Inspection on 19/10/07 for Oakland

This inspection was carried out on 19th October 2007.

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

Oakland 03/03/08

Oakland 23/08/07

Oakland 08/12/06

Oakland 05/05/06

Oakland 31/10/05

Oakland 31/05/05

Oakland 10/01/05

Oakland 27/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Oakland Oakland Oakwood House Bury Road Rochdale Lancs OL11 5EU Lead Inspector Jenny Andrew Unannounced Inspection 19th October 2007 06:45 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 Oakland DS0000040406.V352912.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. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakland Address Oakland Oakwood House Bury Road Rochdale Lancs OL11 5EU 01706 642448 01706 642389 oaklandrochdale@schealthcare.co.uk 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) Southern Cross Home Properties Limited vacant post Care Home 40 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (22) of places Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 40 service users to include: Up to 22 service users in the category of OP (Older People over the age of 65 years); Up to 18 service users in the category of DE (E) (Dementia over 65 years of age) The service should employ a suitably qualified and experienced Manager who is registered by the Commission of Social Care Inspection. 23rd August 2007 2. Date of last inspection Brief Description of the Service: Oakland is a care home providing personal care for up to 40 older persons aged over 65 years in two separate units. One unit provides residential care for 22 people and is located on the first floor of the home. The ground floor unit is registered for dementia care for 18 older people over the age of 65 years. The home does not provide nursing care. All bedrooms are single, with a number providing en-suite facilities. A passenger lift serves both levels of the home. Oakland is situated approximately one mile from Rochdale town centre. A regular bus service to the centre can be accessed within several minutes’ walking distance of the home. A small car park is available to the front of the home, with the provision of a larger one to the rear. A safe, enclosed, wellmaintained garden is situated to the side of the home, which residents can access via the ground floor lounge. The weekly charges range between £334.98 - £499.00, as at August 2007. The differences in prices are dependent upon whether or not the Local Authority funds the service user or whether they are paying for themselves. Additional charges are made for private chiropody treatment, hairdressing, outings and newspapers/magazines. The provider makes information about the service available upon request in the form of a Service User Guide and Statement of Purpose, which are given, upon admission, to each new resident. A copy of the most recent Commission for Social Care Inspection (CSCI) report is displayed in the entrance hall and the summary is contained in the service user guide. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which included a site visit to the home. The reason for this visit was that since the last key inspection, we had received an anonymous complaint, the registered manager had left and Rochdale MBC Social Services staff had done two spot checks of the home and found many areas of concern that they had passed on to us. The staff at the home did not know this visit was going to take place. The visit took place over two days with two inspectors, one of whom was a pharmacy inspector. He spent six and a half hours at the home on the first day and the other inspector spent 16 hours at the home over two days. We looked around parts of the building, checked the records kept on service users to make sure staff were looking after them properly and watched how the staff cared and supported people. Samples of medicine records and the medicines storage facilities were inspected in both units and part of the morning and afternoon medicines rounds were observed. The files of three members of staff were also checked to make sure the home was doing all the right checks before they let the staff start work. In order to obtain as much information as possible about how well the home looks after the residents, the Responsible Individual of the Company, the project manager, deputy manager, manager from another home, eight residents, two senior carers, two care assistants, two relatives, two domestics, the chef and the administrator were spoken to. Before the inspection, comment cards were sent out to relatives of the residents asking what they thought about the service. Two comment cards were returned and this information has also been used in the report. Before the last inspection in August 2007, we asked the previous manager to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what the management of the home feel they do well, and what they need to do better. This helps us to determine if the management see the service they provide the same way that we see the service. Upon its return, it was not fully completed, it was insufficiently detailed and the equality and diversity areas needed expanding upon. During the inspection, it was also identified that the recording of nil for pressure sores was incorrect at the time it was completed at the end of June 2007. Other inaccurate recordings had been made in respect of staff training. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 6 The Commission for Social Care Inspection (CSCI) has not undertaken any complaint investigations at the home since the last key inspection, although one anonymous complaint had recently been received by the CSCI, which was investigated on this visit. Since the last inspection, the registered manager had left and a temporary manager, known as the project manager, was running the home with the assistance of a full management team. What the service does well: What has improved since the last inspection? What they could do better: Many of the staff had not had any training in how to look after people with dementia, even though one of the units at the home was specifically for mentally frail people. This meant they did not have the knowledge and understanding needed to care properly for these residents. The care plans were not being kept up to date so that the care staff would have the information they needed to meet the health and personal care needs of the residents. This was particularly true in respect of people losing weight, infection control and pressure area care. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 7 Care staff did not know how each person in their care needed to be looked after which could result in the residents health deteriorating. Some care staff did not have the necessary skills to safely support the people in their care, which could result in residents being at risk. Care staff were not always giving residents their medicines correctly, as giving out medicines at the wrong time, at the wrong dose or not at all, could affect their health and wellbeing. Also sufficient stocks of medication were not being kept in the home, which meant the residents were not receiving their medicines as prescribed by the doctors. The home’s social activities programme needed to be reviewed to include activities to meet the people’s individual needs so they would have something to keep them stimulated and occupied during the day. When relatives or residents made any concerns or complaints, these should always be taken seriously and the action taken to put them right needed to be recorded. More than half of the staff team had not done any training in what to do if they suspected someone was not being treated properly and this could put people at risk of harm. Only 15 of the staff team had done recognised training (NVQ 2/3). More staff needed to do this training so that they would have more awareness and understanding about how to care properly for the people in their care. Staff must not be allowed to start work before all the right checks have been done so that the manager is sure they are safe to work with vulnerable people. The majority of the staff had not done training in how to care for residents who develop an infection so they will understand how to prevent the infection spreading. Other important training, such as health and safety, first aid and food hygiene, needed to be done by many of the care staff so that residents’ safety would not be compromised. The staff needed to work harder as a team, be more observant, take a greater pride in what they did and value the residents more. The management of the home over the past few months had been lacking resulting in the staff not receiving the help, guidance and direction needed to do their jobs well. There had been lack of communication, records not satisfactorily kept, poor recruitment practice and quality control systems that had not been accurately and honestly implemented. This had impacted on the outcomes for the people living at Oakland receiving an unsatisfactory level of care. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 8 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. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Oakland DS0000040406.V352912.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Whilst residents were assessed before admission to the home, their needs could not always be fully met due to many of the staff team not receiving the right kind of training. EVIDENCE: Three files were checked and found to contain full assessment documentation. The previous manager, or a senior staff member, was responsible for doing the assessments. When residents were admitted via Social Services, a full care management assessment was also received. Upon admission, it was usual practice to undertake body mapping so that any bruises or pressure areas could be identified and included as part of the care planning process. The religious needs of residents were also identified as part of the pre-admission assessment. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 11 One unit of the home catered for people with dementia care needs. From speaking to the staff and checking training records, it was identified that out of a staff team of 25, only nine had done any dementia care training. Eight of those who had not done any training were in a senior carer role. Clearly, if staff have not received specialist training, they have insufficient knowledge and awareness of how to meet the needs of the people in their care and this was observed during the visit. Other training shortfalls were also identified including challenging behaviour, infection control and pressure area care. Due to the concerns, which had already been passed to the Responsible Individual as a result of the spot check visits made by Rochdale Social Services, an action plan had been written. Reference was made to “all current clients are to under-go re-assessment of their needs to ensure that those needs can continue to be met and a high standard of care can be achieved consistently”. The project manager confirmed that this was the case. Training courses were also to be arranged for the staff. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The health and personal care needs of the residents were not being met due to the inconsistent care plans and the inexperienced and untrained staff working at the home. Medicines were not always given to the residents as prescribed, which could seriously affect their health and wellbeing. EVIDENCE: If the present care planning system was recorded upon and used correctly, it would be a good comprehensive document. However, due to lack of care plan training, many of the care plan recordings were inconsistent, incomplete and inaccurate and staff involved in the reviewing and monitoring processes were not picking up important changes in peoples needs. This had resulted in staff not having all the right information to enable them to give safe, consistent care to the residents. We were advised that care plan training was to be held the week of the inspection. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 13 The care plan files of three residents were thoroughly checked. One was for a resident who had pressure sores, one for a resident with challenging behaviour and another for someone with fairly high dependency needs. Loss of weight at this home had been identified in recent safeguarding investigations and this area was looked at during the visit. Two files were contradictory, in that, in one section they contained reference to the people being weighed monthly, which was being done and then in a different section, reference was made to weights needing to be recorded weekly due to significant weight loss. Records showed that weekly recordings had only started since the new project manager had introduced them over the past two weeks. One file showed that in August 2005 a weight of 59.3 had been recorded. On 24 September 2007 weight recorded on the Malnutrition Screening Tool for this person was 44.4 kilos, showing an overall weight loss of 14.9 kilos. Whilst the care plan had an action plan in place to address the weight loss and referred to dietary charts, these were not being regularly completed. Another resident, who was at high nutritional risk, had not been weighed since 21 July 2007. Staff spoken to said this was due to the mobile hoist being out of use. One returned comment card from a relative said, “I don’t think enough care and attention is being given to my mother. She is mostly left on her own to feed herself and she isn’t always capable of doing this. This happens week after week”. Information contained on the Annual Quality Assurance Assessment form (AQAA), completed by the previous registered manager, was incorrect in respect of the number of people in the home who had developed pressure ulcers over the previous 12 month period. A recording of nil had been made. The AQAA had been completed at the end of June 2007 and from speaking to the staff, it was identified that at least two residents had a pressure sore at this time. The care plan in place for a resident with pressure ulcers was looked at. Care plan recordings showed that in February 2007, she had a grade 2 pressure ulcer and the care plan set out what action should be taken to reduce the risks, e.g., use of pressure cushion, mattress and completion of fluid, dietary and turning charts. From February to June 2007 no recordings were made on her care plan reviews about any progress or deterioration in this person’s condition. In July 2007, a recording was made that the District Nurse had been and that the pressure sore was grade 3. The personal hygiene section of this person’s care plan had not been reviewed and updated since 24 July 2007. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 14 Very recent daily recordings showed that a further three pressure areas had been identified and that the District Nurse was continuing to visit and she had also been seen by a GP. Instructions had been given by the District Nurse that due to this person needing a hoist for all transfers, she would have to remain in bed until a new hoist was purchased. This person’s moving/handling assessment on the care plan file did not record that a hoist was needed for transfers. However, the company’s back care specialist had recently assessed her and a new moving/handling assessment was to be written, together with an updated care plan. New turning, fluid and dietary charts had been put into place on the instructions of the project manager but during the two-day inspection, staff were not completing them as specified in her care plan. One resident had an infection that could easily be passed to others and her care plan identified the action that needed to be taken to reduce the risks. However, since the infection had been confirmed on 2 August 2007, no updates of her progress had been made on the care plan file since 17 August 2007. When the deputy manager and senior carers were asked about her present condition, they were unable to say and the acting manager had not been advised of the infection. The deputy manager had to make a telephone call to the GP surgery to check on the up to date position. When asked about her present care, the staff confirmed they were continuing to cream and wash her legs between district nurse visits. A recent daily recording stated that the district nurse’s instructions had changed and that only the nurse would be creaming her legs and that staff should cease doing so. Only one of the three staff spoken to was aware of these new instructions. Clearly, this breakdown in communication needs to be addressed as a matter of urgency in order to ensure the person’s health care needs as instructed by the district nurse are met. Where residents displayed challenging behaviour, the care plan included a behavioural log where any incidents were recorded, including events leading up to the incident. On the case tracked file, it was unclear how the log was being utilised and who was monitoring her behaviour. A recording seen on this person’s care plan was inappropriate due to the way it had been written and the care assistance was asked about the recording. She said she had not intended it to be disrespectful but accepted it could look that way due to the use of some words. The quality varied, and had written actual food consumed. of information provided in daily records, charts and care plans some reporting was vague and lacked clarity. For example, staff on food intake charts - ‘soft diet taken’ with out mentioning the eaten to enable a more accurate idea of the actual nutrition Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 15 All the files had documented visits made by health care professionals such as GP’s district nurses, podiatrists, opticians, etc. As previously identified, if their specific instructions are not passed on to the care staff, then the individual person’s care needs will not be able to be met. Bathing records were not being kept up to date and it was therefore difficult to see when and how frequently people were being bathed or showered. Risk assessments were undertaken upon admission for nutrition, skin care, pressure area care, moving/handling and any other risk areas that are identified. Again, some recordings on these assessments did not correspond to information recorded on the care plans, which meant that people were not receiving the right care. In one of the lounges, two care staff were seen transferring a resident from the lounge chair to a wheelchair. They used a turntable but instead of using the handling belt, they clutched her under both arms, making her shout out. This person had recently been assessed by the back care advisor and, as a result of her and other people’s assessments, two new stand aids had been ordered together with a mobile hoist. From speaking to the project manager and other members of the newly installed management team, it was clear they had already identified that the care plans in place contained inaccuracies. An action plan had been written which referred to a full audit being undertaken of all care plan files with a completion timescale of 26 October 2008. A copy of this plan was given to us during the visit. The plan further stated “Life story books should be completed for all clients within the next eight weeks. This will assist in the formulation of an activity programme specifically designed for the needs of the clients”. Feedback from relatives was generally good in respect of the way they were kept up to date of any problems or treatment that might be necessary. Written procedures and policies were in place that supported the safe handling of medicines although these were not always correctly followed by staff. By observing part of the morning medicines round, which began at 10.20am and finished at approximately 11.15am, it was found that not all medicines were administered at the right time of day. Some medicines, such as those for pain relief and to treat Parkinson’s disease are best given earlier in the day and as a result of receiving medicines late, the health and well being of these residents could be affected. Most medicines were given after mealtimes and this was confirmed by care staff and by looking at the records. However, several currently prescribed medicines that should be given before food were given after meals, this is because the records do not show the correct time to administer them. Giving medicines at the wrong time could affect the way they work and can increase the chances of side effects. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 16 Records of medicines received, administered and disposed of were generally accurate which enabled managers to carry out detailed checks to show if medicines were being correctly administered. However, handwritten records, although usually double-checked by two staff, were not always accurate as important information was often left off. This has lead to some mistakes when giving medicines. Some examples of medicines not “adding up” correctly were found which shows they have not been administered as prescribed and this was particularly noticeable for short courses of treatment such as antibiotics. Records showed that some medicines were “out of stock”. One resident went without their five regularly prescribed medicines for 11 days and another went without a prescribed food supplement for 13 days. Both were due to poor practice by care staff who did not take prompt action when they realised the medicines had run out. Going without prescribed medicines can seriously affect the health and well being of residents. Medicines prescribed as “when required” or, as a “variable dose” do not have written instructions for staff to follow to ensure they are given correctly. Having clear instructions is important for residents who are suffering with pain or who are agitated and have difficulty communicating, to ensure they only receive their medicines when they need them. The manager said, all staff are assessed as competent to give medicines and this is recorded on a formal document. Care staff have received medicines handling training in the past and a refresher course has been arranged. Managers also carry out regular audits and these have identified some poor practice. However, given the recent mistakes and lack of prompt action when medicines have run out, it is clear that all training and assessment of competence should be fully reviewed to ensure it is effective. Following the inspection, a telephone conversation with the project manager identified that one of the senior carers had not received medication training and he was therefore no longer giving out medication. A decision had been made at a staff meeting held on 23rd October that, until further notice, only the project manager, deputy manager and project manager would be giving out medication. This provides clearer accountability. It was difficult to determine whether residents felt they were treated with respect and dignity, as many people were mentally frail and were not able to answer this question. However, two of the more independent residents felt the staff treated them well and were respectful. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 17 Two observations of poor practice were seen during the visit. After lunch, which was served about 12.30, two people in the dementia care unit were seen at 14.15 with tomato soup stains around their mouths and down the front of their clothes. During the morning a resident was observed being assisted to walk through the home with only one shoe on. The carer was holding his other shoe. Good practices were observed in respect of staff knocking on bedroom doors before entering and closing toilet doors when residents had left them open. One relative commented that laundry very often went missing and other people’s laundry would appear in her relative’s drawers. One returned comment card also commented upon this. Another comment card stated, “I don’t think my mother is toileted often enough”. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The ability to make choices in respect of daily routines was often limited by a lack of information from staff about options available, which meant that some residents were not involved in making any daily decisions. EVIDENCE: The activities co-ordinator had been off sick for the past two weeks and therefore the activity programme was not being implemented. During the visit staff in the dementia care unit did spend some time chatting to people and trying to encourage them to take part in one or two activities. One resident was constantly looking to go outside. She said she was bored and that no-one would take her out. She said she was frightened to say anything as she felt she would get into trouble. She again repeated, “There’s not enough staff to take me out”. She was quite distressed about this. The project manager came out of her office and arranged for one of the care assistants to take her out for a short walk. When she returned she was happy and contented. Nothing had been recorded on her care plan or activity sheets that this should be done daily or more often if possible. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 19 Another resident in the ground floor commented upon the music being too loud and that she wanted the television on. Nobody responded to her request. The residents in the first floor unit were left more or less to their own devices. One of the seniors said they did not have enough time during the day to organise activities but evenings were less hectic. Another carer said that residents were difficult to motivate. However, staffing levels had been increased to a level where staff could have spent one to one time or organised group activities for them. One resident on this unit commented she was often bored and had nothing to do. During the two day visit there were periods during both days when staff were talking to each other or standing around the building, time which could have been spent sitting and chatting with the people in their care. The day before the inspection, one resident said she had really enjoyed a musical entertainer who had come in to play an accordion. Care plan files contained activity sheets, which should be completed whenever one to one or group activities had been enjoyed. These sheets had nothing recorded on them since April 2007. Whilst care plans contained some reference to social activities, they were vague and it was evident that insufficient time had been spent on trying to find things to do that would be of interest to the individual. The home’s recently drawn up action plan had already identified shortfalls in this area. It made reference to life story books being written so the staff would have more ideas about what people’s interests were so they could include them in the activity programme. It also recorded that the activity programme should be pictorial and that activities must alternate between the two lounges and residents given the opportunity to interact with each other. Reference was also mentioned that social care plans should be formulated for each person and that the activity co-ordinator should update social care plans monthly. The good practice of taking photographs to show what activities had taken place was noted. A folder was seen, which recorded that seven activities had taken place between 18 May 2007 and 24 July 2007. These were the only written recordings made that anything had been organised from April to October. They included baking, skittles, a trip to the pub, dominoes, games and crafts and pet therapy. This good practice should continue, so that residents can see what they have enjoyed, but instead of keeping the photographs in a file they should be displayed somewhere in the home. The project manager said that she had arranged for the activity co-ordinator from another home to come in to offer ideas about new activities that may meet the needs of the people living at Oakland. She said there was also a DVD that showed a range of activities for people with varying stages of dementia, which would also give more ideas to the staff. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 20 The relatives spoken to said they could visit whenever they wanted and they were made welcome. One person said she felt social activities were lacking and were not geared towards individual people’s needs. She said the person she visited was very hard of hearing and therefore this prevented her from following instructions. On the notice board in the reception area, there was a notice displayed advertising a “relative surgery” every Thursday. This meant that relatives could call in to see the manager if they had any concerns or wished to discuss issues. There was also a resident/relative meeting arranged and individual letters had gone out to people inviting them to attend. One relative commented on a returned questionnaire, “The home allows my mother’s dog to visit her, which makes her very happy”. Residents’ religious needs were identified as part of the pre-admission assessment. It was however, identified that no religious denominations were coming into the home to visit any of the residents. The project manager said she would arrange to rectify this as quickly as possible. Due to the mental frailty of many of the residents, they were unable to hold their own finances and it was usual for their relatives or advocates to handle this on their behalf. Choices of how to spend their day in respect of rising and retiring, where to sit, whether or not to join in with activities and choice of food were promoted with the more independent residents. Those people in the dementia unit were unable to make many choices in their daily routines and it was felt that staff had not bothered to read care plans to find out important information about them. Due to the lack of activities, very often there was no choice but to sit in the lounge and watch television. From speaking to the agency senior night care assistant, it was clear that the only people who were up at the time of the visit on the first day, were the people who had had very disturbed nights and wanted to get up. These people had been washed and dressed and looked cared for. Other people were assisted to get up at varying times. The choice of food was requested the day before and this meant that people with dementia would not be able to remember what they had ordered. Sufficient amounts of both choices should be cooked so that residents’ can see the food and choose it at the time. One of the concerns raised by the Rochdale MBC was that the kitchen had been taken out of use. We only received notification about this, on the third day of the closure instead of before it occurred, so that we could check out in detail the arrangements that had been made whilst it was out of commission. The reason for the closure was so the kitchen walls could be fitted with plastic cladding in order for them to be easily cleaned and more hygienic. Outside caterers had been supplying the lunchtime and evening meals and the staff room had been used to make breakfasts and suppers. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 21 On the morning of the visit, one resident asked for toast for her breakfast, as she did not want cereals. There was no bread so she had nothing to eat. She was overheard saying how hungry she was. The bread appeared at about 11.00. It was unclear why a member of the staff had not gone out to a local shop earlier to buy some bread. On the first day of the visit, the lunch meal was tomato soup and teacakes with a choice of fillings (egg mayonnaise, tuna or ham) followed by jam sponge and custard. The evening meal was meat and potato pie with red cabbage and mushy peas followed by individual trifles. The caterers also supplied cutlery, disposable bowls and plates and napkins. We tried the lunch and the teacakes were soft and fresh with plenty of filling. The soup was hot and tasty. One relative did however, comment that on one of the days she visited, the soup given to her mother was stone cold and it was not heated up for her. The caterers had also supplied a large bowl of fruit with bananas, grapes, apples and pears. The organisation had recently introduced new four-week menus across all their homes, which were referred to as “Nutmegs”. Health care experts had formulated the menus to ensure they were balanced and nutritional. The menus gave choices at all meals. We were advised that the chefs would be receiving training in the implementation of the menus before they were delivered to the residents. After an initial four-week period, it was planned to hold a resident/relative meeting so that feedback about the menus could be obtained. Following this, changes could be made. In any event, if people did not like what was on the menu, the project manager said they would be offered something else and that this would have to be recorded on their care plan. Desserts were no longer being offered after the evening meal. The project manager said that mid-morning and afternoon breaks were now offering more choices, such as home baking, biscuits and fruit, and at supper a selection of sandwiches was being offered together with tea, coffee or a milky drink. There were no large print menus or menu boards displayed in either of the dining rooms. In order that people can see what is on offer and so they may be reminded of this, large boards should be displayed. Rochdale MBC had passed their concerns to us about the lack of cleanliness and hygiene in the kitchen and surrounding areas. On the day of the visit, the chef was spoken to. He confirmed he had come in to undertake cleaning duties before the kitchen equipment was moved back in. He said that at the time of Social Services visit, he had been away on holiday and before he had gone he had undertaken a full deep clean of all areas. He was upset that his high standards had not been kept up whilst he had been away and apologised for this. He confirmed that all meat, vegetables and dry goods were ordered regularly, that all equipment had been cleaned, out of date food removed from fridges and freezers, daily cleaning charts were in place and that the deep fat fryer was emptied and cleaned every two weeks. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 22 When asked about why he felt standards had slipped, he said they did not have a kitchen assistant on a daily basis. The kitchen assistant was at college on Tuesday and Fridays. The chef said he covered as kitchen assistant on Thursdays and that on Tuesday, Wednesday and Fridays some of the staff would come in to wash pots, etc. In a home of this size, a kitchen assistant must be employed daily in order to ensure that the health care needs of the residents are not compromised. Oakland DS0000040406.V352912.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): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Lack of protection training for the staff team could mean that policies and procedures were not being followed thus placing residents at risk of harm. EVIDENCE: A complaints procedure was displayed on the notice board in the entrance area and included in the Service User Guide. Due to the mental frailty of many of the residents in the home, consideration should be given to having laminated copies in bedrooms also. Some of the residents knew who to speak to if they had a complaint. One of the relatives said that it seemed useless to complain as nothing was ever done to put things right. It was identified these were usually grumbles about missing laundry, etc. These smaller issues were not recorded. Discussion took place with the project manager about introducing a system for logging minor concerns so that they could be monitored to ensure they were satisfactorily addressed. Another relative spoken to by telephone said that whenever she had made complaints in the past, usually to the manager or deputy, she was assured they would be looked into but that things never improved. These had been about care practice issues. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 24 There appeared to be two complaint files in use. The project manager said she would look through the files and make them up into one file. Since the beginning of July the complaints log book showed that two complaints had been made. Both complaints had been thoroughly investigated and been upheld. Appropriate action had been taken to address the shortfalls. More recently another complaint had come in and been logged, about the standard of care of a resident when attending hospital out-patients. The management team were currently investigating this complaint. We had recently received an anonymous complaint about general lack of hygiene, insufficient staff on duty and the previous project worker having a closed-door policy to relatives, residents and carers. The complaint was investigated during the visit. It was clear that at the time the complaint was made, the cleanliness and lack of staff would have been upheld. The opendoor policy could not be thoroughly investigated as this manager had now returned to manage her own home. Over the past two weeks, the home had been cleaned throughout, staffing levels had been increased and a new project worker with an open door policy was working at the home. The policy and procedure used by the home for the Protection of Vulnerable Adults (POVA) was the Rochdale Inter-agency procedure. A whistle-blowing procedure was also in place. One of the senior staff spoken with was not familiar with the home’s procedures and was not able to describe what abuse was. He said he had not received any training. From checking the training statistics matrix, it was recorded that only 13 of the staff team had done abuse training. The deputy manager knew and understood the reporting procedure, which she had appropriately used in the past. Three investigations under safeguarding procedures were currently taking place, with the full cooperation of the management team. Oakland DS0000040406.V352912.