Inspection on 22/08/07 for Oakhurst Court Nursing Home

This inspection was carried out on 22nd August 2007.

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 20/08/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Oakhurst Court Nursing Home Tilburstow Hill Road South Godstone Surrey RH9 8JY Lead Inspector Pat Collins Unannounced Inspection 07:00 22 August 2007 nd 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.V344523.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.V344523.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 info@oakhurstcourt.co.uk Oakhurst Court Limited Mrs Pamela Elizabeth Milne Care Home 57 Category(ies) of Dementia - over 65 years of age (57) registration, with number of places Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age of the persons accommodated will be 60 years and over. Date of last inspection 8th May 2006 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.V344523.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit forms part of the key inspection process using the new ‘Inspecting for Better Lives’ (IBL) methodology. Judgements about the home’s conduct and standards of care are based on the cumulative assessment, knowledge and experience of the home’s service provision since the last inspection in May 2006. This includes information supplied to the Commission for Social Care Inspection (CSCI) by the home manager. Two regulation inspectors, Ms Pat Collins and Ms Lisa Johnson, carried out the inspection visit. It commenced at 07.00 hrs and concluded at 19:15 hrs. The home manager and administrator, who is also the company secretary, facilitated the visit. The inspectors looked at how well the home is meeting the national minumum standards for older people, forming judgements about the standard of services and faciities. A partial tour of the building took place and records were sampled. The views of people using the home’s services have been sought through discussions with individuals’ during the visit; also from one person who completed a questionnaire as part of a survey carried out by the CSCI. Communication with some people using services was limited due to communication difficulties. Observations of the body language, appearance and records for these individuals, also feedback from staff, mostly indicated a sense of their well - being. Information obtained during discussions with staff members and from questionnaires completed by 29 relatives/friends of people using services and a general practitioner has been taken into account during this inspection. Though questionnaires were sent to the home to distribute to care managers who purchase services, none were returned. The term ‘residents’ is used hereafter in this report when referring to people using the home’s services. This is in accordance with the expressed preferences of individual residents’ with capacity to communicate their views. This term is used locally by those involved with the home and features in the home’s information and marketing publications. The inspectors would like to thank all who contributed to the inspection process; also residents and staff for their time, hospitality and assistance throughout the inspection visit. What the service does well: The home ensures comprehensive pre-admission assessment of the needs of all prospective residents to be assured needs can be met. Effective arrangements are in place for accessing community health services and professional support and advice, to the benefit of residents, ensuring health Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 6 needs are met. Feedback was received from a general practitioner confirming opinion and that of colleagues, that the home is providing an excellent standard of healthcare. It was also stated that communication from the home with general practitioners is excellent and senior staff are competent and experienced. There is a strong commitment to staff training and development. Whilst some shortfalls in staff training were noted, overall the home’s management prioritises and facilitates the staff-training programme. Training is targeted and focused on improving outcomes for residents and ensuring staff have the necessary competencies and skills. The physical environment of the home is well maintained, safe and secure. It is spacious, comfortable, clean and hygienic. A development plan is ongoing which includes investment in the premises and a programme of upgrading, redecoration and refurbishment. The beautiful landscaped garden affords an attractive outlook for residents’ enjoyment and is used by residents in fine weather. Positive comments were received from a resident who was able to give a good account of life at the home. This person said “ I love Wednesdays, I have a nice long bubble bath with lots of hot water, just how I like it. I choose to spend my days in my room; I enjoy reading and take great pleasure from the view of the beautiful garden, which my room overlooks. The staff are all very good, I mostly get on with them, we have a giggle, and I think the food is excellent”. Feedback from relatives in response to the CSCI survey included many positive comments about the home and staff. In response to the question asking what the service does well, some examples of comments are as follows: ”Skilled care” “Listen to concerns and welcome visitors”, “ They look after my relative exceptionally well, I like the way they take the residents into the garden when possible. I greatly admire the new activities coordinator, she is a treasure. Staff are always very friendly”, “ the home provides basic warm, clean and friendly living conditions; also food of a good standard that is reasonably presented”” I am very pleased my mother is given communion every week. This was arranged by the home without my having to ask”. Many relatives expressed satisfaction with health and medical care and felt staff had a good understanding of their relative’s needs, managed behaviours well and promptly communicated significant information to them. A number of relatives were pleased at improvements in the environment and with the activities programme. . A further comment was, “ The atmosphere is always good, the home clean and tidy, rooms are bright and cheery with lots of ‘family input, pictures, photos etc.” What has improved since the last inspection? Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 7 The home has met requirements made at the time of the last inspection. Care plans have been reviewed to ensure all contain staff signatures and good progress noted in consulting residents who are able or their relatives about care plans. It was positive to note this is the first stage of a more inclusive approach to the care planning process. It was stated that it is intended to in future hold review meeting to which residents and relatives, as appropriate, will have involvement. There has been some improvement to record keeping practices. Systems have been strengthened for monitoring nutrition and linked to systems for liaison with the home’s GP and community dietician. The complaint procedure has been reviewed and updated and staff have received further instruction to ensure complaints are managed efficiently. There is an ongoing refurbishment programme and since the last inspection the dining room has been upgraded, redecorated and refurbished. Work included improving wheelchair access to the dining room and provision of reflective doors in the dining room that has enhanced the appearance of this area. A reflective door has also enhanced arrangements for residents’ safety y and afforded a private area for discussions with relatives, professionals and communication in private between staff. Carpets have been replaced in lounges and wooden flooring laid in the dining room. A number of bedrooms have also been redecorated and refurbished. Action has been taken to improve ventilation in all three lounges. Other improvements include a more robust staff recruitment vetting procedure to ensure residents’ are safeguarded. It was good to see nicely presented trays now used to serve food to residents who do not eat at dining tables. Policies and procedures have also been updated. Quality assurance systems have been developed though further action