Inspection on 27/05/05 for Oakhurst Grange

This inspection was carried out on 27th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Oakhurst Grange 27/03/08

Oakhurst Grange 14/06/06

Oakhurst Grange 19/10/05

Oakhurst Grange 07/10/04

Oakhurst Grange 26/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

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 Grange Goffs Park Road Crawley West Sussex RH11 8AY Lead Inspector Lynne ODonnell Announced Friday 27 May 2005, 09:00am th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Oakhurst Grange Address Goffs Park Road, Crawley, West Sussex, RH11 8AY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01293 536481 01293 612454 BUPA Care Homes Limited Post Vacant Care Home 120 Category(ies) of Care Home with Nursing 120 registration, with number of places Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Dementia - over 65 years of age (30), Old age, not falling within any other category (30), Physical disability (30), Physical disability over 65 years of age (30) Date of last inspection 07/10/05 Brief Description of the Service: Oakhurst Grange is a care home registered to provide nursing care for 120 Service Users aged 65 years and over, 30 of whom may have dementia.The home was purpose built and consists of four separate 30-bedded houses, Copthorne, Charlwood, Balcombe and Rusper. Each house is single storey and each has its own garden area. Copthorne, Charlwood and Balcombe provide general nursing care and Rusper house provides nursing care for people with dementia.There is a further building which houses the reception area, administration offices, laundry and kitchen facilities.Each of the homes has a unit manager. However the post of Registered Manager is currently vacant. The home is situated within a residential area, close to the town centre of Crawley.The Registered Provider of the home is BUPA. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Announced Inspection took place over two full days, Friday and Saturday, and involved four inspectors. At the last inspection in October 2004 the Inspector had observed that improvements to the care service provided were ongoing and that concerns raised in the May Inspection were being addressed. However the early part of 2005, has seen a number of management changes at the home and in April 2005 a number of concerns were raised with both the Commission and West Sussex Social and Caring Services with regards to aspects of both health and personal care of residents at the home. In April 2005 five adult protection referrals were made to West Sussex Social and Caring Services. These referrals were fully investigated under the West Sussex protocols for adult protection by the lead inspector and a consultant nurse from Crawley PCT and involved seven visits to the home. As a consequence of the initial investigation into the five adult protection referrals a further six cases were investigated. The findings of this investigation were shared with all involved agencies and there is a continuing investigation under the adult protection procedures. BUPA, have written to all current residents and their relatives informing them of this investigation and have confirmed their co-operation with this. In addition Crawley PCT are undertaking a reassessment of the health care needs of all residents at the home. As a result of the findings of the above investigation the Commission has served three enforcement notices detailing the areas in which the Registered Providers are not complying with the regulations and outlining what needs to be done in order to ensure compliance. In addition a voluntary agreement undertaken with the Registered Providers to prevent any further admissions to the home has been formalised by the service of a notice of proposal to impose a condition of their registration preventing any further admissions to the home until such a time that significant and sustained improvement has been noted. The requirements listed at the end of this report are taken from the enforcement notices (some of which are outstanding from previous inspections). The time scales recorded in this report are as given in the notices. One further requirement has been made with regard to the position of Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 6 Registered Manager, as the position remains vacant, as previous appointments have not been successful. The focus of this inspection concentrated on the health and personal care provision at the home, as these areas formed the basis of concerns raised under the adult protection protocols. During the course of the inspection the Inspectors spoke with residents, relatives, visitors and staff to gain a sense of how the home is run and the experience of the residents living at Oakhurst Grange. A sample of care records for residents were reviewed in each of the four houses at Oakhurst Grange. Feedback from residents and relatives, both through discussions during the inspection and comment cards received, was mixed. Staff generally demonstrated a caring approach towards the residents. However shortcomings in staff training and supervision were noted and this is an area, that the Registered Providers must address as a high priority. What the service does well: What has improved since the last inspection? What they could do better: The Registered Providers need to ensure that their vision and values provide the basis for the ethos of the home through which residents will benefit from a person centred philosophy. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 7 Individual resident’s assessment of need must be fully completed and the action to meet these identified needs must be set out in a care plan, which must be reviewed regularly. The Registered Providers need to continue with their plan of introducing new care planning systems to ensure that residents personal, health and social care needs are identified, met and reviewed regularly. They also need to ensure that the residents and their representatives (as appropriate) are involved in this process. The advice of other health professionals should continue to be sought as necessary and any advice given should be recorded within the care plan and acted upon. Risk assessments need to be produced to reflect any identified risks for individual residents, rather than generic documentation, and include any action to be taken. These should be regularly reviewed and updated as necessary. Records in relation to social activities and individual interests should be kept and the provision of activities should reflect residents’ personal interests and wishes. Any complaints received should be formally recorded along with any action taken to address them, in line with the Registered Providers own procedures. The handling of complaints by the Registered Providers needs to be audited and reviewed to ascertain why there is a high level of dissatisfaction with BUPA’s responses to complaints. All records that are required to be kept for the protection of residents must be maintained and kept up to date and should be written in an accurate and appropriate manner. Equipment identified as necessary to meet individual needs should be made available and be well maintained. A staff training and development programme needs to be developed and delivered as a priority to ensure that staff are able to fulfil the aims of the home and meet the changing needs of residents. This programme should include training identified through both the adult protection investigation and this inspection. All care staff should receive formal effective supervision, which covers all aspects of practice, philosophy of care and any training development needs. The Registered Providers must ensure that there is an effective quality assurance process in place. This includes ensuring that monthly reports provided to the Commission, under regulation 26, accurately reflect the conduct of the care home at the time of the visit. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 8 A Registered Manager, who is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives, should be appointed as a priority. 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. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 The Statement of Purpose and brochure contain detailed information that prospective residents need to make an informed decision as to whether the home will be able to meet their care needs. However the Registered Providers need to ensure that the aims and objectives, philosophy, policies and procedures detailed within these documents accurately reflect current provision within the home. EVIDENCE: A copy of the Statement of Purpose and brochure produced by the Registered Providers was given to the Inspectors. Reference is made within these documents to person centred care, the visions and values of the home and care planning principles and review of care, however the Adult protection investigation and records seen during the inspection did not support that these underpinned current practice within the home. The in-depth investigation carried out under the Adult Protection Protocols provides evidence that not all residents’ needs were being assessed, met or reviewed appropriately. A requirement is made in respect of this and is also included within the enforcement notices. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 The residents individual care plans do not clearly identify how needs are to be met. In all four houses it was found that care plans have insufficient detail and some are illegible which could result in the appropriate care, for both personal and health care needs, not being given and the needs of the resident not being met, putting residents at risk of harm. Care plans were poorly organised with important information, particularly with regard to health care needs and medical conditions, not being prominently recorded and easily accessible, which again could lead to appropriate care not being given and the promotion of a task orientated approach to care delivery. Professional advice about health care needs and medical conditions is sought from appropriate health professionals however management and staff need to ensure that this advice is then followed. In order to monitor the treatment of wounds and pressure areas photographs are taken periodically. However the quality of these photographs was often found to be poor and inadequate for this purpose. The home demonstrated good practices in medication handling with appropriate policies and procedures for dealing with medication in place. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 12 EVIDENCE: All care plans seen follow the same pattern regardless of need. Five care plans were reviewed in each of the individual houses. There was insufficient information with regards to personal care required, i.e. what actual assistance is required and residents’ personal preferences or requirements on how that assistance will be delivered. Some risk assessments have been carried out, for example manual handling, nutritional need and a bathing assessment, however these often followed a standard format. The bathing assessment is a generic document that highlights in general terms the procedure when bathing someone. There is no information to indicate how assistance to residents will be managed taking into account their individual bathing and moving and handling needs. There is some use of restraint. In each case it was evidenced that agreement from relatives has been sought however, there are no care plans to document how restraint will be used, i.e in what circumstances and how it will be monitored for example checking to ensure that lap belts are not to tight or that the resident has not slipped down causing any form of restriction. Professional advice had been sought with regards to the treatment of a pressure sore for one resident. Whilst this advice was followed the records showed that the sore was improving and getting better. However following an internal audit arranged by the Registered Providers the treatment of this pressure sore was changed resulting in the deterioration of the pressure sore. This inconsistency could be confusing for the nursing staff and does not provide best outcomes for residents. Use of some dressings in the treatment of pressure sores was recorded on the medication administration record charts, however this was not consistent throughout the home. Some care plans had entries hand written on frequently photocopied paper which has resulted in many cases of the care plans being difficult to read, due to marks on the paper. In an action plan previously made available to the Commission the Registered Provider advised that this practice would cease however this was not found to be the case throughout the home. The investigation under the adult protection protocols had identified a failing of the home to carry out appropriate nutritional monitoring and the recording of actions taken when weight gain or loss was noted, for some residents. New monitoring forms have since been introduced for use within each of the houses. During the inspection, one inspector was with a resident whilst a member of staff came to take photographs of bruising to her arms. No explanation was Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 13 given to the resident as to what was going to happen or the purposes of the photographs. This practice does not promote the residents rights to dignity and choice. Of the comment cards received from relatives only 29 considered that they were kept informed of important matters affecting their relatives and that they were consulted with regards to decisions about their care. During the inspection of those visitors spoken with 75 expressed general satisfaction of the care provided to their relatives. However of these 50 had raised concerns during their relatives stay at the home. The reaction of residents spoken with was mixed. A third advised that they were very happy with the care provided and that staff were generally kind and caring, a third advised that they were generally happy but that improvements could be made to certain aspects of care i.e. moving and handling, time taken to respond to call bells. A third did express dissatisfaction with the care provided making particular reference to lack of consistency to staff approaches to care and moving and handling. There were clear, auditable records of medicine receipt, administration and disposal. Part of a medicine round was observed and seen to be done correctly and with respect. The way of recording doses not administered, differed throughout the home. With one exception the criteria for use of medicines, prescribed to be taken when required, was not included in care plans. The majority of residents spoken with considered that staff treated them respectfully and maintained their privacy. Requirements are made at the end of this report in respect of health and personal care issues. These are also included within the enforcement notices. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 The social and cultural needs of some residents are not being met. Care plans provided little information regarding residents’ social, cultural and recreational interests. Relatives and friends are able to visit the home at any reasonable time and are able to visit residents in private. Although there is a choice of main meals served feedback from residents with regards to the food served was mixed. Nutritional assessments and dietary needs are not always met. EVIDENCE: There are two activities co-ordinators who arrange activities throughout the home both on a group and individual basis. However the range of activities is very limited and the majority of residents spoken with during the inspection advised that there was little to do and that they were often bored. Some of the residents spoken with were unaware of organised activities and advised the inspectors that they would like more activities and things to do. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 15 Although within all of the care plans seen during the inspection there was a social well being section, this was not always completed. In addition where hobbies and interests were recorded there were no other records to determine whether residents were supported to enjoy these. All visitors to the home advised that they were able to visit at any time and they were observed to be able to visit their relatives in private. Menus are displayed within each of the houses and residents advised that there was usually a choice of main meal. Residents’ views on the meals were varied with comments such as, ‘sometimes the food is good, sometimes not’, ‘I do not like the food at all and have not been asked what I would prefer to eat’, ‘the food is very good and I have a good appetite.’ Food preferences and likes and dislikes were not always recorded on care plans and it was unclear as to action taken where weight loss was noted. The adult protection investigation highlighted a number of issues in relation to food provision, particularly in relation to the provision for special diets and action taken by staff where significant weight loss was recorded. New monitoring forms have now been introduced within the home, which if used correctly will provide appropriate information on any change in need and the action to be taken. Requirements have been made in relation to these standards and are also included within the enforcement notices. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 18 Records seen for complaints received showed an inconsistent approach in dealing and responding to complaints, which could result in some complaints not being dealt with appropriately or effectively. Residents and their relatives are not always confident that their complaints are dealt with appropriately. There have been a number of Adult Protection referrals since the last inspection in October 2004. BUPA has a policy and procedure in place with regards to Adult Protection, which the majority of staff spoken with had an understanding of. However the adult protection investigation identified areas of poor practice throughout the home, which constituted an institutionalised/ task orientated approach to care provision and failed to address individual needs. EVIDENCE: A complaints procedure is in place and this is included within the Statement of Purpose. Records were seen for complaints dating back to the start of this year. Some complaints had little information recorded and therefore it was difficult to see how the complaint outcomes had been reached in some cases. The records also demonstrated that in some instances a subjective approach was apparent with little or no evidence to support the outcome. The records of a number of residents were reviewed as part of the adult protection investigation and these identified poor care practices in personal, social and health care needs. These were seen to be linked in part to insufficient staff training and supervision. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 17 Requirements have been made in relation to these standards and are also included within the enforcement notices. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 26 As the focus of this inspection prioritised the health and personal care needs of residents the inspectors did not fully look at outcomes for these standards. The home was generally found to be clean and tidy at the time of inspection. However, a number of concerns have been raised by visitors to the home as to the cleanliness of some rooms, including the cleanliness of equipment used. Records seen as part of the adult protection investigation also indicated that appropriate equipment was not always provided or identified as necessary despite the needs of residents. EVIDENCE: 36 of the comment cards received from visitors to the home raised concerns as to the cleanliness of individual residents rooms and of equipment used. It was evident during the inspection that new equipment had been identified as being needed within the home and that orders are now being placed for this. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 19 As this forms part of the enforcement notices the provision of appropriate equipment will be monitored on future unannounced visits to the home. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 30 At the time of inspection staffing numbers were higher than at previous inspections of the home. The Commission of Social Care Inspection has questioned the competencies of staff following the Adult Protection investigation findings. Training records showed that currently there is not an effective staff training and development programme in place. A number of staff have not received training in manual handling and fire safety. In addition training in all aspects of care is inconsistent across the home. Due to the lack of training and variable induction training not all staff may be fully competent and able to meet the changing needs of residents. EVIDENCE: The ratio of care and nursing staff to residents was higher at this inspection than at inspections in the past. The majority of staff spoken with across the home had felt that staffing levels had been too low to be able to manage the needs of the residents. However there is now a general feeling amongst staff that the current staffing ratios are more appropriate and allow them to provide the level of care necessary to meet the needs of residents. Some staff commented that this has in turn improved staff morale. Further comments included that working in the home had become less stressful of late and that they now enjoyed their work and had time to give the residents more attention. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 21 Two of the inspectors who have inspected the home in the past observed that the general atmosphere within the home was more relaxed for both staff and residents. However 81 of comment cards received from visitors to the home stated that they did not feel that there were sufficient staff on duty at all times. One visitor did advise that staffing levels had improved recently. Staff spoken with on an individual basis advised that they had completed inhouse induction training on starting work at the home. This training included guidance in manual handling, fire safety and infection control. However the quality of this training varied with comments from staff ranging from ‘informative and supportive’, to induction training being ‘rushed and left feeling unsupported’ and a feeling of being ‘dropped in at the deep end’. Further comments from staff demonstrated that training provision was very limited with no training in areas specific to caring for elderly residents. One qualified member of staff felt that here