Random inspection report
Care homes for older people
Name: Address: Oakland Care Centre (Moston) 134 Kenyon Lane Moston Manchester M40 9DH two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: John Oliver Date: 2 2 0 6 2 0 0 9 Information about the care home
Name of care home: Address: Oakland Care Centre (Moston) 134 Kenyon Lane Moston Manchester M40 9DH 01616825554 01616827775 oakland-moston@schealthcare.co.uk www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross Home Properties Limited care home 54 Number of places (if applicable): Under 65 Over 65 54 old age, not falling within any other category Conditions of registration: 0 The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 54. Date of last inspection Brief description of the care home Oakland Care Centre (Moston) is a large purpose built provision set in its own grounds and located in the North of the City. The home is owned by Southern Cross Health Care and is registered to offer accommodation to 54 older people. There are carparking facilities to the front and rear of the building and well maintained gardens with a seating area for residents and their visitors. There is a ramp to the homes main entrance and a passenger lift that enables access to all levels of the home. The home
Care Homes for Older People Page 2 of 12 Brief description of the care home offers lounges and dining rooms on both floors. All bedrooms are for single use and have en-suite facilities. The home is equipped to meet the needs of those with mobility difficulties and who may require additional space. The charges for fees range from £390.54 - £585.20 Care Homes for Older People Page 3 of 12 What we found:
The reason for this inspection visit was to look at a number of concerns we (the commission) had following a recent report from the Manchester Coroners Office. The report related to the death of a person using the service in 2006 and the findings of the coroner in relation to the procedures carried out by staff at that time. The coroner identified what was considered to be a number of organisational failures and concerns that included: 1) A failure to provide staff with clear emergency procedures. 2) A failure to ensure the resuscitation status of people using the service was recorded on the nursing record and to ensure this information was communicated to staff. 3) A failure to undertake immediate Cardiopulmonary Resuscitation (CPR) and/or First Aid. 4) A serious delay in contacting Emergency Services. We decided to look at four areas of practice and these related to care, complaints and safeguarding and management. At the time of this visit the new manager of the service was on duty. He told us that he had been in post for approximately four weeks and had been made aware by his line manager of the concerns raised following the Coroners report. Each person living in the home had an individual care plan file that included a Client Profile at the front. In this profile was a section entitled Service Users Consent to Resuscitation. We looked at the files of four people living in the home and all had the profile sheet at the front. Only one had the details relating to Cardiopulmonary Resuscitation (CPR) completed and was signed by the person and their relative. This had not been signed or dated by the person completing the profile. We spoke to one person using the service whose profile regarding CPR had not been completed and asked about their admission into the home. They told us, I am quite happy with the service I receive in this home. The staff are very good and help me with my needs. We asked if anyone had discussed with them things like their wishes at death or in the event of a medical emergency involving CPR? I was told about the home before I moved in but I wasnt asked about my wishes about death or resuscitation. I suppose its one of those things you dont like to think of, but I suppose it should be considered and be written down somewhere. Knowing me, I am liable to change my mind. It is important that people using the service have the opportunity to discuss such matters should they wish to when first moving into the home. Although the Client Profile was seen as being part of the overall care plan, no actual care plans were in place for any person using the service regarding their potential wishes about CPR. This was discussed with the manager who agreed that the information should be included within the care plan. Lack of including such important information in care
Care Homes for Older People Page 4 of 12 plans could lead to a persons wishes not being adhered to in the event of an emergency. There was evidence that people had been involved in deciding about the End of Life Pathway (Integrated Care Pathway for the Dying). This pathway identifies that the individual and/or family has agreed to the end of life care being given and that no attempts to resuscitate will take place. This pathway is only decided upon when a person is considered to be near the end of life. Although we found evidence of a policy and procedure relating to CPR, staff spoken to were not aware of any guidelines being in place for dealing with medical emergencies or CPR procedures. Staffs lack of awareness to available policies and procedures to guide them could lead to inappropriate action being taken in the event of an emergency. We spoke to four members of the staff team on duty and all were confident they could carry out CPR should the need arise. All were able to describe the action that would be taken, for example, Someone would begin CPR, another person would ring 999 for the paramedics to attend and complete necessary paperwork and CPR would