necessary in this area. The Friends of Oakhurst group is a recent positive development. An activities coordinator has been recruited. This has enabled expansion of opportunities for residents to engage in a range of stimulating activities. Change to the home’s management structure have been made which are intended to be more empowering for the team. There has been improvement to communication systems and structures for staff handovers. What they could do better: Some minor amendments are needed to the home’s marketing information. This includes the combined statement of purpose (document that states who the home is for) and service users guide (which states how the home works). The complaint procedure and suggestion box could be displayed in a more prominent position, possibly in reception area, to afford everyone involved with the home opportunity to give feedback and directly raise concerns. Further attention is necessary to care planning, ensuring relevant life history information is obtained and recorded. This will enable a person centred Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 8 approach to care planning. Also assist the activities coordinator in incorporating residents’ interest into the activities programme. Staff can use this in the use of recall techniques for communicating with residents. End of life care plans need further development using appropriate tools and staff trained in their use. It is essential to ensure pressure sore prevention and treatment plans are in place. Also records of assessment and classification of pressure sores and their treatment. The home must maintain a record of all pressure sores and have systems in place for auditing pressure sore prevention and treatment. Further attention is also necessary to care planning for falls prevention where the need is identified by risk assessments. Care plans should also address impact of the environment on individuals. Comprehensive risk assessments must be in place for use of bedrails. Though it has been confirmed that records specific to the care of residents are stored in the home for at least three years after the date of the last entry, some records for residents no longer accommodated could be located on the day of the inspection. Based on information received from a relative following the inspection visit the manager should review routines and practice to ensure appropriate promotion of continence. Further review of the homes policies and procedures needs to take place. There should be an overarching procedure for emergencies and crises, a missing persons procedures incorporating a search protocol and a policy specific to the home relating to tissue viability practice and pressure sore prevention. Suitable contingency arrangements must be in place to ensure maintenance of minimum staffing levels. Notification must be made to the CSCI of staffing shortfalls, particularly night staff. It was noted that it is planned to review the menu and make provision of a cooked option every night for the evening meal, which is important. The menu review should consider ensuring a choice of main dish at lunchtime and clarify the option of a cooked breakfast on request, as advised by the chef. The chef should also take advise on whether pureed food need to be fortified. Quality assurance systems need to be further developed. Additionally a system must be in place to provide feedback to residents and relatives on the outcome of quality assurance surveys and on any action planned. The Responsible individual must ensure compliance with statutory requirements for visits to the home by himself or nominated person, in accordance with the regulations. A report of these visits must be available in the home for inspection. Some adverse comments were received from relatives. A relative reported inadequate supervision of residents at times in communal areas. Six relatives were concerned that the high proportion of staff from overseas, for which English was not their first language, created communication barriers. They felt this was detrimental to the wellbeing of residents also to communication within the home and with relatives, referring to misunderstandings. One relative reported new staff not having a good enough understanding of her mother’s Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 9 needs. Though relatives were pleased that an activities coordinator had been appointed and positive about the benefits of this, some felt more needed to be done to ensure adequate provision for providing appropriate social stimulation. Two relatives communicated a lack of confidence in the home to care for their relative appropriately without their own close oversight of practice. 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.V344523.R01.S.doc Version 5.2 Page 10 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.V344523.R01.S.doc Version 5.2 Page 11 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): Standards: 1,3,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents mostly have the information they need to enable an informed decision about the home’s suitability to meet individual needs. Before agreeing admission a comprehensive needs assessment is undertaken to be sure all the needs of prospective residents can be met by the home. Service provision does not include intermediate care. EVIDENCE: The home’s brochure has been further developed since the last inspection. This good quality document has been professionally produced. It enables prospective residents’ or their representatives to make an informed choice about the home’s capacity to meet individual needs and aspirations. The brochure is available to the public and on display in the reception area of the home. The manager stated that there is a choice of receiving this by post in advance of viewing the home or picking one up during the visit. The brochure describes the homes stated purpose as “providing a caring and comfortable environment for older people who can no longer look after themselves”. Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 12 Discussions during the visit with the manager and administrator included the need to clarify in marketing material whether fees include physiotherapy services. Whilst understood this was the case, though a charge could apply if needs determined frequent physiotherapy required, the brochure does not make this clear. It states that physiotherapy is charged at cost, according to usage. The homes statement of purpose, which informs people who the home is for and service users guide, which tells people how the home works, is a combined, comprehensive document. Attention was drawn to amendments to the care homes regulations requiring greater detail to be included in the service user guides about the standard package of service provision. The terms and conditions that apply to key services, fee levels and payment arrangements need to be included. Additionally it must be stated whether the terms and conditions, including fees, would be different in circumstances whereby someone other than residents’ fund care in whole or in part. It was agreed that this information would be inserted in this document. The manager confirmed that the statement of purpose/service users guide document is issued to residents or their representatives at the time of admission. Feedback from some relatives during the inspection confirmed they had not had access to the home’s latest CSCI inspection report. The service users guide is required to include the home’s latest CSCI inspection report. It is recommended that the statement of purpose, service users guide, complaint procedure and inspection report be prominently displayed in the reception area. These documents should be drawn to the attention of prospective people using services and their representatives when they view the home. It is suggested that time is built into viewing procedures for these documents to be looked at, should people wish to do so, thereby enabling fully informed decisions about the home’s suitability. At the time of the inspection a variation application was being processed by the CSCI to support the intention to introduce a more flexible admission criteria. This will enable a holistic approach to supporting