was a need for training in specific areas such as the management of continence, fluid and nutrition. In addition other staff advised that they would welcome training in areas such as wound care. A new member of staff spoken with was unaware of the homes fire procedures. Of the residents spoken with those who did voice concerns spoke specifically of poor moving and handling procedures, which included rough handling and not using equipment (i.e. hoist). Staffing records seen showed that the majority of staff had received no training, or update training, in moving and handling during 2004 –2005. Records seen during the inspection showed that the home is in the process of setting up a training programme for staff. However this did not include Fire Safety or Manual Handling training. The plan only addresses a small part of the training needs identified during the inspection and also through the adult protection investigation. During the inspection it was noted and observed that some staff have poor communication skills due to English not being their first language. Comments were also received about this from residents during the inspection, with some feeling that their wishes were misunderstood on occasion. Requirements have been made in relation to these standards and are also included within the enforcement notices. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32 There has been no Registered Manager at the home since September 2004. This position has been covered by different people since then however this has led to an inconsistency of approach and until recently no visible increased or monitoring input by the Registered Providers. The lack of a Registered Manager to provide a clear sense of direction and leadership, has led to an inconsistent approach throughout each of the four houses which make up the home. EVIDENCE: The last Registered Manager left the home at the end of August 2004. Despite attempts by the Registered Providers to employ a new manager these have not been successful. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 23 Through discussions with staff it was evident that some form of staff supervision took place however it was not clear what format this took. Through the findings of the adult protection investigation and through records seen during the inspection and discussions with staff and residents it would appear that areas such as aspects of practice and the philosophy of care in the home are not covered with all staff as part of their supervision. Requirements have been made in relation to these standards, some of which are also included within the enforcement notices. Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 24 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 2 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 2 28 1 29 x 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 1 1 x x x x x x Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 25 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14 (1 a b c d) (2 a b) Requirement You are in breach of Regulation 14 (1)(a)(b(c)(d) and (2) (a)(b). 14(1)The Registered Person shall not provide accommodation to a Service User at the care home unless so far as it shall have been practicable to do so – (a) The needs of the Service User have been assessed by a suitably qualified or trained person and (b) the Registered Person has obtained a copy of the assessment. (c) There has been appropriate consultation regarding the assessment with the Service User or a representative of the service user. (d) The Registered Person has confirmed in writing to the Service User that having regard to the assessment the care home is suitable for the purpose of meeting the Service User needs in respect of his health and welfare. 14(2) The Registered Person shall ensure that the assessment Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 26 Timescale for action 13/07/05 2. OP7 15 (1) (2 a b c d) of the Service Users needs is (a) kept under review and (b) revised at any time when it is necessary to do so having regard to any change of circumstances. You are in breach of Regulation 13/07/05 15(1)(2)(a)(b)(c)(d). 15(1) Unless it is impracticable to carry out such a consultation the Registered Person shall after consultation with the Service User, or a representative of his, prepare a written plan (the Service User plan) as to how the Service User needs in respect of his health and welfare are to be met. 15(2) The Registered Person shall (a) make the Service User plan available to the Service User, (b) keep the plan under review (c) where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the Service User plan and (d) notify the Service User of any revision. You are in breach of Regulation 13/07/05 12 (2) (3) 12(2)The Registered Person shall so far as practicable enable Service Users to make decisions with respect to the care they are to receive and their health and welfare. 12(3) The Registered Person shall for the purpose of providing care to Service Users and making proper provision for their health and welfare, so far as practicable ascertain and take 3. OP7 12 (2 3) Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 27 4. OP8 12 (1 a b) into account their wishes and feelings. 