Inspection on 20/09/06 for Oaklands Care Centre

This inspection was carried out on 20th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Oaklands Care Centre 13/05/09

Oaklands Care Centre 16/06/08

Oaklands Care Centre 26/07/07

Oaklands Care Centre 24/02/06

Oaklands Care Centre 11/11/05

Oaklands Care Centre 10/02/05

Oaklands Care Centre 08/09/04

Oaklands Care Centre 29/10/03

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

CARE HOMES FOR OLDER PEOPLE Oaklands Care Centre 4 Oakland Road Moseley Birmingham West Midlands B13 9DN Lead Inspector Ann Farrell Unannounced Inspection 20th September 2006 08:00 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 Oaklands Care Centre DS0000024872.V311847.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. Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oaklands Care Centre Address 4 Oakland Road Moseley Birmingham West Midlands B13 9DN ER 0121 449 3097 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) Exceler Healthcare Services Limited Mrs Rachel Christine Daley Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46) of places Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the Manager successfully undertakes the Registered Managers Award or equivalent by April 2005. 24th February 2006 Date of last inspection Brief Description of the Service: Oakland’s Care Centre provides 24 hour nursing care for 46 older adults. The home has been adapted and extended from an existing property and is situated on a quiet road not far from Moseley village. There is a range of community facilities to be found nearby, and a number of bus routes are within a fairly short walk of the home. There is off road car parking to the front of the property. Bedrooms are a mixture of shared and single rooms; spread over three floors. There are no en suite facilities provided by the home. There are lounges situated on two of the three floors of the home and there is a pleasant enclosed garden area for residents to access. The home has a passenger lift to all floors, a nurse call system and some aids and adaptations to assist residents with limited mobility. Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork inspection was conducted over two days commencing at 8.00 am on 20th September 2006. This was the first statutory inspection for 2005/2006 and the manager was available for the duration of the inspection. During the inspection process the inspector toured the home, sampled residents files and other documentation. Case tracking was used in respect of a number of resident’s files to determine care from the time of admission to the home plus direct and indirect observation. A Pre-inspection questionnaire with comment cards were forwarded to the home prior to the fieldwork to obtain feedback and assist with the process. The questionnaire and 15 comment cards were received at the time of fieldwork. During the fieldwork the manager, one nurse, three members of staff, eight residents, and three relatives were spoken to on the day. Some residents were unable to communicate verbally and their views could not be obtained. What the service does well: Visiting is flexible and relatives are made welcome. Visitors stated staff were friendly and there were a range of activities available in the home. There are a variety of communal areas for residents to sit. Residents stated they enjoyed their meals. One resident stated, “It is every day food and you get a choice”. Written and verbal feedback indicated staff were good. “One resident stated, “ You can have a laugh with them”. The impression was that residents with lower needs were satisfied and their needs were being met. An activities co-ordinator is employed 16 hours a week and undertakes a range of activities with residents providing some stimulation. The managers office is on the ground floor and easily accessible for visitors if they wish to discuss any concerns. Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There must be adequate care staff on duty at all times to meet residents needs plus and suitable arrangements in place to cover periods of absence for any reason. The medication system needs to be improved with regular staff audits to ensure there is a robust system in place to ensure residents receive the medication prescribed. The assessment process needs to be developed further to ensure all residents’ needs are identified. Following assessment comprehensive care plans need developing, which includes advise from health professionals. Also systems put in place to ensure they are implemented and there is a pro active approach to care with early identification of any concerns and referral where appropriate especially for residents with higher needs. The arrangements for activities of the more dependent residents needs to be developed further to ensure they are adequately stimulated and their needs are met. Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 7 A review of the arrangements for meals and menus should be undertaken to enhance choice, meet cultural needs and ensure there are adequate portions are available at all times. Staff development is required in respect of core training e.g. fire, manual handling, infection control; adult protection etc. to ensure a consistent approach to care and safe standards are met. Further improvements are required in respect of deep cleaning and infection control to reduce the risk of cross infection and provide a clean hygienic environment for residents to live. Bathroom, toilet and sluice facilities need up grading to meet the needs of residents with mobility problems adequately. 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 Care Centre DS0000024872.V311847.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 Oaklands Care Centre DS0000024872.V311847.