Inspection on 05/05/06 for Oakland

This inspection was carried out on 5th May 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Oakland 03/03/08

Oakland 19/10/07

Oakland 23/08/07

Oakland 08/12/06

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 5 May 2006 07:30 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.V288261.R01.S.doc Version 5.1 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.V288261.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Oakland Address Oakland Oakwood House Bury Road Rochdale Lancs OL11 5EU 01706 642448 01706642389 oaklandrochdale@highfield-care.com 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 (Hamilton) 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.V288261.R01.S.doc Version 5.1 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. The registered manager must undertake formal/certified training in respect of caring for older people with dementia within 6 months from the date of registration 31st October 2005 2. 3. 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 services both levels of the home. Oakland is situated approximately 1 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 well maintained garden is situated to the side of the home which residents can access via the ground floor lounge. The weekly charges range between £323.01-£470.00 as at 6 May 2006. Additional charges are made for private chiropody treatment, hairdressing, physiotherapy and for providing an escort to hospital or to the Doctors. The provider makes information about the service available upon request in the form of a Service User Guide and Statement of Purpose, which is given, upon admission, to each new resident. A copy of the most recent Commission for Social Care (CSCI) inspection report is displayed in the entrance hall and the summary is contained in the service user guide. Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a day and a half by one inspector. On the first day, the inspector arrived at 07.30 in order to speak to the night staff and observe the staff handover. Time was spent on both units, watching how staff spoke to and looked after the residents. In order to find out what it was like to live at Oakland, 8 residents were spoken to as well as the manager, 2 night and 3 day care assistants, the chef, activity co-ordinator, maintenance worker, visiting district nurse and 5 visitors to the home. Comment cards from a care manager, G.P. and 4 relatives were also received. The inspector also looked around parts of the building, checked the records kept on residents, to make sure they were being looked after properly (care plans) as well as looking at how medication was given out. A new manager was appointed to run the home in August 2005 and since this time, the Commission for Social Care Inspection (CSCI) has seen a big improvement in the way the home is being run. There have been no complaints received about the home since the last inspection in October 2005. What the service does well: The residents and visitors spoken to were very satisfied with the staff team. Comments received about them included: “good”, “excellent”, “perfect”, “treat me well”, “have a laugh and joke”, “nothing too much trouble for them”, “staff listen to me”, “nice to see staff with smiling faces”, “well cared for” and “really caring”. The manager, who was experienced and well trained, had been at the home for about 10 months and had made a lot of changes, which had benefited the residents. There was a nice atmosphere within the home. During the inspection, at different times of the day, the staff chatted to the residents or helped them to move around the home. Several relatives also said they saw this when they visited. Residents said the food was good, varied and they were given choices at each meal. They especially liked the cooked breakfasts, which were on offer to them every day. They also enjoyed the starters of either melon or soup before their main meal, which was served at mid-day. The home was good at making sure residents’ health was taken care of, by sending for district nurses or other health workers when needed. Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Some staff were not passing on information to others so that everyone could care in the same way for the residents. Not all the bedrooms, bathrooms and toilets had liquid soap and paper towels in so that staff could try and make sure that germs were not passed from one resident to another. The ordering of medication needed to be improved so that residents did not run out of medication, which could result in a health problem. More staff were needed to make sure there were enough on duty to care properly for the residents. Not all of the staff had received training in how to do their jobs properly when they first started work. Some staff still needed training in how to help residents move safely and to make sure that infections were not passed from one person to another. Oakland DS0000040406.V288261.R01.S.doc Version 5.1 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. Oakland DS0000040406.V288261.R01.S.doc Version 5.1 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.V288261.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Standard 6 does not apply to this home. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The Service User Guide and Statement of Purpose were detailed and would enable prospective residents and/or their representatives to make an informed choice about whether they felt the home would be suitable for them. Residents were assessed before coming into the home to ensure their needs could be satisfactorily met. EVIDENCE: The Statement of Purpose and Service User Guide had recently been reviewed and updated to reflect the home’s change of provider to Southern Cross Healthcare. The Service User Guide included a copy of the summary, from the Commission for Social Care’s (CSCI) last inspection report, together with the home’s action plan to address the requirements. This good practice is acknowledged, as it gave the reader a clear idea of what the home did well, what had been improved and what the home could still do better. Copies of the Service User Guide, Statement of Purpose and full inspection report were displayed in the entrance hall. New residents and/or their representatives are Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 10 given an admission pack containing all relevant information. In addition, a copy of the service user guide is in every residents’ bedroom. One of the residents spoken to said they had received the information when they first came to the home. The manager or deputy manager undertook pre-admission assessments for all new residents, visiting them either in their own home or at hospital. If there is social work involvement, a care manager assessment is also received. Two files were looked at, for two recently admitted residents, one from the residential unit and one from the dementia care unit. Both contained detailed assessments, which had been done by the manager. The dementia assessment was very detailed and relevant to the resident. From the assessment an initial care plan is drawn up with a more detailed plan being done at a later stage. The manager demonstrated her competence in the assessment process. She said that admissions to the home only took place if she was confident the home could meet their needs. When emergency admissions happen, the resident is assessed within the first day or two of admission. Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The individual health and personal care needs of residents were being met except for some shortfalls identified with regard to medication which could impact on residents’ health. Residents were accorded a standard of care and attention which respected their privacy and dignity, recognised their individuality, fostered independence and enabled them to control decisions in their day to day routines. EVIDENCE: Three people’s files and care plans were checked. Two care plans were for fairly new residents (one from each of the units) and one was for a resident with many needs. Their care plans were detailed, easy to understand and identified their needs and choices with regard to daily lifestyles and routines. The plans were very individualised and one plan demonstrated the home’s willingness to assist a resident with the grieving process following a bereavement. Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 12 Two of the residents were spoken with and it was clear that the care plans reflected their individual needs. The care plan for one resident on the dementia care unit had not been updated to reflect her current needs. The manager said she would ensure this was addressed immediately. Ethnicity, culture and religion were included in the care plan files. Whilst care plans had been written in consultation with residents and/or relatives, two of the plans had not been signed to say they were in agreement with them. The plans were being reviewed and updated monthly although one plan had not been updated since the end of February as the key-worker had left. The new worker was unaware the resident had been allocated to her and was unclear about the personal care needs of this person. Clearly, there had been a breakdown in communication and the manager needed to address this. The manager had implemented a 6 monthly reviewing system whereby residents, their relatives and relevant health care professionals/care managers met to discuss whether the resident was satisfied with their placement and to check if their needs were being met to their satisfaction. Any agreed changes were noted and implemented. At one client review, the minutes, of which were seen on file, it recorded the manager had addressed whether she would like the home to get in touch with a society linked with the country of her ethnic origin. It was recorded that the resident had declined this offer. Where challenging behaviour was identified, the appropriate forms were completed with action plans detailing how staff should address any problems. Risk assessments were undertaken as part of the admission process. All three files contained detailed risk assessments for skin (Waterlows), moving and handling, dependency, nutrition, continence and falls. All had been regularly updated. Where areas had been assessed as high or medium risk, the care plans showed the action taken to reduce the risks identified. Where it was identified there was a high risk of infection, the care plan was extremely detailed and in the main, the plan was being adhered to. However, no liquid soap and paper towels were in this resident’s room. This was immediately addressed as soon as the shortfall was identified during the inspection. Residents health care needs were well recorded. The care plans contained professional visitors sheets which identified visits had been made to the home by chiropodists, dentists, district nurses, GPs, community psychiatric nurses and dietician. The daily information records were detailed especially where residents were suffering from ill health. Residents spoken with confirmed that if they felt unwell, the staff would ask the doctor to visit. One resident was spoken to who was clear suffering from ill health. He said he liked to spend time in his room and that the staff did all they could to make him comfortable. He said all the staff were excellent and that nothing was too much trouble for them. The visiting district nurse was spoken to during the visit. She felt the residents were well cared for and that usually, staff followed her instructions. She did feel that communication needed improving and that