continue until told differently by the paramedics. When asked where they would expect to find information relating to peoples wishes and CPR all said, In the care plans file on the yellow sheets (Client Profile). When discussed further, staff said that the person ringing 999 would usually wait by the door to let the paramedics in, especially out of normal office hours. If not, they would listen for the door bell. It was of concern that should the door bell not be heard, then a delay could be caused for people such as doctors and paramedics gaining immediate access to the premises in an emergency. We also saw in the minutes of a recent relatives/residents meeting that a relative had raised a concern about the length of time it sometimes took staff to answer the door bell, again, especially outside normal office hours. This was fully discussed with the manager who said that an extra internal bell would be fitted in the main hallway. To ensure staff gain an immediate outside telephone line, the manager had placed a notice near all telephones used by staff that stated: In the event of an emergency (Fire, Ambulance, Police) - ring 99 999 FIVE NINES. We looked at the complaints procedure and this was displayed around the home and a copy was included in the Service User Guide, which every person using the service had been given. There was a complaint file with details of any complaints, the investigation process, related correspondence and the outcome of the complaint. There had been five complaints since the beginning of the year, four of which had been satisfactorily concluded and one was ongoing. People using the service were clear how and who to make a complaint to and one person told us, I would speak with the manager, deputy or the administrator. The manager told us there had been two safeguarding referrals made since he has been in post. The safeguarding procedure had been followed in both instances, including notifying the Care Quality Commission. Both referrals had been satisfactorily concluded. The training matrix indicated that all staff had completed Protection of Vulnerable Adults training and all staff spoken to were very clear about the action to be taken in the event
Care Homes for Older People Page 5 of 12 of an allegation of abuse being made. We looked at the numbers and ratios of staff on duty at the time of our visit and these appeared sufficient to meet the current needs of the people using the service. On the nursing unit there were 20 people being supported by two Registered General Nurses (RGNs) and four carers throughout the day. On the residential unit there were 33 people being supported by a senior team leader and four carers throughout the day. Both people using the service and staff spoken to felt that enough staff were available to meet peoples identified needs. Some staff did feel that, at times, due to sickness, holidays and vacant posts, cover on rotas occasionally fell short but were confident that the new manager was ensuring any vacant post would be filled. It is important that appropriate grades of staff and staffing ratios are maintained to a level that meets peoples identified needs at all times. A training matrix was available that identified all training each member of the staff team had participated in. Certificates relating to this training were also found on the individual staffs file. The matrix identified that ten staff had completed First Aid training but this had been completed between 17/01/03 and 30/11/06 and it was therefore recommended to the manager that this training be updated as soon as possible. Staff on duty that had completed this training confirmed that it did include Cardiopulmonary Resuscitation (CPR) but they felt they would benefit from refresher training. We saw evidence that CPR training had been arranged for seven nurses and five senior carers to take place on 30 June 2009. It is important that staff training is regularly reviewed and updated to ensure staffs skills and knowledge are maintained to enable them to carry out their job roles efficiently and effectively. On checking the rota against staff that were First Aid trained it was seen that at least one first aider was on duty every shift but the rotas did not identify this person. Also, when spoken to, staff were not aware who the first aider on duty was. It is important that all staff are aware of which member of staff to seek in the event of an emergency requiring first aid. Staff training files demonstrated that training was taking place and staff spoken to confirmed this. One nurse told us, We participate in all the training other staff do and are responsible for ensuring we maintain our professional skills and training as well. We looked at the files of two recently recruited staff and found that all relevant preemployment checks had been completed and were in place. Evidence was also available to demonstrate that regular checks were taking place of the National Midwifery Councils (NMC) website to check for nurse suspension or exclusion from the register. In addition there was a computerised matrix that identified when PIN numbers were due for renewal. The manager confirmed that all newly recruited staff would receive thorough induction training but evidence of this could not be found on all files examined at this visit. All staff confirmed they received supervision on a bi-monthly basis and records were seen on files. A new manager had recently been recruited and had worked in the home for the last four weeks. He was aware of the policies and procedures available to staff and confirmed that no procedure was currently in place to guide staff when dealing with medical
