Inspection on 06/05/09 for Oakford Manor Nursing Home

This inspection was carried out on 6th May 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 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 11/02/09

Oakford Manor Nursing Home 14/01/09

Oakford Manor Nursing Home 14/05/08

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Random inspection report Care homes for older people Name: Address: Oakford Manor Nursing Home Newshaw Lane Hadfield Glossop Derbyshire SK13 2AJ zero star poor service 14/01/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Brian Marks Date: 0 6 0 5 2 0 0 9 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 Conditions of registration: 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, has completed her registration with CQC. 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 Care Homes for Older People Page 2 of 13 1 4 0 1 2 0 0 9 Brief description of the care home 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 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 3 of 13 What we found: The purpose of this Random Unannounced Inspection was to check compliance with the previously listed legal requirements from our Key Inspection that took place on 14th January 2008. The inspection was carried out by the lead inspector for the home and a pharmacy inspector who looked at the management of medicines. The care records of four people who live at the home were examined in detail and we spoke to a small number of these and some visitors, as well as most of the staff working on the early day shift. We also spoke to the homes Registered Manager, who was in charge during our visit, and a senior manager of the Company who was present throughout. From our examination of case files we found a substantial improvement in quality from the last inspection. The homes manager told us that the needs of everybody living at the home had been reassessed with substantial input from professional colleagues from the Primary Care Trust (PCT) and Derbyshire County Council (DCC). Documents that identify hazards and risk in peoples lives, and the the care plans that identify ways in which staff care and support them to manage those risks, as well as to provide day to day care had been completely revised. The ones we looked at were substantial and comprehensive and were individual to each persons needs. All the files and their contents were completed to the same standard and all had clear evidence that everything had been looked at monthly to make sure that staff are working with up to date information. Where there had been changes in circumstances, incidents that heigtened risk or matters raised by relatives or outside professionals, individual elements of care plans had been renewed or started as new. We found that Requirement 1 made at the last inspection has been met. We looked at the homes systems for handling and recording medicines. We watched part of the morning medicine round and saw that national guidance on the administration of medicines was followed. We looked at medicine charts currently in use and those for the previous month, and saw that records of the receipt and administration of medicines were complete. We compared two records with the numbers of tablets left in stock, and found no discrepancies. We noted that any allergies people suffer from were recorded, and if there were no known allergies this was stated. We were told that only trained nurses have a key to the room where medicines are stored. We found that controlled drugs were stored and recorded correctly and stocks were regularly checked, but also found that some other medicines were kept in a cupboard that could easily be forced open. Medicines requiring cold storage were kept in a locked medicine fridge but the fridge temperature was not adequately monitored. We also found that an oxygen cylinder kept by one persons bed could be knocked over as it was not in a stand or held by a strap. There was no up-to-date reference book on medicines. We made a tour of the bulding with the homes Housekeeper and she identified the improvements that had been made since the last inspection. The laundry arrangements have been brought back completely in house and most of the equipment is situated in the downstairs bathroom that was previously used, unsatisfactorily, as a storage area for soiled linen. This room has been taken out of commission as a bathroom and toilet and is only available to staff. An empty upstairs bedroom is being used for drying and ironing. We also spoke to the laundry person and she told us that the laundry arrangements were back to normal and that quality is now managed properly. We found that Imediate Care Homes for Older People Page 4 of 13 Requirement 3 made at the last inspection has been met. Additionally the Housekeeper told us that the urgent programme of room cleaning and maintenance had been completed and she had been given the overall task of maintaining the standard; she also told us that seven bedrooms had been fully redecorated and fitted with new furniture since the last inspection and we were able to conform good standards of overall cleanliness and hygiene from our observations. The upstairs kitchenette has been refitted and returned to use by staff and people living at the home since the last inspection. We did notice that a number of broken handles on upstairs bedroom doors had not been attended to but were able to confirm that the doors were able to be closed. We found that Requirement 6 made at the last inspection has been met. Before the inspection visit we were forwarded a number of documents that we asked for and these included records of activities carried out by the homes Activities Coordinator. These were a substantial record and indicated a renewed programme for individuals and small groups of people living at the home. People that we spoke to during our visit told us that weve been doing a lot of activities recently - cake decorating, films, music and other crafts and a relative that we spoke to before the visit told us that activities have been a big success recently. However on the day we visited, the Activities Coordinator was on sick leave and nothing structured took place; for this reason we feel that Requirement 3 made at the last inspection has been partially met and the deadline for its completion has been extended. During the times we visited the communal lounge areas we saw people eating breakfast and lunch, and staff in attending to their daytime needs. However, we did notice three people in the upstairs communal areas sitting in their wheelchairs throughout the visit, which was an issue raised at the last inspection. The manager told us that it was their own choice to do so, but in our conversation with another person who has his own specialised wheelchair he told us that from my experience non adapted wheelchairs are totally unsuitable for extended sitting. We found that Requirement 6 made at the last inspection has been partially met, has been editted and the deadline for its completion extended so that further examination of this issue can take place. We looked at the homes written record for complaints and found that there had been 14 made since the last inspection. All were fully written up with details of the investigation that had taken place with outcomes. We did note that most of these had occurred during February and March 2008 and that the last had been made in the mid part of April. We found that Requirement 4 made at the last inspection has been met. We also looked at records kept at the home regarding incidents of referral under the Statutory Safeguarding Procedures and are aware that a number of people living at the home have been referred to Derbyshire County Council since the last inspection. Case files records of individuals that we looked at indicated that care plans had been revised to reflect actions arising from these procedures, and we have been informed through meetings instigated by the Council that the home has responded appropriately and put in place practices to