Inspection on 14/01/09 for Oakford Manor Nursing Home

This inspection was carried out on 14th January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oakford Manor Nursing Home 17/06/09

Oakford Manor Nursing Home 06/05/09

Oakford Manor Nursing Home 11/02/09

Oakford Manor Nursing Home 14/05/08

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oakford Manor Nursing Home Newshaw Lane Hadfield Glossop Derbyshire SK13 2AJ     The quality rating for this care home is:   zero star poor 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: Brian Marks     Date: 1 4 0 1 2 0 0 9 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. that people have said are important to them: They reflect the things 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 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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 36 Information about the care home Name of care home: Address: Oakford Manor Nursing Home Newshaw Lane Hadfield Glossop Derbyshire SK13 2AJ 01457861117 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Rushcliffe Care Limited care home 34 Number of places (if applicable): Under 65 Over 65 34 0 old age, not falling within any other category physical disability Additional conditions: 0 34 The maximum number of service users who can be accommodated is 34 The registered person may provide the following categories of service: 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 Date of last inspection Brief description of the care home Oakford Manor was purchased and registered by Rushcliffe Care Ltd. in October 2007 and the new manager, who was appointed soon afterwards, recently completed her registration with CSCI. The home was established by the previous owners for some years, and is registered for the care of 34 people with nursing and personal care needs who are over 65 years of age or who have a substantial physical disability. This is a modern purpose built home situated in Hadfield, near the town of Glossop. The home is on two floors with passenger lift and staircase access, and its accommodation comprises of 16 single bedrooms (15 with en-suite) and 9 shared bedrooms (8 with Care Homes for Older People Page 4 of 36 Brief description of the care home en-suite). There are two spacious lounge/dining rooms, with a quiet area off the lounge on the ground floor. The home has an activities coordinator who works with residents individually or in small groups to develop their interests and social activities. Support services are in place from local GPs and people are referred to other health support services on request or as required. Information about the service is provided in the Statement of Purpose and Service User Guide; the former is available upon request and people are given a copy of the latter when they move into the home. The current weekly fee is in the range #364 - #498. Care Homes for Older People Page 5 of 36 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: zero star poor 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: This was a Key unannounced inspection that took place at the home over one day. The inspection was carried out following urgent meetings and discussions we had had with professionals from the three key authorities who are responsible for financial sponsorship of people living at the home - Derbyshire County Council, Tameside Borough Council and Tameside and Glossop Primary Care Trust (PCT). They had become very concerned with aspects of the way the home was being run - so much so that all three authorities had suspended contracts with the homes owners in December 2008. Additionally time was spent in preparation for the visit, looking at key documents such as previous inspection reports, records held by us, the written Annual Quality Assurance Assessment document (AQAA), which was prepared and returned to us in October 2008. Because of the short timescale in arranging this inspection we did Care Homes for Older People Page 6 of 36 not use any surveys that we normally send out to the agency, its staff and the people living at the home. The inspection was carried out by two inspectors and at the home, apart from examining documents, files and records, time was spent speaking to the area manager of the Company that owns the home, who was there throughout the visit, and all of the staff working on the early day shift. The care records of six people who live at the home were examined in detail and and some of these were interviewed along with others who were able to speak to us, along with a number of relatives and visitors who were at the home during the inspection. No other inspection visits have been made to the home since the last Key unannounced inspection on 14 May 2008 and the assessment was made against the key National Minimum Standards (NMS) identified at the beginning of each section of this report, as well as other Standards that were felt to be most relevant. What the care home does well: What has improved since the last inspection? What they could do better: We have identified areas across a broad front in which the running of the home has deteriorated since the last inspection and a number of statutory requirements, including two immediate requirements, have been made as a result of this inspection. We saw that a broad-based reduction had been made in previously agreed staffing levels since the last inspection and this directly affected staff being able to meet the personal and healthcare needs of residents at all times. A number of concerns about standards of care have been made by relatives of people living at the home and these have been confirmed by outside