Inspection on 03/03/08 for Oakland

This inspection was carried out on 3rd March 2008.

CSCI found this care home to be providing an Adequate service.

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 19/10/07

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 3rd March 2008 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oakland DS0000040406.V360286.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.V360286.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 www.southerncrosshealthcare.co.uk Southern Cross Home Properties Limited 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) 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.V360286.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. 19th October 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. As at March 2008, the weekly charges range between £334.98 - £499.00. 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. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key inspection, which included an unannounced site visit to the home. The staff at the home did not know this visit was going to take place. A key inspection of the home took place in October 2007 when it was assessed as a poorly performing home. In order to make sure the home was taking action to put things right, we have done two random unannounced inspections, in November 2007 and January 2008. The November inspection highlighted that the home had still not done everything we had asked them to do, especially in connection with giving out medication safely. This meant we had to send them an enforcement notice setting a timescale in which to put things right. At the January 2008 inspection, done by the pharmacy inspector, the requirements we had made had been addressed within the timescales we had set. This key inspection was done to check whether the level of care being given to residents had improved since the previous visits and to check that staff were continuing to handle medication safely. The outcome of this visit was that the manager and staff had worked together to improve the outcomes for the people living at the home. However, when a home has been assessed as a poor providing service, we need to continue monitoring the home to make sure that it continues to maintain or still further improve outcomes for the people living there. This unannounced inspection took place over one day with two inspectors. One inspector spent nine hours in the home looking around parts of the building, checking the records kept on residents, to make sure they were being looked after properly (care plans), as well as looking at staff files and training records. The second inspector spent four and a half hours at the home, two and a half hours of which was spent observing the care being given to a small group of people in the ground floor lounge. In order to find out what it was like to live at Oakland, five residents were spoken to, as well as the acting manager, responsible individual, a team leader, two care assistants, the chef, administrator, activity worker, domestic, maintenance man and one relative. The visiting district nurse was also spoken to. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 6 Since the last key inspection, in October 2007, we have not received any complaints about the home but we have attended several safeguarding meetings about the neglect of some of the people living at the home, before the present manager started working there. The acting manager and operations manager have co-operated fully with both the Local Authority and ourselves during the time these investigations were ongoing. The allegations of neglect were upheld. Before the July 2007 inspection, we asked the manager who was working at the home at the time to complete an Annual Quality Assurance Assessment (AQQA) 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, one section was inaccurate, it was insufficiently detailed and the equality and diversity areas needed expanding upon. At the last random inspection we asked the current acting manager to complete another AQAA. This had not been completed but we were assured it would be sent to us by the end of the following week so we would have the up to date information needed. What the service does well: The staff team are caring and supporting people in a very person centred way so that individuals can follow their preferred routines and feel secure and cared for. The manager is staffing the home so that the individual needs of the people living there will be able to be fully met. The activity worker had got to know each of the residents so that she could put together an activity programme that met their individual and group needs. This had resulted in residents enjoying a more varied social life, instead of just watching television. The chef was good at his job and the menus were varied and nutritious. He knew the importance of making sure that people had choices at each meal and residents’ special dietary needs were well catered for. He also knew each person’s likes and dislikes and took their preferences into account when serving their meals. Out of a team of 20 care staff, ten had successfully completed a recognised training course (NVQ) either at level 2 or 3 and another six staff were part way through the courses. This training included health and safety elements so they would know how to do their jobs safely, both for themselves and for the people they were supporting. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The staff who work with people with dementia must receive awareness training, so they have the knowledge to understand how to meet their physical, social and emotional needs. Medicines for external use, such as creams, that are kept in the residents’ own rooms but administered by staff must be administered as prescribed and risk assessments must be made to ensure they are safely stored. When the operations manager has done his official monthly visits, he must send us a copy of his report so that we can monitor the improvements to residents’ care are being maintained. The bath and mobile hoists in the home must be serviced every six months so they will be safe for the people using them. Oakland DS0000040406.V360286.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.V360286.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.V360286.