries on the medication administration records were not always signed, witnessed or countersigned to ensure that transcription errors were minimized. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily routines of the home are flexible and people are encouraged to maintain contact with family and friends whilst living there. The management of meals is good and visitors are made welcome to the home. Evidence: It was noted that the people living at Oakfield Nursing Home were highly dependent on the assistance of staff. Therefore, a planned, varied activities programme would not be appropriate for this group of people. However, it was established that a dedicated staff member provided regular quality time with each individual, giving people aromotherapy, hand and head massages or just simply sitting with the residents and talking to them, so that people were given the same opportunities by receiving some form of stimulation and contact. We saw that an information booklet about equality and diversity was available for people to read in the reception area of the home and it was evident from records and from observation that people were treated as individuals. One person told us that he liked reading and that he was assisted every week to enter the mobile library, which had wheelchair access and therefore he was able to select his Care Homes for Older People Page 16 of 30 Evidence: own reading material, which he delighted in showing to us. The registered manager showed us a box, which the mobile library left each week and which contained a variety of items linked to days gone by, so that people living at the home could sit in small groups and talk about the past. One group of people were seen playing dominoes and staff were seen having discussions with people on an individual basis, which they seemed to enjoy. Records were maintained of events that people joined in, so that an audit of participation could be conducted in order to avoid isolation or over stimulation. When asked if there were suitable activities provided by the home, one person living there indicated on the comment card that there were always activities which they could join in. The others felt that there were sometimes activities that they could join in. One person living at the home wrote on the comment card, they (the staff) always have time for me and their relative added, whenever we visit the staff are always helpful. At the time of our site visit to the home, the priest from a local church was visiting some of the people living at the home, who were taking holy communion, which was provided in private and with respect, so that the religious needs of people living at the home were being met. The daily routines of the home were seen to be flexible and people living there were offered a variety of choices throughout the day, so that they had some control over their lives and were allowed to excercise choice. People were seen visiting their relatives within the privacy of their private accommodation or within the communal rooms, if they preferred. One visitor said that she felt very comfortable visiting the home as she was always made to feel welcome and she commented, the staff are a great lot, they are really nice and they always brew up for me. I even had my Christmas dinner here last year, which was lovely. We saw staff interacting well with visitors, making them feel included in the daily lives of the people living at the home. We were told that if someone did not want a particular person to visit, then their wishes would be respected, so that the person living at the home was adequately protected. Although at the time of our site visit to the service there was no-one using an advocate, there was a process in place so that people could access an independent person to act on their behalf, should they so wish. When asked what the service does well, the registered manager wrote on the homes self-assessment, we aim to provide a lifestyle for residents, which satisfies their social, cultural, religious and recreational interests and needs. We help people to exercise as much as possible choice and control over their lives. Care Homes for Older People Page 17 of 30 Evidence: We observed lunch being served and noted that a high percentage of people living at the home required some assistance to eat their meals. It was pleasing to see staff sitting with the people they were assisting, engaging in conversation with them about everyday things, whilst encouraging them to eat their meals in a respectful manner. People were not rushed and were allowed as much time as they needed to eat their lunch so that the dining experience was pleasant for those living at the home. The meals looked appetising in order to aid in nutrition and specialised crockery and cuttlery were provided where necessary so that people could maintain their independence as far as possible. The menu of the day was displayed in the dining room and the four weekly menu offered a variety of nutritious meals, with choices being available on each occasion. Hot and cold beverages were available with lunch and condiments were supplied as required. People spoken to confirmed that they were asked each day what they wanted for their meals the following day and this information was supported by a staff member being observed asking people their choice of meals for the next day. Following the main course the sweet trolley was taken to each person, so that they could select their own pudding. This trolley was spectacular, consisting of a wide range of hot and cold amazing homemade desserts and was the highlight of the meal for the people living at the home. Specialised diets were catered for and people were able to eat in their own rooms , if they preferred to do so. When asked what the service does well, the registered manager told us, We provide meals, which constitutes a wholesome, appealing and balanced diet in pleasant surroundings. Five people living at the home showed on the comment cards that they always enjoyed the meals served and one person said that they usually did. One relative added to a comment card, the meals we have seen always look tasty and fresh. There are always choices at all meal times. The sweet trolley is amazing. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are well managed and people living at the home are adequately safeguarded from abusive situations. Evidence: A clear accesssible complaints procedure was available at the home so that people were aware of how to make a complaint should they wish to do so. When asked what the service does well, the registered manager told us, we provide and when necessary operate a simple, clear and accessible complaints procedure. We take all necessary action to protect peoples legal rights. We make all possible efforts to protect people from every sort of abuse and from the various possible abusers. Those spoken to said that they would know how to make a complaint. One resident told us how to access the complaints procedure, which was incorporated into the homes brochure. All six residents who submitted comment cards said that they would know who to speak to if they were not happy about something at the home and that they would know how to make a complaint, should they need to do so. One relative added to the comment card, we know we could approach matron or the assisstant matron if we were not happy about something at the home. Both staff members who submitted comment cards said that they would know what to do if a person living at the home, their relative, friend or advocate had any concerns about the home. One of these people wrote, I would refer to the managers. A Care Homes for Older People Page 19 of 30 Evidence: member of staff spoken to on the day of our visit said that she would know what to do if she had any concerns about people in her care and she felt that people living at the home were being protected. The registered manager told us that training was provided for staff in relation to the protection of vulnerable adults and this was confirmed by certificates of training on staff files. Policies and procedures were available at the home about safeguarding adults and staff were aware of how to access further information, should the need arise. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is warm, comfortable and hygienic, providing a pleasant and safe environment for people to live in. The control of infection is managed well, so that people living there are adequately protected. Evidence: During the course of our site visit to this service we toured the premises, viewing a random selection of private accommodation and all communal areas. The home was warm, comfortable, safe and fit for purpose. A friendly and homely environment was evident and people looked happy in their surroundings. People living at the home were able to bring a range of their own belongings with them, so that their individual rooms were personalised and homely. People spoken to were content with their bedrooms and said that they are cleaned regularly. One person said, I am quite comfortable living at Oakfield. I have a lot of my own things in my bedroom. The bedrooms were all of single occupancy, except for one, which was a double room for those preferring to share facilities. Many bedrooms had en-suite facilities The premises were clean and, in general, pleasant smelling, so that an agreeable environment was provided for those living at the home. Clinical waste was being disposed of in the correct manner and infection control policies and procedures were Care Homes for Older People Page 21 of 30 Evidence: available at the home, so that staff were aware of how to reduce the possibility of cross infection and therefore protect the people living at the home. It was pleasing to see that training was being provided on the day of our visit to this service, in relation to the management of harmful chemicals, so that staff were aware of the dangers of such substances and what they should do if they came into contact with any. The registered manager wrote on the homes self-assesssment, the physical environment is designed for the patients convenience and comfort. She told us that the building and grounds are maintained in a safe condition and that specialist equipment is available to maximise peoples independence. She wrote, the premises are kept clean, hygeinic and free from unpleasant odours, with systems in place to control the spread of infection. All six people who live at the home and who submitted comment cards said that the home is always fresh and clean. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff working at the home have the right skills, qualifications and experience to meet the needs of the people living at Oakfield. However, the recruitment practices adopted by the home did not always protect the vulnerable people living there. Evidence: A staff rota was in place, showing which staff were on duty at any time of the day or night, so that the skill mix of staff on each shift could be easily identified. At the time of our visit to the home there were twenty six people living there. The numbers of people on duty and the qualifications and experience of the staff team together ensured that the needs of these people were being consistently met. A qualified nurse was on duty at all times, so that the nursing needs of people were being met. Staff seen and spoken to were enthusiastic and keen doing their jobs and felt that on the whole there were enough staff to meet the needs of those living at Oakfield. The home did not need to use agency or bank staff because any staffing shortfalls were covered with their own permanent staff, so that continuity of care was consistently maintained. All new employees had been guided through a detailed and structured induction process and a wide range of training was provided for all staff, so that they were able to carry out the duties expected of them and so that people received a good standard of service. Three staff files were examined, which showed training that each had Care Homes for Older People Page 23 of 30 Evidence: undertaken, by retention of training certificates. A member of staff told us what training she had completed and was pleased to tell