having a member Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 13 of staff to escort her and note any instructions about each person, would be a way of ensuring that the necessary information was passed to all staff. Nutritional screening was undertaken upon admission and residents weight was recorded on their care plan. Where a resident had lost quite a significant amount of weight, but was not considered under-weight, there was no action plan in place to address the weight loss. The home must ensure that any significant weight loss is monitored and the care plan reflects what is being done to address the problem. Detailed medication policy and procedures were in place but staff were not always adhering to them. It was noted that for varying reasons, 5 residents had run out of medication over the weekend, one person being without five different tablets because there had been a mix up with her prescription. Whilst the deputy manager was addressing this, the situation would not have arisen if staff had communicated the problems to the relevant persons earlier. Supervision notes on senior staff files identified the deputy manager had been reinforcing good medication practice to them, but clearly problems were still arising. The manager must ensure that where it is identified staff need further training this is implemented. The Boots representative had called to collect the medication returns on the Saturday but the senior on duty had only returned the medication from one unit. The returns on the other floor were still in the medication room awaiting pick-up. A returned comment card from a G.P. indicated improvement was needed in relation to areas around medication. The arrangements in place for controlled drugs were in order and staff were following the procedures. None of the present resident group were self medicating but if a resident did wish to self-medicate then a risk assessment would be done. The home’s philosophy of care contained reference to core values such as privacy, dignity and independence and resident feedback was good with regard to how staff treated them. All service users interviewed said the staff were respectful and treated them well. In order to uphold privacy, the District Nurse saw residents in their own bedrooms as did religious visitors to the home and this was evidenced during the inspection. Observation of records and information provided by the service users and staff indicated that service users were being encouraged and supported to be as independent as possible within individual capabilities and enabled to follow their preferred routines. Throughout the day frequent interactions between staff and service users took place and it was observed the staff treated the residents with respect through their kind and caring manner. One care assistant was observed covering up a resident who continually played around with her clothing. Another resident kept pulling up her trouser leg and staff patiently put it right for her. The Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 14 maintenance man, domestic and activities organiser also clearly knew the residents as individuals and had good relationships with them. There was a good atmosphere in the home on both days of the inspection. Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area was good. This judgment has been made using available evidence including a visit to this service. Residents were encouraged and supported to exercise choice in their daily routines in relation to lifestyle and activities and to maintain contact with their relatives. The dietery needs of residents were well catered for with a balanced and varied selection of food available at each meal. EVIDENCE: Feedback from residents indicated they were able to make choices with regard to their daily routines and lifestyles. One resident liked to spend the day in his room and said that staff popped in regularly to see if he was alright. Another resident said she chose her own clothes, could choose what time to get up and go to bed and if she didn’t want to join in social activities, this wasn’t a problem. Another resident had arranged to go to the kitchen every day to get portions of fresh fruit and on the day of the inspection, was seen to enjoy a bowl of fresh strawberries. Bedrooms had been personalised and two residents said they had been encouraged to bring ornaments and other personal possessions in with them to make their rooms more homely. In the main, residents rely upon their families to handle their finances but if they have the capacity to do this Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 16 themselves, then this would be encouraged. The home had leaflets displayed about an advocacy service which offered a wide range of services. The home had signed up to the service but had not yet implemented the necessary paperwork which would enable residents and/or their relatives to use the services offered. This should be addressed. A new activity worker was in post who had previously been a professional entertainer. From observations made, he clearly enjoyed his job. He had worked at the home for approximately 10 weeks but the first 6 weeks had been spent getting to know a bit about each resident and what they liked to do. He had written an activity programme which was displayed on both units but was still adding to it, dependent upon what the residents wanted. He had started taking residents out on an individual basis to the shops, pub etc. and was planning to organise trips out for larger numbers during the Summer months. So that he could understand more about the people he was working with, he had arranged for a representative from the Alzheimers Society to give a talk, the week following the inspection. Several relatives as well as some of the staff were attending and some members of the