Inspection on 08/12/06 for Oakland

This inspection was carried out on 8th December 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 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 8th December 2006 07:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oakland DS0000040406.V312906.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.V312906.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@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 Home Properties Limited Mrs Donna Oldham Care Home 40 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (22) of places Oakland DS0000040406.V312906.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. 5th May 2006 2. Date of last inspection Brief Description of the Service: Oakland is a care home providing personal care for up to 40 older persons aged over 65 years in two separate units. One unit provides residential care for 22 people and is located on the first floor of the home. The ground floor unit is registered for dementia care for 18 older people over the age of 65 years. The home does not provide nursing care. All bedrooms are single with a number providing en-suite facilities. A passenger lift 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 £328.41 - £480.00 as at December 2006. 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 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 but on this inspection, it had not been updated since the last inspection. Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last inspection in May 2006, two further inspections had taken place. One inspection on 20 July 2006 was done as a result of a complaint made to the Commission for Social Care Inspection and many of the concerns raised were found to be true. As a result of that inspection when poor medication practices were observed, the pharmacist inspector visited on 15 September 2006 when record keeping was judged to be poor, resulting in 4 requirements and 2 recommendations being made. This unannounced inspection took place over one day by 2 inspectors, one of whom stayed 9.45 hours and the other 6 hours. One inspector spent 2 hours on the dementia care unit watching how staff spoke to and looked after the residents. In order to find out what it was like to live at Oakland, 7 residents were spoken to as well as the manager, deputy manager, operations manager, 2 day care assistants, the chef, visiting district nurse and 2 visitors to the home. Comment cards from a care manager and 2 G.Ps were received as well as a letter sent from one G.P. practice, voicing some concerns. 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. All the things that needed to be put right, from the last two inspections, were also followed up. What the service does well: What has improved since the last inspection? Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 6 More trips out had been arranged for the residents, which they had really enjoyed. A lot of the things that needed to be put right, following the pharmacist inspector’s visit had been done but some poor practices were continuing. A lot of re-decoration work had taken place, which had made the home look brighter. The home also smelled fresh and clean. The residents were pleased with these improvements. The roof of the building had been repaired and it was no longer leaking. Bedrooms that had been affected had been re-decorated. Window catches had been fitted on all upstairs windows so that residents would not be at risk of falling. Work on the new walk-in shower had been finished and residents were enjoying having the choice of a shower or bath. It was well fitted out so that residents could be as independent as possible when using it. The manager had been making sure that the staff had one to one meetings with her so she could make sure they were doing their jobs properly. What they could do better: None of the residents had been given terms and conditions of residence setting out what services they could expect the home to give them, how much it cost and what they would have to pay for as extras. Two residents said they were not having a weekly bath and the personal care sheets were not up to date so the care they were receiving could not be checked on. Not all the staff were following the home’s medication policies/procedures to make sure that the giving out of medication to residents was safely done. During the inspection, staff did not spend much quality time with the residents and the activity programme was not being done. As a result, residents were falling asleep or were simply watching television programmes they were not really interested in. When new staff started work they were not always doing the right training to make sure they understood their jobs. Some of the staff had not had any training in fire, safe handling of food, how to make sure they did not spread infection and moving/handling which could place themselves and the residents they were caring for at risk. Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 7 The hoists for assisting residents into the bath and the mobile hoists for transferring people from chair to wheelchair were not being serviced every 6 months to make sure they were safe to use to use. 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.V312906.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 : Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst thorough assessments were taking place before service users were admitted, residents did not have written contracts so they would know the terms and conditions of their stay. EVIDENCE: An informative service user guide and statement of purpose had been written which would enable anyone thinking of coming into the home to assess whether or not the home would be suitable for them. However, the residents spoken to were unclear as to whether or not they had received a copy of the service user guide. The manager stated a copy was in each of the bedrooms but on checking some of the rooms, this document could not be seen. It was later identified that all the service user guides had been taken out of the bedrooms in order to update them with a copy of the last inspection report summary. Given the last report was done in May 2006, the inspector advised the manager to replace the guides in the rooms and wait until she had received a copy of this report before updating them. As the guide contained the complaints procedure it was important the residents had access to it. Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 10 The 4 resident files inspected did not contain a copy contract or statement of terms and conditions of residence. Those who were funded via care managers did however, have a Service Delivery Agreement in place. The operations manager said that the organisation had recently reviewed and updated their contractual agreements and sent copies to the home for all the residents. During the inspection, the agreements were found, but none had been completed or signed. This must now be done. None of the files contained copy letters advising residents of any increase in annual fees and the residents spoken with said their families looked after their finances. The home must ensure that any increase in fees is notified to the resident at least 1 month in advance. The files of 3 residents admitted over the past 10 months were checked. All contained detailed pre-admission assessments. The manager undertook preadmission assessments for all new residents, visiting them either in their own home or at hospital. If there was social work involvement, a care manager assessment was also received and two of the files contained detailed assessments, setting out the mental health needs of each person. Two of the residents spoken to remembered being asked questions by the manager before coming into the home. From the assessment an initial care plan was drawn up with a more detailed plan being done at a later stage. She said that admissions to the home only took place if she was confident the home could meet their needs. When emergency admissions happened, the resident was assessed within the first day or two of admission. Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 : Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In the main, residents’ health and personal care needs were being met but shortfalls in record keeping and some unsatisfactory medication practices could place residents at risk. EVIDENCE: Four people’s care plans were checked, two for people living on the dementia unit and two for those on the first floor residential unit. Three care plans were for residents admitted this year 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 where residents had particular medical conditions, they clearly showed how their needs were being addressed. Ethnicity, culture and religion were included in the care plan files. Whilst care plans were said to have been written in consultation with residents and/or relatives, 3 of the plans had not been signed to say they were in agreement with them. The plans were being reviewed and updated monthly. Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 12 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 4 files contained risk assessments for skin (Waterlows), moving and handling, dependency, nutrition, continence and falls. Where other risk areas had been assessed, detailed assessments were in place. 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. Two residents said they did not always get a weekly bath or shower. This could not be followed through as in many instances, the personal care recording sheets for areas such as bathing, showering, shaving, nails, hair washing etc. were not being kept up to date by the care assistants. These records are important as they enable the manager and senior staff to monitor that the correct care is being given in accordance with the person’s individual care plan. This was particularly important, given the number of concerns raised over recent months about the home not meeting the personal care needs of the residents. On the day of the inspection, with one exception, the residents on both units were clean and appropriately dressed. One person, who had been assisted to get up by night staff, had not had their eyes bathed and this was to be addressed by the manager. Residents health care needs were well recorded. The care plans contained professional visitors sheets which identified when 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. The visiting district nurse was spoken to during the visit. She felt the care of the residents had improved and that staff usually followed her instructions. She did however, feel that communication was still in need of improving, stating that on the day of the inspection, she had found it hard to pass on her instructions to someone in authority. This was raised at the last inspection, when it was suggested that having a member 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. A district nurse communication book had been implemented but if staff were not always escorting district nurses, then precise instructions could not be noted. The manager was now meeting with the district nurse team approximately every 3 months in order to try and ensure that any problems could be identified and addressed immediately. Minutes of the meetings held in August and November were seen when it was recorded that pressure areas were healing well and staff attitude had improved. Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 13 The 4 files checked, clearly showed that residents had been weighed upon admission and had continued to be regularly weighed. The home were using the Malnutritional Universal Screening Tool (MUST) which is a nutritional assessment approved by the Health Care Trust. The community dietician had visited the home to train the staff in its use. Assessments were in place in all 4 care plan files inspected and action to address the risks was well documented. One of the files showed that one resident had gradually gained in weight and their risk assessment had moved from high to medium. Another of the care plans identified one person to be at high risk of malnutrition. Food intake and fluid charts were in place, together with turning charts and the care plan addressed all risk areas. At the inspection which took place in May 2006, some concerns were raised with regard to the administration of medication. The pharmacist inspector therefore undertook a further inspection on 15 September 2006 when it was identified record keeping was poor and did not support the safe administration of residents’ medication. The requirements and recommendations from that inspection were followed up on this visit and some improvements in practice were identified. The newly appointed deputy manager was now in overall charge of medication but the manager was continuing to undertake medication audits which were being done on a monthly basis. The audit reports dated 10 October and 7 November 2006 were seen. In addition a manager from another home had, in November 2006, undertaken medication competency assessments of the senior staff. The manager had written to G.P. practices requsting consent for certain homely remedies to be used by residents. Replies from 2 practices had so far been received giving consent. Tablets were no longer being crushed for any of the residents. The deputy manager was clear that if this became necessary, the consent of the person’s G.P. should be sought. Since the manager had been responsible for the ordering of medication, it was no longer running out as it was being re-ordered in plenty of time. Where handwritten entries were made on the medication administration records (MAR), they were now being signed, checked and countersigned to reduce the risk of error. Fridge temperatures were being monitored and were satisfactory. Where residents had been prescribed dietary supplements, they were being recorded on the MAR but on 2 occasions they had not been signed for. There were some areas which still needed to be addressed. The comment cards and letter received from G.P. practices raised concerns about staff not demonstrating a clear understanding about the needs of service users they visited and that there was not always a senior staff member available to speak with. Comment was also made about specialist advice not always being followed. Examples were given where the surgery had twice been requested to visit service users, they had prescribed medication and then further visits for the same residents requested 24 and 48 hours later. On their return, the prescribed medication from their first visits had not been dispensed. The Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 14 manager said she would follow up on these concerns. The MAR sheets were still showing occasional gaps where medication had not been signed as given or code letters saying why it had not been dispensed. Errors were also identified in the recording of controlled drugs. In some instances, two staff were not signing to say the drug had been administered and on one occasion the drug had not been given to one resident. 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. All staff had received medication training and the deputy manager, who had recently been appointed had undertaken accredited medication training. The inspectors were advised that the organisation were also providing in-house medication awareness training. Clearly action must be taken to address the continuing shortfalls in the administration of medication which were first highlighted in May 2006. The home’s philosophy of care contained reference to core values such as privacy, dignity and independence. Residents on the first floor residential unit felt they were treated well by both day and night staff. In order to uphold privacy, the District Nurse saw residents in their own bedrooms and this was evidenced during the inspection. Staff spoken with were able to give examples of how they upheld residents’ privacy and dignity e.g. closing doors, keeping people covered when assisting with personal care tasks and knocking on doors before entering. Observation of care plan records and information provided by the residents 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. This was evident during the inspection when residents got up and had breakfast at differing times. They were also encouraged to walk to their rooms and to the toilet with the necessary support. Several residents on the residential unit liked to stay in their rooms and their wishes were respected. On the first floor unit, some interactions between staff and service users took place but this could be improved upon. Residents were however, spoken to politely and respectfully during the inspection and it was clear that some of the staff and residents had good relationships with each other. Comments about staff and resident interaction is made in the section below. Oakland DS0000040406.V312906.R01.S.doc Version 5.2 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. 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. Residents were encouraged and supported as far as possible, to exercise choice in their daily routines in relation to lifestyle and activities and to maintain contact with their relatives. EVIDENCE: Feedback from residents on the residential unit indicated they were able to make choices with regard to their daily routines and lifestyles. One resident liked to spend the day in their room and said that staff popped in regularly to check if she needed anything. She saw her room as a bedsit and enjoyed the independence this afforded her. 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. Bedrooms had been personalised and several residents said they had been able to bring ornaments and other personal possessions in with them to make their rooms more homely. In the main, residents relied upon their families to handle their finances but if they had the capacity to do this themselves, then this would be encouraged. The home had leaflets displayed about an advocacy service which offered a wide range of services. Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 16 The worker responsible for activities was also employed as the maintenance worker and had 20 hours a week allocated for activities. At the visit undertaken in July 2006 when complaint issues were being investigated, the lack of social activities had been highlighted. In an effort to address this shortfall the activity worker had attended an activity training day on 23 November which was run by the Alzheimers Disease Society and the week prior to the inspection had attended a conference on activities. Whilst it is appreciated both days were only recent, no evidence was seen that improvements had been made in respect of day to day stimulation/contact with residents, either by the worker or staff. One of the inspectors spent one and a half hours in the dementia unit observing interaction between the staff and residents. During this time, one care assistant had good interaction with one person, sitting with the resident for about half an hour offering reassurance and support. Other than this, little staff and resident contact took place. Although staff kept coming in and out of the lounge area, they generally only spoke to those residents who were able to respond. Three of the residents remained passive or asleep for the whole observation. The activity programme displayed within the home was not always being implemented and this was confirmed by both residents and staff. The manager said that after the Christmas period, she would be addressing this continued shortfall with the staff team. Comments were made by several residents that on a day to day basis, there was still nothing much being organised and two residents said all they did was watch television. Doll therapy had however, been introduced on the dementia unit, after staff had received facts and information on this type of therapy and one resident was clearing finding comfort in this. Several trips out had however, been arranged for residents on both units. These included a trip to Blackpool illuminations (two trips each for 6 people), a trip on a canal barge and visits to concerts or parties being held at two of the other homes in the area, owned by Southern Cross. Also halloween and bonfire night celebrations had been arranged. Some of the residents spoken to had been on one or more of the trips and had enjoyed them. The home had started to take photographs of events and trips so that they would be able to remember and chat about their experiences. Two of the care staff team had arranged to come in on their days off to escort two residents on a Chirstmas shopping trip. Residents religious needs were continuing to be addressed as part of the admission procedure and recorded on each residents social history sheet. Different denominations were visiting the home on a regular basis. The residents spoken with were satisfied with the existing provision. Two relatives were spoken with during the inspection and 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 still having Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 17 to repeat things about her mother to different staff but she did feel the care had improved. The other person identified an improvement in the décor and cleanliness within the home but felt that more social stimulation was needed for people on the dementia unit. Residents continued to be satisfied with the meals they were offered and all said they were given choices. Cooked breakfasts were available every day and several residents enjoyed these. Orange juice and grapefruit segments were also offered. 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. 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 to enable this to happen. 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 well catered for. Where food supplements were being given to residents, they were recorded on their medication administration record (MAR) sheets and in the main, these showed they were being taken regularly as prescribed by their GPs. Four residents required a liquidised diet and portions of food were liquidised separately so that the food looked appetising. At lunch time, staff on the dementia unit gave really good support to the residents in an unhurried manner. They assisted residents with their meals on a one to one basis and gently persuaded them to eat more and to finish their drinks, before getting up from the table. Residents were offered second helpings of food and plenty of drinks were given. Oakland DS0000040406.V312906.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were policies/procedures in place for complaints and protection of vulnerable people but staff needed further training in order to ensure they understood and could fully meet the needs of the vulnerable people they were caring for. EVIDENCE: The home had an easily understandable complaints procedure which was contained in the service user guide. Usually, each person had a copy of the guide in their bedrooms but on this visit, they had been removed in order the guides could be updated. The manager said she would make sure the guides were put back in all the rooms. Residents spoken to said they would feel able to discuss problems with any of the staff. One person said “I would speak to one particular member of staff because she’s really nice”. The complaints record showed the manager responded to issues raised and carried out investigations in a thorough manner. Since the last key inspection in May 2006, 5 complaints had been logged, all of which had been investigated by the manager who had recorded the outcome of each investigation. In July 2006, the Commission for Social Care Inspection received an annonymous complaint which was investigated by them. The complaint was upheld with regard to poor health and personal care practices, lack of social activities, health and safety of residents in respect of hazards in the building, cleanliness and staffing. As a result of the complaint, the manager had