professionals from the Council and PCT who have been in regular contact with the home and based there since the beginning of January 2009. Care activities identified as not being carried out ranged from the simple to the complex, and staff told us that there has not been enough staff on duty to complete all care tasks in a timely way, so that the welfare of people living at the home has been badly affected. A recent audit of the homes medicines management was recently carried out by a professional from the PCT, and a number of issues for urgent action were identified. The reduction in staff hours had been applied to domestic cleaning also, with the result that standards of cleanliness and hygiene in all areas of the home have been badly affected. The lost hours have been replaced and improvements have been noted, but the member of staff specifically assigned to deal with this indicated that the programme of intensive cleaning and refurbishment was not yet completed and the comfort of the home not returned to its former high standard. The hours of kitchen staff had also been reduced and we noted pressures in this area so that the capacity to maintain high quality cleaning had also been affected. Whilst the more obvious aspects of the homes performance have been deteriorating the people responsible for the running of the home have not been taking the right Care Homes for Older People Page 8 of 36 steps to identify and act against these problems. Audits that measure quality performance have not been taking place but with action having been taken by the statutory agencies things have been now started to be addressed. The deteriorated performance of the home assessed at this inspection is reflected in the overall quality rating that has been reached. 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 36 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 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not always come to live at the home without the care they need being properly identified, and little information is being obtained about their social world which compromises the ability of the homes staff to care for them consistently and safely. Evidence: In the AQAA we were told that the care needs of people coming to live at the home are identified before a decision is made for them to move in and that information is given to people and their families that helps them make that decision. The assessments carried out include an NHS nursing assessment and assessment of mental capacity and decision making. We were also told that people are encouraged to visit and meet staff, judge the homes facilities and see the homes environment. For the purpose of this inspection we looked at the care records of six people who are Care Homes for Older People Page 11 of 36 Evidence: living at the home, including somebody who had moved in about six weeks before the inspection and somebody who had lived there for some years. Within most of these records, there are clear assessments of the physical care needs of the person concerned including details of complex health and medical issues. The information has been obtained from the person concerned, from their family, or from outside professionals such as doctor, hospital nurse, physiotherapist or speech and language therapist. However, in the records for the person admitted at the end of November 2008 there was little evidence that a full assessment of needs had been made at the time she was admitted which, we were told by staff, had been arranged as an emergency. Because of this it is not clear how it had been established that the home is suitable for her. Two of the care records looked at did not contain a recent photograph of the person concerned, which is something that indicates personalisation of peoples records. None of the records looked at contained anything more than very brief amounts of information about the psychological and social worlds of the people concerned, which does not support person centred care for everybody living at the home. All of the care records looked at contain assessments of the general and specific areas of risk that are relevant to the individuals concerned, such as safe moving and handling, skin breakdown and pressure sores, falls and nutrition. Some, but not all, indicated high areas of risk directly linked to an action plan. This described the detail of how staff were to work safely and consistently and maintain the persons welfare whilst living at the home. Some, but not all, of these had been looked at regularly to make sure that up-to-date information is being used by staff and to make sure that the level of risk has not changed. The home does not provide intermediate care so Standard 6 does not apply. Care Homes for Older People Page 12 of 36 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at the home have care and risk assessment records in place but actual practice in the home has deteriorated through reductions in staffing levels so that the capability to meet personal and healthcare needs in ways that respect individuality, privacy and dignity has been severely compromised. Evidence: In the AQAA we were told how staff at the home provide high standards of personal care to people living there and that they meet their individual needs wherever possible. We were also told that they promote as high a level of independence as possible whilst maintaining the health, safety and wellbeing of the group, and that the care plans in residents files support the achievement of this. The care records that we looked at contain clear descriptions of the areas where people need help or where they experience risk, as