public had also rung the home to ask if they might attend. The response from the public was particularly pleasing as their attendance could foster links with the local community. During the first day of the inspection, many of residents on the dementia unit enjoyed the freedom of going outside into the garden where music was being played. One resident enjoyed dancing and playing with a football with two of the male staff. A game of skittles in the dementia unit was also enjoyed by several of the residents. Three of the residents spoken to said they had enjoyed the Easter bonnet celebrations and were looking forward to more trips out in the Summer. One trip had already been planned to the Ronald Gorton Centre for a concert. One of the relatives spoken to said activities had greatly improved but that she would like to see some quieter activities which would meet the needs of some of the more reserved residents. The manager had also organised social events e.g. a bistro night and Halloween and Christmas parties and both resident and relative feedback was very positive about the events. Several relatives said they were always invited to the home when events were organised, which they enjoyed attending. Residents religious needs were addressed as part of the admission procedure and recorded on each residents social history sheet. Different denominations were visiting the home and staff were in the process of arranging for a resident to have a regular visitor from her particular faith. A phone call about this was taken on the second day of inspection. During the inspection, 6 relatives were spoken with. All felt the standard of care offered had improved considerably since the manager was appointed and positive comments were made about her finding time to speak to them if they Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 17 had any concerns. They confirmed they could visit whenever they wanted and that they were made welcome. One person still felt that communication could be improved as she felt she was having to repeat things about her mother time after time to different staff. Feedback questionnaires were also very positive about the manager. A new chef and assistant chef were in post and service user feedback indicated food had improved. Comments received included “food better here than I was having at home”,, “the food is good and there’s always a choice” and “the food is getting better and better”. Cooked breakfasts were available every day and several residents enjoyed these. This was witnessed on both days of the inspection. The four weekly menus offered a variety of nutritious food with plenty of fresh vegetables and fruit being included. Milk based puddings and custards were regularly offered and fruit was also incorporated into desserts. The main meal was served at lunch time when a starter of either soup or melon was served. Observations showed the residents were especially enjoying the soup. A choice of two main meals was offered daily to the residents and they could make their choice at lunch time as the chef made sure he cooked enough of both meals. He said he could now make a fairly accurate guess how much of each meal to cook. This good practice enabled each of the residents to have a real choice. A hot snack or sandwiches together with a dessert was served at teatime. Toast or biscuits was offered at supper time together with drinks of their choice. Special dietary needs of the residents were being catered for. Where food supplements were being given to residents, they were recorded on their medication administration record (MAR) sheets and these showed they were being taken regularly as prescribed by their GPS. At mealtimes, residents were observed being assisted on a one to one basis. Those on the dementia care unit were gently persuaded to eat more and to finish their drinks, before getting up from the table to ensure they got sufficient food and drink. Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. An effective complaints system was in place which residents were familiar with. Adult protection training had improved since the last inspection and there was clear evidence that residents were being protected from abuse. EVIDENCE: The home had an easily understandable complaints procedure which was contained in the service user guide. Each resident had a copy of the guide in their bedrooms. Residents spoken to said they felt able to speak to any of the staff if they had a problem. Comments included “If I’m not happy about something, the staff put it right” and “the staff can’t do enough for you”. The complaints record showed the manager responded to issues raised and carried out investigations in a thorough manner. Only 1 complaint had been logged since the manager had taken over the running of the home. This was seen to have been appropriately actioned. Relatives said the new manager was addressing issues as they came up, to their satisfaction. Twenty five staff had done in-house protection of vulnerable adult (POVA) and whistle blowing training which had been facilitated by the manager. The sessions lasted for approximately 3 hours. Staff files showed POVA first checks had been obtained prior to new staff starting work and Criminal Record Bureau (CRB) checks had been either obtained or applied for. Two files inspected were awaiting results of CRB’s but these staff were working alongside a more Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 19 experienced care assistance. One of the new care assistants confirmed that he was not undertaking any personal care tasks without supervision. Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The home was clean and well maintained and in the main, provided a comfortable and safe environment for the residents. EVIDENCE: The home was in good decorative order throughout and fitted with appropriate aids and adaptations so that residents were able to be as independent as possible. Close circuit television cameras (CCTVs) were in use but only on the entrance areas. Plans were in place to include the car park at the rear of the building. A maintenance programme was in place, which was being implemented by the maintenance worker. New carpets had been fitted in the ground floor lounge and reception area and the ground floor corridors had been re-painted. The maintenance worker was currently painting the first floor corridors during the night, so that residents would not be inconvenienced or put at risk. As Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 21 bedrooms became empty, they were re-decorated before a new resident moved in. Signs on the ground floor toilets were still not in place but the maintenance man said they were on order and awaiting delivery. In the meantime, the home should make their own signage to help residents identify the toilets. During the inspection, many residents were seen walking around the area, unsure of which of the toilets to use. At the last inspection, undertaken in October 2005, it was identified that the first floor bathroom was out of use as it was being re-fitted. In order to offer residents more choice, this bathroom had been converted into a walk in shower, but was still out of use, due to the flooring being unfinished. The manager had been waiting for approximately 3 months for this work to be carried out by the Estates Department, which is unacceptable. During the inspection, it was confirmed that the flooring would be fitted the day after the inspection. Inspections had been undertaken over the last 12 months by the Greater Manchester Fire Department and the Environmental Health Officer. The manager and maintenance worker confirmed that all requirements from the fire report had been implemented and that when the fireman had returned on 13 April, 2006, he was satisfied with what had been done. A return visit by the Environmental Health Officer was made on 14 March 2006 with a second visit being made on 18 April 2006. The letter confirming all necessary works had been addressed was seen. Problems had been identified, at previous inspections, regarding missing laundry and clothes being given to the wrong residents. Relatives spoken with confirmed that clothing was now being returned to the right residents and much quicker than previously. Residents also said the laundry service had improved. At a relatives meeting, a suggestion was made that a linen basket be kept in the laundry where relatives could place clothing, which needed repairing. This had been done. It was noted that on the first day of the inspection, the tablecloths in both dining rooms were creased. The manager said this was because a laundry assistant was not on duty at weekends and the staff would not have had time to iron the tablecloths. If this is the case then additional tablecloths should be purchased so that the tables look well presented. The home was clean throughout and after meals, the dining rooms were cleaned of any spillages so that residents were not put at risk. Detailed infection control policies/procedures were in place but these were not being fully adhered to. Not all bedrooms, bathrooms and toilets were equipped with liquid soap and paper towels. This was of particular concern, given that cross contamination of infection was a high risk factor within the home. The wrong liquid soap had been ordered which would not fit the current dispensers and the new delivery had not arrived. When the shortfalls were identified, in Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 22 one bedroom and the staff toilet in particular, liquid soap from other areas within the home were substituted. One resident also commented that he had been without paper towels for a full day. The District Nurse also commented that paper towels and liquid soap were not always replenished in rooms. The manager must ensure that staff regularly check supplies to make sure they have not run out. Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The team had a good balance of staff in relation to age, gender ethnicity and experience but additional staff hours were needed to ensure the needs of the residents were being met. More staff needed to undertake NVQ training to expand their knowledge in order to provide a higher standard of care for the residents. EVIDENCE: Staff rotas for both weeks of the inspection were checked and a shortfall of hours was noted. Week commencing 1st May 2006, there was a shortfall of 12 hours and for week commencing 8th May 2006, a 26 hour shortfall. The manager was unaware of how the staff hours were calculated and thought the present staffing levels had been agreed with the CSCI. She said that in the future she would make sure the home was correctly staffed. Sometimes the activity co-ordinator was being used as an escort to take residents to the hospital or dentist and this occurred on one of the days of the inspection. He did not have a problem doing this, but clearly his job is to undertake social activities with the residents and the escorting of residents is a care assistant’s role. The organisation had equal opportunity and equality/diversity policy procedures in place. The age, experience, gender and ethnicity of the staff team was mixed and this enabled the needs of the residents to be met. The Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 24 home had quite a high number of male residents and 4 day and 2 night male care assistants were employed. The client group was predominantly white British with 2 Eastern European residents living at the home. Whilst there were staff from other ethnic backgrounds working at the home, they could all speak English and the residents were able to understand