Inspection on 20/08/08 for Oakhurst Court Nursing Home

This inspection was carried out on 20th August 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 Court Nursing Home 22/08/07

Oakhurst Court Nursing Home 08/05/06

Oakhurst Court Nursing Home 17/10/05

Oakhurst Court Nursing Home 21/06/05

Oakhurst Court Nursing Home 21/09/04

Oakhurst Court Nursing Home 27/04/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Oakhurst Court Nursing Home Tilburstow Hill Road South Godstone Surrey RH9 8JY Lead Inspector Lisa Johnson Unannounced Inspection 20th August 2008 09:00 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 Court Nursing Home DS0000013343.V369270.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 Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakhurst Court Nursing Home Address Tilburstow Hill Road South Godstone Surrey RH9 8JY 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) 01342 893043 01342 892690 pamela.milne@oakhurstcourt.co.uk Oakhurst Court Limited Mrs Pamela Elizabeth Milne Care Home 57 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Oakhurst Court Nursing Home DS0000013343.V369270.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 with nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age not falling within any other category (OP) The maximum number of service users to be accommodated is 57. 2. Date of last inspection 22nd August 2007 Brief Description of the Service: Oakhurst Court Nursing Home provides nursing and personal care for older people with dementia who may have physical and sensory disabilities and various health conditions. The home is for people of mixed gender from 60 years of age. This large detached property is set in beautiful landscaped grounds in a semirural location and has good car parking facilities. It has been extended and refurbished over recent years, and care taken to tastefully combine the modern and period features of the building. Godstone village is a short drive by car where there a small range of shops, a church, public houses and restaurants and access to public transport. Bedroom accommodation is mostly single occupancy with en-suite facilities, arranged on the ground and first floor and served by two passenger lifts. Communal areas are on the ground floor. These comprise of a choice of three lounges and large dining area, which is multi-functional and also used for social and recreational activities. The building is wheelchair accessible throughout and WC’s and assisted bathrooms are on both floors. The home has a fire alarm and nurse call system and is equipped with hoists, grab rails and other suitable aids. Fees range from £550 to £975 per week. Oakhurst Court Nursing Home DS0000013343.V369270.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 that people who use this service experience adequate quality outcomes. This site visit was part of a key inspection. The visit was unannounced and took place over six hours and forty minutes commencing at 9.00am and finished at 3.40 pm. Two regulation inspectors Mrs. L Johnson and Ms.S Hall carried out this visit. Mrs. P Milne registered manager represented the service. Information was provided to us by the service prior to this visit in the Annual Quality Assurance Assessment. (AQAA) This is a self-assessment that focuses on how well outcomes are being met for people using the service. Reference is made to this assessment throughout this report. People with dementia are not always able to tell us about their experiences and we have used a formal way to observe people in this inspection to help us understand. We call this the “short observational Framework for Inspection” (SOFI). This involved us observing five people who use the service for two hours recording their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who use the service and the environment. We received surveys from people living in the service, their representatives, health care professionals and care managers A tour of the home took place, staff recruitment, and training records, care plans, and risk assessments, medication records and policies and procedures were sampled. The registered manager has made some significant improvements to the service since our previous visit. However until some improvements including medication administration and risk management are imbedded into practice and demonstrate sustainability people using the service may not be fully protected from harm. The quality rating is a reflection of this. The inspector would like to thank people living in the home and staff for their time, assistance and hospitality during this visit. Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Improvement was observed in the maintenance of records in respect of people identified as being at risk of developing pressure sores. Correct procedures were being followed when making changes to medication administration records. A privacy lock has been fitted to the sliding communal toilet door. The arrangements for appropriate staffing levels and the amount of hours they work has taken place Staff have received training in wound care The registered provider now conducts monthly quality audit visits in the home. Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 7 The manager has also responded to a number of the good practice recommendations made at the previous inspection What they could do better: 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 Court Nursing Home DS0000013343.V369270.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 Court Nursing Home DS0000013343.V369270.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, 3 & 6 People using the service experience good outcomes this area. This judgement has been made using available evidence including a visit to this service. Prospective people considering the home as a place to live are provided with the information to enable them to make a choice about the homes suitability as a place to live. The home is able to demonstrate that pre-admission assessments are completed prior to admission to the home. The home does not support people for intermediate care. EVIDENCE: The home provides a statement of purpose and service guide, which has been reviewed since our previous visit. The homes brochure has also been updated and the last Inspection report was available for people to see. The service now has a web site that people and their representatives can access to gain information about the home and a marketing manager has been recruited. The manager has identified in the self-assessment that the service user guide would benefit from being provided in alternative accessible formats to meet the varying needs of people considering this home as a place to live. Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 10 A pre- admission assessment is completed prior to any person moving into the home, which are carried out by the registered manager or a senior qualified member of staff. The assessment covers physical, psychological, orientation and mobility information is also gathered at this time about people’s life histories, hobbies and interests, but if this information is not gained at the time of the pre admission assessment then this sought from people and/or their representatives at the earliest opportunity. The manager has identified in the self-assessment that they need to address the requirements within the mental capacity act as part of their pre-admission process A health care professional surveyed said, “a health care needs assessment is always requested and community care assessment if this is needed” The home does not provide intermediate care therefore standard 6 does not apply Oakhurst Court Nursing Home DS0000013343.V369270.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, 10 & 11 People using the service experience adequate outcomes this area. This judgement has been made using available evidence including a visit to this service. The home has a plan of care that the person or their representative has been involved in making. People’s health care needs are met, although improvements are needed in risk management. People are treated with dignity and their right to privacy is respected. Weakness in the medication practices could place people at harm. People and their families will be treated with sensitivity and respect at the time of their death EVIDENCE: People living in the home have an individualised plan of care based on full needs assessment and dependency profiles. During this visit six care plans were sampled. Care plans recorded details of the current needs of people and instructions of the care to be given were recorded. Information provided in the care plans demonstrated that care plans were discussed with the person or their representative and that they had been signed by them to confirm their agreement. Care plans are reviewed monthly with the outcomes recorded. Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 12 Daily notes sampled reflected the care objectives as recorded in the care plan although some lacked detail. This was demonstrated by one persons care plan which states that have issues with feeling distressed the daily notes recorded that this was happening but did not detail when this was happening to get an idea of what the triggers may be. The manager has commenced gaining life histories from families to include people’s likes, dislikes and preferences, which are recorded on a separate form which is maintained with the care plan. Risk assessments were completed including moving and handling and where people are identified as at risk of falls. Information provided in one persons care plan identified that they require transferring using a hoist and requires support from two members of staff. During this visit staff demonstrated that these instructions were followed. Tissue viability risk assessments were conducted and where specialist equipment is required such as pressure relieving cushions this had been documented. Records were in place to confirm to confirm that nutritional assessments and monthly weight records are monitored. While carrying out SOFI observations it was observed that one person had some abrasions on their legs and we were informed that this was due to the person knocking into things when mobilising. This matter was not recorded in their care plan and it is also required that a risk assessment is completed to identify preventative measures ensuring the persons safety and wellbeing. During a tour of the home it was observed that one persons bedroom had a bedside lamp, which had, the bulb removed because they are at risk of removing them. During discussion with the manager it was apparent that no risk assessment had been completed People are supported to have access to a range of health care professionals including the General Practitioner, psycho geriatrician, community matron, district nurse, physiotherapist, optician and chiropody. A health care professional said, “If a resident develops a health care need that the staff are not competent in meeting they will always contact us to ensure that they can meet this in a timely manner” and another health care professional said, “the general care has improved over the last year”. Records are maintained of all care consultations. However one record viewed only recorded the name of the doctor visiting and did not record the outcome of this visit. The home operates a policy of privacy and dignity. Bedroom and bathroom doors were observed to be shut when carrying out personal care with people. People living in the service were observed to be clean and appropriately dressed. Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 13 A health care professional surveyed said, “on my visits the clients privacy and dignity have always been respected and I have been impressed by the caring nature of the staff”. SOFI observations carried out during this visit confirmed that staff spoke to people politely. However on two occasions staff were heard using terms that were not age appropriate and respectful such as “good girl” and “ naughty “. These matters were brought to the attention of the manager who is advised to address these matters through staff training and supervision The inspector examined the medication storage arrangements and some records, including Medication Administration Record (MAR) sheets, the record of medication disposal and controlled drugs record. Most MAR sheets were completed correctly but not all of those examined were fully completed. Only registered nurses give out medication in the home. There is a medication storage room and secure trolleys that staff can use to transport the medication to individual service users. It has the correct controlled drug storage facilities and a drugs fridge, which is monitored to ensure the correct temperature, is maintained. Several areas of concern were seen and brought to the attention of the registered manager. It was evidenced that doses of medication were not given to some service users as a partial audit of medication showed tablets had been signed for but not given. Medication that had been prescribed for one service user, with three tablets needing to be given, many nurses gave just one. Another service users medication was well under the number of tablets that