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,6 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service. The home provides information for prospective residents regarding the services available, but it requires some additions to ensure comprehensive information is available. Assessments require further development with involvement of the resident or their representative in order to provide sufficient information to staff to enable them to meet all residents’ needs. EVIDENCE: The home generally admits residents for long-term care or respite care. A service users guide was available in the reception area and it stated the document was available in cassette from on request. Consideration should be given to large print and copies should be made available to all residents. The document states that smoking is not allowed in the home, but does not give any indication of the arrangements for residents who do smoke. Also there was no information as to the arrangements for residents to make and receive telephone calls in private. Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 10 A copy of the statement of purpose was forwarded to the Commission following the inspection. It appeared to be a corporate document and needs personalising and developing further to provide information about the services provided by the home. A small sample of resident’s files were inspected and there was evidence that a pre admission assessment is undertaken prior to residents moving into the home. However, the home does not write to prospective residents to confirm that they can meet their needs. On inspection of a pre admission assessment it was noted that some areas had not been completed and there was some conflicting statements. On some occasions a pre-admission care plan had been drawn up to reflect the needs identified at the time of assessment. The home has some residents who suffer with dementia and challenging behaviour. Staff will need training in caring for these residents. Some of the bathrooms and toilets have limited space with domestic type baths and are not suitable for the client group due to manual handling etc. The manager of the home must ensure that when assessing residents for admission to the home these factors are taken into consideration and residents matched to the facilities. Oaklands Care Centre DS0000024872.V311847.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. The judgement has been made using available evidence including a visit to this service. Aspects of care and medication were adequate in some areas only. However, the needs of the higher dependent residents were not being consistently met and aspects of care advised by health professionals were not being implemented. Some areas of medication were poor and it could not be guaranteed that residents received the medication prescribed to them. EVIDENCE: Following admission to the home a further assessment with risk assessments are undertaken. In some cases it was found that documents had not been dated or signed, the manual handling assessment had not been fully completed, a nutritional risk assessment indicated a problem, but there was no indication of this in the records and there was no follow up to it. Continence and bowel assessments were undertaken, but again where issues were identified there was no evidence of follow up. Residents are weighed on admission, but there is no objective tool, such as body mass index, to determine if the residents are of an adequate weight. Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 12 Staff draw up a care plan for all residents following assessments outlining how the resident’s needs are to be met by staff. On inspection of a sample of records it was noted that some lacked detail, gave vague instructions and there was no evidence that the resident or their representative was involved in the process. Some were not comprehensive, were based on physical needs, advise from health professionals had not been included in the plan of care for some residents and they had not been updated when there were changes in residents conditions. Also risks had been identified and there was no plan of action to address the risk. The care plans for one resident identified a problem and records indicated that it was not referred to the doctor for over one month. There was no detail about catheter care and on discussion with staff they could not clarify the process. There was no information about the care of PEG feeding tubes or administration of medication via the feeding tube. In one case there was no information about the size of sling to be used when hoisting a resident and a member of staff stated they would make a decision based on the size of the resident. In one case the care plan for a resident who was not eating anything stated to have mouth care twice a day and at inspection it was noted that their mouth was very dry and staff gave different accounts as to how their mouth would be cleaned. In other areas related to personal care it was identified that the care plan was not being implemented. This is not adequate and action must be taken to ensure a consistent approach to care. The care plans were not evaluated regularly and where a review had been undertaken with social worker and family there was no written record. On inspection of daily records concerns had been raised, but there was no evidence to indicate that they had been followed up or had been resolved. On discussion with one family they advised that the residents had lost weight and they had requested two meals a day instead of sandwiches in the evening. On the first day of inspection this did not occur. When the issue was raised with eh manager it was stated that a relief cook had been on duty and the information had not been communicated to them. The home has been working with the tissue viability nurse and a range of pressure relieving equipment had been provided. Charts were also in use to record when residents were turned or pressure was relieved. Some of the charts indicated that a number of residents had been turned at the same time and others indicated that some residents had only been attended to 2-3 times in 24 hours, which is not acceptable practice. During inspection it was noted that a high dependency resident had developed a pressure sore even though the care plan stated equipment was in place and turns were being undertaken. Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 13 A number of residents need assistance with moving/handling but there were no slide sheets available in bedrooms. When one was found on another floor it was short and could lead to problems with shearing of heel if used on its own, but on discussion with staff they were not aware of any potential problems. The feedback obtained indicated that residents had to wait a long time for responses to call bells and it was hard to find a member of staff between 7.15pm and 8.15pm. Also it was noted that some residents did not have access to a call bell when in their room. The inspector spent time in the lounges on the ground and first floor. It was not evident that people had been supported to undertake personal care to a good standard. Examples of men who had not been supported to shave, people whose hair had not been brushed and people with food and sleep residue on their face was apparent. The home uses crash mats where residents are at risk of falling out of bed and it was stated that there are times when the crash mats are not in position, so putting residents at risk. During inspection was noted that some residents were not sitting comfortably in chairs or were not supported appropriately when sitting in chairs. Also some of the rubbers on residents walking frames were worn need replacing and the home does not have any suction apparatus. This is concerning as they have identified residents who are risk of choking. The home liaise with health professionals such as GP, dentist, optician, chiropodist. However, records did not demonstrate these visits were occurring on a regular basis or that there were regular checks for residents with chronic diseases such as diabetes, hypertension, asthma etc. This area will need to be followed up, action taken where necessary and records maintained to demonstrate this aspect of care. During the inspection it was stated by a member of staff the some residents have aromatherapy. The G.P. will need to be contacted for advice regarding the use of oils. The home uses a monitored dosage system of medication, which is stored appropriately. On inspection of the medication charts (MAR) the administration and recording was found to be satisfactory for medication that was in the blister pack, but audits for other medication was not satisfactory and it appeared that nurses had signed to indicate medication had been given, but it remained in the box. Areas that require attention include: • The fridge temperature had been recorded as 25 degrees and the room temperature as 29 degrees. Medication should be stored at between 3 and 8 degrees in the fridge and the room temperature should be maintained at 25 degrees or below. • A number of audits on boxed medication were not accurate. • Eye drops and creams had not been dated when opened. Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 14 • • Handwritten medication details had not been countersigned There were no guidelines for the administration of rectal diazepam. Feedback indicated that staff were generally good, but there is a lack of response to call bells at times. Staff were noted to knock residents doors before entering, but there were areas in respect of residents presentation that need to be addressed e.g. one resident had a mixture of day and night wear on and only one sock walking around the home. Some residents did not have bibs removed after meals; a number of others did not have appropriate footwear on or socks/stockings. One member of staff was observed to approach a resident and tell them to sit down without enquiring as to what they wanted and another was unable to manage a residents behaviour in an appropriate manner. All these areas will need to be reviewed and training given where appropriate. There is a pay phone in the reception area. It was stated that residents could use an office if they wished to make or receive calls in private. This information needs to be included in the service user guide. Oaklands Care Centre DS0000024872.V311847.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service. Visiting is flexible and relatives are made welcome. There is a range of activities, but this area needs to be developed further to ensure adequate stimulation of the more dependant residents. The meals are of a satisfactory standard. The menus need to be reviewed to provide a greater choice in respect of cultural options and action taken to ensure there are adequate portions at all times. EVIDENCE: Residents are free to come and go as they wish depending on the capabilities. Visiting is flexible and this was confirmed on discussion with relatives. Residents are able to bring personal items into the home and on discussion with some they stated they could get up and go to bed when they wished. An activities co-ordinator is employed for 16 hours a week. Activities include one to one sessions, outings to the pub and shopping, music and video sessions. Recently there has been a summer fete and a day trip to Weston Super Mare. It was stated a newsletter is produced each month although one was not seen. Also there are meetings every three months with residents and relatives and wine and cheese is provided. Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 16 There are visits from the “motivation man and aromatherapy sessions, but residents have to pay an additional fee for these services. At one stage in the inspection it was noted that three care staff were sitting in the lounge with the more able residents and there was no stimulation of the more dependent residents. On discussion with some residents they stated they did get bored and one stated, “There is nothing to pass the time”. This is an issue that was identified at the last inspection and action will need to be taken to address this area. The home employs separate catering staff who provide three full meals per day. However, a carer is taken from the floor in the evening to cover kitchen duties, which results in a reduced staffing level on the floor to care for residents needs. On the second day of the inspection a member of kitchen staff was off sick and again a carer was moved into the kitchen leaving them short of care staff to attend to residents personal needs. This is not acceptable. The manager must ensure there is adequate kitchen staff at all times. There is a four-week rotating menu, which provides a choice of meals and it has been in use for over one year. There were very few