Inspection on 23/08/07 for Oakland

This inspection was carried out on 23rd August 2007.

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

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

Other inspections for this house

Oakland 03/03/08

Oakland 19/10/07

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 Bernard Tracey Unannounced Inspection 23rd August 2007 08:30 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.V346447.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.V346447.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 Mrs Donna Oldham 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.V346447.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 for Social Care Inspection. 8th December 2006 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.V346447.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 manager was not made aware that this inspection was going to take place. Several weeks before the inspection questionnaires were sent out to doctors, social workers and nurses, as well as to the residents of the home and their relatives. The questionnaires asked what people thought of the care and services provided by the home. The manager was also asked to fill in a questionnaire, telling us what she thought they did well, what they have improved on and what they need to do better. Where appropriate, these comments have been included in the report. The inspector spent 5.75 hours at the home. During this time, we looked at care and medicine records to ensure that health and care needs were met and also studied how information was given to people before they decided to move into the home. A full tour of the building was undertaken and time was spent looking at records regarding safety in the home. We also examined files that contained information about how the staff were recruited for their jobs, as well as records about staff training. The inspector spent time speaking to six residents, as well as speaking to three relatives, eight staff and the deputy the manager. The Commission for Social Care Inspection has received three complaints regarding issues in the home and two of the issues were looked at during our site visit. A further matter is being looked into by the Local Authority and investigated under the Protection of Vulnerable Adults procedure. The manager is co-operating fully with the investigation. What the service does well: Oakland Care Centre has very good admission procedures, which include a detailed assessment process that fully identifies the needs of new residents. Care planning and the standard of actual care delivery are also good, as are the arrangements for accessing healthcare services. The home is staffed by a dedicated and skilled team, who provide a stimulating and cheerful atmosphere for residents. There are good resources for residents to enjoy a variety of activities and occupation. Residents’ wishes are taken into account when planning their care and staff show respect for residents’ choices. Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 6 The cook is fully aware of residents’ dietary needs, and serves good quality meals which residents enjoy. Both residents and staff benefit from the home’s strong leadership and open management ethos. Comments received include the following: “This care home cannot be faulted, the management and staff do all in their power to see that everything runs smoothly. You are always welcomed in and the girls are ever so pleasant and will talk to you. The rooms are clean and residents always have clean clothes, even if that means changing them. If all care homes were up to this standard there would never be any complaints”. “We are very happy with our Mums care”. What has improved since the last inspection? What they could do better: When the District Nurse request that the staff obtain dressings from the Pharmacy, this should be done without delay. Residents and relatives tell us that there are not sufficient staff in the home to provide for the needs of the residents and our observations confirmed this. There needs to be an increase in staffing. Some decorating is required in the personal accommodation of the residents. Care staff require further training to help them understand how to deal with residents who develop an infection and to understand how they prevent the infection being spread. Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 7 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.V346447.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 & 3. Standard 6 does not apply The quality outcome in this area is good. The system for ensuring that all prospective residents had a detailed assessment undertaken prior to admission to the home gave an assurance both to residents, relatives and staff that a resident was only admitted if the home could meet their needs. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Before any resident was admitted to the home, an assessment of their needs was undertaken, either by a senior member of the staff or, usually, the home’s manager. Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 10 The assessment documents of three residents were looked at. The assessments were detailed and gave a clear indication of the residents’ needs and their capabilities. The assessments looked at the physical, mental and social care needs of the residents, as well as the involvement, if any, of their relatives. The inspector spoke with the relatives of a resident who had recently been admitted, who stated that the manager had been out to the resident’s home to undertake an assessment of her needs and also provided information that helped them to come to the decision that the home would be able to meet her needs. All of the questionnaires returned to the Commission confirmed that each individual felt that they had received enough detailed information prior to making a decision to come into the home. The home has issued new contracts to all residents since the last inspection and evidence of the notification of fee increases were seen and were within the required timescales suggested. All of the relatives and two residents spoken with stated that they had received a contract from the owners that describes the terms and conditions of their stay. Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. Residents’ health and personal care needs are being met and are addressed in detailed care plans. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The manager has reviewed and, where necessary, rewritten the care plans for all residents since the last inspection. The care plans are now extremely informative to enable staff to identify with residents’ specific care needs, together with their preferences, likes and dislikes. All health, social and emotional care needs are identified and individual care plans are prepared for each of the identified needs. The care plans are signed to confirm agreement with them. Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 12 Relatives spoken to on the day of the inspection confirmed that they had discussed the care plans with the manager or her deputy and were able to discuss the residents’ preferences in relation to meals, times of going to bed and getting up and how the service users like things done. Risk assessments are undertaken on all residents in relation to daily living and appropriate measures are put in place to reduce or remove any potential risk. These are recorded in the care files and the agreement of family members is obtained for the use of bed rails and for the use of any other protection equipment, such as pressure mats placed at the side of the bed. All care plans and risk assessments are reviewed on a monthly basis, or as changes in care needs are identified, and these are updated as appropriate. Staff actively promote the residents’ right of access to the health and remedial services that they need, both within the home and in the community. Regular appointments are seen as important and there are systems in place to make sure appointments are not missed. Records show that the home arranges for health professionals to visit frail residents in the home and provides facilities to carry out treatment. Staff keep a regular check on health aids, making sure they are working effectively and that each resident has the necessary aids to improve their quality of life. Records held in the home provide evidence of the input by other healthcare professionals and advice is sought from District Nurses and the Tissue Viability Specialist Nurse as necessary. During our visit we were able to talk with two District Nurses. They confirmed that the staff of the home were good at asking for their advice and intervention in a timely fashion. They also confirmed that the staff carried out the instructions for care as necessary. They felt though that, at times, the staff did not order new dressings that had been requested and this led to a delay in carrying out their treatments. Residents have choice over their personal care and are encouraged to be independent and responsible for their own personal hygiene where possible. Following a recent review in the home there is now a robust medications policy in place and staff have received training in the revised procedures. Inspection of the medications records provide evidence that the staff follow the procedure. All records relating to medications were found to be well maintained and up to date. The medication rooms and trolleys were seen to be clean and organised. Appropriate arrangements are in place for the disposal of unwanted medications through a contract with a disposal company. Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 13 Visitors confirmed that the residents were treated with respect and in a dignified manner at all times. Privacy is respected at all times. Residents are free to meet with their visitors in the privacy of their own bedroom or in one of the communal areas. Visitors confirmed that they were welcome to visit the home at any time and that the staff were approachable and available to speak with them whenever they wished. One visitor said that it was lovely that the staff were forthcoming with updates of their relative’s care without having to ask. Visitors spoke highly of the manager, the care and ancillary staff and commented on how committed and caring they were. “They always ring me to let me know if my aunt has had an accident or a fall since with her condition this does happen. They are careful to let a doctor see her when this happens”. Comments from residents regarding the care include: “Staff are excellent” “The care is really good and I feel really safe here” Oakland DS0000040406.V346447.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The quality outcome in this area is good. The social activities in the home provide the residents with enjoyment and interest and are planned to meet individual preference. The dietary needs of the residents are well catered for, with a balanced and varied selection of food available that meets the residents’ tastes and choices. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Great importance is attached to ensuring that residents are given opportunity for stimulation through leisure and recreational activities. activities organiser is in place who encourages residents to participate in day’s activities and ensures that individual attention is given, as well as more organised group programme. the An the the Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 15 During our visit, two separate groups of residents were seen to join in a baking session, making scones which were later taken with a cup of tea. During the course of conversations, residents spoke frequently about making choices, for example, in relation to what they do during the day, what time they got up or went to bed, and whether they spent time with others or alone. Residents’ rights to follow and practice their religious beliefs are acknowledged and well promoted. The home also holds details of Ministers of Religions who can be contacted to provide services for residents if they are not of the Christian faith. Relatives are invited to meetings, which are held at the home every two months. The dining tables were appropriately set for breakfast and lunch. Residents received appropriate and sensitive assistance with their meals. The lunchtime meal was taken in a relaxed environment, which would have been further enhanced with soft music playing in the background, with staff and residents regularly interacting with each other. Time was taken for residents to eat their meals and staff would ask each person if had they finished or would like a further helping. Staff were observed to assist those residents requiring help in a caring, sensitive and unhurried way, gently encouraging the resident to continue with their meal until they had finished eating. Menus were nutritious and balanced and included a good variety of meat, fish, fresh vegetables and fruit. The home confirmed that, should a resident request something that was not on the menu, alternative meals were available. Residents said they were asked in the morning what they would like from the choices for lunch and tea and all felt this was a good idea. There were many compliments and expressed satisfaction by residents and relatives in respect of the food offered by the home. Oakland DS0000040406.V346447.