well as the areas in which they are independent, and the care and nursing activities to be carried out by staff are identified. In most of the records examined the various elements of the care plans had Care Homes for Older People Page 13 of 36 Evidence: been reviewed on a regular basis but not all had been looked at monthly and the care plan for the person who had come to the home most recently had not been subject to this process since she moved in in November 2008. Because her health care needs have been changing in that time, staff may be providing support using out of date information. As referred to above, the descriptions of social interests and life background are generally brief in all the records we looked and much of the activities of staff are described in terms of tasks to be completed rather than in ways that promote an individualised approach to care. In spite of documentation of a planned approach to care being in place the reality of events is a different matter. The observations made by us during the inspection, the comments received from staff, people living at the home and relatives and information given to us before and during the inspection indicate that a severe deterioration in the homes capability to meet the personal and healthcare needs of everybody living at the home has occurred since the last inspection. This was backed up by information from the two outside professionals who were based at the home carrying out reassessments. We were told that because of a severe shortage of qualified and care staff being available those that are on duty find themselves running from one thing to the next - usually late and playing catch-up all day. We were told by staff that we dont have time to sit and chat, we havent got the time for the residents and that they just carry out a series of physical tasks and some of them get missed. For one resident we spoke to the problems in his daily routine start at the beginning of the day and continue throughout the morning: they know I like to get up early but dont usually get round to me until 10 so Im not getting breakfast until late morning others are not being given theirs until lunchtime. Lateness of basic routines has had a particular impact on him through the poor timing of him receiving his medicine with the result that my pain management has been failing. Additionally he reported that his catheter bag, which needs replacement every three months, was missed at the last change for 2008 and was changed two months late when I realised and reminded them. He had also observed the arrangements at meal times for other people living at the home when four or five need assistance; impossible with the numbers of carers available and meals just go cold. Another resident who is a wheelchair user and has become increasingly dependent told us through her relative that she has had to wait over an hour to be taken to the toilet on more than one occasion and once they didnt come soon enough, which was very degrading and embarrassing. Another person supported these comments and confirmed that on the day of the inspection it wasnt until 10:30 am that she had got up because there arent enough staff to get us up, had been given her morning tablets at 11:45 am and had no breakfast and the first cup of tea of the day was cold. The relatives of another commented about their massive concerns recently with the poor staffing levels and their ability to meet Care Homes for Older People Page 14 of 36 Evidence: mums needs through the use of agency staff. For example they are not aware of her allergy to eggs and she keeps being given them. Another relative had reported to the assessment team that specific instructions from the physiotherapist were not being carried by staff assisting with exercises to improve posture. With the assessment staff being in the home every day for the week before the inspection, substantial evidence from their observations has been made available to us. They told us that they have seen: late breakfasts becoming routine, with six people receiving theirs as late as 1:00pm only six days before the inspection, poor manual handling practices, with people in wheelchairs being lifted underarm from behind, wheelchairs being used without footplates and without using brakes, wheelchairs being used as all day seating, people not being helped to the toilet before lunch, people being left in their rooms with their lunch, unable to help themselves, general lack of cleanliness of the clothing of people living at the home, people who are nursed in bed being left for long periods of time and without stimulation, poor arrangements for privacy of people sharing double rooms, the atmosphere in the communal rooms is usually very quiet with minimal interactions with staff. During the morning of the inspection we were stationed in the two communal areas of the home and were able to see what was happening. Upstairs a number or residents were seen receiving their breakfast up to 11:00 am, at which time a number of staff were present there having a brief break. Lack of use of footrests was noted on two wheelchairs - a member of staff found and fitted the missing pair at our request. In the downstairs area at 10:30 am two residents in wheelchairs were given breakfast by the cook, three others were dozing in their wheelchairs. The radio was playing music in the background until a member of staff turned the television on. Staff attendance in this area was sporadic outside the time of lunch being served. The care records that we looked at confirmed that contact with external healthcare services is routinely made, particularly the local doctors