CARE HOMES FOR OLDER PEOPLE
Oakland Grange 10-12 Merton Road Southsea Hampshire PO5 2AG Lead Inspector
Richard Slimm Unannounced Inspection 31st October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oakland Grange DS0000011767.V257371.R01.S.doc Version 5.0 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 Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Oakland Grange Address 10-12 Merton Road Southsea Hampshire PO5 2AG 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) 023 9282 0141 Crescent Care Limited Mrs Angela Kish Care Home 43 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (6), Old age, not falling within any other category (43), Physical disability over 65 years of age (2) Oakland Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Four named service users betweem 55 and 65 years of age in the categories LD and MD may be accommodated No more than six service users in the categories MD(E) and DE(E) may be accommodated at any one time No more than two service users in the category PD(E) may be accommodated at any one time 13th June 2005 Date of last inspection Brief Description of the Service: Oakland Grange is a large, period, detached residence situated in a quiet residential area of Portsmouth. The home is maintained to a good standard providing a valuing environment to residents. The home is registered with the Commission for Social Care Inspection (CSCI) to accommodate up to 43 older people, including up to six with an age related mental health problem and two service users with a physical disability. Accommodation is organised over a number of floors with access available to frail persons via the provision of a shaft lift. It is one of a number of registered care homes that the registered responsible individual has an interest in. The home is centrally placed and is close to the shopping area in Southsea where there is a wide range of shops situated. The local bus stop, where buses run regularly into Portsmouth’s main shopping centre is nearby as is the main seafront at Southsea. The home provides regular structured activities and entertainments at the home, based on the wishes of the resident group. Oakland Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on the 31st October 2005 over 1 day. Since the last inspection there had been a number of incidents that have involved an adult protection investigation. The home acted responsibly throughout this investigation involving and co-operating with all relevant agencies. This visit focuses on issues identified by the adult protection investigation. The day was spent visiting service users in their own rooms, and communal areas of the home and interviewing them in order to establish their views of the quality of service provided by the home, the inspector also joined residents for lunch in the main dining area of the home. The inspector checked records and other relevant documentation, interviewing care, and management staff. Two visitors were spoken to and both made positive comments about the services provided at the home, to their loved ones and confirmed that they could visit whenever they wished, were always able to see their relative in private if they wished, and were always made welcome at the home. The visit was positive and residents were found to be generally satisfied with the quality of service provided. Twenty-three residents were spoken to and all confirmed that they were satisfied with the general quality of the service provided, and a significant number of residents were found to be very happy living at the home. This report will make one requirement and three recommendations covering the national minimum standards, aimed at supporting the ongoing development of the service. What the service does well:
The home provides a good level of care and support on a practical basis. Action had been taken with regard to the ongoing development of care-planning systems that should identify all relevant resident daily needs. Residents were very helpful and spoke candidly about their experiences. Some residents explained that while they missed their own homes, they were very comfortable living at Oakland Grange, and they were also aware that they now needed 24 hour care and support. Residents confirmed that the staff team are caring, polite and considerate and treat them with dignity, kindness and respect. A number of residents spoken to were able to confirm that there were regular activities provided at the home. Managers and staff appeared to be committed to providing the best possible service and a commitment to the ongoing improvement and development of the home was evident. New admissions to the home are handled with sensitivity and care, and a new resident had been enabled to settle well into their new surroundings. Residents were found to be aware of whom to speak to if they had any concerns. There was a clear commitment to providing staff that were appropriately trained, experienced and qualified. The home provides a range of structured activities throughout the week that are displayed for residents on a notice board. Residents’ are given the opportunity to be involved in anonymous resident surveys as to the
Oakland Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 6 quality and satisfaction with the service provided, and regular resident meetings are held to consult and involve residents in the running of their home. The registered responsible individual who is also a representative of the company that own the home visits regularly and each month a report of the conduct of the home is forwarded to the CSCI. Residents spoken to were very happy with the quality and variety of food provided at Oakland Grange. What has improved since the last inspection? What they could do better: 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 Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 7 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 Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 8 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): 3 The home does record assessment information about residents’ personal interests and wishes adequately. The home does record assessment information about residents’ personal care needs, and transfers this information to a plan of care to guide staff on a daily basis. The home does not actively / adequately involve residents and/or advocates of residents in a thorough assessments of their needs, abilities and associated risks to manage their own financial affairs. EVIDENCE: The home’s systems of assessment and care planning continue to develop. Assessments currently could be developed further in line with the needs of residents and the national minimum standards (NMS). Increased emphasis could be placed on establishing and identifying the needs and the abilities of residents to manage their own financial affairs, and any identifiable risks. Resident skills and abilities to use facilities and bedroom door locks could be focused on and where there are any difficulties in this or any other area, action taken to provide additional support or protection by the home.
