CARE HOMES FOR OLDER PEOPLE
Oakhaven - City of York Council 114 Acomb Road York North Yorkshire YO24 4HA Lead Inspector
John Trainor Unannounced 5 July 2005 09:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oakhaven - City of York Council Version 1.20 J53_JO4_S34921_Oakhaven_V221479_190705_Stage4.doc Page 3 SERVICE INFORMATION
Name of service Oakhaven Address 114 Acomb Road, York, North Yorkshire, YO24 4HA 01904 791599 01904 784985 N/A City of York Council Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Cynthia Spaven (Registration application pending). PC Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Oakhaven - City of York Council Version 1.20 J53_JO4_S34921_Oakhaven_V221479_190705_Stage4.doc Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 23rd November 2004 Brief Description of the Service: Oakhaven is a care home run by City of York Council and is registered to provide a service for 27 older people of either gender aged over 65 years who do not have any specialist requirements. Oakhaven was purpose-built approximately 50 years ago and is located within a short walk of Acomb Village centre. The accommodation is provided in single rooms on two floors. The upper floor is accessible via passenger lift. Structural alterations have been completed in the last 12 months to create more open lounge space and additional toilets. Up to 6 day care places per day are available. Oakhaven - City of York Council Version 1.20 J53_JO4_S34921_Oakhaven_V221479_190705_Stage4.doc Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out on 5 July 2005. It was unannounced and took 6 hours to complete. The majority of time was spent within with the residents in the home at the time of the inspection and with the staff on duty. There were opportunities to have discussions and observe staff interaction with the residents. A sample of resident files was examined and a check was made as to whether the home had complied with recommendations from the last inspection. Feedback was given at the end of the inspection to the manager. What the service does well: What has improved since the last inspection? What they could do better:
There are a number of areas where improvements could be made. Written information about the home should be made available for residents thinking of moving to Oakhaven. This would help prospective residents make an informed choice. Care plans are required for all residents to ensure that current care needs are identified properly and to assist staff in supporting residents to live as independently as possible. To determine whether staff have been properly checked and are suitable to work in Oakhaven with older people, staff records need to be kept by the manager in the home. Oakhaven - City of York Council Version 1.20 J53_JO4_S34921_Oakhaven_V221479_190705_Stage4.doc Page 6 The pharmacist should be invited to inspect the home’s systems for the administration of medication to ensure that it is given to residents as safely as possible. Whilst there were no concerns raised by residents, some staff thought the food brought in from the hospital was repetitive and unappetising. To settle the issue, it would be sensible for the home to carry out its own survey of the views of residents. In the last inspection report it was recommended that staff undertake training in the protection of residents from abuse. To date this has not happened. To ensure residents are safeguarded this training needs to carried out. With regard to the premises, additional storage space is required to make sure that equipment used in the home is stored safely and the premises look homely. The alarm call system is in working order but is out of date. It needs to be replaced to ensure that failure of the current system is avoided and residents are always able to summon help when they need to. There are some staffing issues that need to be sorted out. To make sure care practices are up-to-date, staff need to undertake NVQ2 training. In addition, regular supervision is required which will also help in improving standards of care. The General Assistants post need to be reviewed to determine whether it is practical for them to carry out care duties. If they are not fulfilling this part of their job then the care available for residents is short. The manager thinks that there is a lack of organised activity and has identified this as an area for improvement. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Oakhaven - City of York Council J53_JO4_S34921_Oakhaven_V221479_190705_Stage4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Oakhaven - City of York Council J53_JO4_S34921_Oakhaven_V221479_190705_Stage4.doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 Prospective service users are not enabled to make an informed choice about moving to Oakhaven. EVIDENCE: Prospective service users are not provided with written information about the home prior to moving in. There were requirements in the last inspection report regarding the need to compile a Statement of Purpose and Service User Guide. To date, the corporate templates for the documents have been obtained but have yet to be completed specifically for Oakhaven. Oakhaven - City of York Council J53_JO4_S34921_Oakhaven_V221479_190705_Stage4.doc Version 1.20 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 - 9 Generally, service users’ health and personal care needs are met but there are areas where considerable improvements could be made. EVIDENCE: Each service user has a care plan but the information is sketchy and the same care needs are identified for most service users. In the sample inspected, care plans did not reflect the service users’ day-to-day care needs identified in the daily contact sheets. A requirement was made in the last but one inspection report regarding the need to improve care plans by 30/10/04. Although annual reviews are carried out, there were no minutes held on service users’ files. In May 2005 there were 2 errors in the administration of medication. The matter is currently being investigated by the City of York and will be resolved in due course. In the last inspection report it was recommended that the pharmacist should be invited to carry out an inspection the systems for the administration of medicines but to date this has not been carried out. Oakhaven - City of York Council J53_JO4_S34921_Oakhaven_V221479_190705_Stage4.doc Version 1.20 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12-15 Service users are generally happy that the quality of life at Oakhaven meets with their expectations. EVIDENCE: Service users said they were happy with what Oakhaven had to offer. They said that they are able to see their relatives and friends and this was observed on the day of inspection. There is a lack of organised activities but none of the service users expressed any concern about this. This may reflect a low level of expectation and one service user said, ‘there’s not much to do but it doesn’t bother me’. The manager has identified this as an area for improvement. In the main lounge the television was on quite loud but nobody was watching it. It was also left on during lunch. This was discussed with the manager during feedback and she said it was unusual for this to happen. Service users said that the food was mostly good. The meal is brought in from the hospital and regenerated in the home’s kitchen. On the day of inspection it looked presentable. There was a fair amount of waste returned to the kitchen but none of the service users complained. Staff have concerns that the food is repetitive and unappetising but this is not borne out by comments from service users. As a quality assurance exercise the home should consult service users about their views on the food.