and a number of specialist healthcare clinics and mobility specialists. Staff told us that this is one area that they feel we are able to keep on top of. However we also received reports from the assessment team that a number of instances had been reported to them where interventions had been late. An example of slow response to the onset of a pressure wound was given as one example of this. Irregular management of diabetes by lateness of medicines was another. We looked at the weight records of residents at the home for the twelve months of 2008 and noted that substantial weight losses had been recorded in many cases and substantial weight gain in one person; there was no evidence in the care records that any action had been taken regarding these changes. A full inspection of medicines practice was carried out by a professional from the PCT on the day after this inspection. We were made aware of the findings of that Care Homes for Older People Page 15 of 36 Evidence: inspection, which included a number of concerns about the storage, recording and administration of medicines at the home, during the preparation of this report. Because of the overall deterioration in performance since the last inspection, notice of an immediate requirement was left with the providers area manager at the end of the inspection. Care Homes for Older People Page 16 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some people at the home enjoy lifestyles and routines that suit them but most have limited opportunity to take part in organised leisure and social activities. Standards of catering remain positive but the impact of care activities impact badly on peoples enjoyment of the lunchtime meal in a dignified way. Evidence: In the AQAA we were told about the increasing activities taking place for people living at the home, and how these are planned to be appropriate for identified needs. We were also told how documentation about individual needs is recorded and retained in care records and how training is to be provided to the activities co-ordinator to assist her role. We confirmed that an activities coordinator is in post and she has the responsibility for encouraging activities and structuring leisure time. However she was on annual leave during the inspection and no structured activities took place on the day of our visit. Additionally we could find no records of events that had been planned for the week in her absence or any that had recently taken place, other than some sessions that had occurred with specific individuals. All of the feedback we received was very negative Care Homes for Older People Page 17 of 36 Evidence: about this aspect of the homes activities and, as previously noted, there was little recorded in the care plans we looked at or within the companys document entitled Getting to know you, which had been placed on two of them. One person told us that theres not been much happening recently although he was able to continue with his own routines and studies. Relatives of another were concerned that the activities used to be excellent but not any more. The friend of another said that although shes one of the more able ones theres nothing to stimulate her and nobody much to keep her company, she spends a lot of her time here in the reception area. We noticed that by the middle of the afternoon a small group of people living at the home had assembled in this area, leaving the communal areas increasingly empty. People have told us that the home has retained a strong community reputation over the years and many of the people living there have families who live locally. Visitors continue to come to the home - some every day - and a number were seen and spoken to during the inspection as noted previously. Whilst some wished to continue to support the home, another group of relatives said they have lost confidence in the way the home is being run and that communication is poor - the only way we find out about things is notices put on the board such as the building of the extension and the replacement of the laundry. There used to be a regular newsletter that kept us informed about what was going on. Some residents continue to use local community facilities such as day services and three people attend the local church regularly. However staff told us that there were others who had said that they wanted to join in with this but, as they would need staff support, are unable to do so. The assessment team told us about another person living at the home who has a non-Christian religion but this had not been properly addressed and he remains frustrated. Although the more able people we spoke to told us that they tried to lead their lives according to their established routines they all shared this sense of frustration by the current way that the home is being run and their inability to fill their lives in ways that they want to. A brief visit was made to the kitchen and the cook and kitchen assistant described current arrangements. The cook described how she had tried to maintain good standards in the catering service, and the same form of menu as at the last inspection is being followed. The menu indicates a choice at the main meals of the day and a hot option available for breakfast and at lunchtime - the main meal has reverted to late afternoon on Mondays to Fridays, as requested by the people living at the home. Although some negative comments had been received by the assessments team about food options, we also received some strongly favourable comments - as we did at the last inspection when most people were generally very positive in their feedback about the standard of food at