older people with their range of physical and mental health needs. The manager confirmed plans to consider referrals for up to a maximum of twelve older people with impaired cognitive functioning not caused by dementia but other conditions. It was emphasised that it was not intended to segregate residents and the home’s pre-admission assessment procedures will enable appropriate placements. Six pre-admission assessments were examined. The manager was observed to carry out comprehensive pre-admission assessments, visiting all prospective residents to ensure needs can be met. Copies of care management health and social care assessments and primary care trust continuing health needs assessments are obtained for residents, where they exist, as part of the preassessment process. The assessments sampled were detailed, incorporating Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 13 personal and health care needs, medication, tissue viability, mobility, communication, mental health, emotional needs, orientation, social, religious and cultural needs. Records examined included statements to residents or their representatives detailing information about nursing contribution to be paid and deducted from fees. Although the National Minimum Standard 2, which relates to contracts was not assessed, it was noted that the home’s ‘Service Users Agreement and Terms and Conditions’ document inserted in the information pack available in the home referred to ‘Free Nursing Care’ payments. The manager states these are forwarded to relatives in full within seven to ten working days of receipt by the organisation’s bankers. There is also a disclaimer that the home is not liable for delays in payment. The manager advised that it is not unusual for receipt of these payments by the organisation to be substantially in arrears of up to two to three months. Comment was received after the inspection visit from a relative reporting delays in receiving these payments, despite being informed by the agency responsible for payments that regular payments are sent to the home. The inspection process did not include follow up in this matter or establish the accuracy of this information. The home does not offer intermediate care services. Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 14 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): Regulations: 7,8,9,10,11. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The principles of respect, dignity and privacy were put into practice in the delivery of care at the time of the inspection visit. Whilst positive to note improvement in care plans and action taken to discuss their content with relatives, further development in this area is needed. The stated intention to introduce a more inclusive approach to care planning is welcomed. Health care needs are mostly met and medication management is overall satisfactory. Some improvements in both areas however is needed specific to record keeping, risk management and clinical practice relating to pressure sores. EVIDENCE: The inspectors observed care practice for periods across the day from early morning. Interaction between staff and residents was friendly and staff ensured residents’ privacy and dignity was respected. Staff deployment and routines ensured residents were adequately supervised during this visit. A comment received from a relative however after the inspection visit indicated that there are times when observation levels are not adequate. This person stated that on a number of occasions there was no staff in any of the Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 15 communal areas for lengthy period and on occasions had to go and find staff to attend to residents who had fallen. This was one of the shortfalls in practice identified at the time of the investigation into a complaint received in January 2007. There is a need to ensure good management monitoring of arrangements for supervising residents. It should be noted that other relatives considered staff to be always around if needed. Feedback from a resident able to give a good account of her care and her daily life confirmed staff respected her rights, supported her independence and afforded opportunity for choices in her daily life. These include what to wear, when to get up and go to bed, where she sits and what she does with her day, when to have a bath and which staff will assist her and choice of meals. Another resident stated, “This is the third home I have lived in and it’s the best, the staff are wonderful, I’m very happy here”. The inspectors had contact with a number of residents who were unable to communicate their views about the home. All appeared content and smiled when spoken with, were alert and giving eye contact and were appropriately dressed and well groomed. An individualised approach to meeting residents assessed and changing needs was evidenced by record keeping. The majority of relatives who responded to the CSCI survey were very satisfied with standards of care. Comments included “ Staff understand my mothers mental and physical state and look after her personal and health needs. Staff cope with mum’s behaviour well and keep me informed if problems occurr”. “ The care is excellent”, “ All staff always communicate with residents in a warm and friendly manner, encourage conversations, respond to needs and always respect residents’ dignity”. Not all relatives were satisfied and some comments received are recorded in the reports summary. The home has established links with other community services which is of benefit to residents’ health and wellbeing. Examples include a general practitioner’s (gp) surgery which takes place in the home every two weeks for residents’ registered with that particular practice. Feedback received from a gp confirmed all gp’s from that medical practice considered the home to provide an excellent standard of care which was improving all the time. Also commenting that communication is excellent and senior staff are competent and experienced. Residents have a choice of registering with other medical practices if preferred. Feedback from relatives confirmed a high level of satisfaction with medical care. A dietician was stated to regularly visit and to be always available to offer advice by telephone. Nutritional up- take is linked into liason between the gp and dietician. Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 16 The local psychiatric team for older people conducts assessments and reviews for residents’ in the home. This is a valued arrangement of significant benefit to residents’ wellbeing by reducing the stress of travelling to hospitals and waiting in the unfamiliar surrounding of an out - patient department. The home is able to promptly access professional expertise in between these visits in response to residents changing needs. The manager confirmed all residents receive a physiotherapy assessment within the first two weeks of admission. It was also stated it is possible to make direct referrals for speech and language therapist assessment. The inspectors examined the care documents for nine residents, including three former residents. Care plans had mostly been generated from comprehensive needs assessments. They covered physical and health needs, emotional, social, leisure and religious needs, though some could be more detailed. Goal plans were in place for personal grooming, mobility, elimination, sleeping and feeding. Weights were monitored for all residents and dietary and fluid intake monitored as necessary. Areas of discussions with the manager included the need for assessments to establish a baseline reflecting residents’ life history, strengths, abilities and interests. This information can be obtained from residents’ themselves through use of reminiscence materials and techniques and through consultation with relatives and friends as appropriate. This will enable a person-centred approach to care planning and meeting residents needs and enhance communication between staff and residents. Whilst some details about likes and dislikes were recorded these could be expanded upon. Care plans should also be further developed to include the impact of environment, addressing need for clear, visible signage for toilet and bedroom