Inspection on 27/08/08 for Oakhurst

This inspection was carried out on 27th August 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Oakhurst 30/10/07

Oakhurst 06/02/07

Oakhurst 06/07/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Oakhurst 4 Courtland Road Paignton Devon TQ3 2AB Lead Inspector Stella Lindsay Key Inspection (unannounced) 27th August 2008 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakhurst Address 4 Courtland Road Paignton Devon TQ3 2AB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 524414 01803 524414 www.saffroncare.co.uk Saffron Care Ltd Manager post vacant Care Home 16 Category(ies) of Dementia (16), Old age, not falling within any registration, with number other category (16) of places Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) The maximum number of service users who can be accommodated is 16. One specific service user in the category MD(E) may be accommodated. 30th October 2007 2. 3. Date of last inspection Brief Description of the Service: Oakhurst is an attractive detached house next door to the library, with views across the park, and a short walk from shops and Paignton sea front. There are five steps with a rail up to the front door. Easier access is via the back door. Oakhurst is built on four levels, with stairlifts provided to all. There are steps to three rooms on the ground floor. The four rooms at lower ground floor level have direct access on to the homes garden. A new extension will provide three new bedrooms at this level. As well as the Manager’s office, there is one bedroom on the top floor, which should be offered to people only after risk assessment. The home provides accommodation for up to 16 people who are over the age of 65. Most residents now are mentally and physically frail. There is a communal lounge, large conservatory, and dining room available to residents. Fees range from £360 to £426 per week. Information for prospective residents, including the most recent inspection report, was on display in the entrance hall. Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star. This means the people who use this service experience adequate quality outcomes. This inspection was unannounced and took place over two days in August 2008. Two inspectors visited on the first day, to tour the premises and meet with residents. We met with four residents in their rooms, and five in the lounge and dining room. This approach aims to gather information about what living at the home is like, and make sure that residents’ experience of the home forms the basis of this report. We also discussed developments with the Manager and Home Owner. One inspector returned the following day to examine care records, staff files, and the medication system, and to meet with staff. We also met with two regular visitors to the home. The Manager provided information about the running of the home. The Commission for Social Care Inspection had sent questionnaires to residents and received three completed, and sent surveys to staff, receiving four replies. What the service does well: What has improved since the last inspection? A new Manager had been appointed, with skills and experience in health and social care of older people including people with dementia. She had improved pre-admission assessment and made sure that people were admitted only if the home was suitable for their care. She had introduced improved care planning and recording, to ensure that staff knew the health and personal care needs of the residents. Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 6 A fine new conservatory had been provided, giving residents more space and a choice of social areas. It was enjoyed for its sunny aspect, and views across the garden and the park. There was space for games. The care records and medication had been moved out of the dining room, giving residents more space and fewer disturbances during meals. Improved call bell arrangements had been introduced, and staff had pagers to communicate with each other. The home owners had commissioned a survey by an Occupational Therapist, and following their advice had provided ramps and more grab rails to improve access around the house. New stairlifts had been installed, so that all stairways now had one. The hall and stairs had been re-carpeted with a plain colour, which made the stairs much clearer and the house safer for residents to walk around. Conditions in the bathroom were improved, and paper towels provided in each bedroom and communal toilet, for better hygiene. Clinical waste collections had been increased, to maintain cleanliness in the backyard. The Manager had been provided with a bigger office, to give room for staff supervision and confidential meetings as well as proper organisation of documents. She had updated and improved policies and procedures for the guidance of staff. All minor complaints and concerns had been recorded, and any response, so that everybody knew what had been done. At the time of this inspection a major building project was nearing completion. As well as three new bedrooms on the lower ground floor with access to the garden and en suite facilities, this included a new laundry, and a terrace, which would be accessible from the new conservatory and give residents easy access to fresh air and views over the garden. What they could do better: Oakhurst needs enough staff on duty to assure residents’ safety at all times of day. This had been difficult in the afternoons, especially at teatime, and when staff had been off sick. Oakhurst needs enough Senior staff to maintain good supervision of the home in the absence of the Manager, and to help her develop good care practices for people with dementia. Training was needed to ensure that staff were competent in their roles and understood safe working practices as well as specific problems of the residents. In particular, more staff should be trained and competent to administer medication, and there should always be a qualified first aider on duty. A toilet should be easily and safely available to residents in the lounge and dining room. There should be a communal shower to give residents choice in bathing facilities. Access via the front door should be made safer for people with mobility problems. Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 7 A safe way to the garden should be provided for residents. The kitchen must be given sound easily cleanable surfaces, in order to provide a safe and hygienic place for the residents’ meals to be prepared. The Registered Providers must provide documents as agreed during the inspection. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care had been taken to assess peoples’ needs fully before offering a service at Oakhurst, so that new residents could be confident that the home was suitable for meeting their needs. EVIDENCE: Information about the home is on display in the entrance hall and available on request, and some information is also available on their web site. The Statement of Purpose has been updated include information about current staff. We asked three of the residents if they had a copy of the Service Users Guide or brochure and they all said that they had. The Manager had taken care to assess peoples’ needs before offering accommodation, and had admitted residents whose needs could be met by the service and facilities available. She was heard to invite a prospective resident and their family to visit the home whenever they wanted. A visitor said they Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 10 had brought their relative to look around, and that the staff at Oakhurst had been very helpful. Information and assessments had been gathered from health professionals who had worked with residents in hospitals and in their previous settings, including occupational therapists and members of the Community Mental Health Team. Staff had been alerted to specific needs of clients with regard to their diagnoses, and the advisable way of dealing with symptoms and expected behaviour. Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ personal and health care needs were being met according to their individual needs and preferences, and with regard to their dignity. EVIDENCE: All residents had written care plans. A life history and personal profile were recorded. Specific information with regard to people’s daily routines and current health care needs were recorded, and arranged clearly so that staff could quickly gather the information that they need. The Manager said that she intends to include peoples’ individual goals and aspirations, and to ensure that cultural and spiritual requirements and practices are included. Daily records had been kept, to help consistency of care and to bring any problem or change to the attention of senior staff. Two of the three care plans that we examined had been reviewed regularly by staff in the home, to make sure that any changes were noticed and acted upon. The third was a recently admitted resident. The Manager said that the Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 12 resident was not prepared to discuss the care plan with her, so she was making an arrangement to meet with the next of kin to review it. Health records were kept clearly. There were records of visits to the surgery. One person went regularly for blood tests because of the medication they were taking. District Nurses input with regard to skin care and provision of equipment had been recorded. The home had a policy for the safe administration, storage and recording of medication, which had been recently reviewed by the Manager, in order to promote good practice and help keep residents in good health. The procedures included arrangements to be made for people to maintain responsibility for their own medication if they wished, as long as they were assessed as being competent to do this. This helps people keep their independence, as long as it is safe. Agreements were seen on file, signed by the resident, when they had agreed to give up responsibility for looking after their own medication. The medication trolley was chained to a solid wall. It cannot be wheeled to bedrooms. The Senior Carer was seen taking medication to residents in their rooms, then completing the Medication Administration Record in the proper way. There were no Controlled Drugs in use in the home, but a storage facility was available. The pharmacist under contract to the home had audited the system in April 2008 at the request of the Manager, and was due to carry out the annual audit later in the year. Some staff had received training and been assessed as competent to carry out this task, but not yet enough to cover all shifts, and arrangements were frequently needed for the Manager or another competent person to come in on their day off. Another concern expressed was that sometimes the morning medication took such a long time to administer, because staff shortages led to the person doing this task being called away to help with care tasks, that some peoples’ morning drugs were taken too close to lunch for their well being. These issues are referred to in the ‘Staffing’ section of this report. Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff were trying to be flexible and respond to individual need, but did not always have time to do this. Good meals were served, with choice every day. EVIDENCE: Only one staff member returning a survey said they always have time to meet residents’ individual needs – two said sometimes, and one said ‘never,’ as at tea-time and in the mornings it takes all their time to meet health and personal care needs, and they feel that residents are missing out as they do not have time to give attention. The Manager had discussed with staff how they could make life in the home more positive for residents, to counteract any feelings of helplessness or boredom, but they needed less pressure on their time to be able to accomplish this. One staff member said that residents get up gradually through the morning, and that they are not hurried to get up. The Senior on duty was spending up to 2.5 hours taking the medication to residents and sometimes there was only one other carer to help all the residents get up and dressed, who would need to ask for help with some residents. Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 14 Some residents had a sociable life in the home, and some chose not to join in. Entertainers were engaged every Friday, to lead residents in singing and word games. An activity was also provided every Wednesday - craft, music or pets visiting the home. Some residents preferred not to leave their rooms, but most came to the dining room for their meals, and several liked to linger after tea, chatting round the table for about an hour. Two staff were pleased to tell us they were planning a ‘30s evening, with music, food and dressing up. A Carer told us that they had taken a resident to the shops and a walk round the park, and will offer to take another. The home owner said that this would be made more widely available, as agreement had been reached to increase staff levels. One of the residents said that she is regularly taken out by the Manager but another said that she was not given the opportunity to go out unless her son took her. Current residents all needed assistance as they were not able to go out independently, even to the garden, which was not easily accessible. We met two relatives who were regular visits to the home, who told us they were happy with the service at Oakhurst. One said they had enjoyed Sunday lunch with their mother at Oakhurst. We were aware of at least two other family visitors during this inspection. The menu for the day is displayed on a notice board and showed that the residents are offered a choice of both courses at lunch. The cook visits each resident during the morning to discuss their menu choice. One resident said that she did not want either of the daily options and that she would ask for chicken instead. Several residents said that the food was good and there was plenty of it. Of the residents who returned questionnaires, one said they always enjoy their meals at the home, and the others said ‘usually’. A bowl of fruit was available for residents if they wanted a snack between meals. The cook said she was currently catering for one resident who likes her food to be pureed and three with diet controlled diabetes. All food intake is recorded in the kitchen for residents with dementia. Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed policies underpin good practice in this area. Issues brought to the attention of the Manager had been dealt with effectively. EVIDENCE: There is a clear complaints procedure. It is displayed in the home, and each resident had their own copy. A full and complete record of complaints made in the home had been kept, with action taken in response. Notifications had been sent to the Commission for Social Care Inspection as required. A complaint had been received by the CSCI in January 2008 regarding the safe administration of medication. This was in the period before the arrival of the new Manager. The Registered Provider looked into it and sent us a full report. Satisfactory arrangements have been made to maintain safety. We received another anonymous complaint on 17/06/08 regarding a young and unqualified person being left in charge of the home while the Manager was on holiday. The Registered Person wrote to us to say that while the newly appointed Senior Carer was under 21 at the time, she was not left in charge of the home. Waste disposal and catering were also the subject of this complaint, and were dealt with satisfactorily in the Registered Provider’s report. The Manager revised the home’s policy on safeguarding adults and the prevention of abuse in June 2008. It includes reference to the Mental Capacity Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 16 Act 2005 (MCA) and includes a ‘policy on working with service users who might lack capacity’. The Manager had demonstrated her ability to deal effectively with allegations and circumstances that might affect the well being of residents, with referrals to the safeguarding team on 15/02/08, 11/07/08, and 01/08/08. The Missing Persons Procedure was activated on 07/03/08, with a satisfactory result. The Manager was booked to attend training on the implementation of the MCA. She includes discussion of Complaints, Whistle blowing and safeguarding in the home’s induction programme, and has obtained DVDs for in-house training to complement external training on a regular basis. The agenda for a staff meeting during the week following this inspection was to include a discussion of different types of abuse, and how to respond to a disclosure. There was a commendable openness in discussions of difficult situations in the home. Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Oakhurst was providing an attractive environment, but further work was needed to make it safer and more accessible. EVIDENCE: The house was attractive and in pleasant surroundings. A major project to provide more bedrooms on the lower ground floor, along with a laundry, was nearing completion. A large and pleasant conservatory had been built in place of a small one and this would give access to a terrace roof garden which was not available to residents at the time of this inspection but was evidently close to completion. The conservatory was proving popular with residents, for activities, and for its views across the park. Heating had not yet been installed; fixed wall heaters were being considered. Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 18 A maintenance worker was employed, and staff confirmed that a prompt response was made to their alerts. He was able to work during evenings when residents were not using the stairways and facilities, which was found to be very helpful. An Occupational Therapist had been engaged to assess the premises and make recommendations to enhance the safety and independence of the residents. Acting on this advice, the home owners had provided improved access around the house, with stair-lifts to all floors, and small ramps to enable easier movement around the ground floor. A new plain carpet had been fitted, which made the stair edges clearer to see. A concertina door had been fitted to an en suite toilet to make access easier, and this was working well. The home owners were still working through the recommendations made, which included a second rail for the steps to the front entrance to the home. The dining room was not large enough for all residents to eat together, so they were served in two sittings, and were quite happy with this arrangement. The homeowners told us that plans had been approved for an extension, though they were not proposing to build in the near future. The garden had been