should have been still available. Medication coming into home on a monthly basis is signed in on the MAR sheets. However, some medication that had come into the home during the month had not. Most MAR sheets seen did not indicate the amount of medication already in stock at the start of the month. The medication is not currently supplied by the pharmacy in a monitored dosage system. Monitored dosage systems (MDS) have been promoted as a safe system of medicine administration in care homes Safe practice is not guaranteed by use of a system alone but is promoted by only allowing staff who are trained and competent to give medicines. A care home (nursing) employs registered nurses. The Nursing and Midwifery Council (NMC) Code of Professional Conduct requires each nurse to be individually accountable for making sure that all medicines are administered correctly and to be personally accountable for upto-date practice currently they should follow the UKCC guidelines for the administration of medication. The amount of stock being kept for some service users was excessive. The registered manager agreed to make suitable arrangements to deal with this Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 14 matter. Discontinued medication was still in the home’s trolley a month later. Arrangements are in place for the correct disposal medication. During a tour of the premises a number of creams and ointments were seen for people who were not living in that room and therefore did not belong to them and they had not been dated when opened. Since our previous visit the home have introduced the Liverpool Care Pathway ensuring that peoples end of life care needs and desires are discussed and recorded. The home has also worked closely with the local Marie Curie palliative care team. Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 15 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 &15 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Further improvement is needed to ensure that people living in the home are provided with a range of recreational and leisure activities that meet their needs. People’s religious and cultural needs are met and they are able to maintain relationships with their families and friends. People are supported to make choices in their daily lives and they have well balanced and attractive meals. EVIDENCE: The home employs an activities coordinator and we were informed that they people engage in-group and individual activities and that the activities coordinator maintains records. We were informed that events had taken place for service users to celebrate the Olympics. Seasonal activities are arranged and events such as members of the local community participate in activities in the home and the local school perform carols for people living in the home at Christmas. The home has recently participated the “breath of fresh air activities” which was a national competition with the aim to focus the activities coordinator to develop new and Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 16 more inclusive outdoor activities with people. We were also informed that reminiscence sessions are held. It was encouraging to hear that some people are involved now in activities such as laying the tables for meals to maintain independence and skills. One person was observed to be removing the tablecloths after lunch. Some people have been involved in growing some vegetables in the garden During this visit the SOFI exercise was carried out over two hours in one of the small sitting rooms. Five people were observed and three of these people had limited verbal communication. During the morning a music session was held in the large main sitting area and it was observed that not everybody in one of the small sitting rooms was provided with the opportunity to attend this activity. Staff presence was maintained throughout although they were observed to interact mainly with people with verbal communication who were sitting at the other end of the room and little interaction was provided to other people. During this time there was no activities taking place for three people except for assistance with refreshments. A number of staff were observed to walk through this room and missed opportunities to interact with people as well. The outcome of this exercise was discussed with the manager. It is recommended that consideration is given to reviewing the current activity arrangements in the home ensuring that they meet the needs of all people living in the home particularly for people with non verbal communication. The home considers the religious needs of people by holding Holy Communion monthly but would actively assist people to attend the local church or other place of worship if this meets their preference. The home operates an open visiting policy. During this visit family and friends were seen visiting. A relative spoken with said that they are always made welcome when visiting .The home also provides beverages, snacks and meals for visitors free of charge. During this visit peoples bedrooms were personalised with people’s belongings and they are encouraged to bring in any personal items into the home. Information supplied in the self-assessment states that people have the opportunity to exercise their rights to vote in local and national elections. The home has contacted all local political parties to provide suitable literature for people to access information. Since our previous visit the home has employed a new chef and the menus have been reviewed. Menus sampled were varied and well balanced. The community dietician was involved to ensure that all meals provided are of nutritious content. Since our last visit the evening supper now consists of a hot option, which was recorded on the menu. However the choice of other options Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 17 for lunch were not recorded. The manager and staff spoken with said that choices could be accommodated if somebody does decide they do not like the meal. One person is Hindu by religion and appropriate meals are provided which meet their cultural needs. During this visit the lunchtime meal was well presented and tables were with provided with table clothes and refreshments. Staff were observed to be providing appropriate support to people who require assistance with eating and drinking. A relative surveyed said, “there is a very good chef and the food is always good and there is a great variety”. A health care professional said, “Client’s families have reported that the food is good”. Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 18 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 & 18 People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service complaints procedure and their views are listened to. People living in the home and their representatives have access to an effective complaints procedure and their views are listened to. Robust policies and procedures are in place, which ensures people are protected from abuse. EVIDENCE: The home has a complaints procedure in place. A suggestions box was also seen on display in a prominent position in the reception. The homes complaints and compliments were viewed. A number of compliments had been received and it was positive to see a lot of people were happy with the care that their relatives received. Information provided in the self-assessment states that the home has received five complaints since the previous visit. The complaints information viewed demonstrated that these have been dealt with appropriately. It was positive to see in one that the home is not afraid to apologise when they have got things wrong. This was seen in particular in one case where there were concerns about untidiness of the laundry and the food. People surveyed confirmed that they were aware of the homes complaints procedure. A relative said, that had not had not needed to make a complaint and that if they did they knew if they did it would be taken seriously. Another person said that they were given an information pack that they think included the complaints procedure within that. This person also said that he Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 19 had had a couple of issues in the past that that the manager sorted things out straight away. The service has safeguarding vulnerable adults from abuse and whistle blowing policy. During this visit the manager the updated local authority safeguarding vulnerable adults from abuse procedure was available Staff receive regular safeguarding training which was confirmed by staff training records sampled and the manager has also attended the local authority training. Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 20 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, 24 & 26 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service People living in the home have a well maintained and comfortable home to live in, although areas were identified needing improvement ensuring that people living in the home have a clean and hygienic home to live in. EVIDENCE: The home has a continuous programme for refurbishment and routine maintenance. Since the previous visit and as a result of the annual quality audit carried out significant amounts of bedroom furniture has been replaced. A tour of the building was conducted with the manager. There is pleasant well-maintained secure and accessible gardens which are accessible to people living in the home. During the tour it was observed there is a slope, which is in place between the old building and the new building which is steep. It was recommended a matter of urgency that handrails be fitted ensuring that people living in the service are protected from falls. Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 21 A number of people’s bedrooms were seen. The rooms seen were suitably furnished, and been personalised by service users in most cases. Most of the home including the bedrooms was in a good state of decoration. The home has mainly single rooms with several shared rooms that they are looking to possibly turning into suites. One that has been transformed was seen, it had been furnished to a high standard and gave a very pleasant area to live and entertain in. Bedrooms also offer an en-suite facility of hand washbasin and toilet. In the shared rooms, to give privacy, there are dividing curtains. It was noted that some en-suites were used to store service users continence pads, these were in a small tray on the floor this was not appropriate and they spilled out on to the floor and was unhygienic. The bedding in some rooms seen was slightly soiled and had not been changed when the beds were made this is not acceptable. The sluice on the first floor was found to be in a very dirty state. There was a smell of stale urine in some bedrooms and corridors around the building. The carpets were being cleaned on a regular basis; the flooring in some cases may need to be changed to something more appropriate for the individual service user. A family and service users spoken to had noticed this. The home has an air freshener system but it was not able to cope in some areas. It was noted that some of the nursing beds have bedsides with bumpers to protect the service users. The bathroom on the first floor was seen and it contained a specialist bath, it was clean however it was not very homely in appearance. Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 22 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 &30 People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The numbers of staff on duty were in the main meet the needs of people living in the home. People using the service are supported by staff that are trained and competent to do their jobs and they are protected by the homes recruitment policies and procedures. EVIDENCE: Information supplied in the self-assessment has identified that twenty-five full time and seven part time nursing and carers are employed. At the time of this visit the home was supporting fifty-two people. During the day eight to nine nursing and care staff are on duty. At nighttime people are supported by a registered nurse and four carers. The manager works supermmary to the staffing establishment to be able to carry out her management tasks and responsibilities. Information supplied in the self assessment states that the service has started to use a more flexible work pattern in order to meet the varying needs of people living in the service and a twilight care worker has been appointed who can meet the retiring needs of people. Systems are now in place for the appropriate supervision of people across the building. The home also employs also an activities coordinator catering, ancillary and administration staff. There are currently two care vacancies. People using the Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 23 service and their representatives said that staff are available when they are needed. The staff team are of mixed ethnicity and cultural background. Information supplied in the self assessment states the service provides English lessons to a small number of staff who have been recruited from abroad who need additional support with the English language. Care staff are supported to complete National Vocational