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): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Recent refurbishment and cleaning of the home have significantly improved the environment for the people living there. EVIDENCE: Rochdale MBC Social Services staff had alerted us to many areas of concern in respect of cleanliness and hygiene within the home. These were checked on the visit. A walk around the home showed that cleanliness had significantly improved since their visit. Also a programme of refurbishment was underway. The carpets in the ground floor lounge had been replaced, new flooring in the conservatory had been fitted as well as 12 bedroom carpets. Some new chairs had been bought and new beds were on order. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 26 Decorators were painting corridor walls and said they were to continue painting throughout the home. As previously mentioned, the kitchen had been thoroughly cleaned and was back in use. The requirements made at the last Environmental Health inspection had previously been met. Several bedrooms were checked and they were clean, tidy and personalised. There were no bad odours anywhere in the home. Clean towels and flannels were seen in the bedrooms and liquid soap and paper towels were provided in all bedrooms, bathrooms and toilets. Two domestics were spoken to when they arrived on duty at 07.15. They said they had been short staffed for about three months with a domestic being off sick and that was why the cleanliness in the home was not being maintained. They said no agency staff had been employed during this period. They confirmed additional cleaners had recently assisted in the overall cleaning of the home. They said they finished work at 14.00 and that no other cleaners came on duty after this time. The project manager said she had already identified this shortfall and that she would be employing an evening cleaner. The temporary vacant post had been advertised and applications had been received. Interviews were to take place shortly. In the interim an agency domestic had been arranged to provide additional cover for the next three weeks. We checked the ground floor toilets off the reception area at around 15.00. Faeces was on both toilet seats and one of the toilets did not have a paper towel waste bin in place. The project manager said it was the role of the staff to check toilets after the domestics had left and this would be reinforced to them. The project manager was making daily walk around checks of the home in order to monitor that all the home’s policies and procedures in respect of cleanliness, hygiene and infection control were being followed. The laundry had recently been extended, redecorated and had new shelving fitted. New flooring was to be fitted in the next couple of weeks. A whole new consignment of bedding had been delivered and put into the laundry. There were new duvets, new sheets and valances and new duvet covers. All the equipment in the laundry was in full working order. Several comments had been made during the inspection from the residents about laundry going missing or appearing in someone else’s drawers. One relative spoken to on the telephone said several of her mother’s new clothing had gone missing and never found. She also said that she was continually finding items of clothing in her mother’s drawers with someone else’s name on them. The project manager said the laundry assistant and staff would be instructed to be more vigilant in this area and that this would be monitored. Oakland DS0000040406.V352912.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): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Whilst staffing levels were more than adequate, the staff’s lack of training and experience meant that residents’ health and personal care needs were not being met which could place them at risk. EVIDENCE: Information from the Annual Quality Assurance Assessment document, completed in June 2007, showed there was a good ethnic mix of staff and seven male staff were employed. This meant that the male residents could choose to receive personal care from a male carer. The age mix of staff was mainly in the 18-34 group, although there were nine employed over this age. Over the last two weeks, staffing levels had been increased. From discussion with the managers and checking rotas, it was seen that two care assistants, one senior carer and a manager were operating on each unit. A unit manager from another home and the deputy manager of Oakland were each supervising staff to try and make sure that the new routines and instructions they had been given in respect of health care practices were being implemented. They were also undertaking a mentoring role. One of the senior staff commented upon how useful this had been and that he had learnt more in two weeks than he had learnt in the last few months. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 28 It was also confirmed that the management team were trying to move away from employing agency staff in order to provide more consistent care to the residents. Several of the part-time staff had been approached to do additional hours and they were happy to do so. The present level of staffing was more than adequate to meet the needs of the people living at the home, provided the care staff knew and fully understood their roles and responsibilities and the needs of the people for whom they were caring. Designated staff were now being deployed to work on a specific unit. The staff spoken to said that staff morale had improved somewhat over the last two weeks, as they could now see that the problems that had been cropping up were being dealt with. They felt they worked well together as a team and saw the new way of working, e.g., designated staff appointed for each floor as an improvement, as they felt they would be able to get to know the residents’ individual needs in more depth. The depth of current knowledge staff had about the residents was insufficient and it was apparent they were not reading the care plans or passing on important information about people when their needs had changed. In order for staff and relatives to be able to speak to the manager without an appointment, a surgery was advertised on the notice board on Tuesdays between 14.00 –16.00. The Annual Quality Assurance Assessment (AQAA) returned by the previous manager contained inaccurate information about the number of staff who were currently doing their NVQ level 2 training. The document recorded that 12 staff were doing it when in fact, the figures given on this inspection were that five were currently doing it. Two people had completed their NVQ level 2 and another two had completed their NVQ level 3. The administrator said that 26 care staff were employed in total and that training figures would not have changed much since June 2007. This meant that only 15 of the staff team had a recognised qualification. Four staff files were examined for people who had been recruited from February – July 2007. The files were in disarray and a manager from another home had been deployed to audit the staff personnel files, reformat them and check for what documentation was missing. Two of the files contained evidence of application forms, two references and Pova first and Criminal Record Bureau (CRB) checks. The other file showed that the care assistant had previously worked at the home, left and had then returned. No new application form, references, POVA first and CRB checks had been done. The Responsible Individual of the home confirmed that immediate action would be taken to address this serious shortfall. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 29 Some files contained outdated contracts of employment and basic information such as start dates, etc., had to be searched for. The new action plan already identified shortfalls in these areas. It was of concern that whilst three of the staff had started work in February, June and July, their Skills for Care signed sheets showed their training had been completed when in fact many of the mandatory training courses had not been undertaken. One carer had not done moving/handling, abuse or infection control. Another person had not completed infection control and had last done abuse training at a previous home in 2001. Another carer had only done dementia awareness and fire training. Her last moving/handling training had been done in 2005. One person who had been appointed as a senior and had started working at the home in June 2006 had only completed fire and food hygiene training. There did not seem to be any clear guidelines about what experience or care qualifications staff should have before being promoted to senior status. There was no evidence of how the Skills for Care competencies had been assessed, as there were no work books or other documents in place. Staff training over the last 12 months has been lacking in respect of both specialist and mandatory training. During the visit, the Responsible Individual gave us an up to date training matrix together with training statistics so that it could easily be seen what training had been given and where the shortfalls were. These documents had been drawn up to be included in the action plan that had recently been written. From checking the matrix, it was clear that staff training over the past 12 months had been given a low profile. Several staff had not done moving/handling, no challenging behaviour training had taken place and only nine out of 26 staff had done dementia care training. Only two staff had received any training in infection control and this had been in 2006. Other gaps in training identified were in fire safety, first aid, food hygiene, health and safety and nutrition. Both the Responsible Individual and the project manager gave their assurances that all the training shortfalls, that they had themselves already identified, would be addressed as quickly as possible. Dementia training had already been arranged for some of the staff and this would be over a ten-week period. One relative returned questionnaire commented, “In my opinion, the staff do not have the right skills and experience. They should be mentored until they are properly trained and able to do the job to the standards required”. A further comment made was, “Staff should have more involvement with the residents and take more interest in their work”. One person commented, “Staff should have enough time to water flowers in bedrooms and dispose of them when they are dead”. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 30 An area of concern brought to our attention has been lax standards in respect of hygiene, infection control and cleanliness. A requirement was made at the last inspection in August 2007 for all staff to undertake infection control training with a timescale of 30 November 2007 being given. The project manager confirmed that this timescale would be kept to. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 31 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): Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Poor management has meant that the people living at the home had not been receiving an acceptable standard of care in respect of their health and safety needs. EVIDENCE: The registered manager had left in September, without giving full notice of intentions. Another project manager had been transferred from one of company’s other homes to cover this position and had worked with registered manager for a week handover period. After she had left, manager in charge had identified many problems within the home that had been addressed over several months and raised her concerns to Responsible Individual who had acted on her feedback straight away. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 her the the the not the Page 32 The Responsible Individual of the organisation was spoken to on both days of the inspection. He was visiting the home daily to monitor that the action plan that had been drawn up on 18th October 2007, to improve the outcomes for the people living at the home, was being implemented. He had held a staff meeting at the home the week before this visit to emphasise the importance of the team pulling together, improving practice and moving forward for the benefit of the people living there. A full management team was now in place, each person having designated roles to play. A project manager was in post to manage the home in the absence of a permanent manager. A unit manager from another home was working alongside staff providing leadership and guidance, as was the deputy manager. They were also checking out carers’ routines and care practices. A manager from another home had also been deployed on a short-term basis to do a full audit of staff personnel files. The project worker said her current role was to manage the home in the absence of a permanent manager. She was experienced and had completed her Registered Manager’s Award. She was supernumerary at all times and had spent the past weekend in the home so that she could observe staff working practices at weekend as well as during the week. She was spending time on the floor checking how care was being delivered and if she saw evidence of poor practice was immediately addressing it with the person concerned. This was evidenced during the visit. She was also checking that the present standard of cleanliness within the home was being maintained and was monitoring the care of the people with pressure sores. She was starting to audit all the care plan files, following which reviews with relatives and residents would take place so that care plans could be updated in full consultation with all parties. The group clinical nurse advisor was supporting her in respect of care plans and other care practices. Care plan training had also been arranged for the staff. In view of the poor standards of care and poor practices described in the report, discussion took place in respect of the home’s quality monitoring system. A corporate quality monitoring and assurance system was in place and the Responsible Individual said the previous registered manager had completed the monthly audit tools in respect of medication, the environment, staffing, pressure sores and falls. He said the content of the audits had not given any cause for concern nor had the Regulation 26 visits done by the operations manager. Given the number of problems identified by both Rochdale Social Services Department and ourselves, the validity of these documents needs to be checked. The project manager and other managers were closely monitoring staff practice and routines on all shifts including nights and weekends. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 33 The finances for the three case tracked residents were checked and found to be in order. All financial records and transactions were held on computer. The system enabled a full audit trail to be followed. Receipts were retained when staff had purchased items on behalf of residents and separate books were kept showing when hair and podiatry fees had been paid. Information provided in the AQAA indicated that hoists had not been serviced since December 2006. All hoists must be serviced at least six monthly. Two maintenance records were randomly checked. According to the stickers on the fire extinguishers, they had been serviced in December 2006 but the servicing document could not be found. The gas appliances had been serviced in February 2007. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 34 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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 x 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 1 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 2 Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? YES but the timescale has not yet expired. 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 15 Requirement Timescale for action 30/11/07 2 OP8 13(4(c) 3 OP8 13(5) Each service user must have a care plan in place that accurately reflects their present needs so that the care staff will be able to give them the right care. Risk assessments must be 30/11/07 reviewed and updated and action needed to address the risks, be transferred to each persons care plan. Attention should be specifically given to pressure sores, weight loss and infections. This will ensure that each resident will have a plan in place, which will try to make sure the risks are lessened and the right care given. Updated moving/handling 30/11/07 assessments must be transferred to individuals care plan files so the staff will know how to handle people safely. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 36 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. 4 Standard OP30 Regulation 13(3) Requirement Staff must receive appropriate training in relation to the prevention of cross-infection, including caring for residents with MRSA. (This requirement was made at the last inspection but the timescale had not yet lapsed). Medicines must be given to residents as prescribed and at the right time in relation to food intake. Receiving medicines at the wrong dose, wrong time or not at all can seriously affect the health and well being of residents. Ordering procedures must ensure sufficient stocks of medicines are kept in the home to help ensure residents receive them as prescribed. Staff responsible for giving out medication must receive training to ensure they have the knowledge to do it safely. Staff must make sure they always look after people in such a way as their dignity is upheld. An activity programme must be implemented which meets the differing needs of the people accommodated so they will not be bored and unfulfilled. Timescale for action 30/11/07 5 OP9 13(2) 30/11/07 6 OP9 13(2) 30/11/07 7 OP9 18(1)(c) 30/11/07 8 9 OP10 OP12 12(4)(a) 16(2)(n) 30/11/07 30/11/07 Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 37 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. 10 Standard OP16 Regulation 22(3) Requirement All complaints must be investigated and responded to so that the person making the complaint knows what action has been taken to address it. Staff must receive abuse training so they will know what to do to protect the person if they suspect this is taking place. Staff must not start work unless all the required references and checks have been done which will help to ensure that vulnerable people are being cared for by staff who are safe to do so. A registered manager with the experience and qualifications needed must be appointed to run the home so that it is being run in the best interests of the people living there. A person must be identified to check that the home’s quality assurance and monitoring system is being utilised and completed accurately so that ongoing monitoring can be undertaken to ensure the improvements are maintained and standards do not fall. Timescale for action 30/11/07 11 OP18 13(6) 14/12/07 12 OP29 19 30/11/07 13 OP31 8 14/12/07 14 OP33 24 30/11/07 Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 38 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. 15 Standard OP33 Regulation 24 Requirement The Annual Quality Assurance Assessment form must be resubmitted and accurately completed which reflects resident care and staff training. All staff must receive training in fire, moving/handling, food hygiene and health and safety so as to ensure the residents’ health and safety needs are met. First aid training must also be undertaken by identified staff or a risk assessment drawn up to show why this had not been done. All hoists must be serviced on at least a six monthly basis to ensure the equipment is safe for residents’ use. Timescale for action 30/11/07 16 OP38 18(1)(c) (i) 21/12/07 17 OP38 13(5) 30/11/07 Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 39 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 OP7 Good Practice Recommendations Where residents display behaviour which is challenging, the manager should monitor the behavioural sheets in order to see if the care plan in place is accurate and addressing this persons needs. The daily recordings needed to be more detailed and state exactly what care had been given. The sheets recording personal care needs such as bathing, etc. should be kept up to date so that checks can be made that the care needs of the residents are being met. Care plans should be drawn up in consultation with residents and/or their relatives, who should sign to say they are in agreement with the plan. Patient information leaflets should be used for all medicines kept in the home to ensure medicines are administered correctly. All handwritten medicines records should be an exact copy of the pharmacists dispensing label, which should be double checked and countersigned to help prevent mistakes. Care plans for medicines prescribed as “when required” or, as a “variable dose” should be produced to ensure they are given to residents correctly. Social activity sheets should be completed so that the manager can monitor that activities appropriate for the person are being done. Contact should be made with religious denominations, after identifying with residents, who they would like to come in to see them. When minor complaints/grumbles are received they should be logged so that it can be monitored that appropriate action has been taken to resolve the problem. As part of the Skills for Care induction training, work books or some other system should be implemented so that it can be seen how the competencies have been assessed. 2 3 4 5 6 OP7 OP7 OP7 OP9 OP9 7 8 9 10 11 OP9 OP12 OP12 OP16 OP30 Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 40 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 12 Refer to Standard OP30 Good Practice Recommendations 50 of the care staff group should be trained to NVQ level 2 standard. Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection Manchester Local Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU 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 Oakland DS0000040406.V352912.R01.S.doc Version 5.2 Page 42 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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