totally redesigned, and built with a grant to improve the environment for residents, including water features, a sensory garden, bird table and a variety of seating areas. This was not finished at the time of this inspection, but was seen to be nearing completion. However, apart from those residents on the lower ground floor with their own door onto the garden, there was no easy access to the garden. Residents would need to go out of the front door, which involves five steps, through the car park and down a ramp. No residents would be able to manage this unaided. During the inspection the home owners identified a site on the lower ground floor where an external door could be installed, thus allowing residents safe access to the garden from the home. There is only one communal bathroom. It had been improved, with a safer bath hoist, a new shower fitting, and new flooring. Several residents had showers in their en suites, but were unable to use them. It could be beneficial to remove them to give more spacious en suite toilets. Some residents were using commodes in their rooms because they were unable to access their toilet. One said they would use their shower when it was fixed. There is no toilet convenient for residents to get to from the lounges and dining room. Unless their bedroom is very close, they go to a toilet by the front door, which involves negotiating steps. Two new grab rails had been installed, but this remains a hazard for residents. A piece of equipment had just been ordered which will enable staff to help residents up from the floor after a fall. Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 19 There was a call bell system, whose buzzers could be placed beside the resident wherever they were. The display box had been re-sited at the Carers’ Station, instead of the dining room where it was disruptive at meal times. Unsuitable locks had been removed from bedroom doors, and some doors had new locks fitted. Lockable drawers or boxes in private rooms were being considered to meet different peoples’ needs and preferences. On the top floor of the house there is one bedroom with its own toilet. The occupant said that their room can get very hot, and we found the office on the same floor to be uncomfortably warm. The suitability of the top floor room for use as a bedroom should be reviewed. While a resident uses the toilet on the top floor, it should be provided with a call bell in case of emergency. The kitchen had been inspected by an Environmental Health Officer, and found to be not of the required standard to provide a hygienic place to prepare food for residents. The home owners told us that plans had been approved for an extension of the kitchen, but this building work is not expected to start in the near future. Work must be done to meet the requirements of the EHO, and provide easily cleanable surfaces to avoid risks to the health of residents. The laundry and tumble-dryer were in unsuitable situations at the time of this inspection, but the new laundry to be provided on the lower ground floor was expected to come into service by October 2008. The house was clean and sweet smelling. Infection control procedures were in place to prevent cross contamination, with disposable gloves available in the bathroom, and in residents’ rooms where personal care is given. Paper towel holders had been installed in every room. Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although staff are caring and hardworking, they had not been employed in sufficient numbers at all times of day to meet the needs of the residents, or provided with the training they need to ensure best practice. The recruitment system is robust, to protect residents from potential harm. EVIDENCE: A written rota was kept, which showed that there were usually a Senior Carer with two Care Assistants from 8 – 2pm and with one Care Assistant from 2 – 8pm. There was not always a Senior Carer on duty, especially on Sundays. The Manager had been on-call at these times. We were told that a third Senior had just been appointed, so that in future there will be a Senior in charge seven days per week. There have been failures to cover for absences. In the mornings, the administration of medication can be delayed if the person doing this is interrupted to help colleagues with care tasks. This means that some residents will not get their medication until 10.30am or sometimes later which then impacts on their lunchtime medication. The Registered Provider told us that the afternoon staffing levels would be increased to three, and the recruitment process had started to put this into practice. This is important, because staff duties include serving the tea-time meal and administering medication as well as providing care and attention to Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 21 people, some of whom have complex needs, in a building which is on four floors. Night staffing had recently been improved, and there were two staff on waking night duty, in order to safely meet the needs of residents by night. In addition to the care staff one full time and two part time cooks are employed. There is one full time cleaner and handyman and one part time cleaner. Many of the staff had been recruited recently, and at this time only three out of eleven care staff had achieved NVQ level 2 in care. The Manager said she would be encouraging staff to make progress when they have completed their foundation training. We looked at three staff files, including two of recently recruited staff. These showed that two written references had been obtained, and Criminal Records Bureau had been received, or applied for, including for a voluntary worker. Staff were satisfied with their induction training. The home has clear and robust policies for their advice. Resources had not been made available for staff training, but a training budget had recently been agreed. There is a backlog of training needs to be met, in particular, Moving and Handling training for all staff, and also training in the Protection of Vulnerable Adults, Control of Infection, First Aid and Food Hygiene. DVDs had been purchased to complement external training. Records were seen of training courses that had been booked for named staff or were planned. The Manager was keen for care staff to attend training to advance their understanding of life from the point of view of people with dementia, to improve their communication skills, and understanding of unusual behaviours. Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An effective Manager had been appointed, but resources had not always been made available to maintain a safe service in the best interests of the residents. EVIDENCE: The Responsible Individual for Saffron Care Ltd is Mrs Joanne Spurle. She has been involved in the running of the home. She has engaged in the Registered Managers Award. A new Manager was appointed and started work at Oakhurst on 4th February 2008. She had been given a job description giving her the authority to direct care in order to meet the National Minimum Standards. Difficulties in this period had stemmed from insufficient provision of care staff. The Manager had worked many extra hours over the past seven months, too Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 23 many to be sustainable. This had been due to the lack of sufficient Senior staff who could be left in charge of the home, and the need to administer medication when no-one on duty was competent to do this. The Manager was unable to make time for supervision sessions and staff training, due to covering for absent care staff. There were not enough senior staff to help with implementation of care planning and to cover for the Manager’s absence. It was partly due to resources not being made available, and pertly to slow response to recruitment. Agreement with the service providers had just been reached to increase staff levels in the afternoon, and this needed to be accompanied by reliably covering for absences. Essential training had been arranged by the Manager, then postponed due to budget not being available. The Directors supplied a copy of the Profit & Loss account for the home, and agreed to send a forecast for the next six months when it is prepared. The building project was almost completed, and the Directors were expecting occupancy levels to rise. The Registered Providers had worked to meet the requirements made at the previous inspection. They had written an annual development plan, and the Manager had produced three monthly action plans to help them identify the most urgent items to be dealt with. A quality assurance assessment system is still needed. Feedback was being gathered at the time of this inspection. Some had been received from residents, and other questionnaires were to be sent out. Mrs Spurle said she would collate these and send us her report. Amounts of cash were kept on behalf of five residents, by the choice of the resident or for their protection in consultation with their representative. All transactions were recorded with two signatures and a running balance, and receipts kept, to ensure accountability. The Manager had been introducing staff to the purpose of supervision sessions, and had prepared a Supervision Contract. Notes on staff files showed that she had started to implement her programme, and on the notice board were individual sessions she had booked for staff to spend with her over the following month, to focus on either ‘Nutrition’ or ‘Reflective practice’, ‘Induction’ or ‘Cleaning’, depending on the needs and role of the team member. She was expecting to introduce staff to new policies and work practices as well as consider and record their performance and achievements, any difficulties, and their training needs. Staff returning surveys to us said that they felt well supported. The Manager was aware that she needed time to work through this programme in order to ensure that staff make progress and are competent in their roles. There had been continual efforts to maintain safe working practices during this time of changes to the building. Many of the Occupational Therapist’s recommendations had been introduced, though not all. Hot pipes coming from Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 24 the boiler in the dining room needed to be covered to protect residents from potential harm. The electrical system had been made safe, and the home owner sent us a copy of the certificate. There was not a first aider on duty at all times. The Fire risk assessments had been professionally carried out on 08/08/08. There was currently no Fire Warden, and some staff still needed training in order to respond correctly in the event of an emergency. Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 2 2 X 3 X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Sufficient staff must be trained and competent in the administration of medication. The Registered Providers must meet the requirements made by the Environmental Health Officer in their visit during August 2008. There must be sufficient staff on duty with the skills and competence to meet the needs of residents in a safe manner. The hot pipes in the dining room must be covered to protect residents from potential harm. Staff must be kept up to date with training in Fire Safety and Moving and Handling. The appropriate staff must be trained and competent in First Aid in order that a qualified first aider is always on duty. Timescale for action 31/10/08 2. OP26 13(3) 30/11/08 3. OP27 18(1)a 30/09/08 4. OP38 13(4)c 30/09/08 5. OP38 23(4)d 13(5) 13(4) 31/10/08 6. OP38 31/10/08 Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 27 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. Refer to Standard OP12 Good Practice Recommendations Staff should be enabled to increase the amount of person centred and individualised activity in accordance with resident wishes. An accessible shower should be provided, to give choice and safety in bathing facilities. Further progress should be made to enrol staff on NVQ training. Staff should receive training in order to help them meet the particular requirements of the residents. The registered Providers should supply the CSCI with a copy of the financial forecast. 2. 3. 4. 5. OP21 OP28 OP30 OP34 Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: 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 © 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 Oakhurst DS0000066583.V369985.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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