doors, quiet or stimulating atmosphere needs and preference, visual access and lighting. Consideration could be given to provision of additional orientating information in communal areas. Care plans are reviewed at least monthly. Since the last inspection the staff were stated to have focused on making improvements to record keeping and on consulting residents and/or relatives about the content of care plans. Effort has been made to raise awareness to care plans through discussion with residents and or their relatives/representatives. Where possible relatives /residents signatures are recorded on care plans. Some contact with relatives in this matter has been by phone for those unable to visit frequently. The manager confirmed the intention to implement internal procedures for holding regular review meetings. These will involve residents who have capacity to contribute and relatives who wish to be consulted. A number of relatives present in the home at the time of the inspection stated they would welcome opportunity to attend review meetings and a more inclusive approach to care planning. The manager referred to self assessment systems having strengthened monitoring of residents needs and care plans. These had identified areas for improvement to information flow through care plan documention. The Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 17 handover procedure observed beween the night and day shift was comprehensive and detailed. This enabled good communication between staff and created conditions which promote continuity of care. The organisation and delegation of responsibilities to staff on day shift was well managed during the visit. Areas of clinical responsibility are delegated to team leaders and other registered nurses. These include medication and liaison with the pharmacy, liaison with medical practitioners and other specialists, care planning, infection control, continence management and liaison with continence advisors. Feedback from a relative received after the inspection visit highlighted need for further staff training to ensure continence is promoted. This relative stated her mother has informed her of occasions when she requests the toilet staff tell her not to worry as she is wearing a pad. Recommendations include delegating lead responsibilities to nurses for tissue viability and falls prevention. Some shortfalls were identified in these two areas. Specifically a care plan had not been developed for a resident readmitted to the home from hospital with a pressure sore. This person had been hospitalised for treatment of an injury sustained during a fall at the home. A care plan was required for pressure sore prevention and treatment of the existing wound. It was concerning that no records were found to evidence regular assessment and classification of the pressure sore or of treatment. It is acknowledged that once this was pointed out to the manager immediate remedial action was taken. The manager was advised of the requirement to maintain a record of all pressure sores and recommended to implement systems for regular audit of pressure sore treatment and prevention. Noting the home does not have a local procedure for pressure sore prevention and treatment, though nurses have access to clinical practice guidance, it is recommended also that a procedure and guidelines be produced specific to the home. This should set out expectations relating to assessment and record keeping practice, consent for photographic assessment of wounds, content of care plans and support staff in selecting appropriate combinations of pressure sore prevention equipment, based on assessment information. The home has a range of pressure relieving mattresses and cushions. The manager is aware of the need for nurses to have access to wound care refresher training and stated this was being arranged. The file for the same resident included pre-admission assessment information of a prior history of falls. Whilst fall risk assessments had been carried out highlighting potential risks there was no care plan generated for measures to reduce risks until after this individual had had a serious fall. It is acknowledged that some of the care files sampled did include care plans for prevention of falls. The manager’s attention was drawn to the variable standard of care Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 18 planning and record keeping noted. Also reminded of the need for records of risk assessments to be maintained for use of bedrails. Admission trends were discussed with the manager who reported a tendency for residents to be much frailer on admission and their stay often shorter than in the past. A significant increase in the home’s death rate was also discussed which the manager directly attributed to this reason. This change in the social care funding system now promotes and supports older people to remain in their own homes for as long as possible. Observations confirmed need to further develop advanced/end of life care plans for residents including those in need of terminal and palliative care. The records examined included those of a former resident admitted to the home whose care notes made reference to the palliative care team for support. No care plan was produced however to demonstrate what had been discussed and agreed with this person and the palliative care team. The end of life care plans that were in place contained basic information and need to be expanded, reflecting views and wishes of residents and relatives where known. It is acknowledged that the wishes of one or two relatives are recorded. It is recommended that the manager explore available end of life tools, consulting hospice liaison professionals if needed and ensure staff are trained in end of life care planning. Two records examined of residents recently deceased were incomplete to the extent it was not possible to assess the quality of terminal care received. Further comment on this observation is made in the Management & Administration section of this report. The management of medication, medication policy, procedure and practice was inspected. This included observations of medication records for five residents. . Medication was securely and appropriately stored and disposal arrangement satisfactory. A record is maintained of medication received and disposed of. A list was seen of all staff authorised to administer medication. There is also a record of authorised homely remedies by the GP. Observations confirmed storage, administration and record keeping for controlled drugs was satisfactory. The manager was informed of the need to ensure staff following correct procedures when making changes to medication administration records. There were four occasions when nurses had hand written alterations to medication dosages and added antibiotics to these records that were not countersigned by a GP. In such circumstances staff must record the name of the doctor giving the new instruction on the medication administration record, ensuring the entry is dated and signed by the nurse making the alteration also by a staff witness. Personal care was delivered with respect for residents’ dignity and privacy at the time of the visit. Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 19 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): Standards: 12, 13, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The appointment of an activities coordinator has enabled expansion of the home’s activities programme. This could be further enhanced by the practice of gathering life history information as part of the care planning process and providing activities that incorporate the social interests of residents. Residents’ religious, ethnic and culture diversity is respected and opportunity made for the exercise of some choice commensurate with individual capacity. Visitors are made welcome by staff. A wholesome, varied diet is provided. It was positive to note the intention to further develop the menu. EVIDENCE: A positive development since the last inspection has been the appointment of an activities coordinator. The activities coordinator works four days a week including one day at weekends. The manager confirmed the activities coordinator had attended a workshop organised by the Alzheimer’s Society since taking up post, furthering her knowledge of suitable activities for people with dementia. The activities coordinator was stated to have a separate budget for activities and activity materials. Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 20 On the day of the inspection visit the activities coordinator had a day off. It was good to see care staff making provision of activities in her absence. Crafts and board games were being encouraged and a group of residents seen to enjoy a game of snakes and ladders using an oversized floor game. The activities coordinator was noted to maintain individualised record of all activities that residents’ engage in. It is recommended these records be integrated with other records maintained on residents’ files. The activities recorded included singing, music, word games and a combination of group and one to one activities is offered. As previously stated in this report, discussion took place with the manager regarding the benefits of gathering life history information for residents. Knowing residents’ earlier personality, approach to life and interests will help communication with residents. Also enable the activities coordinator to plan activities relevant to residents’ individual’s interests and aspirations. Although former interests and hobbies were recorded in some of the care plans sampled it was not clear how these were currently being responded to. Staff interaction with residents’ was observed to be respectful and age appropriate. The environment contained visual images reflecting the local community. It was understood that the home does not provide transport to enable residents to engage in local community activities. One relative expressed opinion that transport provision would enhance the lives of residents. Residents are encouraged to make use of the services of a visiting hairdresser. Records sampled detailed residents’ religious beliefs. All residents accommodated at the time of the inspection were recorded to be Christian. Arrangements were in place for a regular communion service to be held at the home. Photographs were on display of the home’s summer fete and of Easter celebrations and other social activities and events. An informative newsletter was also on display. Various entertainers visit the home throughout the year. Visitors were present in the home throughout the inspection visit. One visitor introduced was the chair - person of the Friends of Oakhurst group whose composition includes residents’ relatives and representatives. Feedback from visitors was mostly complimentary about the home and about the caring approach of staff. Catering arrangements were inspected. Work on upgrading the dining area had been completed. This had entailed widening the corridor leading to the dining room from ground floor rooms at the rear building. The dining area had been refurbished and a wooden floor laid. The new décor and reflective doors in this area created a light and congenial setting. It was stated that residents’ able to do so had been involved in decisions about the new dining furniture. Practice for serving breakfast and lunch was observed during this inspection visit. A few residents who were up and dressed were eating breakfast in the dining area when the inspectors arrived. Other residents were eating breakfast Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 21 in their bedrooms. It was good to observe improvement in the way food is served on nicely presented trays. There was noted to be choice of porridge or cornflakes followed by toast & marmalade and a cup of tea. The porridge sampled by an inspector tasted very good and was made with whole milk. Portion sizes were substantial. Staff respected the wishes of residents’ known to prefer a later breakfast. Although cooked breakfasts did not feature on menus the chef stated this is available on request. It is recommended that the menu refer to the option of a cooked breakfast. The chef works full time and has a catering qualification and basic food hygiene certificate. A second chef is employed on Saturdays and a care assistant who is supernumerary to staffing levels, cooks the meals on Sundays. The kitchen was inspected by the Environmental Health Department in December 2006 and requirements from that inspection have since been met. The chef is responsible for the day-to-day cleaning of his kitchen and contract cleaners deep clean this area annually. A kitchen assistant is responsible for making beverages and washing up in the annex off the main kitchen. Food storage was satisfactory and the kitchen generally clean and organised for the time of day it was viewed. Menus rotate over six weeks. The menu reflects the ethnicity of the majority of residents who are White British, marking English cultural by serving fish and chips on Fridays and a roast dinner on Sundays. The menu also incorporates dishes of other cultures and the manager stated that curry was a popular meal. The day’s menu was displayed on a white board in the dining room. The main meal of the day is two course cooked lunch and dessert. A choice of main dish was stated to be occasionally available, though usually there is one main dish. The manager confirmed that the chef takes into account residents’ likes and dislikes in planning the days menus. The evening meal always includes soup and a range of desserts, yogurts and fresh fruit. Three days a week sandwiches are provided for this meal and on other days light cooked dishes include quiche and sausage rolls. Home baked cakes and scones are made for afternoon tea The chef responds to request for soft and pureed diets and was noted to be preparing a number of meals suitable for residents with diabetes. He said a dietician came into the kitchen from time to time, examining the home’s menus and food provision. He believed she was satisfied with catering arrangements. Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 22 Records demonstrated that residents’ weights were routinely monitored and recorded. Assessments include nutritional assessments and the manager ensures referral to relevant professional for weight loss and swallowing problems. It was noted that some residents were receiving food supplements and a commercial food thickener is available. It was suggested that the chef takes advice on fortifying pureed foods with milk, cream or milk powder. It was good to note the calm, unhurried atmosphere during both mealtimes. Dining tables were nicely presented with tablecloths and assistance provided to residents with food as needed. Areas for improvement included the practice of some staff noted to remain standing whilst assisting residents with eating. Also for consideration to be given to purchasing more age appropriate clothes protectors than those in current use. It was good to note internal systems for monitoring satisfaction with food and menus and that the menu was under review in response to recent feedback. The manager stated the revised menu would include a hot choice of meal every evening. Two relatives commented positively in the surveys returned to the CSCI about the standard of food provided by the home. Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 23 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): Standards: 16, 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was a shortfall in the home’s complaint procedure and practices identified earlier this year however this has since been rectified. Robust safeguarding adults procedure, also the staff training programme and staff recruitment procedures protect residents’ from abuse. EVIDENCE: The Commission received a complaint about the home for Social Care Inspection and Surrey’s local Care Management Team in January 2007. The complainant reported complaints not being responded to by the home, lack of staff supervision of residents’, poor ventilation, no access to care plans, lack of activities, poor odour management and inadequate monitoring of fluid intake. The complaint was referred to the home for investigation and impartially investigated by an external consultant specifically employed by the home for this purpose. The complaint was partially upheld and an action plan for improvement implemented. Since then the complaint procedure has been reviewed and now contains timescales for responding to complaints. Additionally staff have received further instruction supported by a guide produced and available in the office to ensure a timely and appropriate response to all complaints. The home has made a complaints and suggestion box available in the reception area. Also and a “Friends of Oakhurst” group is a new development through which there is opportunity to raise concerns and make suggestions. The inspectors Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 24 recommended that the suggestions box be in a more prominent position in the reception area and a copy of the complaint procedure displayed next to it. An inspector examined the complaints log and noted a further two complaints investigated by the manager under the home’s complaint procedure. Another matter has been referred by the home for review under the Surrey multiagency safeguarding adult’s procedure. The manager stated that copies of the complaint procedure are sent to residents’ relatives or representatives at the time of issuing contracts. A resident consulted was clear of how to make a complaint. The majority of relatives who gave feedback were also informed of how to make a complaint. Two respondents stated they were not aware of the complaint procedure however and two others did not complete this section of the questionnaire. Feedback was mixed regarding the home’s response to concerns and complaints. Some relatives said the response was always appropriate and others stated usually appropriate. The home has a current copy of the Surrey multi- agency safeguarding adult procedure. Also an internal adult protection procedure that links in with local multi-agency safeguarding procedure. The home’s management is clear when an incident needs to be referred to the local authority and the police. Four staff training records were viewed. These evidenced staff receive training that enables them to identify indicators of abuse and ensures awareness of safeguarding adults procedures. Staff consulted demonstrated knowledge and understanding of this subject. They were clear how they must respond to suspicions or evidence of abuse or neglect. The manager had attended the local authority safeguarding training. Since the last inspection four matters have been referred under these procedures. Improvement in staff recruitment vetting procedures further safeguard residents from abuse and neglect. Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 25 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): Standards: 19, 22, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is ‘fit’ for purpose and there is an ongoing maintenance and redecoration programme. Residents’ benefit from a safe, clean, comfortable environment that meets individual needs and promotes independence. EVIDENCE: The premises were safe and secure at the time of the inspection. A rolling programme of redecoration and refurbishment was ongoing. Substantial improvement to the environment was noted since the last inspection. Feedback received from some relatives confirmed they were pleased with these improvements. One relative thought that some chairs in lounges were shabby and should be replaced however. The standard of décor and furnishings overall is good and the home is well maintained. It was positive to note residents able to do so were stated to have been involved in choosing new dining furniture and the colour scheme for Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 26 redecoration of the dining room. In the past twelve months many areas of the home have been redecorated and new carpets laid in two lounges and a number of bedrooms. An adjoining corridor off the dining room has been altered to give better access to wheelchair users. Reflective doors off the dining room and the reception are a positive new feature and enhance safety. A laundry assistant has delegated responsibility for laundry and the management of laundry was hygienic and efficient. Ancilliary staff were hard working and all areas of the home viewed were clean. Feedback from relatives was overall very positive about cleaning standards and odour control. Odour control was good on the day of the visit. Feedback received from a relative since the visit suggested the need for staff to be more vigilant in noticing lounge chair cushions are wet due to incontinence. Appropriate hand washing facilities are in place and staff had completed infection control training. The bedrooms sampled were adequately spacious and a number had been redecorated and refurnished to a good standard. Bedrooms are mostly single occupancy and all have en suite facilities and emergency call bells. Lounges were observed to be comfortable and spacious and action noted to have taken place for improving the ventilation in all three lounges. The manager was requested to fit a privacy lock on the sliding toilet door of a toilet just near the same lounge. Comment has been made earlier in this report on the kitchen under standard 15. Cleaning schedules were in place for maintaining kitchen hygiene. Also on need to increase environmental signage and orientation cues. The extensive landscaped garden has attractive lawns, raised flower and shrub beds, which were in full bloom during the visit. The grounds and gardens are maintained to a very high standard. Since the last inspection additional garden furniture has been provided also a grill fitted over the pond as a safety precaution. The manager stated that with the exception of one person who has been assessed as safe to access the garden without a staff escort, staff directly supervise all other residents in use of the garden. A risk assessment has been carried out for the whole environment. The manager was aware of a potential trip hazard specific to a ramp fitted over a small flight of stairs in the home and stated residents do not use this area unaccompanied. It was stated a risk assessment was in place for this hazard. A recommendation was made for further attention to signage in the home to aid orientation. It is important to work with residents as individuals to establish the cues appropriate to each and every one when developing sign posting or other orientation cues that help residents recognise their rooms and toilets. Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 27 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): Standards: 27, 28, 29, 30. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staff recruitment procedures and practices have overall improved since the last inspection. The home’s management recognises the importance of staff training and tries to deliver a programme that meets statutory requirements and national minimum standards. Some gaps in training were identified however. There have been some shortfalls in staffing levels and management needs to strengthen arrangements for covering short-term staff absences. EVIDENCE: The staff rota was examined during the inspection visit. Staffing levels have been adjusted and reduced during the day in response to a reduction in occupancy. Currently two nurses and seven or eight care staff are planned for the early shift and one nurse and five or six care staff for the late shift. There has been no change in night staffing levels of one nurse and four care staff. Staff turnover in the last twelve months has been two full time staff and seven part time staff. The manager confirmed her intention to recruit to three care staff vacancies. Discussion about staff recruitment confirmed a substantial number of staff employed from overseas for which English is not their first language. Feedback received from relatives after the inspection visit confirmed six respondents raised this as an issue. They reported language barriers having an adverse impact, in their opinion, on meeting residents’ communication needs. They expressed the view that this created additional problems for residents’ to cope with on top of sensory and cognitive impairments. Also Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 28 raised was the difficulty relatives’ sometimes experienced in communicating with some staff and language barriers at times creating mis-understandings. Another