Qualifications. The self-assessment states that eighty four percent of care staff hold National Vocational Qualifications (level 2) or above. New staff receive induction and follow the Skills for Care common induction standards. The home has obtained the Investors in people award in recognition of their staff training and development. The home provides good staff training and a development plan in place. An external organisation and a range of health care professionals provide training. Training records sampled for members of staff demonstrated that staff receive up to date statutory training including health and safety, first aid, infection control, fire awareness, moving and handling and food hygiene. Training records viewed also identified that staff receive training in other specialist areas including dementia awareness, epilepsy, and continence and tissue viability. The Marie Curie organisation has also supplied training in end of life care. A health care professional stated, “The staff show an active interest in wanting to develop their knowledge and skills to improve their residents care”. Four members of staff personnel files were sampled, which contained the required information including two written references. Protection of Vulnerable Adult first checks (POVA) and Criminal Record Bureau checks are conducted. Files sampled for registered nurses contained a copy of their up to date personal identification number issued by the nursing Midwifery Council ensuring that they are registered to practice. Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 24 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, 37& 38 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The registered manager is able to demonstrate that she has the appropriate qualifications and experience. The home is run in the best interests of people living in the home and their financial interests are protected. Identified weaknesses need to be addressed in order to reduce risks to people living in the service. EVIDENCE: The manager is a registered General Nurse and eight years management experience in care home settings. The manager has obtained the Registered Managers Award, a National Vocational Qualification (Level4) in Health and Social care management and has gained a diploma in dementia care. Information supplied in the self-assessment states that internal communications have improved by carrying out regular staff meetings and a line management structure has been put in place. Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 25 During this visit the manager was observed to have an open, friendly and inclusive approach and made her self-accessible to people living in the home visitors and staff. The home has a policy in place for the safe handling of peoples finances. We were informed that the home does not hold any monies on behalf of people. An invoice system is in place for charging items such as hairdressing, newspapers, clothing and chiropody, which is supplied, to people’s representatives. The home holds bi- monthly Friends of Oakhurst meetings where ideas or suggestions from people or their representatives where suggestions and any improvements are discussed. People who are unable to attend the meeting are actively encouraged to submit their comments to the chair of the group so that their views can be raised A copy of the minutes of this meeting are displayed on the notice board and provided to people and their families. A relative surveyed said, “The matron and staff are always willing to help and I have felt informed at all times. The home conducts annual quality feedback surveys, which are provided to people living in the home, families, care managers and other health care professionals who are in contact with the service. The outcomes of the survey are analyzed and action is taken to improve any areas where any shortfalls have been identified. Since the precious visit the registered provider now conducts monthly quality monitoring visits, which were available to view and demonstrated that consultation takes place with people. The self-assessment has highlighted that the home is considering developing internal quality audit systems to safeguard people The home has a range of policies and procedures, which have been reviewed and included one for missing persons, which was recommended at the previous visit. The home has a range of health and safety policies in place. During this visit the fire book was examined which demonstrated that regular fire alarm checks and fire drills are conducted, however emergency lighting checks were not checked on a monthly basis, therefore it is required that these checks are conducted to ensure that equipment is working adequately to protect the safety and wellbeing of people living in the home. Water temperature monitoring is checked on a monthly basis. Certificates were in place for servicing and maintenance of equipment including gas, electricity and water legionella. This inspection identified some matters that require management attention including the homes medication practices and risk management procedures ensuring the safety and well being of people living in the service. Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 26 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 2 8 2 9 1 10 2 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 1 Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 27 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 OP8 Regulation 13(4) (b) (c) 15(1) (b) Requirement The registered person must ensure that where risks to the health or safety of any person is identified this must be recorded in the care plan to include a risk assessment. Timescale for action 20/09/08 2. OP9 13(2) 3 OP38 23(4) The registered person must 23/08/09 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the home. The registered person must 20/09/08 ensure that arrangements are in place for the emergency lighting to be checked on a regular basis Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 28 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 OP7 OP12 Good Practice Recommendations It is recommended that more detail be provided in the daily records. It is recommended that the home review their current activity programme ensuring that each persons needs can be appropriately met. For the menu to include choice of cooked meal served at lunchtime. OP15 Oakhurst Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Court Nursing Home DS0000013343.V369270.R01.S.doc Version 5.2 Page 30 - 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. 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