Oakland Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 9 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 Each resident has an individual plan of care. Each resident has an individual daily log of care and support provided, that monitors all relevant events, and informs the ongoing development of care plans. EVIDENCE: Care planning systems take account of residents’ daily care and support needs at the home. Plans in place provided documented information to guide staff in meeting certain needs of residents. There was a need to ensure that residents independence is more fully promoted by the provision clearer assessments in the area of looking after personal finances and care plans need to specify in detail the actions needed by staff to ensure that residents remain independent, and where risk assessments indicate the need for intervention this is clearly documented. Residents’ spoken to confirmed that they were happy with the arrangements made at the home to meet their daily support and care needs. Staff members were observed to interact in a professional, sympathetic, good humoured and polite manner with residents’. Residents’ confirmed that they were treated with dignity and respect. Staff members spoken to were found to be aware of the need to promote the core values of privacy, respect, choice, independence and rights for residents. Each resident has an individual daily log
Oakland Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 10 of support provided, that records chronologically day-to-day interventions of the staff, and other meaningful events in the resident’s life at the home. Oakland Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 11 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): 12-13-15 The home actively listens to the views of residents. The home promotes residents rights to stay in contact with family and loved ones, and to maintain links with people from outside of the home. The home strives to promote resident choice and provides regular stimulating activities. The home provides a full varied and nutritious diet. EVIDENCE: Two visitors to the home were interviewed, and confirmed that they were always made to feel welcome at the home. Each visitor stated that they felt confident that their loved ones were well looked after at the home. The home provides a variety of activities on a regular basis, with planned events happening at least 3 times a week by external activity providers. Residents said there were usually enough things going on at the home to keep them amused, but there were occasions when they became a little bored. This was usually due to their inability to self occupy or move around independently. Plans are under way to arrange a Christmas pantomime and other entertainments for the festive season. Residents said they were happy with the quality and variety of food provided on a daily basis. Where main menu options are not to the individuals liking alternatives are provided. Oakland Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 12 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): 18 The home makes all possible arrangements for the protection of residents from abuse. The home, following advice from the CSCI, liaises and co-operates with external agencies when issues of adult protection arise at the home. The home takes adult protection responsibilities very seriously. The home makes arrangements to promote the safety of residents. The home needs to check the criteria for referring staff to the POVA register, while adult protection investigations are completed. EVIDENCE: A number of incidents have arisen at the home that needed referral under the adult protection procedures. Once the home had identified these matters, they were reported to the CSCI. On the guidance of the CSCI action was taken to follow the adult protection procedures, and the home has since co-operated fully with the police and the local social services staff involved in the investigations. At the time of the visit the home had not liaised with the Department of Health with regard to the criteria for referring suspect staff, in order to prevent further access risks to other service users outside of the home, or in other registered services, until criminal investigations are complete. The CSCI is aware that the local social services have written to the home to offer advice in this regard. The home is currently undertaking an investigation into concerns brought to CSCI attention. The home have demonstrated a commitment to co-operating with relevant agencies in the area of adult protection, and the manager accepts that she has learnt a lot through what has been a challenging period for the home. The responsible individual acted promptly once advised of concerns, and quickly commenced investigation of these matters.