the home: the food remains the one redeeming feature here and the cook still looks after the Care Homes for Older People Page 18 of 36 Evidence: extra things I buy at the local supermarket and I like my food very much, its always very nice. Problems with the timing of breakfast have already been mentioned and this has had a particular impact on Saturdays and Sundays when the main meal is served at lunchtime. Arrangements for purchase, storage and stock control are satisfactory. The cook routinely deals with people who have special dietary needs, and these include diabetic and softened. Regarding the latter the cook said: each food item is fork-softened or liquidised and served separately, and a relative demonstrated this after lunch during the inspection, indicating a sensitive approach to individual needs. Care Homes for Older People Page 19 of 36 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has not responded to complaints made by residents and their representatives in ways that accord with their own procedure, and people living at the home have been placed at risk of harm by the failure to follow statutory safeguarding procedures. Evidence: In the AQAA we were told that complaints are responded to promptly according to Company Policy and Procedure and that all complaints are duly recorded. We were also told how a problem solving approach is used to address isssues before they become formal complaints. However, the one complaint referred by a family member to the Commission since the last inspection was primarily concerned with the lack of response by the people responsible for running the home to a written complaint from as early as March 2008. We were also told about the failure to respond to concerns being verbally expressed about standards of care being given to their relative; this complaint was received by us in December 2008. We were also told by the outside professionals at the home about a written complaint from one family lodged with the homes management in August 2008 that had not been responded to and two others made in December that had not been acknowledged. A family member that we spoke to during the inspection also told us about a written complaint made in September 2008, which had not been responded Care Homes for Older People Page 20 of 36 Evidence: to and that the usual response they receive to any concerns has been to take it up with Rushcliffe. They also told us that they were unaware that any planned meetings between the homes staff and the people living at the home and their relatives had occurred recently - in the past these had been an opportunity for informal issues to be raised. We were verbally informed by staff that apart from some very recent appointments, everybody had received training in their responsibilities to recognise and alert others to suspected abuse. We were not able to access the staff training records to confirm this. The policies and procedures in place are in line with the statutory procedures on safeguarding vulnerable adults but we did identify at the last inspection that the home receives people from a number of different Local Authorities areas and as a result there has been an expectation that the manager should follow a number of different statutory procedures. The homes policy manual reflects this potential for confusion. There has been one situation since the last inspection that has been investigated through Derbyshires procedures which was found to have resulted from an accident. However the recommendation from that investigation that everybody living at the home should be subject to a specific risk management process has not been carried out, so that the potential for harm has not been eliminated. Care Homes for Older People Page 21 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is purpose built but standards of maintenance and cleanliness have been allowed to deteriorate considerably since the last inspection. The people running the home have taken steps to reverse this but the programme of improvement has not been completed and the comfort and hygiene of people living at the home remains badly affected. Evidence: In the AQAA we were told that the homes environment is homely and welcoming and that homes management are refurbishing rooms to improve its appearance. However reports received from officers of the commissioning agencies in December 2008 indicated that a substantial deterioration in overall standards of cleanliness of the home and in the decorative standards of some bedrooms had occurred since the last inspection. We were told about: unhygienic and unclean conditions throughout the home with soiled equipment, furnishings and furniture in bedrooms and communal areas, damaged plaster in bedrooms, poor odour in many areas of the home, particularly in bathrooms where soiled linen was being placed, inappropriate curtains in double rooms that are too short to protect privacy and dignity, lack of security of the building with the result that a vulnerable person had wandered out on to the main road and also into the kitchen and started dangerous equipment, lack of protective gloves and apron for staff to use whilst giving personal care, Radiator covers or Care Homes for Older People Page 22 of 36 Evidence: protective devices not in place, an extension to the home is being built which has impacted on the running of the home, particularly in the operation of the laundry service. Following these issues being raised with the people who responsible for running the home, a programme of urgent cleaning was started and the results of this was seen during this inspection. We spoke to all the domestic staff and