them. Sufficient ancillary staff were employed e.g. cooks, kitchen assistant, domestics and laundry assistant. Staff spoken with said staff morale had improved since the manager had been in post and this had clearly impacted positively on the residents. As highlighted throughout the report, resident and relative feedback about the team has been good. Turnover of staff had reduced and this had benefited the residents in that they were now getting used to the staff who were able to give them more consistent care. The home had not achieved the CSCI’s target that 50 of care staff must have achieved NVQ level 2 by December 2005. At the time of the inspection 1 person had successfully completed NVQ level 3 and two carers had done their NVQ level 2. A further 6 staff had recently enrolled to undertake NVQ level 2 training. The manager should ensure that staff continue to enrol on the course until the home has achieved its target of at least 50 of trained staff. Robust recruitment and selection policy and procedures were in place which were being followed. Three staff personnel files were checked and contained all the relevant documents e.g. fully completed application forms, 2 satisfactory references, a POVA 1st check or a CRB disclosure and interview records. Since coming into post the manager had formulated individual training profiles for each member of the team as well as a training matrix showing when renewal training was due. It was identified from speaking to new staff that they had not been given a copy of The General Care Council’s “Code of Practice”. The manager said there was a copy in the staff room but that individual copies were not given. As part of the induction process, each employee must be given an individual copy and the supervisee should monitor that the carer understands and is working within the code. The staff personnel files were difficult to check, as they were not in any particular order. The administrator had however, started to collate the files so they would all contain the same information in the right order. When new staff begin work, they must undertake induction and foundation training which is to the Skills for Care specification. Other than a first day training record, which included many administrative tasks, the two new files did not contain any evidence that the workers had received any form of induction training. These staff had started working at the home on 13 March and 19 April 2006 respectively. From speaking to the newer care assistant, it was established that he had been given an induction booklet but had not yet started to work through it. The booklet did not address all the required Skills Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 25 for Care units and this shortfall must be addressed. From September 2006, all new staff must complete their induction and foundation training within 12 weeks of starting work. Staff training had greatly improved. The manager had made training one of her priority areas and whilst there were still shortfalls, a lot of progress had been made during the time she had worked at the home. Many staff had still not done moving/handling and infection control. The deputy manager had however, just completed the facilitators training for moving/handling which qualified her to undertake in-house training. This was being organised at the time of the inspection. In addition, she was booked to attend an infection control training course, which on completion, would enable her to train the staff in-house. The manager was intending for all staff who had not done this training to have done it within the next few weeks. From checking the training matrix, it was identified that 17 staff had undertaken dementia care training. The matrix showed that all but the newest staff had received a minimum of 3 days paid training over the last 12 months. The staff personnel files that were checked contained copy training certificates. Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home was being well run by an experienced, qualified manager who had a clear understanding of the areas that still needed improving for the benefit of the residents. EVIDENCE: The manager had previously managed another home for older people. She had successfully completed the NVQ level 4 Registered Managerss Award in November 2005 and had then undertaken a 2 day dementia care course in March 2006. Certificates for both courses were seen during the inspection. Until she started working at the home in August 2005, there had been no registered manager for over a year. During her time in post, she has made many improvements which have benefited the care residents are now Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 27 receiving. Areas she had worked on included: more detailed and updated care plans, the introduction of 6 monthly resident reviews, improved the quality assursance and monitoring systems and facilitated more staff training. Feedback from the staff about the manager was good. They felt team morale had improved, that they were given excellent support and that with her experience and training she was able to give them advice when needed. Relatives also made very positive comments about her including: “cleanliness much improved since Donna has managed the home”, “Staff staying longer and they talk a lot more to the residents - its nice to see”, “The manager has always got the time to see me”, “my relative always looks well cared for now”, “no problems with the laundry any more as clothes are clean and ironed”. , “I think the manager and staff are doing a good job”, “the food quality seems to have improved”, “activities are much better”. A staff supervision system had been introduced and whilst not all staff had yet received supervision, a calendar was displayed on the office wall, showing when supervision was due for