Oakland Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 13 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 The home provides a safe, well-maintained and valuing environment for residents. The home was cleaned to a good standard, with a minor odour problem in one area that needed attention. There is an ongoing plan of upkeep and development for the environment of the home, and residents are consulted. EVIDENCE: The home employs separate domestic staff and a handy person who work hard to keep the home maintained, clean and tidy. The home was well presented, maintained and decorated to a good standard, both internally and externally. The upper floor had benefited from redecoration and 6 bedrooms had been refurbished. At the time of the visit there was a minor problem of incontinence odour on the second floor that was pointed out to the manager of the home. Residents said they liked the colour schemes around their home and the way their individual rooms had been decorated, residents confirmed that they had been encouraged and supported to personalise their own rooms and would be
Oakland Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 14 consulted about redecoration. Residents were appreciative of the efforts made by both care and domestic staff. There are plans to develop the loft space to provide staff facilities and to redecorate the kitchen area in the near future, and there was evidence that Oakland Grange provides a valuing environment for people to live in. Oakland Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 15 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): 27-30 Care staffing levels, and NVQ trained staff, at the time of the visit were above the national minimum standards. The home provides staff with training and development opportunities in addition to NVQ. The homes’ staff induction practices met legal requirements. The manager of the home has enrolled on the NVQ 4 RMA course. EVIDENCE: The staff roster indicated that the home was providing 748 care staffing hours for the week to meet the needs of the residents accommodated and these arrangements were found to be above the previously agreed levels. The home continues to provide opportunities for staff to be trained to NVQ 2 and 3, and at the time of the visit 75 of staff had at least NVQ 2 training. The registered manager, and the deputy manager have enrolled on the NVQ 4 / registered managers award, and the manager has over 17 years experience working with older persons and NVQ 3 currently. Other training opportunities are provided to ensure that baseline training is given to staff in such areas as food hygiene, basic first aid, manual handling and moving, fire training and health and safety. Residents stated that they were happy with the staff working at the home. A new staff member confirmed that she had received induction and support/supervision in her role at the home. Oakland Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 16 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): 35 The home does not hold adequate records of residents’ personal items or allowances held on their behalf. The home should avoid holding large quantities of cash, and should make arrangements to bank surplus amounts into the resident’s individual bank/savings account. EVIDENCE: Arrangements made for handling residents’ money deposited with the home for safe – keeping, were found to be in need of further development. Currently there are chequebooks belonging to residents deposited in the home safe with no clear record of the deposit or a clear receipting system. Records of personal allowances and monies held on behalf of residents did not provide a full audit trail. Records need to be developed in order to provide a clear statement of the amount held, date deposited, signature of staff member and resident (where able), amount out, and reason for use, including record of receipt where money is spent on behalf of the resident and a clear balance of amount left in
Oakland Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 17 the account. There were 25 separate accounts held on behalf of residents. In one case over seven hundred pounds was being held in cash. Oakland Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 4 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 1 X X X Oakland Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP35 Regulation 20 17(2) Sch 4(9) Requirement The registered persons must make arrangements for adequate records to be maintained of any/all personal valuables/monies deposited with the home for safekeeping. Such records must provide a comprehensive audit trail, in order to protect all persons concerned. Timescale for action 01/12/05 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 OP3 Good Practice Recommendations The home should assess residents’ needs in all relevant areas including personal finances. The needs and wishes of residents should be recorded, and resident abilities to use such facilities as the lockable storage and bedroom door locks should be assessed, and keys provided where appropriate, in the context of enabling residents to remain as independent as possible in this area of living, and to risk assess such matters at the point of admission, and at
DS0000011767.V257371.R01.S.doc Version 5.0 Page 20 Oakland Grange 2 OP18 3 OP26 care reviews. Where a decision is made following a risk assessment to restrict residents access to bank cards, or chequebooks this should be fully recorded in the individuals care plan with the reasons. The registered persons should seek guidance from the Department of Health with regard to a POVA referral following the current investigation into thefts at the home, and the criteria for referring an ex-staff member who has a warrant for arrest outstanding, in regard to police investigations. The registered persons should take all necessary action to overcome the odour of urine evident on the day of the visit on the second floor of the home Oakland Grange DS0000011767.V257371.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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