they informed us that daily cleaning hours had been halved at some time in the months before Christmas 2008 with the result that the whole of the building had become neglected. We were told that at the end of December 2008 domestic cleaning hours were restored and an additional member of staff was deployed to deep clean the bedrooms one by one, and to work alongside the maintenance man to refurnish and refurbish. Improvements were clearly evident and we were told that within another three weeks all rooms will have been restored to the previous high standards of cleanliness. As part of the of the building extension work the area containing the homes laundry has been demolished and laundry is being sent to an outside business. This has resulted in the storage difficulties of soiled linen that remains in the home until collection each morning; the problems of poor odours was noted as the the days bags were in the staff bathroom when we carried out this inspection. Staff told us that the target turnaround time for laundry was the next day but people living at the home told us that it was frequently longer that this. We were also told about the poor quality of some of the cleaning carried out, which included the temperature that the outside laundry operated at not being up to that required for proper management of soiled linen. We have not had notice of the intention to extend the home, which is not legally required at this point in time, but neither have we been given any plan of how any negative impacts of building works will be managed. Because of the urgency of this matter, notice of an immediate requirement was left with the providers area manager at the end of the inspection. Other issues identified as part of this inspection: The majority of door handles and locks on the doors of the first floor bedrooms are not operating properly, The security of the front entrance door is also compromised by the handle not functioning properly and absence of a lock that can be used by staff and visitors. Patches of plaster on the walls of one bedroom had fallen off or been knocked off by furniture. Some of the ensuite rooms in double bedrooms had not been fitted with storage or shelving that allows for the separation of toiletries. As noted above people are being left to sit in uncomfortable wheelchairs all day and not enough suitable seating was available to them in the lounge areas, The window areas in the kitchen had become dusty and stained, both inside and out as a result of the building works outside; staff told us that kitchen hours had been reduced by 4 hours which had reduced their ability to maintain standards. Care Homes for Older People Page 23 of 36 Evidence: On a more positive note we saw that two specialist Parker baths had been delivered ready for their imminent fitting within two of the bathrooms. Care Homes for Older People Page 24 of 36 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not have adequate numbers of staff to carry out the physical care needs of the people living there, although systems of training and recruitment have remained in place to support the staff group. Recruitment processes have not always been operated properly and the safety of the people living at the home may be compromised by this. Evidence: In the AQAA we were told how the home has a good record of staff training and about staff involvement with and commitment to the people in their care. We were also told that homes ability to avoid the use of agency staff was good. During this inspection we spoke with all of the staff on duty during the early shift as well as the area manager who was in the home throughout the time of the inspection. We have already referred to the fact that a reduction in staffing levels was made by the people who run the home sometime in the last third of 2008. As a comparison we noted that at the last inspection there were two qualified staff on both day shifts along with seven care staff in the early and four/five carers in the late shifts. This was initially reduced to one qualified and four care staff on both day shifts and subsequently increased to two qualified staff on the early shift. We were informed by staff at the home and the outside professionals at the home that during December the Care Homes for Older People Page 25 of 36 Evidence: actual numbers of staff on duty has been less than this. On the day of the inspection there were two qualified and five care staff due to be on the early shift and two qualified with four care staff on the late shift. Even at this stage of urgent actions one care staff was absent in the morning and not replaced. The impact of this on the staff group has seen a number of established staff leave the home and increased levels of sickness and tiredness, requiring remaining staff to work additional hours and leave days. The use of agency staff, which was absent at the last inspection has now been started again to bring staffing up to a working level, an action step that is not without difficulties resulting in lack of continuity and pre-knowledge of the needs of people living at the home. At the same time in 2008 the amount of domestic hours was reduced from eight to four per day and the kitchen rota reduced by four hours. The overall impact of the changes in staffing has already been described. Although shortfalls in numbers is a key a factor, the skill mix of those actually on duty, particularly those recently recruited and those being supplied by agencies, have been described to us by experienced staff and the outside professionals as presenting problems for efficient and effective working. On a more positive note the staff