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. Residents were confident that complaints would be listened to, taken seriously and acted upon. Appropriate systems were in place to protect residents from abuse. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: A complaints procedure was displayed on the notice board in the entrance area and included in the Service User Guide (although this did need updating). Staff interviewed were familiar with the procedure. Residents and relatives knew who to speak to if they had a complaint but said that matters were usually dealt with straight away, so there was no need to complain. These smaller issues were not recorded. The manager may wish to do so for monitoring purposes. The CSCI has recently been notified of a complaint about the home and, at the time of the inspection, the Local Authority Social Services department was investigating the matter. Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 17 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 and staff interviewed showed their understanding of it. The deputy manager knew and understood the reporting procedure, which she had appropriately used in the past. All staff had received POVA training and residents spoken with felt safe living at the home. One investigation under safeguarding procedures is currently taking place, with the full co-operation of the manager and staff. Staff have received adult protection training and were able to demonstrate an awareness of the content of the policy and know the immediate action to take, and who to refer to. Feedback from relatives and others associated with the home stated that they are very satisfied with the service provision, feel very safe and well supported by the home, which has the protection and safety of residents as a priority. Oakland DS0000040406.V346447.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. A safe, clean, pleasant, hygienic and well-maintained building was provided for residents. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Residents live in a homely, comfortable and safe environment. recently been a complete refurbishment redecoration of the home. There has Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 19 A tour of the home confirmed that the home was well maintained, clean and free from any offensive odours. Ramped access was provided to the front door and level access throughout each of the two floors. A passenger lift was provided and handrails fitted to corridors throughout. Everyone spoken with thought the home was a safe place to live and work in. Progress has been made in improving signage and orientation aids on the dementia care unit. For example, toilet doors have been repainted a pastel colour which research has found to be a useful aid to orientation. Further improvements made include the use of fabrics for tactile pleasure situated along the handrails on the corridors of Acorn Unit. There has been improved signage, for example, toilets areas show a picture of a toilet on the door. Each of the bathrooms had a detailed and tasteful mural covering the walls, providing a good atmosphere in which residents were bathing. An alternative shower room was also provided for those residents who preferred to shower. Grounds were seen to be safe, tidy and accessible. Residents said they looked forward to sitting outside in the good weather. The manager may wish to consider the removal of the small kerbstone that edges the lawn area as this could be considered a trip hazard. The Environmental Health Department had undertaken a food inspection in June 2007 and the requirements and recommendations have been met. Five residents spoken to were very pleased with their individual rooms and said that they had “brought in a number of personal possessions to make them feel more homely”. However, one bedroom visited, Room 26, had missing wallpaper and small areas requiring re-plastering where equipment had been removed. All bedrooms were fitted with door locks and lockable storage space to ensure residents’ valuables were kept safe. Staff have a master key, which could be used to gain access in an emergency. Residents and visitors said staff kept the building clean and odour free; inspection of the premises supported this view. Discussion with two domestics verified that sufficient staff and equipment were provided to ensure the home was maintained in a clean and hygienic condition. An infection control policy was in place and training was provided in this area. Staff spoken with described safe infection control practice but were unclear about infection control guidance for residents who may have MRSA. Discussion at feedback identified further training in this aspect of infection control was required for all staff. Disposable gloves and colour-coded aprons were provided for staff use and liquid soap was available throughout. Satisfactory practice was in place with regard to disposal of clinical waste. Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 20 The laundry was sited away from the food preparation area and was seen to be clean and orderly. Sufficient and suitable equipment was provided and laundry was attended to efficiently. Five residents said that they were satisfied with the laundry system at the home and that there was a quick turnaround on the clothes sent for cleaning. On some occasions, residents commented that they had the wrong clothes placed in their wardrobe and the home should take steps to ensure more care is taken with residents’ personal clothing. Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 21 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 adequate. The deployment of staff throughout the day is not sufficient to meet the needs of residents. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Staffing levels within the home were not seen to meet the needs of residents. There was evidence that a further care staff were required between 0800 hours and 1300 hours. This would ensure that residents’ needs could be fully met as this period is a particularly busy time. As well as residents requiring support and help, one senior staff is responsible for administering medicines and, as was the case on the day of the visit, District Nurses are attending the home and require that a staff member accompany them during the visit. These responsibilities lead to a lack of available care staff to ensure that the other residents’ needs are being met. Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 22 Care staff were observed carrying out their duties in a friendly and caring manner. Residents confirmed that staff were always respectful and met their needs competently. In the main, residents were satisfied with the support they were given. Comments received included: “The carers support me when I need help”, “I have to wait sometimes because they are busy with someone else”, “The staff very helpful and willing”. Sufficient ancillary staff were employed, e.g., domestics, laundry and kitchen assistants, cook and handyman. Staff were, in the main, knowledgeable about the needs of residents and demonstrated that they understood their own role. Staff files demonstrated that a robust recruitment process is in place, with all appropriate checks being undertaken. These include references, Criminal Record Bureau disclosures. New staff undertake a full induction programme that is followed by further inhouse training. Eight staff have completed NVQ Level 2 and three staff are qualified to Level 3. Eight staff are presently undertaking National Vocational Level 2 and a further three staff studying to Level 3. Since the last inspection several staff have received training in abuse awareness and more are booked to attend in the future. Staff spoken with showed that their knowledge had increased since the training and that they were more aware and confident in reporting concerns. All staff have attended training in care for residents with dementia. As identified in the Environmental section, further training is required for all staff in the management of infection, particularly MRSA. Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. The home was well managed and run in the best interests of the residents. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The manager had successfully completed the NVQ Level 4, Registered Manager’s Award, in November 2005 and had then undertaken a two-day dementia care course in March 2006. On the day of the site visit, the manager was away on annual leave. However, the deputy manager was able to provide detailed responses to assist the inspection process. Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 24 Since her appointment, the present manager had demonstrated a clear sense of direction and leadership and had made positive changes at the home with regard to management systems, day-to-day supervision and oversight of care planning meetings to determine how residents’ care needs will be met. Staff, visitors and residents said the manager was easily accessible and welcomed her ‘open door’ policy, as well as providing structure and a sense of direction through more formal meetings. Residents said she made sure she spoke to them on her arrival at the home each day, to check out how they were feeling. Throughout the inspection the inspector was able to evidence the professional, capable and approachable manner in which the deputy manager undertook her role when dealing with residents, staff and visitors. The manager was receiving good support and regular supervision from the Operations Manager. Similarly, the manager had continued to implement supervision sessions for the staff team and the matrix showed that all staff were having 1-1’s at regular intervals. Team meetings were taking place and minutes of the meetings were seen. A corporate quality monitoring and assurance system was in place and the audit tools were being utilised. The manager was completing a monthly audit sheet, monitoring medication, randomly checking residents’ rooms and walking around the home on a daily basis, holding relative/resident meetings and having afternoon surgeries, when relatives could call in to see her without an appointment. Any comments, complaints or compliments were noted and any necessary action taken. Senior managers were making regular visits to the home and the Regulation 26 visit sheets were being sent to the CSCI. All safety equipment was regularly serviced in accordance with the manufacturer’s instructions and the appropriate documentation to support this was available for examination. Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP27 Regulation 18(1)(a) Requirement The registered person must ensure that there are adequate numbers of staff in the home to meet the assessed needs of the residents at all times. Staff must receive appropriate training in relation to the prevention of cross-infection, including caring for residents with MRSA. Timescale for action 30/10/07 2 OP30 13(3) 30/11/07 Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP30 OP7 OP7 OP9 OP19 Good Practice Recommendations 50 of the care staff group should be trained to NVQ level 2 standard. 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. Daily entries in the residents’ records should be timed as well as dated. Dressings required for the District Nurse to carry out treatment should be ordered in a timely fashion requested by the practitioner. An assessment of the whole of the premises should be undertaken in respect of painting and decorating required, ensuring that the décor in the premises, especially room 26, is improved for the benefit of the residents. A plan of works should be provided to the Commission for Social Care Inspection. Oakland DS0000040406.V346447.R01.S.doc Version 5.2 Page 28 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.V346447.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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