each person. Team meetings were also now taking place on a more regular basis and minutes of the lasts meeting 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, holding 6 monthly care reviews, randomly checking residents’ rooms, holding relative/resident meetings and having late night surgeries when relatives could call in to see her without an appointment. The minutes from the January relative meeting were seen and it was commented that vast improvements in the running of the home had been noted since Donna took over. Senior managers were making regular visits to the home and the regulation 26 visit sheets were being sent to the CSCI. The last one had been undertaken on 4 April 2006. The last manager’s monthly audit, dated 3 May 2006 was seen and where problems had been noted, action was being taken to address them. Relative questionnaires had been circulated and 12 had been returned. However, these had been sent off to the Head Office and had not yet been returned so the responses were not available. Another new initiative the manager has implemented is for a resident representative to attend part of the staff meeting. This enables residents to air the views about anything they like and for staff to listen and give their resonses. At the last staff meeting a resident had attended and given some suggestions about meals, which had been implemented. Staff meetings were held approximately 6 weekly and minutes were seen. Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 28 As the home’s administrator was not available, the administrator from another of the organisation’s homes stood in when residents finances were checked. Three files were looked at, two of which were in order. The third resident, who had not lived at the home for very long had not been put on the system, but this was addressed during the inspection. Where the home held any money for the residents, all income and outgoings were listed on the computer and printouts were given to residents and/or relatives upon request. The home were holding a significant amount of money for one relative who would not have the capacity to operate a bank account. Relatives had little contact and the manager said she would arrange for the money to be put into the organisations client account. The Service User Guide states clearly that there is a pooled account where money can be placed but that no interest is given. Relatives spoken to were satisfied with the finance systems in place. One person said she brought money in to the home whenever she was advised her mother had no money and was issued with a finance balance sheet. The organisation have detailed health and safety policies and procedures in place which are reviewed and updated as needed. Maintenance records were in order according to the information recorded on the pre-inspection questionnaire. The fire book, hot water temperature recordings and accident book were randomly sampled and all were up to date. The accidents which had been noted from individual residents care plans had all been entered in the accident book. Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 30 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 OP7 Regulation 15 Requirement Staff must ensure that residents’ care plans reflect their present needs and that an action plan is formulated when weight loss is identified. Medication must be ordered on time, in line with the home’s policy, so that residents are not without their medication. Staff responsible for medication must receive further training to ensure they are conversant with the home’s policies. The flooring in the first floor bathroom must be fitted so that the shower may be used. Liquid soap and paper towels must be in each resident’s bedroom and in all communal toilets, bathrooms and staff toilets. A designated member of the team must be appointed to be responsible for checking that supplies do not run out. Staffing levels, which equate to 15 care hours per resident per week between the hours of 08.00 – 21.00 must be maintained. DS0000040406.V288261.R01.S.doc Timescale for action 30/06/06 2. OP9 13 30/05/06 3. OP9 18 30/06/06 4. 5. OP19 OP26 23 13 30/05/06 30/05/06 6. OP27 18 30/06/06 Oakland Version 5.1 Page 31 7. 8. OP29 OP30 18 18 9. OP30 18 All staff must receive a copy of 30/06/06 the Social Care Council’s “Code of Practice”. Al new staff must undertake 31/08/06 thorough induction training, which meets the TOPSS/Skills for Care specification within the required timescales. All staff must receive training in 31/08/06 respect of food hygiene, infection control and moving and handling (previous timescales of 30th May 2005 and 31 December not met) 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. Refer to Standard OP71. OP12 OP19 Good Practice Recommendations 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. When reviewing the activity programme, the co-ordinator should consider the addition of some quieter activities, which would suit some of the current residents. Signage on the toilets and bathrooms, appropriate to the needs of people with dementia should be displayed to allow those who retain some capacity to remain orientated to the home. (This recommendation was made at the last inspection). Tablecloths should be ironed before being put on dining tables. Better communication links between staff on differing shifts should be addressed. The activity co-ordinator should not be used to escort staff on appointments. 50 of the care staff group should be trained to NVQ 2 by December 2006. (This recommendation was made at the last inspection). DS0000040406.V288261.R01.S.doc Version 5.1 Page 32 4. 5. 6. 7. OP26 OP27 OP27 OP30 Oakland Oakland DS0000040406.V288261.R01.S.doc Version 5.1 Page 33 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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