made changes in how she monitored and audited the care and building. She was Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 19 now undertaking monthly medication audits, daily walks around the building to inspect for safety and cleanliness, holding meetings with the District Nurse team and a deputy manager had also been appointed to assist in the running of the home. At this inspection, improvements in the majority of these areas were noted. Whilst the manager had attended protection training, she had not done the Rochdale MBC Protection of Vulnerable Adult (POVA) training. Given the problems experienced in the home within the last few months, she should attend the next available training course. Twenty five staff had done in-house protection of vulnerable adult (POVA) and whistle blowing training which had been facilitated by the manager. There were still several carers who needed to do this training and this should be arranged. Staff files showed POVA first checks had been obtained prior to new staff starting work and Criminal Record Bureau (CRB) checks had also been obtained. Since the last inspection, two protection of vulnerable adult investigations had taken place involving the Police. One of these was still ongoing with a conference having been arranged for the week following the inspection. The manager had co-operated fully, during this time, with the Police and Social Services Department and had also initially advised the Commission for Social Care Inspection (CSCI) of the allegations which had been made. Appropriate action was taken to ensure that residents were safe whilst the investigation was ongoing. The outcome of the first investigation was that the Police felt there was insufficient evidence to proceed to court as it was the resident’s word against that of the staff on duty at the time. The case therefore lies “undetected” on Police records. The outcome of the second investigation had not yet been concluded. As a result of the above incidents, the Social Services Department had made recommendations for the staff to undertake more training in cultural awareness, personal choice and dignity and dementia. Behaviour management training also needed to be done by many of the staff team. The manager had already arranged for 16 staff to undertake a 2 day dementia care training entitled “Yesterday, Today and Tomorrow”. The course was arranged for the 18th and 19th January and 13th and 14th February 2007. The staff spoken to during the inspection, were aware of the whistle blowing policy and were able to say what they would do if they suspected a resident was being abused. Oakland DS0000040406.V312906.R01.S.doc Version 5.2 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. 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. Significant improvements had been made within the home, affording residents a warm comfortable and safe environment in which to live. EVIDENCE: Since the complaint investigation visit in July 2006, significant improvements had been made within the home. Redecoration had taken place in the ground and first floor lounges, corridors, reception, stairs and dining rooms. Following the roof being repaired, 6 bedrooms had been re-decorated and many of the carpets had been cleaned. Some murals had been painted on the dementia care unit and bedroom doors on the Acorn unit had been fitted with brass knockers, letterboxes and been painted different colours. One resident was spoken to in her bedroom. She said she had chosen her own wallpaper and was really pleased with her room. Both she, and other residents spoken to, were all satisfied with cleanliness within their rooms and the communal areas of the home. It was noted that in some of the bedrooms, the over-bed light Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 21 had been removed. The manager said this was because they had been identified as “unsafe”. Bedside lights were to be provided as an alternative. From walking around the building, there were no malodours and all areas, including the sluice room, were clean. The new walk in shower room had been completed and was in frequent use. It was well adapted so that residents could be as independent as possible and this provision gave them a choice with regard to bathing or showering. The other bathrooms and toilets were also well adapted for the residents. Close circuit television cameras (CCTVs) were in use but only on the entrance area for safety reasons. Since the last inspection, no visits had taken place by either the Fire Service or Environmental Health and requirements from their last reports had been implemented. Detailed infection control policies/procedures were in place, which were being followed by the staff. Bedrooms, bathrooms and toilets were equipped with liquid soap and paper towels to try and cut down on cross infection. New bins had been supplied in bathrooms and toilets, with properly fitting lids and staff were observed using disposable gloves and aprons when assisting residents with personal care tasks. The laundry facilities were adequate for the number of residents living at the home. One resident said he was still experiencing clothing going missing. From the minutes seen of the resident/relative meeting held in October, the manager had asked all relatives to check the unnamed clothing in the laundry due to labels having come off and requested if clothing was identified that they sew on new labels. She had also asked that any new clothing items be identified to staff so they could be recorded on the personal belonging sheet in the care file. The laundry assistant said that if she found and identified unmarked clothing, she would always make sure it was re-named. One resident spoken to had returned to his room just before lunch. He commented that he had no clean flannel or towel since they were taken out of the room for washing during the morning. This was raised at the last inspection and such items should be replaced immediately the soiled ones are removed from bedrooms. The manager was to follow this up. Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 : Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst sufficient staff were on duty, they had not all received the relevant training in order to meet the needs of the residents currently living on each of the units. EVIDENCE: Staff rotas were checked and for the number of residents on each of the units, there were sufficient staff on duty. If numbers increase however, the manager will need to ensure that staffing levels are increased accordingly. Four night staff were on duty, two on each of the units, which ensured that the needs of the residents were able to be met. Sufficient ancillary staff were employed e.g. cooks, kitchen assistant, domestics and laundry assistant. At a previous inspection, it was identified communication between staff on different shifts needed to be improved. The inspector arrived at the home at 07.45 in order to observe the staff handover. Day staff were expected to arrive by 07.50 but 3 staff arrived late, at 08.08, 08.10 and 08.20. Of the latecomers, only the senior had any meaningful handover and this should be addressed by the manager. Residents spoken to said staff were “alright”, “nice”, “fine”, “very nice” and “pleasant”. They were all asked about how they were cared for by both the day and night care staff and no-one had any negative comments to make. Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 23 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. Whilst there had been some turnover of staff since the last inspection, staff spoken with said staff morale had improved and they felt this had also improved the atmosphere within the home. From observations made during the inspection, it was noted that the attitude of a minority of staff towards senior staff could be improved. The home had not achieved the CSCI’s target that 50 of care staff must have achieved NVQ level 2 by December 2006. At the time of the inspection only 4 staff had achieved NVQ Level 2/3 qualifications. A further 9 staff were in the process of undertaking 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. Any new staff should enrol on the training as soon as possible after starting work. The recruitment and selection policy and procedures were being followed. Three staff personnel files were checked and contained all the relevant documents e.g. fully completed application forms, 2 satisfactory references and a POVA 1st check or a CRB disclosure. Copies of The General Care Council’s “Code of Practice” had been given to staff and the form was seen where they had signed upon receipt. Supervision should be used to monitor that the care assistant understands the document and is working within the code. All three files contained evidence of induction training, which was to the Skills for Care specification. It was however, noted that in one instance, the whole training programme had been delivered and signed off on the same day which is unacceptable as clearly the learning could not be done in such a short time scale. Induction training for a carer who started working at the home in the middle of September had still not been completed. Clearly induction training should be completed within the first 12 weeks of work and should evidence how the competencies have been achieved. During this time a member of staff, who is qualified and experienced should be appointed to supervise the new worker and as far as is practicable, the staff member should be on duty at the same time as the new worker. The staff personnel files that were checked contained copy training certificates. As identified in the complaints section above, other training needed to be done by some of the staff team around values/principles (customer care), behaviour management and cultural awareness. The manager should ensure that within supervision, training needs are identified and staff receive appropriate training without delay. Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 : Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had had many problems over the past few months but the manager was aware of the areas she needed to address, to ensure the home was run in the best interests of the residents. EVIDENCE: The manager had successfully completed the NVQ level 4 Registered Managers Award in November 2005 and had then undertaken a 2 day dementia care course in March 2006. Certificates for both courses were seen at the last inspection. Since then she had completed a 2 day moving/handling facilitator course and a 2 day dementia care course run by the Alzheimers Disease Society entitled “Yesterday, Today and Tomorrow”. Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 25 Over the last 9 months, the home had had 3 inspections by the Commission for Social Care Inspection, one main inspection in May 2006, another in July to investigate a major complaint and one in September by the Pharmacist inspector. At the May inspection, many positive areas were identified but following the inspection, management/staff problems had arisen, resulting in standards in the home falling. One of the main problems had been that the home had been without a deputy manager for some time but the post had been recruited to and the deputy was now in post. This meant that the manager would now be able to delegate some tasks and concentrate on the more urgent management areas which needed to be addressed. Feedback from the staff about the manager was positive. They felt team morale had recently improved and that they were given good support. One carer said “ I can talk to her about anything and she’s been really supportive to me.” The home had experienced many staffing problems over the past few months and as a result teamwork had deteriorated. The manager felt that the majority of these problems had been resolved and she was hopeful that the team would now be able to work well together in order to meet the needs of the residents. The manager was receiving good support and regular supervision from the