spoken to did say that opportunities for training had continued since the last inspection and one carer described training in Dementia Care, NVQ and Palliative Care that she has received or shortly will receive. The AQQA told us that the national target for care staff achieving the National Vocational Qualification (NVQ) level 2 has been reached but we could not confirm this because the records were locked away. The staff spoken to described how some new staff had not been subject to a proper induction, including basic health and safety training and the absence of a programme for staff receiving instruction in safe manual handling was one of the reasons why the commissioning authorities took action against the home just before Christmas 2008. We understand that this position was rectified last week. At the last inspection we were unable to assess the robustness of systems in place to safely recruit new staff because it was Company policy to retain recruitment files and documents at their headquarters. We were given a commitment at that time that copies of key documents would be retained at the home but this was not actioned until a few days before the inspection. We looked at the records of two staff who were recruited during 2008 under the same procedures that are currently in use. Whilst one was comprehensive and contained evidence of all the required checks and references, the other had an incomplete employment history and only one reference, which was from the homes manager not a previous employer. Despite all the difficulties we were impressed by the attitudes and honest reporting from all of the homes staff. In spite of working long additional hours and rest days in some cases, their continued commitment to the home and the people living there is Care Homes for Older People Page 26 of 36 Evidence: something the homes management can build on for the future. We were told that staff try to work as best they can together and that support is good within the staff team and between qualified and care staff. One person rounded off our conversation with the comment that things are very hard at the moment but weve got to keep going for the residents and make it the best for them that we can. Care Homes for Older People Page 27 of 36 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people responsible for the running of the home have not acted properly to identify and deal with its problems and have not listened to the people living at the home or their representatives as well as the staff working there, when they have tried to express their concerns. Evidence: The new providers and manager took over the running of the home in the latter part of 2007 and the manager completed her registration process with the Commission in 2008, just before the last inspection. The registered manager has previous experience of running a care home before she came to Oakford Manor and has achieved the recognised managers qualification. At the time of the last inspection the comments received from staff, relatives and people living at the home were very positive about the level of organisation and improvements that have been made since these changes took place. The registered manager was on annual leave during this inspection and we dealt with the Companys area manager throughout. Communication was a particularly Care Homes for Older People Page 28 of 36 Evidence: important issue that was brought up during this inspection but we were not given any evidence of recent meetings between the people responsible for the operation of the home and the people living there and their representatives, nor about any formal meetings with staff. Additionally there was no evidence that the system for planned meetings between senior and individual staff is in place; some records, dated May 2008, of this formal supervision were identified by the area manager but they did not indicate that the arrangements occurring regularly enough to meet the National Standard and to ensure that staff are properly supported and their work is being monitored. We have reported above that there are substantial problems at the home in many areas, and that these stemmed from the reduction in staffing levels across a broad front in the latter part of 2008. At the same time, the impact these changes were having were not identified and acted upon by the people responsible for the running of the home, for example in the standards of cleanliness and hygiene of the home. They were brought to the attention of the authorities responsible for the financial support of peoples accommodation - the two local Councils and the Primary Care Trust (PCT) and the Commission, and the contracts with those authorities were suspended in December 2008. A number of people - relatives and staff in particular - have told us that they tried to voice their concerns but that they were not listened to, and we have seen that even when issues were raised formally in writing they were not responded to. Staff and relatives told us that notification of changes at the home have been made by posting of notices rather than verbal contact. The reports from outside professionals in contact with the home have indicated a defensive attitude in the running of the home and that staff have been unable or unwilling to make their voices heard. They also reported a lack of awareness of the need to change things, although we have identified that steps are now being taken to rectify the problems as they have been highlighted to the people responsible for the home. In the words of one of the people living at the home action being taken needs to deal with resources being withdrawn as peoples needs were increasing. The systems in place for looking after residents money were found to be satisfactory at the last inspection and remain unchanged so a full assessment of this was not carried out; this will occur at the next inspection. The AQAA told us that standards of health and safety activity and regular servicing of equipment had been maintained, so that a full audit of health and safety matters was not carried out; this will occur at the next inspection. Care Homes for Older People Page 29 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 30 of 36 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 1 7 12 All personal and healthcare 22/01/2009 needs must be met in a timely way by the provision of sufficient numbers of staff at all times. This is so that residents health and welfare is maintained. 