Oakhaven - City of York Council J53_JO4_S34921_Oakhaven_V221479_190705_Stage4.doc Version 1.20 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Service users are safeguarded from abuse but more could be done to raise staff awareness of the issues. EVIDENCE: In the last inspection report it was noted that Oakhaven had a ‘whistle blowing’ policy, the ‘Multi-Agency Procedure for the Protection of Vulnerable Adults’, and a copy of ‘No Secrets’. Care staff had not participated in adult abuse awareness training and a recommendation was made that this should be arranged. To date this has not been action. Oakhaven - City of York Council J53_JO4_S34921_Oakhaven_V221479_190705_Stage4.doc Version 1.20 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 Service users live in a home which, on the whole, is well-maintained and safe. EVIDENCE: Service users’ bedrooms are comfortably furnished and have been decorated with personal items such as photographs and ornaments. There are a number of pleasant sitting areas and all communal areas are in good decorative order. In the last inspection report it was noted that there is a lack of storage for wheelchairs, mobile hoists and zimmer frames. This problem still exists. The alarm call system is in working order but is obsolete. Oakhaven - City of York Council J53_JO4_S34921_Oakhaven_V221479_190705_Stage4.doc Version 1.20 Page 13 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 - 30 Service users’ practical rather than social care needs are met and the staff are unhappy about a number of issues. EVIDENCE: Staff are able to assist service users in practical ways but have little time to engage in social activities. The manager said that this is an area that she would like to see improve. The general assistants who spoke with the inspector said they do not carry out any care duties even though they are supposed to use 20 of their time in this capacity. The care leaders are concerned that too much of their time is taken up trying to find cover for gaps in the rota. And that there is an expectation that they will cover vacant shifts if an alternative cannot be found. They said that the relief pool is inadequate. Staff records are not available in the home. There are insufficient numbers of staff who have obtained NVQ2 qualifications. Oakhaven - City of York Council J53_JO4_S34921_Oakhaven_V221479_190705_Stage4.doc Version 1.20 Page 14 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 Service users are cared for by staff who do not receive appropriate levels of supervision. EVIDENCE: In previous inspection reports it has been noted that staff do not receive supervision consistently. This is still the case and should be addressed. The manager said she had identified this as an area for improvement. Oakhaven - City of York Council J53_JO4_S34921_Oakhaven_V221479_190705_Stage4.doc Version 1.20 Page 15 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2
COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x x x x x x x Oakhaven - City of York Council J53_JO4_S34921_Oakhaven_V221479_190705_Stage4.doc Version 1.20 Page 16 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4&5 Requirement A Statement of Purpose and Service User Guide must be compiled. (Previous timescale of 31/01/05 not met An individual care plan should be compiled for each service user. It should detail for staff as to how they are to meet identified needs and it must reflect any current and ongoing issues. (Previous timescale of 30/10/04 not met) Staff recruitment records must be held in the home. (Previous timescale of 31/12/03 not met). Timescale for action 31/08/05 2. 7 15 31/09/05 3. 29 17 31/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 9 15 18 Good Practice Recommendations The supplying pharmacist should be invited to inspect the homes systems for the administration and safekeeping of medication. Service Users should be surveyed regarding the quality of the meal supplied, All staff should participate in training in safeguarding
J53_JO4_S34921_Oakhaven_V221479_190705_Stage4.doc Version 1.20 Page 17 Oakhaven - City of York Council 4. 5. 6. 7. 8. 19 19 28 36 27 service users from abuse. A plan to create additional storage space for wheelchair, walking frames and hoists should be drawn up. A plan to replace the alarm call system should be drawn up. 50 of care staff should be qualified to NVQ2 by 31/12/05 Care staff should receive at least 6 formal supervision sessions per year. The role of General Assistants should be reviewed to determine whether it is practical for them to carry out care duties. Oakhaven - City of York Council J53_JO4_S34921_Oakhaven_V221479_190705_Stage4.doc Version 1.20 Page 18 Commission for Social Care Inspection York Area Office Unit 4, Triune Court Monks Cross York, YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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