us that she was in the process of doing a National Vocational Qualification. At the time of our visit to the home there were 35 of care staff who had achieved this certificate and three people who were in progress, showing that the home was working towards achieving a minimum of 50 of care staff having achieved this qualification. Some staff working at the home were assessors and internal verifiers for the National Vocational Qualification and the home was an accredited training centre, which was commendable. The records of three people working at the home were examined, so that recruitment practices could be assessed. It was noted that references received had not always been dated, so it could not be determined if these had been obtained before employment. Criminal Record Bureau disclosures and POVA (Protection of Vulnerable Adults) checks had not always been conducted before perople started working at the home. Relevant checks had not been conducted for one long standing member of staff, so this needs to be addressed as a matter of urgency to ensure that people living at the home are consistently protected. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed well so that the health, welfare and safety of the people living and working there is adequately protected. Evidence: The home had conducted a clear annual audit, so that the quality of service provided could be closely monitored. A wide range of policies and procedures were in place at the home, which had been reviewed and updated on a regular basis, so that staff were provided with up to date guidance and any changes in legislation. Staff spoken to were aware of how to access the policies and procedures or to obtain further information, as was needed. Oakfied Nursing Home had achieved a recognized, external quality award, which was linked to surveys being conducted for people living at the home and their relatives. We were told that surveys were conducted annually in order to obtain the views of people who use the service. We suggest that surveys now be conducted for staff and for stakeholders in the community, who have a professional interest in people living at the home, such as General Practitioners, so that their views are sought as to Care Homes for Older People Page 25 of 30 Evidence: how the needs of people are being met. Health and safety guidelines were clearly displayed within the entrance of the home, so that any interested parties could easily access this information, if they wished to do so. At the time of our visit to the home, there was clear access to fire exits and corridors were free of obstacles, making the environment a safe place for people to live. A fire safety risk assessment was in place and staff confirmed that they had attended fire awareness training. Certificates of attendance were seen and fire fighting equipment had recently been serviced, so that people were adequately protected against the risk of fire. A random selection of service certificates were examined, which showed that systems and equipment within the home had been appropriately checked by competent people to ensure that they were safe for use. The registered manager wrote on the homes self-assessment, the management of the home creates an open, positive and inclusive atmosphere. The financial interests of those living at the home are safeguarded. The home uses effective quality assurance and quality monitoring systems. The home ensures that the health, safety and welfare of people living and working at the home are promoted and protected. One member of staff wrote on the comment card, I am very happy the way the home is managed. The residents health, safety and comfort comes first. When asked what the service does well another member of staff wrote, communication with relatives and friends is good. Matron is very understanding and listens when you go to ask questions or to get advice on work or personal issues. Oakfield is a nice place to work with a family feeling. The home was being well managed by a competent person, who is a qualified nurse and National Vocational Award assessor and who has a lot of experience in the management of care services. However, she has not enrolled on the Registered Managers Award, so that she will achieve a management qualification. Those spoken to were satisfied with how the home was operated and they felt that the management team were very approachable and would attend to any issues raised. One member of staff said, I really like working here, it is a lovely place. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 29 17(3)(b)Sche dule 2Regulation19 (1)(b)(i) The manager must undertake the required staff pre-employment checks to ensure the safety and welfare of the people who live at the home. 17/01/2008 Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 Robust recruitment practices 30/11/2008 must be adopted by the home. This includes obtaining a POVA first check and a Criminal Records Bureau disclosure before people are employed to work at the home. This is so that people living at the home are adequately protected. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Any hand written annotations on the medication administration records should be signed, witnessed and countersigned to reduce the possibility of transcription errors. The home should continue working towards 50 of care staff achieving a National Vocational Qualification so that the staff team are fully trained to deliver the care required. References obtained for prospective employees should be dated, showing that they have been received before employment commenced. Page 28 of 30 2 28 3 29 Care Homes for Older People 4 5 31 33 The manager of the home should work towards achieving a recognised management qualification. It is recommended that the views of stakeholders in the community be sought as to how the goals for people living at the home are being achieved. It is also recommended that surveys be conducted for staff to obtain feedback about what it is like working at the home. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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