put things right. Because a number of of situations are still under investigation and review, we found that Requirement 5 made at the last inspection has been partially met, and the deadline for its completion extended. Broad issues around the homes staffing were identified as areas of serious concern at the last inspection and these were looked at throughout this visit. We looked at the records for the last staff member to complete the recruitment process and these were found to be in order with the Companys established system fully implemented. We did note the Care Homes for Older People Page 5 of 13 absence of documentary evidence that a POVA1st check had been completed with the Criminal Records Bureau (CRB), but were reassured by the Companys senior manager that the process was routinely followed and that he would confirm this for the example chosen. A full check from the CRB had been completed. We found that Requirement 8 made at the last inspection has been met. We looked at the duty roster for the current and previous weeks and these indicated reduced levels of staff than had occurred following the last inspection and had been set at one qualified and five care staff on throughout the day shifts; the manager was also listed as a second nurse. The manager told us that these levels reflected the reduced numbers of people living at the home but that three new nurses and five new care staff had been recruited and that the previously agreed levels of staff of two qualified and six carers on the day shifts would be achieved shortly in anticipation of occupancy of the home improving. Immediate requirements 1, 2 and 4 were met within timescales set at the least inspection but a replacement requirement is included with a new timescale for this inspection. Before the inspection we received a detailed outline of the staff training activity that had occurred since the last inspection and updated information was given to us by the manager which indicated that the required and recommended programme had been substantially achieved. A number of topics had been booked for groups of staff in the weeks after the inspection and we found that Requirement 7 made at the last inspection has been partially met, and the deadline for its completion extended. In a similar way we found that there had been much activity to reestablish the programme of formal staff supervision meetings, and records indicated that all staff had had at least one since the end of January. For this reason we found that Requirement 11 made at the last inspection has been partially met, and the deadline for its completion extended. During our visit we spoke to most of the staff on duty during the early day shift and were pleased to note a much more positive outlook from them about the current operation of the home. They told us that things are a lot better, theres system where there was chaos before, nurses are now able to concentrate on nursing tasks, were now getting a better skill and experience mix of staff and can deploy better, a lot of training has happened and this refreshes your mind and you can take the new things back to the workplace and you come into work and people are smiling again. We discussed the positive aspects of this inspection with the two managers present and they described to us the changes made to management systems that ensures they indentify and react to problems in service delivery as they occur. We agreed that a move form a reactive to a more proactive style of management needs to be made, and that the real test for the home will be sustainability of these improvements in the longer term. For this reason we found that Requirements 9 and 10 made at the last inspection have been partially met, and the deadline for their completion extended. What the care home does well: The people responsible for the running of the home have made progress in addressing the legal requirements made at the last inspection and the morale of the people living and working there who were spoken to was more positive than at our last visit. The documentation that supports the staff in their work has been substantially overhauled with the help of professionals from the Councils Social Care and Primary Care Trusts Healthcare teams and this is helping them to work in more consistent and safer ways. Better record keeping in respect of direct care and indirect administration is now taking place and the condition of the building, its cleanliness and facilities have been much Care Homes for Older People Page 6 of 13 improved so that the people living there are more comfortable and safer. We found that at the time of this inspection the systems in place for managing medicines were safe. What they could do better: 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 2. Care Homes for Older People Page 7 of 13 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 13 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, 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 9 13 Medicines must be stored in 30/06/2009 secure cupboards and in a room with restricted access. All medicines must be locked away when unattended. To ensure the safety of people in the home and to prevent theft or misuse. Previous requirement partially met and new timescale set. 2 10 12 Staff practices in relation to 30/06/2009 caring for people in wheelchairs must at all times be focused on the needs of the individual person. This is so that residents health, welfare and safety is maintained. Previous requirement partially met and new timescale set. 3 11 16 People living at the home must be supported to enjoy organised and individualised activities at the home that are based on their identified 30/06/2009 Care Homes for Older People Page 9 of 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 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. Previous requirement partially met and new timescale set. 4 18 13 All recommendations arising 30/06/2009 out of any investigations made under statutory Safeguarding procedure must be implemented. This to make sure that all people living at the home are safeguarded from harm. Previous requirement partially met and new timescale set. 5 27 12 All personal and healthcare 30/06/2009 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. Previous requirement partially met and new timescale set. 6 29 18 All people working at the 30/06/2009 home must receive training in skills suitable for the work Page 10 of 13 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 that they carry out. So that they work safely and consistently and the people living there are safeguarded from harm. Previous requirement partially met and new timescale set. 7 32 12 The people responsible fopr 30/06/2009 the running of the home must do so in a way that fully provides for the health and welfare of the people living there. This is so that people living at the home can lead safe and fulfilled lives that meet their needs and preferences. Previous requirement partially met and new timescale set. 8 33 24 The people responsible for 30/06/2009 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. Previous requirement partially met and new timescale set. 9 36 18 Staff must be supported by a 30/06/2009 formal system of meetings Page 11 of 13 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 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 people living at the home. Previous requirement partially met and new timescale set. 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 The registered provider should ensure that the maximum and minimum temperatures of the medicines fridge are recorded daily, to show that medicines are being stored at the correct temperature at all times. The registered provider should ensure that a current copy of the British National Formulary is available for staff reference. 2 9 Care Homes for Older People Page 12 of 13 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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. 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