added that communication was not always good between staff. Yet another relative was critical of observations of staff communicating with each other in their own language in the presence of residents. This person stated this had been witnessed on more than one occasion and made the respondent feel uncomfortable so presumed it was the case for residents, also. A high proportion of comments received from relatives however were overall very positive about staff. Comments described them to be caring, dedicated, friendly, wonderful, fostering a family atmosphere and skilled. A residents’ able to express opinion about staff stated, “ I mostly get on with staff, we have a giggle. They are all very good but some don’t like me very much because I speak my mind. Some of the staff are from the Philippines and Romania and they are very nice. It is extraordinary how quickly they pick up the English language”. Two staff gave information that no contingency arrangements were in place for covering staff shortages if unable to do so from staff employed by the home. They referred to shortfalls in staffing levels on occasions, primarily due to late notification of staff sickness. The home has a small bank staff system and there are overtime arrangements in place to cover staff shortages. Feedback from most relatives confirmed the opinion that staffing levels were adequate though there were some relatives who considered staffing should be increased. The staff rosters sampled and the daily diary confirmed the accuracy of information that there were occasions when staff numbers on night duty were below minimum levels. A high level of staff sickness throughout June this year had compounded difficulties in covering staffing shortfalls. Information was also received that there had been occasions when staff, after working a morning shift have reported back on duty the same day to work a night shift. This was not indicated on the rotas viewed however. Consultation with staff confirmed occasions when staff have come back in the evening and have worked until midnight but not the whole shift. This was discussed with the manager also the failure to notify staffing levels shortfalls, particularly night shifts, to the Commission for Social Care Inspection. A requirement was made that this matter be addressed and the manager ensure that the night staff cover is maintained at the correct levels; also where cover is provided to make up for shortfalls this is clearly identified on the rota. The manager is further advised to consider looking at other means of covering staffing levels shortfalls, for example, use of agency staff. Staff numbers for housekeeping staff appear adequate. A full time chef is employed and a part time chef on Saturdays. On Sundays a care assistant who is supernumerary to care staffing levels is designated to undertake catering duties. A maintenance person is employed and the company secretary works part-time in the home, carrying out administrative tasks, examples include financial and staff recruitment work. Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 29 The personal files and recruitment records were examined for four members of staff. Improvement has been made in this area of the home’s activities. Evidence was seen of a POVA check carried out for a newly appointed member of staff. Records were maintained in good order and contained applications with full employment history, identification and contracts. One file sampled for a qualified member of staff contained evidence that a check had been made with the Nursing & Midwifery Council to evidence ‘fitness’ to practice. Three out of four files sampled contained two written references. One person’s references were not present, although the company secretary stated that these had been obtained as part of the overseas recruitment programme. The employee concerned verified these had been obtained. The manager was requested to locate the missing document and maintain it on this individual’s file. Evidence was seen of Criminal Record Bureau Disclosures obtained for employees. The home has obtained the Investors in People Award. This means the organisation has been recognised for promoting enhanced skills in management and developing staff. The home has provided training opportunities to three staff from overseas to undertake and complete a nurse adaptation training. The staff induction programme is based on the Skills for Care induction standards. A staff member consulted confirmed having completed this induction programme. A number of staff stated they considered they were well supported in meeting their training and development needs. The home has a staff training and development plan and training is provided by an external organisation. Records are maintained of training that is planned and has taken place. It was evidenced that a rolling programme of mandatory training is conducted. The manager stated that refresher training is provided for staff as necessary. Food hygiene refresher training was being planned also for first aid. Training records were examined for four members of staff. The home provides dementia awareness training and training in epilepsy. During discussion with the manager it was found that staff do not receive training in tissue viability. The need for staff to receive this training also for nurses to have access to refresher wound care training was discussed. The manager has supplied information to the Commission for Social Care Inspection that eighty four percent of care staff have attained an NVQ qualification in health and social care, Level 2 or above. Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 30 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): Standards: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is registered by the CSCI and is suitably qualified and experienced. Residents are safeguarded by accounting and financial procedures. The work to improve the home’s policies and procedures and care plans is recognised however further improvement necessary to records. It was positive to note the home’s quality systems have been upgraded however these need developing and to be supported by verifiable methods. Also systems in place for actions and outcomes of quality audits to be communicated to residents and their representatives. The responsible individual must make arrangements for compliance with statutory requirements for visits to the home by himself or representative in accordance with the regulations. EVIDENCE: Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 31 The registered manager has a Registered General Nurse professional qualification. Also NVQ Level 4 in Health & Social Care Management, the Registered Managers Award qualification and Diploma in Dementia Care. There has been a recent change in the home’s management structure that no longer includes a deputy manager post. The deputy manager continues to work in the home in another capacity. The senior management team comprised of the company secretary responsible for finance and administration, who works at the home three or four days a weeks, the manager and three registered general nurses who have been designated team leaders roles. The team leaders took up their new designated roles in June 2007 and have defined areas of responsibility. These are for marketing, medication including liaison with medical practitioners, pharmacist and other health professionals, infection control/physical welfare, nursing care/care plans. Team leaders have line management responsibilities for staff. Discussions with the manager indicated positive professional relationships exist between her and external management. It was stated that two company directors regularly visit. The manager stated she was usually supernumerary to staffing levels but likes to remains actively involved in care, providing direction and leadership to the team. One relative who responded to the CSCI survey commented the manager did not have a visible presence at times this person visited. Though there were clear lines of management accountability within the home and with external management, observations identified the need to review and clarify on-call management arrangements. This is necessary to ensure the manager is able to have