Inspection on 26/07/05 for Oaklands

This inspection was carried out on 26th July 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Oaklands 13/04/07

Oaklands 03/01/06

Oaklands 08/12/04

Oaklands 01/06/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Oaklands Lower Common Road West Wellow Romsey Hampshire SO51 6BT Lead Inspector Pat Trim and Liz Palmer Unannounced 26 July 2005, 10:00 th 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 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. Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Oaklands Address Lower Common Road, West Wellow, Romsey, Hampshire SO51 6BT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01794 322005 Delicourt Limited Mr Robert Tyson Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Mental Disorder, excluding learning disability or dementia - over 65 (45) Dementia - over 65 years of age (45) Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 08/12/2004 Brief Description of the Service: This residential home is registered to provide personal care and accommodation to 45 service users who are over 65 years in age and are in the category of Old Age. They may also have dementia or mental health problems. The home is privately owned by Delicourt Limited. This organisation also owns a number of residential and nursing homes in the county. The Registered Manager is Mr. Rob Tyson. Accommodation is provided in a large house that has been extensively extended to provide 35 single and 5 shared bedrooms located on the ground and first floors. 30 bedrooms have en suite facilities. Two shaft lifts enable service users to access both floors. Communal space is provided in four lounges, a chapel/quiet room and a large dining room. The home has a large patio area and garden to the rear of the property with car parking space at the front. It is situated in a quiet residential road in a rural area between Romsey and Salisbury. The home is close to local shops, amenities and public transport. Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection for 2005/2006 and was unannounced. It was completed by two inspectors in 5.5 hours. Four residents, two relatives and three staff were interviewed as part of the inspection. A partial tour of the premises was undertaken and a random sample of staff and care records were inspected. Information was also gathered from the pre inspection questionnaire and feedback forms from residents, relatives and health care professionals. During the inspection the people that lived in the home were asked what title they would like used to refer to them in the report. They chose the title of “residents” and this term is used throughout this report. What the service does well: What has improved since the last inspection? What they could do better: Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 6 Staff are able to demonstrate their knowledge of individual residents’ needs. However, new staff would not be able to get this information from the care plans as these do not identify individual wishes and needs. The care plans do not contain sufficient detail to give staff guidance on how to provide the care in they way the resident might want. Risk assessments are not used to support residents to manage their own care and daily living activities, by providing action plans to minimise risk. Care plans and risk assessments should be developed in partnership with residents, where appropriate, to provide a detailed plan of how individual wishes and needs may be met. 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. Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 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 standard(s) EVIDENCE: The core standards were not assessed on this inspection but will be covered at the next inspection. Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9 and 10. The information recorded in care plans is insufficient and does not give enough guidance to enable staff to provide a consistent approach to meeting the care needs of individual residents. Good working relationships between staff and health care professionals enable residents to have access to a wide range of health care provision and to have their health care needs met. Robust procedures in the management of medication and training of staff ensure that residents’ medication needs are met safely. Staff training and the ethos of the organisation promote core values so that residents feel they are treated with dignity and respect. EVIDENCE: Four care plans were assessed. These contained a wide range of assessment tools but very little information about the person’s individual needs. For Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 10 example, there was no information about what time they liked to get up, or where or when they liked to have breakfast. The staff spoken with were able to give detailed information about each individual but this valuable information had not been recorded. Much of the information recorded was confusing and contradictory. It is essential that accurate information is recorded in the care plan, both to evidence the individual approach taken to provide care, and to also ensure all staff have clear guidance on how to meet individual needs in a way the person wants. This will assist a consistent approach to care. Risk assessments had been completed for moving and handling but these did not show evidence of being updated when care needs changed. However, staff spoken with were aware of the changing needs. Risk assessments must be linked to the relevant section of the care plan and should contain an action plan to enable staff to support the resident to complete the identified activity safely or with minimum risk. Residents confirmed they were able to access a wide range of health care services and were able to see their doctors when they wished. Feedback from the primary health care team evidenced that there is a good working relationship with the home and the Registered Manager confirmed residents have access to regular visits from district nurses, community psychiatric nurses and continence advisors. There was evidence in individual daily records that residents regularly received these services. The Registered Manager expressed his concern about new guidance received from the Primary Health Care Trusts. He felt this could make it harder for residents to have services such as regular eye tests and the provision of individual wheelchairs. No current residents were self medicating, although one care plan stated that someone was. A new system for storing and administering medication had been adopted. The Registered Manager confirmed that this system provided each tablet in a monitored dosage system. It was expected that this would make the various changes to residents’ individual medication easier and safer to manage, as individual tablets could be removed from the system without compromising the storage of the rest. The pharmacist providing the medication also offered review of storage and staff training as part of the package. Staff were observed dispensing medication at breakfast and lunchtimes. Medication was offered to each resident with a drink and the record signed to confirm the medication had been given. This evidenced that staff were dispensing medication in accordance with Royal Pharmaceutical guidelines. Medication storage is kept to a minimum. The new system means that more supplies can be quickly obtained and negates the need to keep large stocks. Only staff who have completed a distance learning course in managing medication are permitted to give out medication. Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 11 The majority of residents spoken with or who returned questionnaires were very satisfied with their treatment by staff. They felt they were enabled to make decisions about their daily lives and were treated with respect. One or two felt staff sometimes did not listen to their wishes, but thought this was due to the amount of work they had rather than through lack of respect. Staff were observed giving care at the resident’s own pace and asking what help was required. They knocked on doors and waited for permission to enter. More than half the current staff have achieved their NVQ 2 in care. One section of this training explores the meaning of core values and helps staff identify how they can make sure they are incorporated into giving care. Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 12 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 standard(s) 12, 13, 14 and 15 The home provides a wide range of activities that provide stimulation to residents and which they enjoy. The home’s policy on visitors enables residents to be confident their visitors will be made welcome. The daily routines of the home are organised so that residents are able to exercise choice and control over their daily activities. Dietary needs of residents are well catered for with a balanced diet that provides a wide range of options for residents to choose from. EVIDENCE: Residents were able to access a wide range of entertainment and said they looked forward to the various events. One member of staff had started a monthly magazine that gave information about activities and residents. This had proved very popular and residents were making contributions for publication. The home was holding a summer fayre on Saturday and residents were observed being shown items collected for the sale. Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 13 Information from residents, staff and the pre inspection questionnaire confirmed activities such as pet therapy, music and movement, quizzes, art and craft and over 60s disco were well received. Activities outside the home included various clubs and church services. Residents commented on how much they liked going out to the garden area. There is a large patio area with seats and paths leading round lawns and flowerbeds. The Registered Manager said the stable block was being converted to provide a number of summerhouses. These would be furnished with tables, armchairs and a small fridge containing cold drinks so that residents could find more quiet areas to sit and read or watch the birds. Visitors to the home said they always felt welcome and were offered drinks. They were able to use the quiet areas in the home to visit away from other residents. The visiting policy for the home was displayed in the entrance hall and confirmed that visitors were welcome at any reasonable time and the Registered Manager was heard giving this information to someone who telephoned during the inspection. As stated in the previous section of this report, care plans did not evidence individual choices, but residents confirmed they were able to make choices about their daily living activities. Daily records confirmed that residents chose when they got up and how they spent their day. Staff spoken with were aware of each resident’s daily routine and felt it was their job to make sure these routines were followed. Residents were observed moving freely around the home. Some chose to stay in their rooms for most of the time, having their meals there, whilst others came down just for meals. Many residents mentioned how much they liked sitting in the conservatory and that this was much better now that blinds had been fitted to provide shade in hot weather. During the inspection it was noted that some residents were still having their breakfast at 10:30 a.m. Lunch was a social event and residents were encouraged to take their time over their meal. The majority of residents were satisfied with the meals provided. The daily menu only recorded one choice of main meal, but residents confirmed there were always at least two choices and residents were observed at lunchtime choosing a number of different options. There were some complaints about sandwiches being offered several times a week for tea. The cook explained that there were always alternatives. It was suggested that the menus be amended to incorporate the lunch and teatime alternatives and that staff be instructed to make sure all residents were aware of their options. Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 14 A menu is not displayed before lunch as this had been tried in the past and found not to be an effective way of informing people what was on offer. Asking people to choose prior to lunch also had not worked too well. It was recommended that alternative methods of giving this information should be tried such as showing residents pictures or the meals already plated up. The use of finger food for residents with dementia has been reported in previous reports and the home commended for this practice. However, it was felt that this practice must be monitored to ensure residents are still offered the option of choosing one of the main meals, even if this means they require assistance to eat it. Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 15 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 standard(s) 16 and 18 There was a robust complaints procedure that enabled residents to raise issues and to feel confident their concerns would be acted upon. Residents are protected from abuse by the use of training, policies and a robust employment procedure. EVIDENCE: Residents were confident they could raise issues with the Registered Manager and that their concerns would be listened to and acted upon. The complaints procedure was displayed in the entrance hall. A written record of complaints was kept and this recorded actions and outcomes. The Registered Manager was observed responding to a complaint made by a resident on the day of the inspection. Another resident raised an issue with the inspectors which was passed to the Registered Manager to resolve. Training on Adult Protection Procedures was included in the training calendar and the majority of staff had attended some courses. The Registered Manager confirmed he was arranging for the Community Psychiatric Nurse to provide further sessions later in the year. Staff spoken with confirmed they had received training as part of their NVQ 2 and were aware of their responsibility to report abuse. All staff were required to sign a record to confirm they had read the Whistleblowing policy. Information leaflets about abuse were displayed in the main office. Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 16 The Registered Manager confirmed all new staff had to complete a Protection of Vulnerable Adults (POVA) check as well as a Criminal Records Bureau Disclosure. Staff appointed from overseas had to have evidence similar checks had been completed in their own country and completed the above checks after they had been in the U.K. for three months. Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 17 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 standard(s) 19, 23 and 26 Investment in the home has provided a comfortable, safe and well maintained home that residents enjoy living in. The safety of residents in their own rooms could be compromised if personal alarm cords cannot be reached when residents are in bed. Adequate staff training and infection control procedures enable staff to protect residents against the risk of infection. EVIDENCE: The home has been extensively renovated in the past two years and furnished to a high standard. All areas of the home were clean but there was an unpleasant smell in one area of the home and a communal toilet in this area was badly stained. This was discussed with the Registered Manager who explained the reason for this and what steps were being taken to resolve the issue. The home employs cleaners to carry out all domestic work. Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 18 The Registered Manager confirmed that the home had not had a recent inspection by Environmental Health and that there were no outstanding requirements from previous visits. The fire officer visited in February 2005. There were no requirements from this visit. A random selection of bedrooms were visited. These contained all required items of furniture such as bed, bedside table and hanging space. In addition residents confirmed they had been encouraged to personalise their rooms with their own belongings. All rooms could be locked by the resident from inside and outside. It was noted that the personal alarm call bell in one room was missing. The window blind from the en suite toilet in this room had fallen down. The Registered Manager gave a verbal undertaking that these problems would be immediately resolved. A requirement was made that he should carry out a check on all bedrooms to make sure all cords were in place. Residents were satisfied with the laundry service provided by the home. Items of clothing are washed, ironed and put in individual named baskets to be delivered back to the resident. All soiled linen is collected and washed in protective bags to prevent the spread of infection. Washing machines have a programme for the disinfection of laundry. The home has a contract for the removal of clinical waste. Infection control training is included as part of the core training completed by all staff. Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 19 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The staff employed at the home have a wide range of experience and training that enable them to understand the needs of residents and to improve their quality of life. The number and deployment of people working in the home ensure that there are sufficient staff to meet the needs of current residents. The Registered Manager supports a culture in the home where assessment, supervision and training are seen as positive. This creates a motivated workforce that are able to develop the skills needed to meet the needs of the residents they care for. EVIDENCE: Some residents felt that staff had a lot of work to get through and that they did not always have time to complete it at the pace the resident would like. They thought calls for help were answered promptly and that they did not have to wait too long for assistance, given the number of people who needed it. However, sometimes this was longer than they would ideally like to wait. The Registered Manager provided information about residents’ dependency levels and staff hours in the pre inspection questionnaire. He confirmed in this and during the inspection that care hours are based on the Residential Forum Guidance and are reviewed as and when residents’ needs change. Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 20 On the day of the inspection there were six care staff and the Registered Manager working in the home. There were also five domestic staff, including a cook and kitchen assistant. There are five care staff on duty from 2 – 6:30 p.m. and four staff on duty from 6:30 to 10 p.m. There are three waking night staff. Care staff are not responsible for any other work such as cleaning, laundry or cooking. The rota confirmed that these are the normal staffing levels at all times. Three staff were interviewed during the inspection. They had a wide range of knowledge and training between them. All confirmed they were expected to continue to develop their skills by attending training courses and identifying personal objectives during supervision. 75 of staff have achieved their NVQ2. All staff are expected to be involved with residents, whatever their job. During the inspection all staff were seen talking to residents and attending to their needs. Tasks for the day are allocated at the start of the morning shift with staff working as teams to meet the needs of residents. Two new staff had been employed. Their records showed all relevant checks had been completed prior to their employment, such as completing application forms, having an interview and providing references, but the Registered Manager was reminded that Criminal Records Bureau disclosures were no longer portable. Staff had completed a basic induction programme. The Registered Manager said he felt to be inadequate and a new one was being introduced that would comply with Skills for Care. Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 21 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These core standards were not assessed but will be covered on the next inspection. Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x 2 x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x x Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 23 NO Are there any outstanding requirements from the last inspection? 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 7 Regulation 15 Requirement Timescale for action 1/11/05 2. 22 23 Comprehensive care plans must be developed that give staff clear guidance on the abilities and needs of residents and enable them to provide consistent care in the way the resident wishes. Ensure that all personal alarm 1/9/05 call bells are in place and are accessible by residents when they are in bed. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 15 15 15 Good Practice Recommendations Consideration should be given to ensuring daily menus record all meals offered to reflect the choice available. Consideration should be given to finding method to enable residents to be aware of all choices on offer for each meal. The use of finger food for residents with dementia should be monitored to make sure they would not prefer one of the options being offered to other residents. Oaklands H54 S11639 Oaklands V238714 260705 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Hampshire Area 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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