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. Residents were assessed before admission to the home, in order to ensure their needs could be fully met. Standard 6 was not assessed as the home does not provide intermediate care. EVIDENCE: Since the last key inspection on 19th October 2007, no new residents had been admitted to the home. The three files checked, for people who had lived at the home for some time, contained pre-admission assessments. The manager said it was her usual practice to always go out and do her own assessments of any potential residents. This practice was followed whether people were funding themselves or being funded by the Local Authority. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 11 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. Due to concerns Social Services had about whether the home were meeting the needs of some people, all the residents have been recently re-assessed, resulting in some people moving out to more appropriate placements where their needs can be better met. One unit of the home caters for people with dementia care needs. At the last key inspection, it was identified there was a low percentage of staff who had received training in dementia awareness and on this inspection there had been little improvement. From speaking to the staff and checking training records, it was identified that out of a staff team of 20, only six had done any dementia care training, although on the day of the inspection, two senior carers were on the Yesterday, Today and Tomorrow dementia care course. The manager said that several of the staff who have recently left had done the training but that this was not reflected in the training figures and they were now having to put on more training courses for the newer staff. She said dementia care training was encompassed in other trainings courses, such as protection training, which almost all the staff team had now received. More training dates for dementia training would be coming out in April. In the meantime, the manager said only staff who had received training or were experienced in supporting people with dementia, would be working in this unit. Oakland DS0000040406.V360286.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 good. This judgement has been made using available evidence, including a visit to this service. Residents’ health and personal care needs were being met by staff who were aware of the need to treat people with respect and dignity. EVIDENCE: The manager said that since the last key inspection, all the care plans had been re-written in a more person-centred way and that they included the information gained from the recent Social Services care management reviews. In conjunction with this, all risk assessments had also been reviewed and updated. Only managers and staff who had done care plan training, were involved in this process. During this time, the manager said they had been able to find out more information about people’s backgrounds and likes/dislikes. This had resulted in people being able to follow their preferred routines, e.g., going to bed much later and getting up when they wanted to, having a bedside light on during the night. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 13 Two care plans and assessments for residents on the first floor and one for a resident on the dementia care unit were looked at. The care plans were much more person centred and included detailed information, which would enable care staff to meet the needs of the people in their care in a consistent way. As well as addressing health and personal care needs, they also addressed choice, privacy, dignity and independence needs. The staff spoken to during this inspection demonstrated their knowledge of people’s needs and how each person needed supporting. Risk assessments were in place in respect of skin, moving/handling, nutrition, falls, continence and dependency. In addition, where risks in other areas were identified, such as choking, falling out of bed, scalding, etc., assessments had been written and implemented. Where high or medium risks had been identified, a care plan was in place addressing how to lower the risk to keep the person as safe as possible. The Malnutrition Universal Screening Tool (MUST) was being used. Those people who had been identified at high risk were being weighed on a weekly basis and their weights had been recorded on the care plans. Where problems had been encountered, advice had been sought from the appropriate health care professional, such as dietician, speech therapist or district nurse. All other residents were being weighed on a regularly monthly basis. Care plans addressed weight issues and more biscuits, fruit, home baking and food supplements were now being offered more regularly. Food supplements prescribed by GP’s were being given regularly and recorded on the medication administration record (MAR). Fluid and dietary charts were also in place so that the manager could easily see what people were getting to eat and drink, so that individuals causing concern could be closely monitored. Personal hygiene records were being completed daily and showed that people were getting regular baths, showers or bed baths. When asked what had improved for residents in the last few weeks, one care assistant said, “The residents are now getting more than one bath or shower a week, we are assisting people to go to the toilet on a regular basis and making sure that people with continence problems are having their pads changed when needed”. In order to meet the needs of the more dependent people in respect of moving/handling, new hoists had been delivered and were in use. Upon coming on duty, staff were now given clear instructions in respect of their duties for the day. The staff spoken to felt this was much better as they were clear about their roles and accountable if they did not do their jobs properly. This meant that tasks were not missed, duplicated or simply ignored. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 14 Observations made during the visit, showed people to look clean and cared for with appropriate clean clothing being worn. Two relatives spoken to at the last random inspection were very satisfied with the care being given to the people they visited. Only one relative was seen on this visit. She said, “The presentation of residents has really improved. My mum is always nicely dressed and looks cared for. She also has more regular baths now and her skin is much improved. The district nurses are very pleased with her”. The visiting district nurse was spoken to during this visit. She had been coming into the home since November 2007 and said she had seen big improvements in care practice. She also said, “Residents are now getting the basic care they need, pads are changed regularly, they are clean, looked after and if there’s a wound problem, the staff are letting us know straight away. People’s appearances have improved. We’ve been in today to see a resident who has a pressure sore and are happy with the care he is getting. Staff are following our instructions and applying the Cavalon cream as needed. Also, they are ordering dressings on time and no longer running out”. The nurse also said, “The manager is very helpful and works with us. The staff attitude is great, especially the person who has accompanied us today – she’s brilliant”. The district nurse also confirmed that the staff were following the MUST protocols for those people who were assessed as being at risk of malnutrition. Over the past five months, due to concerns about the way medication was being handled, the pharmacy inspector has visited the home three times. The visit on 29th November 2007 resulted in the home being served with an enforcement notice, telling them that if they did not do everything that was needed to ensure residents’ safety, that they would be prosecuted. On his last visit in January 2008, he felt the manager and staff had adhered to the notice and that medication was now being administered safely to the people living at the home. He did, however, note that two areas were in further need of improvement and therefore only these areas were looked at on this inspection. One concern was the way staff were giving out medication, when needed (PRN), to reduce anxiety levels in some of the residents. Care plans were now in place for all people on PRN anti-anxiety drugs, clearly setting out what staff should do if they became agitated, before giving them medication, e.g., offering distractions, spending time with them, taking them to a quiet area. This meant that on each shift, staff were now working consistently with individual residents. One care plan stated “Senior staff to administer medication if needed but please report and record any problems in respect of agitation so we can monitor when this is occurring”. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 15 The other concern was in respect of records for external medicines, such as creams. The cream records were kept in individuals’ bedrooms and three were checked. The record for one person was missing and the manager addressed this with the team leader at the time of the inspection. The other two residents charts showed missing signatures on some days which indicated the creams had not been applied. The manager spoke to the staff concerned who confirmed they had applied the creams but had forgotten to sign the sheets. The manager said this was an area that would be closely monitored to ensure staff complied with the correct procedures. Care plans recorded that creams should be signed for when given. The pharmacy inspector had also identified there were insufficient staff trained in giving out medication for both the day and night shifts. Action had been taken to address this and the Manager advised that five seniors were doing Boots training on 7th March 2008. Following the training, assessments and supervisions were to be done to assess competency to ensure the home’s policy and procedures were followed. Privacy and dignity of residents had significantly improved since the last key inspection. Care plans addressed these areas, and recordings such as “Make sure her hair is brushed”, “Likes to be smartly dressed”, “Smart proud lady let her choose her own clothes” were noted. Residents on both units were appropriately dressed and looked cared for. One resident said, “I like to shower myself with a bit of help from the girls. You can get up when you’re ready – they don’t wake me. They’re all very nice girls and helpful”. The relative who was spoken to said she felt that the residents were treated with respect and in a dignified manner at all times and we observed good practice during our visit. Residents were free to meet with their visitors in the privacy of their own bedrooms or in one of the communal areas. During the inspection five residents were observed for two and a half hours in the morning, in the dementia care unit. One person spent a lot of time asleep; the other four were relaxed and seemed to be in a positive state of mind. There was warm and friendly interaction between people and staff. There was at least one member of staff in the lounge area throughout the observation. Relatives and care staff told us that this was normally the case. No poor interactions were observed. People being observed were happy, smiling and laughing. They related well to each other and to staff. Carers asked people questions about what they thought and what they wanted. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 16 The staff spoken with were able to give examples of how people’s privacy and dignity were upheld. One male care assistant knew which residents did not like a male carer to assist with personal care tasks. He also said he waited outside the toilet for one person who got embarrassed. Other examples given were locking the bathroom door and telling staff not to interrupt, taking clean clothes into the bathroom so the person would not be left in a state of undress, knocking on doors before entering and closing curtains. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence, including a visit to this service. People could follow their preferred lifestyles/routines and a good social activity programme ensured their social and emotional needs were being met. EVIDENCE: A requirement was made at the last key inspection, for an activity programme to be put into place, which met the needs of the people living at the home. This had been fully met. A full-time activity co-coordinator was now working at the home, organising group activities, as well as allocating one to one time to those people who enjoyed it. Care plans were now recording residents’ social and leisure preferences and the activity worker was completing a sheet showing what each person had enjoyed doing on each session. It was evident the activity co-ordinator had spent time getting to know each person and what they liked to do. Photographs were displayed on both levels of the home showing some of the activities that people had been involved in. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 18 One resident spoken to expressed how much she had enjoyed making Christmas crackers and joining in the craft sessions. Another person said she simply enjoyed having a chat to her. Activities recently enjoyed included making mother’s day flowers, having sing-songs, dancing, armchair exercises, exercises with balloons and soft balls, organ playing, nail care and craft sessions. Three of the male residents had been out to the local pub twice and one of the staff was trying to arrange to purchase a fruit machine, as it had been identified that one of the male residents really enjoyed this type of activity. The activity worker had given another resident, whose only real interest is music, a small portable IP3 player that he carried around the home playing and humming to. Plans were in place to introduce memory boxes for each person so that photographs and other mementos could be used for reminiscence one to one sessions. During the visit an activity was observed taking place in the ground floor lounge. Residents were given ribbons to wave in time to music. People enjoyed watching the activities co-ordinator do this, although the people being observed did not physically join in. One person being observed clearly enjoyed dancing to the music, and a relative commented that this was one of the pleasures this person had retained. In the afternoon, another activity took place in the first floor lounge and residents also enjoyed chatting to the activity worker. One shortfall identified at the last visit had been the absence of church visitors to the home. The manager had addressed this and a monthly service was now being held at the home. The photographs on one of the notice boards showed people enjoying this. Observation and discussion with residents and staff showed that residents were able to make day to day decisions regarding rising/retiring times, what clothing to wear, where to sit, what to eat and whether or not to be involved in activities. Residents’ wishes regarding involvement in their financial affairs were established on admission. The majority had asked relatives or friends to be responsible for finances. Residents were able to bring personal possessions, including furniture, with them and evidence of this practice was seen in bedrooms. The chef on duty had not been working at the home for very long but he had already got to know people’s individual likes and dislikes. He also knew who needed to be on special diets and was catering well in this respect. The care plan of one person recorded they needed to have a pureed soft diet. At breakfast, this person was served a plate of soft scrambled eggs, which she really enjoyed. Upon finishing it she was asked if she would like some more and another plate was offered. At lunch, her meal was pureed and served in appetising individual portions and she was able to eat it without assistance. This resident said the chef was very good and that she liked the food he made. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 19 Another resident said, “The chef makes the right food for me now and I can eat it. He has a list of what I like to eat, before it was always sandwiches”. The visiting relative said, “When I bring my mother back at lunch time, the food looks nice and its hygienically kept so it can be warmed through”. Care staff were sensitive to the needs of residents, for example, they gave encouragement, assisted as needed and carefully monitored what people were eating. Southern Cross, as an 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. The chef had received the appropriate training. At the last inspection, it had been identified at a resident/relative meeting that people wanted to make some changes to these menus to include different foods, such as bread and butter pudding, more roast dinners, mackerel and rice pudding. The chef had listened to this and made the changes. Bread and butter pudding was offered on the day of the visit and it was very tasty. We also sampled the main course, which was a choice of vegetarian lasagna or pork casserole served with green beans, new potatoes and cauliflower. Both were nicely presented, hot and tasty. The kitchen and dining rooms were clean and tidy, and kitchen assistants were now employed to cover kitchen duties seven days a week. A short period over lunch was observed. The only concern was that people had to sit at the dinner table and wait for more than 15 minutes before the meal was served. During this time, staff were not available in the dining area and people were becoming agitated and restless. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 20 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. This judgement has been made using available evidence, including a visit to this service. Residents and visitors to the home had confidence their complaints would now be listened to and acted upon and staff had been trained in what to do if abuse were suspected in order the people in their care would be protected. EVIDENCE: A complaints log was in place and, since the last inspection, one complaint had been recorded in respect of missing clothing. This had been appropriately addressed. There is a monthly complaints monitoring and audit and these, together with a record in the Southern Cross Complaints Register, ensure the correct procedures are being followed. We have not received any complaints about the home since the last key inspection. Residents and relatives interviewed were satisfied that complaints would be listened to and acted upon and were aware of how to make a complaint if needed. One relative said, “I address things immediately with the manager and she puts things right before they become problematic”. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 21 Over the past few months, and before the present manager started working at the home, there have been a number of safeguarding alerts, alleging neglect of residents. These have been investigated by staff from Rochdale MBC’s Social Services Department. The outcome of all the investigations was that neglect of residents was upheld. The current manager and staff team have worked cooperatively with us and Social Services during this difficult time and have implemented all requirements and recommendations made both by ourselves and Social Services. The responsible individual for Southern Cross confirmed on inspection that the name of one former staff member had been submitted to the Department of Health for their consideration in respect of inclusion on the Protection of Vulnerable Adult register. A copy of Rochdale MBC’s Guide for the Protection of Vulnerable Adults was in place, as well as the Southern Cross Vulnerable Adult and whistle blowing policy. A requirement was made at the last inspection for all staff to receive protection training. This had been met for all but the very newest staff members. The staff interviewed were clear about the reporting process and said they would have no hesitation in reporting bad practice. They all felt these sessions had been productive and their awareness was now greater about the need to make sure that residents were looked after as set out in their care plans and risk assessments. The manager said she had stressed to the staff that they had a duty of care to the residents and any neglect would be classed as abuse. At the last random inspection, we were advised that one senior carer had used the home’s whistle blowing policy in respect of two staff, resulting in them being dismissed on the grounds of gross misconduct. Whilst the misconduct did not directly involve the residents, it was heartening to see that staff now feel sufficiently empowered to use this policy to report problems. At a safeguarding meeting attended by us on 12 February 2008, one relative commented she had seen a marked improvement in the appearance of the person she visited. Another relative said she was pleased to see staff now wearing red tabards when giving out medication, so they were not disturbed during this process. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 22 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. 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: Since the last key inspection, improvements were identified in respect of redecoration of bedrooms, lounges, dining rooms, corridors, stairs and reception area. In addition, new beds, bedding and towels have been purchased and new curtains ordered for the first floor lounge. The first floor dining room had also been fitted with a small kitchenette area so that drinks and snacks could be prepared there. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 23 Upon arrival at 08:00 the home looked clean and there were no unpleasant odours around the building. The kitchen was also clean and tidy and a recent Environmental Health visit had taken place, resulting in no requirements being made. We spoke to one of the domestics who had worked at the home since December 2007. She said she worked full-time and that another domestic was employed full-time and one part-time to work evenings. She felt this worked well and said the home could be kept clean and fresh and they had sufficient time to bottom bedrooms on a rota basis. She also confirmed that several bedroom carpets were cleaned on a daily basis in order to ensure the rooms did not start to smell. One of the residents spoken to said, “The girls keep it nice and clean” and the relative also said, “There are no smells in the home any more, it’s much cleaner now”. The manager’s future plans were to upgrade all toilets and the shower room and to re-decorate the bathrooms. The laundry was well equipped and new non-slip flooring had been fitted. Also, there were more shelves provided so that each resident had their own basket in which to put clean clothes when sorted. A relative commented, “The laundry situation is much better now. The laundry worker is very good and conscientious. It used to be chaotic.” Good infection control practices were evidenced, e.g., staff wore blue aprons for serving and assisting with food and white ones for personal care duties; there was a good supply of gloves and disposable aprons; paper towels and liquid soap were supplied in all areas, including people’s bedrooms. A requirement in respect of staff receiving infection control training had been made at the last two inspections. This requirement had now been met with 30 staff having completed this training. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 24 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 good. This judgement has been made using available evidence, including a visit to this service. The home was well staffed, which meant the personal, health and social care needs of the residents were being met by staff who had received the right training. EVIDENCE: From checking the rotas and speaking to the manager and staff, it was evident that the home was well staffed for the number of people currently living there. The manager said she wanted the residents to feel cared for and secure with the new staff team and for staff to have time to spend with the residents, as well as keeping up to date with the paperwork. There were always four staff on at night, with a senior always on duty. Since the last inspection, the manager had appointed new staff to deputy and senior posts. There were now two team leaders who were each responsible for their own units and also designated seniors. The new management team had been closely monitoring and supervising the staff to try and make sure they were working safely and caring for the residents so that their identified needs would be met. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 25 The manager, with support from the operations manager had taken a strict approach to poor practice within the home, resulting in some staff receiving disciplinary warnings, being dismissed or leaving for other jobs. This had resulted in a high turnover of staff but it was felt this was for the best, given the poor care practices identified in the past. The manager felt she now had a good team of staff who were working well together and co-operating with her. The staff felt they were now working better as a team, were being given proper guidance and support, resulting in staff morale significantly improving. One carer said, “We’re committed to working as a team, I understand now about what to do and the care of residents is therefore much better.” Another carer who had worked at the home for only four weeks said, “It’s the first home that I’ve felt at ease in because everything is done right for the residents”. One of the team leaders who had worked in the home since November 2007 said, “The new team is great, we’re all working well together and fully meeting the needs of the people we are caring for”. She also felt that as a result of staff spending much more time with residents on a one to one basis, those people who had previously not communicated had begun to talk and express their wishes more. She also said that staff had been encouraged to complete paperwork in lounges rather than the office so they could interact with the residents. All the staff spoken to felt the residents were much happier and contented and that the atmosphere and morale within the home was good. Of the 20 care staff currently working at the home, six had completed NVQ level 3 training or had other equivalent qualifications. One carer was currently doing the training and two had recently signed up for level 3 training. In addition, four carers had completed their NVQ level 2 training and five were doing it. This equated to 50 of qualified staff. This level of trained staff had significantly improved since the last inspection. Three staff files were checked. All contained completed application forms, two references, interview notes, Pova First checks and evidence that Criminal Record Bureau checks had been sent for. The manager was reminded that care staff should not be working unsupervised until a satisfactory CRB check has been obtained. In addition, staff handbooks had been given to the staff that contained shortened versions of the organisation’s policies and procedures. Training files were in place for each of the three staff. These showed two staff to have undertaken thorough induction training with another person having done induction training to the Skills for Care standards at their previous job. Within the 12 week induction period, or within the last 12 months, the files contained evidence that mandatory training had been completed. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 26 On the day of the inspection, four staff who had been recently recruited but had not yet started work, were at the home undertaking a day’s induction training which was being given by a manager of another of the organisation’s homes. She showed us the induction programme which was thorough and addressed Skills for Care standards. A new fire induction training book had just been introduced and was now used as part of induction training. From checking the training matrix, improvements were noted in the number of staff who had now attended training in fire safety, infection control, moving/ handling and food hygiene. Only the very newest staff were still waiting to do this training and the manager said this would be arranged as quickly as possible. Nine staff had also done nutrition training. From checking the training matrix, it was noted that only seven staff had done first aid training. The manager should be aware that a member of staff trained in first aid should be on duty at all times, unless a risk assessment indicates otherwise. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 27 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 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Whilst the home is now being well managed, the manager must ensure that the improvements are sustained so that the outcomes for the people living there continue to be positive. EVIDENCE: The home has been without a registered manager for approximately seven months. Since the last key inspection in October 2007, a temporary management team have been working at the home, addressing the major shortfalls that were identified at the October 2007 inspection. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 28 The current acting manager was appointed and accepted a contract to be the manager of the home in mid January 2008, although she had been working at the home for longer. She is a qualified registered general nurse with many years’ experience in the nursing profession. She is also an experienced care home manager and had successfully managed another Southern Cross care home since 2001. She completed the Registered Manager’s Award two years ago and has also done a dementia training module for “Care of People with Dementing Illnesses”. She confirmed she would be completing an application to become the registered manager of the home very shortly and would be submitting the application to us as soon as she had obtained the necessary documents needed to accompany the application. The key inspection in October 2007 highlighted major shortfalls in how the home had previously been managed, which had resulted in residents not being properly cared for. The new acting manager and the operations manager have worked hard to address these shortfalls, resulting in major changes being made to ensure people living at Oakland are having their needs fully met by staff who understand their jobs and have been trained in how to care for people with respect and dignity. Clearly, this has been an uphill struggle and it is to the manager’s credit that she has achieved major changes in the culture of the home. It was evident from interviewing staff that they now understood that the main focus of their job was person centred care. Whilst these positive changes are acknowledged, it is now crucial that the progress and improvements made are sustained so that the residents and their relatives will have confidence in the staff team and know the residents’ needs will continue to be met by staff who are committed to their jobs. The following improvements were noted: staff meetings were now being regularly held, more staff training courses had been arranged, thorough induction training was taking place, staff had daily designated duties resulting in residents being monitored in the lounges, staffing levels ensured people were receiving regular baths/showers, being toileted regularly and having time spent with them on an individual basis so as to meet their social and emotional needs. Care plans were up to date and person-centred and risk assessments were in place where risk areas had been identified. The manager was spending time on the floor observing staff practice and making sure residents were clean, appropriately dressed and cared for. In addition, the home was clean and hygienic and many areas had been re-decorated and upgraded. Whilst supervision was taking place, two staff files for more recently employed staff showed they had not yet received supervision. This should be addressed. Both the operations manager and the responsible individual had been regularly calling at the home to monitor that the improvements were continuing. The manager was also doing unannounced visits at weekends to ensure the staff were following instructions and fulfilling their roles as she expected. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 29 Staff feedback about the new manager was positive. At a safeguarding review meeting we recently attended, relatives of people still living at the home were complimentary about the way she had tackled the previous bad practice and introduced new improved ways of working within the staff team. One relative said, “The new staff have caring attitudes and take time to sit with residents”. A relative spoken to on the day of the visit said, “I’ve got confidence in her, she’s very passionate about her job”. Other feedback received from the staff included: “She’s very fair and treats everyone the same”; “ She spends a lot of time with the residents”; “Staff have respect for her; “She’s approachable”, “Very caring, strict about standards but fair”; “She checks you’re doing your job properly and that’s meant the care for the residents has improved”; “She can be abrupt and doesn’t stand for any messing but this means things get done”. A corporate quality monitoring and assurance system was in place and the audit tools were being used. The manager did a monthly audit that was validated by the operations manager. Due to the many problems that had been identified in the past in respect of medication, pressure sore care, weight loss and falls, these audits were also being done regularly. Action plans were completed where shortfalls were identified. Resident falls in the home had recently lessened due to the manager taking action to ensure that lounges were appropriately staffed, people were getting the right food and being properly cared for. Questionnaires to relatives were sent out twice yearly and the next batch was due to be sent out very shortly. These were then returned to the regional office so that responses could be collated before they were returned to the home. When results of the feedback are available, a copy should be forwarded to us (The Commission for Social Care Inspection), so that we can monitor that improvements are being maintained. Two recently returned relative comment cards were seen and expressed satisfaction with the improvements in care to the residents whom they visited. Relative/resident meetings were being held, the last having taken place on 31st January 2008. The next one was due to take place on 27th March 2008. Suggestions made at the last meeting for changes to the menus, had been implemented by the chef. The manager was addressing other issues that had been raised. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 30 As previously stated, the operations manager was closely monitoring the home’s performance and Regulation 26 visit sheets were seen on site for November and December but not for January and February. The manager said these visits had been done but the reports had not yet been received. In order for us to monitor that the present improvements are maintained, copies of the Regulation 26 visits must be sent to us for the next three months, up until the end of May 2008. Where the home held any money for the residents, all income and outgoings were listed on the computer and print-outs were given to residents and/or relatives upon request. Due to the mental capacity of the residents, their relatives or advocates managed their financial affairs and regularly liaised with the administrator to check that sufficient money was held at the home to pay for hair, chiropody, etc. The financial records of three residents were looked at and were satisfactory. The organisation had detailed health and safety policies and procedures in place which were reviewed and updated as needed. Information contained on the Annual Quality Assurance Assessment (AQAA), returned to us in July 2007, showed that the required maintenance checks had been carried out. A random sample of fire records and lift servicing showed the fire maintenance checks were in order but the servicing of the bath hoists were a month overdue. This must be addressed in order to ensure the safety of the residents. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 31 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 3 8 3 9 2 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 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 X 3 X X 2 Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 18 Requirement Staff who work with people with dementia must receive dementia awareness training so they will understand the needs of the people for whom they care. Suitable arrangements for the recording, administration and storage of external medicines, such as creams, must be made to ensure they are administered to residents correctly and not mishandled. (Previous timescale of 17/02/08 not met). The operations manager must send a copy of the Regulation 26 report to us for January and February 2008 and for the next three months so that we can monitor that the improvements in care practice are being sustained. All bath and mobile hoists must be serviced at least on a six monthly basis to ensure the equipment is safe for the people using it. Timescale for action 31/05/08 2 OP9 13(2) 31/03/08 3 OP33 26 31/05/08 4 OP38 23(2) 31/03/08 Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 33 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 Refer to Standard OP15 OP30 Good Practice Recommendations Residents should not be assisted to the dining room until it is time for food to be served, so they will not become agitated and restless. A member of staff trained in first aid must be on each shift, unless a risk assessment has been done that identifies this is not necessary and the reasons why residents will not be put at risk. Oakland DS0000040406.V360286.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Manchester Local Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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.V360286.R01.S.doc Version 5.2 Page 35 - 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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