adequate time off. The manager confirmed that since the last inspection she had reviewed and developed all new procedures for the home. The need to produce a procedure for pressure sore prevention and treatment specific to the home was discussed. Additionally a missing person’s procedure incorporating a search protocol and procedure for emergencies & crisis. Whilst it is recognised there are procedures specific to certain types of events, for examples, safeguarding adults, accident and fire, there is needs for an over-arching generic procedure with links to the range of separate procedures that details on-call arrangements and action expected of the nurse in charge. Information supplied to the CSCI by the manager confirms the home has a policy in place for the safe handling of residents’ finances. The home does not hold any money on behalf of residents. An invoice system is in place for charging for items not included in fees. Examples include hairdressing, chiropody, clothing and newspapers, which is sent to residents’ representatives who are responsible for fee payments. The financial records viewed were appropriately maintained. A relative commented after the visit that the home did not give advance notification of fee increases, stating advice was received after the new fee introduced. On examining the terms and Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 32 conditions agreement produced by the home this refers to annual reviews for fees but does not specify terms of notice. Discussion took place regarding a matter pertaining to the property of a former resident. This had been referred for investigation under Surrey’s multiagency safeguarding adult procedures. The manager has worked hard to put in place a quality assurance system based on the CSCI Key Lines Of Regulatory Assessment. Discussion about this confirmed that the method used was not verifiable in that judgements were stated to be formed based on the managers observations and opinion and staff feedback. The need for internal audit tools to be developed and used was discussed. A questionnaire survey had elicited feedback from some residents and relatives. This information had been collated and summarized. Discussed was the need to evidence how the results are communicated to residents’ and their representatives. An action plan should be developed arising from the analysis of survey information. Though the company directors were said to make regular visits to the home and the company secretary works part –time in the home, there was no evidence of compliance with regulations for statutory provider visits. A requirement was made in this matter. Areas for improvement include record keeping specific to care planning, pressure sore prevention, treatment and assessment, the staff roster and accident records. In the latter a fall recorded in the handover record on the day of the visit was not recorded in the care notes of the resident concerned or in the accident record. Requirement has been made for the manager to ensure records relating to the care of former residents are retained complete for at least three years from the date of the last entry. It is also recommended that social care records be held in residents’ files. Information received from a relative following the inspection visit referred to an outbreak of scabies that was not notified to the CSCI. The information received was that staff were aware of this problem but it was this relative who noticed and reported symptoms of scabies on the resident visited. Also that visitors had not been informed of this outbreak. Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 33 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 1 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 x x 2 x x x 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x 2 2 Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 34 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 OP7 Regulation 14(1), 15(1) 17(1) Requirement For risk assessments, assessments and care plans to be further developed in accordance with observations in the main body of the report. Additionally records of all pressure sores must be maintained and an audit system developed for monitoring pressure sore prevention and treatment. For staff to follow the correct procedures when making changes to medication administration records. For a privacy lock to be fitted to the sliding communal toilet door as discussed with the manager. For minimum staffing levels to be maintained and adequate contingency arrangements made for covering staff shortages. Where staff shortfalls cannot be covered, particularly at night, this must be notified to the CSCI. For the staff-training programme for care staff to include pressure area care. Nurses must ensure DS0000013343.V344523.R01.S.doc Timescale for action 22/11/07 2. OP9 13(2) 23/08/07 3. 4. OP10 OP27 12(4)(a) 18(1)(a) 22/10/07 23/08/07 5. OP30 18(1) (c)(i) 22/10/07 Oakhurst Court Nursing Home Version 5.2 Page 35 6. OP31 37(10(e) 7. OP33 26(2)(3) (4)(5) they receive regular refresher training in wound care. For notification to the CSCI of 23/08/07 any event that adversely affects the well being of residents, which includes scabies infection. For the home to be visited by the 22/09/07 Responsible Individual or representative to carry out monthly visits in accordance with the Care Homes Regulations and prepare a written report of the visit which is supplied to the manager and available in the home for inspection. 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 OP1 Good Practice Recommendations The Service Users Guide must be updated to include additional information in response to amendments to the Care Homes Regulations. The most recent CSCI inspection report is part of the Service Users Guide and therefore must be accessible to prospective residents and residents and/or their representatives. If it is practicable to do so, at least one month’s notice should be given of an increase in fees. For review of practice specific to promoting continence in older people to identify any unmet staff training needs and to be confident that toileting practice meets individual needs and promotes residents’ dignity. For more age-appropriate clothes protectors to replace those currently in use. For the menu to include choice of cooked meal every evening and reflect opportunity to request a cooked breakfast. For advice to be sought on whether pureed meals should be fortified. For the complaint procedure to be prominently displayed in DS0000013343.V344523.R01.S.doc Version 5.2 Page 36 2. OP8 3. 4. 5. 6. OP10 OP15 OP15 OP16 Oakhurst Court Nursing Home 7. 8. OP22 OP26 9. 10. 11. 12. OP31 OP37 OP37 OP37 13. OP38 the reception and the suggestion box in this area to be relocated to be more visible. To encourage visitors to give feedback it is suggested that complaint forms be made available in this area together with a pen. For attention to signage in the environment to aid orientation. For review of the home’s procedures for minimising risk of cross infection of scabies through known contacts. Also to reinforce with all staff the need for vigilance and to report immediately any rash observed on residents. For review of management on-call arrangements and for this to be documented and available to the nurse in charge when the manager is off duty. For records in respect of residents’ social care be integrated with other records in residents files. For the home to have an over-arching procedure for responding to emergencies and crisis and a missing persons procedures which incorporates a search protocol. For the home to have a local policy and procedure to underpin clinical practice and record keeping specific to pressure sore prevention and supports nurses in the selection of pressure relieving equipment. For management systems ensure regular monitoring of practice for supervising residents in communal areas across the full spectrum of the waking day. Oakhurst Court Nursing Home DS0000013343.V344523.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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.V344523.R01.S.doc Version 5.2 Page 38 - 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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