Care Homes for Older People Page 6 of 12 emergencies. During our visit the operational manager called at the home to carry out supervision with the manager and she informed us that one of the Directors of the organisation was in the process of completing a policy and procedure relating to medical emergencies that should be available by the end of June 2009. It was confirmed that a copy would be made available to the commission. We also took the opportunity to discuss the policy relating to Cardiopulmonary Resuscitation (CPR). It was agreed that the policy clearly states: 2.3 Named Nurse/Team Leader is responsible for determining, with other professionals, the Service Users wishes and preferences with regard to resuscitation and for ensuring that they are clearly documented, and communicated to other Care Centre Staff. 3.6 It must always be borne in mind that the Service User having made a choice to agree to resuscitation or not, may change his or her mind at some later stage. The Service Users preferences in this regard must be reviewed periodically, involving their GP and family and the outcome formally recorded either in an advance directive or clearly documented and signed by all parties concerned in the Service Users care file. 4.1.9 In the event of an emergency, a decision will need to be made about what action is taken and this will need to be justified after the event. This emphasises the need for resuscitation to be discussed during the admission assessment and a care plan prepared as necessary. All such discussions and decisions should be fully documented in the Service Users care plan. Lack of such important information being available on peoples files demonstrated that the home/staff were operating in breach of their own clearly defined policies and procedures. What the care home does well: What they could do better:
Although information about each person living in the home was recorded in their care plan files, details regarding action to be taken in a medical emergency was not. At the assessment stage of admission, and following the organisations own policy and procedure relating to Cardiopulmonary Resuscitation (CPR), people should be asked about all things that could effect their life whilst living in the home, for example, what action would they want to be taken in a medical emergency? It is important that information such as this is recorded in all relevant documentation used in the home and that a care plan is in place that is accessible to all staff. Staff spoken to during the visit said they felt confident to carry out tasks such as CPR but were not aware of any procedures to follow in the event of a medical emergency arising. It is important that all staff have the knowledge and information readily available to them when dealing with accidents and health emergencies and to help minimise the potential risk of inappropriate action being taken at such times.
Care Homes for Older People Page 7 of 12 It was found that on occasions, gaining access to the premises was delayed as staff could not always hear the door bell, especially outside normal office hours. In an emergency situation it is important that people such as GPs and paramedics gain immediate access to the premises to avoid potential delays in treating people in emergency situations. Staff trained in providing First Aid, including CPR were on duty at the time of our visit. Staffing rotas did not clearly identify who the designated first aider was on any particular shift and staff spoken to did not know. To minimise the potential risk of inappropriate action being taken in the event of an accident/emergency situation it is important that all staff are aware of who the designated first aider is at all times. Although it was confirmed by the manager and the staff spoken to that all staff received a full induction into their work role, evidence of completed inductions could not be found on all staff files examined. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 13 (4) (c) The use of the `Bucket? chair is a form of restraint and as such a risk assessment for its use must be undertaken 17/10/2007 Care Homes for Older People Page 9 of 12 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 38 12 A policy and procedure must 28/08/2009 be developed that advises staff what to do in a medical emergency, for example, key personnel to contact, obtaining an outside telephone line, ensuring prompt access for any emergency services attending. This will ensure that peoples preferred wishes regarding the care they receive in the event of a medical emergency arising, such as Cardiopulmonary Resuscitation (CPR) will be adhered to and acted upon immediately. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 It is recommended that each person using the service has a care plan put in place that clearly defines their wishes in
Page 10 of 12 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations the event of a medical emergency. 2 30 It is recommended that following their induction, staffs induction programme/record is placed on their personnel files for future reference. It is recommended that all staff receives First Aid training that includes specifice training in Cardiopulmonary Resuscitation (CPR), including refresher training for those staff that currently hold a First Aid certificate. It is recommended that all staff be made fully aware of the policy and procedure that is in place regarding Cardiopulmonary Resuscitation. 3 30 4 38 Care Homes for Older People Page 11 of 12 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 12 of 12 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