1 You are in breach of Regulation 12 (1)(a)(b) 13/06/05 5. OP8 13 (1 b) 12(1) The Registered Person shall ensure that the care home is conducted so as – (a) to promote and made proper provision for the health and welfare of Service Users; (b) to make proper provision for the care and where appropriate treatment, education and supervision of Service Users. You are in breach of Regulation 13/06/05 13 (1) (b) 13 (1) The Registered Person shall make arrangements for Service Users (b) to receive where necessary treatment, advice and other services from any health care professional. You are in breach of Regulation 12 (4)(a)(b) 12(4) The Registered Person shall make suitable arrangements to ensure that the care home is conducted – (a) In a manner which respects the privacy and dignity of Service Users; (b) With due regard to the sex, religious persuasion, racial origin, and cultural and linguistic background and any disability of Service Users. You are in breach of Regulation 13 (4) (b)(c) 13(4) The Registered Person shall ensure that(b) Any activities in which 6. OP10 12 (4 a b) 13/06/05 7. OP7 13 (4 b c) 13/06/05 Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 28 Service Users participate are so far as reasonably practicable free from avoidable risks and (c) unnecessary risks to the health and safety of Service Users are identified and so far as possible eliminated. and shall make suitable arrangements for the training of staff in first aid you are in breach of Regulation 13 (7) (8) 13(7) The Registered Person shall ensure that no Service User is subject to physical restraint unless restraint of the kind employed is the only practicable means of securing the welfare of that or any other Service User and there are exceptional circumstances. 13(8) On any occasion on which a Service User is subject to physical restraint the Registered Person shall record the circumstances including the nature of the restraint. You are in breach of Regulation 16 (2)(m)(n) 1692) The Registered Person shall having regard to the size of the care home and the number and needs of service users (m) consult Service Users about their social interests and make arrangements to enable them to engage in local social and community activities and to visit or maintain contact or communicate with their families and friends. 8. OP18 13 (7 8 ) 13/06/05 9. OP12 16 (2 m n ) 13/07/05 Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 29 10. OP15 16 (2 i 4) (n) consult Service Users about the programme of activities arranged by or on behalf of the care home and provide facilities for recreation including, having regard to the needs of Service Users activities in relation to recreation fitness and training. 7. You are in breach of regulation 16 (2) (i) (4) 16(2) The Registered Person shall having regard to the size of the care home and the number and needs of service users (i) provide in adequate quantities suitable wholesome and nutritious food which is varied and properly prepared and available at such time as may reasonably be required by Service Users. (4) In this regulation ‘food’ also includes drink. You are in breach of Regulation 13 (6) The Registered Person shall make arrangements by training staff or by other measures to prevent Service Users being harmed or suffering abuse or being placed at risk of abuse. 23(2) The Registered Person shall having regard to the number and needs of the Service Users ensure that (c) equipment provided at the care home for use by Service Users or persons who work at the care home is maintained in good working order (n) The Registered Person shall having regard to the number and needs of the Service Users ensure that suitable adaptations 13/06/05 11. OP18 13 (6) 13/06/05 12. OP22 23 (2 c n ) 13/06/05 Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 30 13. OP27 18 (1 a ) are made and such support, equipment and facilities as may be required are provided for Service Users who are old, infirm or physically disabled. 18(1) The Registered Person shall having regard to the size of the care home, the statement of purpose and the number and needs of the Service Users 17/05/05 14. OP30 13 (4) 15. OP36 18 (2 a) (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of Service Users. 13(4) The Registered Person 13/07/05 shall ensure that suitable arrangements are made for the training of staff in first aid 18(2) The Registered Person 13/07/05 shall ensure that (a) persons working at the care home are appropriately supervised. 17(1) The Registered Person shall 16. OP37 17 (1 a) 13/06/05 17. OP37 17 (3 a b 4) (a) maintain in respect of each Service User a record which includes all of the information documents and other records specified in Schedule 3 relating to the Service User. 13/06/05 17(3) The Registered Person shall ensure that the records referred to in paragraphs (1) and (2) i. are kept up to date and ii. are at all times available for inspection in the care home by any person authorised by the Commission to enter and inspect the care home Version 1.30 Page 31 Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc 18. OP33 24 (1 a b) 17(4) The records referred to in paragraphs (1) and (2) shall be retained for not less than three years from the date of the last entry. 24(1) The Registered Person shall establish and maintain a system for i. reviewing at appropriate intervals and ii. improving the quality of care provided at the home including the quality of nursing care where nursing is provided The Registered Provider shall appoint an individual to manage the care home where there is no registered manager in respect of the care home and the Registered Provider is an organisation or partnership. 13/06/05 19. OP31 8 (1 a b) 13/07/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Oakhurst Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 32 Commission for Social Care Inspection 2nd Floor, Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 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 Grange H60-H11 S24184 Oakhurst Grange V220477 270505 Stage 4.doc Version 1.30 Page 33 - 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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