2 8 12 All personal and healthcare 22/01/2009 needs must be met in a timely way by the provision of sufficient numbers of staff at all times. This is so that residents health and welfare is maintained. 3 26 13 The management of soiled 22/01/2009 linen must be improved and be suitable for the purposes of meeting the needs of the people living at the home. An action plan of how this is to be achieved must be forwarded to the Commission by the due date. In order to prevent infection of and risk to the people living at the home. 4 27 12 All personal and healthcare 22/01/2009 needs must be met in a timely way by the provision of sufficient numbers of staff at all times. This is so that residents health and welfare is maintained. Care Homes for Older People Page 31 of 36 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 3 14 The personal and health 30/04/2009 care needs of all people coming to live at the home must be assessed before they move in and these must be kept under regular review - at least monthly for areas of need that have been identified as presenting high levels of risk in the persons life. This is so that it can be established that the home is right for them and that the care activities of the homes staff are based on up-todate information and reflect the complexity of care that is required. 2 9 13 The recommendations of the 28/02/2009 medicines audit carried out on behalf of Tameside and Glossop Primary Care Trust must be carried outby the due date. This is so that residents health and welfare is maintained. 3 10 12 Staff practices in relation to 28/02/2009 caring for people in wheelchairs, people who need assistance with feeding Care Homes for Older People Page 32 of 36 and those occupying double rooms must at all times be focused on the needs of the individual person. This is so that residents health, welfare and safety is maintained. 4 12 16 People living at the home must be supported to enjoy organised and individualised activities at the home that are based on their identifies needs and preferences. The person responsible must prepare a detailed programme of how this is to be done. This is so that they have opportunities to enjoy a satisfying and stimulating lifestyle that is in line with their capabilities. 5 16 22 All complaints made about the standards of care of people living at the home must be investigated and responded to according to the stated procedure of the home. This is to make sure that good standards of acre are maintained and areas of poor practice eliminated. 6 18 13 All recommendations arising out of any investigations made under statutory Safeguarding procedure must be implemented. 28/02/2009 28/02/2009 28/02/2009 Care Homes for Older People Page 33 of 36 This to make sure that all people living at the home are safeguarded from harm. 7 19 23 The standard of maintenance of the homes physical environment must be improved. So that the comfort, safety of and facilities available to the people living at the home is established and their lives enhanced. 8 29 18 All people working at the 28/02/2009 home must receive training in skills suitable for the work that they carry out. So that they work safely and consistently and the people living there are c safeguarded from harm. 9 29 19 All of the documents and 28/02/2009 checks outlined in Schedule 2 of the Care homes Regulations must be obtained for all staff working at the home. So that only people who are suitable to work at the home do so and the safety of the vulnerable people who live there is safeguarded. 10 32 12 The people responsible fopr the running of the home must do so in a way that fully provides for the health and welfare of the people living there. 28/02/2009 28/02/2009 Care Homes for Older People Page 34 of 36 This is so that people living at the home can lead safe and fulfilled lives that meet their needs and preferences. 11 33 24 The people responsible for the running of the home must make sure that good standards of care are maintained by constantly reviewing activities and practices that take place there. This is so that people living at the home can lead safe and fulfilled lives that meet their needs and preferences. 12 36 18 Staff must be supported by 28/02/2009 a formal system of meetings that take place every two months with the manager or senior member of staff. This is so that they can have individual opportunities to talk about their work and any problems they may have and to receive advice about ways of improving their performance and the ways in which they care for the homes residents. 28/02/2009 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 Care Homes for Older People Page 35 of 36 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 © (2009) Commission for Social Care Inspection (CSCI). 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