Operations Manager. Similarly the manager had continued to implement supervision sessions for the staff team and the matrix showed that all staff were having 1-1’s at regular intervals. The newly appointed deputy was in the process of undertaking appraisal interviews. Team meetings were taking place and minutes of the meetings were seen. A corporate quality monitoring and assurance system was in place and the audit tools were being utilised. The manager was completing a monthly audit sheet, monitoring medication, randomly checking residents’ rooms and walking around the home on a daily basis, holding relative/resident meetings and having afternoon surgeries when relatives could call in to see her without an appointment. A new initiative had recently been introduced where the manager would ring up 3 different relatives each week to ask whether they had any problems they wanted to raise. Any comments, complaints or compliments were noted and actioned as necessary. The minutes from the October relative/resident meeting were seen and discussion had taken place in relation to food, laundry, cleanliness, activities and Christmas arrangements. Senior managers were making regular visits to the home and the regulation 26 visit sheets were being sent to the CSCI. The finances for 3 residents were checked. 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. Large sums of money were not held on site but were kept in 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. Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 26 The organisation had detailed health and safety policies and procedures in place which were reviewed and updated as needed. From checking the training matrix, it was identified that since the last inspection, the manager had continued to send staff on available training courses but many had still not attended all the required mandatory training. Whilst it is acknowledged there had been some turnover of staff, some of the staff who had worked at the home for a considerable time had still not done all the required training. A requirement regarding mandatory training has been in the last 3 inspection reports and if this is not addressed, enforcement action will be taken. Four staff still needed to do moving/handling training and several had not done infection control, food hygiene and fire. Several staff had undertaken first aid training but the manager should ensure that at least one person on each shift has undertaken the training. The manager and the maintenance/activity worker had both been on moving/handling facilitator courses. The manager said 6 staff would be receiving in-house moving/handling training on 25 January 2007. According to the pre-inspection questionnaire, all but one of the maintenance checks were up to date. The fixed and mobile hoists had not been serviced since 27 March 2006. These must be done at least every 6 months. The fire book and record of testing of portable appliances were randomly checked and in order. However, the manager could not find the 5 year electrical wiring check but agreed she would fax it the CSCI office. Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 27 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 2 1 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 28 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. 2. Standard OP1 OP2 Regulation 5(2) 5(1)(ba)(b-d) 5A(3) 12(1) Requirement A copy of the service user guide must be given to each resident. Each resident must have a contract or terms and conditions of residence so they will know their rights. The home must notify each resident at least one month in advance of any increase in fees. The manager must ensure that residents receive regular baths or showers and that their files record when this has taken place. Medication prescribed by G.Ps must be given to all residents, in accordance with their instructions. (Previous timescale of 15/09/06 not met). When giving out medication, the senior must ensure they sign the Medication administration record (MAR) when the medication has been given. The home’s policy/procedure must be followed for the handling and dispensing of controlled drugs. Having regard to the needs of DS0000040406.V312906.R01.S.doc Timescale for action 31/01/07 31/01/07 3. 4. OP2 OP7 31/01/07 31/12/06 5. OP9 13(1)(b) 31/12/06 6. OP9 13(2) 31/12/06 7. OP9 13(2) 31/12/06 8. Oakland OP12 16 31/01/07 Page 29 Version 5.2 9. OP30 18(1)(c) (i) 10. OP30 18©(i)(ii) 11. OP38 23(2)(c) the residents, staff must ensure they provide appropriate activities and stimulation for them. (Previous timescale of 28/07/06 not met). Staff must receive induction 31/01/07 training within 12 weeks of starting work and the programme should meet the Skills for Care specification. The manager must identify which 28/02/07 staff need training in values (customer care), culture and behaviour management and ensure the training is arranged for them so they will be able to better meet the needs of the residents. All fixed and mobile hoists must 31/01/07 be serviced at least every 6 months. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations 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. A senior member of the team should escort district nurses and G.P.’s when they visit the home and record their instructions, in order to ensure their instructions are understood and followed. The manager should undertake the Rochdale MBC’s protection of vulnerable adult training. When towels and flannels are removed from residents’ rooms for washing, they should be immediately replaced. 50 of the care staff group should be trained to NVQ level 2 standard. 2. OP8 3. 4. 5. OP18 OP26 OP30 Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 30 6. OP38 The manager should fax a copy of the 5 year electrical check to the CSCI office. Oakland DS0000040406.V312906.R01.S.doc Version 5.2 Page 31 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: 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. 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