cultural options and the home have a number of residents of Afro Caribbean origin. On discussion with residents from minority groups they stated they would prefer such meals on a regular basis. Residents stated that the quality of the meals was good, but there were times when there were not sufficient amounts of food and no choices were available. On the day of inspection the second choice was not available and residents had to wait for it to be cooked. The inspector was informed that there are times when the choice sheets are not completed and provided to the kitchen by the care staff. It was also stated that residents did not always receive an early morning drink and had to wait until breakfast was served before receiving a hot drink. Lunch as taken with residents and it was found to be satisfactory, but there is a lack of fresh vegetables used. At present the home uses mainly frozen vegetables, consideration must be given to using fresh ingredients to ensure that the food served is wholesome, balanced and nutritious to meet resident’s needs and preferences. All residents will not like frozen or tinned vegetables and will prefer fresh as this has a different taste, texture and appearance. At one stage it was noted that staff were standing up whist assisting residents with feeding. This is not good practice. Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service. Procedures are in place to deal with complaints and adult protection. Staff training is required in these areas to ensure there is an open approach and to provide assurance that all concerns/allegations would be addressed appropriately. EVIDENCE: The adult protection procedures were discussed with some staff and the responses were variable, suggesting that some staff are not aware of the action to take in the event of any allegation of abuse. The manager must ensure that all staff receive training in respect of adult abuse and whistle blowing procedures to ensure residents are adequately protected. The homes complaints procedure is displayed on the notice board and they retain a record of complaints. Records indicated they had received five verbal complaints since March 2006, which had been addressed. The Commission had not received any complaints at the time of the inspection. On discussion with some residents they were not aware of the complaints procedure. Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 18 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): 19,20,21,22,23,24,25,26 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service. The communal area have been redecorated and furnished providing a warm inviting environment. The bathing and sluice facilities need upgrading and aspects in respect of cleanliness and infection control need to be improved. EVIDENCE: The home is a large detached property set it’s own grounds with level access for residents who use wheelchairs. The accommodation is generally well maintained having recently had corridors and stairwells re-decorated and new flooring provided. On entering the first morning of the inspection security systems were not adequate and the manager will need to review this aspect. On touring the home there were some isolated areas of odour, deep cleaning was not adequate in some areas and doors were propped open with wedges. Communal areas consist of an adjoining lounge/dining room on the ground and first floor plus an additional small lounge on the ground floor. All areas are Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 19 well decorated, furnished and provide a pleasant place to sit and take meals. Corridors are rather narrow and limited for residents who use wheelchairs. There is access to the garden via a side entrance and an entrance to the rear of the building. Ramped access is to be provided to these doors and the paving slabs are to be replaced, as they are uneven and not suitable for residents who use wheelchairs. There are 32 single rooms and 4 shared rooms. Some bedrooms have recently been re-decorated and new carpets provided. The single rooms are well appointed. All rooms have wash hand basin, call bell, are adequately furnished, but some did not have over bed lighting that was easily accessible from the bed and some of the linen was worn/frayed. Rooms were personalised to the extent preferred by residents. The home has recently obtained four profiling beds and a range of pressure relieving equipment for use with residents who are at risk of developing pressure sores. Privacy curtains were provided in shared rooms. There is a range of bathing facilities in the home, but the baths are domestic in type and not suitable for the current resident group and one was used as a storeroom. Also some of the shower rooms are very small and there is one shower room in the reception area, which has an impact in respect of privacy. It was stated that the bathing facilities are to be reviewed in the near future. All areas are individually and naturally ventilated and restrainers are fitted on windows for security and safety. The lighting in the corridor on C floor was found to be inadequate and a double adaptor was in use in one room. An electrical extension must be used to comply with health and safety. There is a sluice on each floor, but there is no sluicing disinfector. Some were found to be very small cleaning materials were stored in them and they were not locked. Cleaning materials must be stored in a locked cupboard in order to comply with health and safety legislation. Some of the practices in respect of infection control were not adequate e.g. staff were walking around the home with gloves and aprons on. Staff should remove them after dealing with incontinence and wash their hands. Paper towels, liquid soap and waste bins were not available in all areas, disposable gloves were not available in the laundry and some disposable gloves and been discarded in a general waste bin. The laundry area is adequate with a separate ironing room and separate staff employed to undertake the laundry. Feedback indicated that laundry went missing despite the fact that it was labelled. The system will need to be reviewed. The kitchen has recently been refurbished and temperatures of fridges, freezers and hot food were recorded. Areas that need to be addressed to Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 20 ensure satisfactory hygiene practices in the kitchen include decanted foods must be clearly dated and disposed off after the use by date, food in fridges must be dated when opened, chopping boards need replacing, paper towels must be available for staff hand washing and the area needs more thorough cleaning. Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. The judgement has been made using available evidence including a visit to this service. Adequate staffing levels were not consistently maintained and the recruitment procedure needs to be developed further to ensure residents are adequately protected. EVIDENCE: The duty rotas were inspected and it was found that there are usually six care staff plus two nurses on duty during the morning, five carers plus two nurses in the evening and three carers plus one nurse over night. Domestic, catering, maintenance and administration staff supports care staff. It was noted that a carer is required to go into the kitchen every evening to deal with catering tasks. Also on the day of inspection a member of care staff had to go into the kitchen as a member of catering staff was off sick. This is not acceptable as there is not sufficient staff on the floor to care for residents. The home must ensure there are adequate staff on duty at all times to meet residents needs and make adequate arrangements to cover periods of absence or sickness. A small sample of staff files were inspected and the recruitment process was not satisfactory. An application form and health declaration form are completed as part of the process. However, in some cases these had not been fully completed or signed and there was no evidence that gaps in the employment history had been explored. Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 22 In one case only one reference had been obtained, evidence of CRB checks were not available and in one case a member of staff who was known to have cautions had commenced employment without a POVA check, which is required before employment starts. In other cases there was no evidence that some overseas staff were eligible to work in the country. This process will need to be improved to ensure residents are adequately protected. Over 50 of staff are qualified to NVQ level 2 and the remaining staff are enrolled to undertake the training. The home has induction training for newly appointed staff, but it did not meet the standards of the Social Skills Council. Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. The judgement has been made using available evidence including a visit to this service. The management arrangements are satisfactory. Arrangements for staff training need to be developed further to ensure staff have the appropriate knowledge and skills to care for residents. There are some arrangements in place for quality assurance and these are to be further developed by the managers. Arrangements for resident’s monies and general maintenance were satisfactory. EVIDENCE: The general manager takes overall responsibility for the home and is supernumerary. There is also a care manager who works as a nurse on the floor and is supernumary for six hours each week. Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 24 An external organisation has undertaken an audit in respect of quality assurance and the manger has sent out questionnaires to residents and relatives, but there has only been a 50 response. It was stated that they are to be sent out again and this time they will be returned and analysed by the area manger in the hope of achieving a better response. Feedback should also be obtained from other stakeholders and upon completion a development plan drawn up indicating outcomes for residents. The home holds money and valuables on behalf of residents. On inspection of the records in respect of resident’s monies they were found to be of a good standard and in order. There was no record of the valuables that are held in the home on behalf of residents and this will need to be addressed. The home had undertaken servicing and maintenance in respect of equipment, to ensure adequate health and safety in the home. Outstanding areas that need to be addressed: • • There was no evidence of servicing of wheelchairs. The passenger lift appears to have problems and breaks down on a regular basis. If this continues more positive action will need to be taken to ensure it is fit for purpose. A small sample of staff training records were inspected and updated training is required in respect of manual handling, basic food hygiene, fire prevention, fire drills, and infection control. Staff will need to undertake training in respect of first aid and there should be at least one first aider on each shift. Also consideration needs to be given to other areas of training in aspects related to resident’s conditions. Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 25 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 X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 1 2 3 2 2 2 STAFFING Standard No Score 27 1 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement The Registered Person must ensure the statement of purpose is reviewed, amended updated and is available in the home at all times. The Registered Person must review the Service User Guide and ensure it provides comprehensive information for residents entering the home and all residents receive a copy. The registered person must ensure: • The pre-admission assessment is fully completed, signed and dated. • The home write to residents confirming that they are able to meet their needs. • The admission assessment in the home is fully completed with risk assessments, dated signed and is comprehensive. The registered person must ensure all staff undertaken training in respect of caring for DS0000024872.V311847.R01.S.doc Timescale for action 30/12/06 2 OP1 5 30/12/06 3 OP3 14 18(1) 30/10/06 4 OP4 18(1) 28/01/07 Oaklands Care Centre Version 5.2 Page 27 5. OP7 15 18(1) 6 OP7 12(1) 7 OP7 12(1)(a) 8 OP8 12(1) people with dementia and challenging behaviour commensurate with their position in the home. Unmet from the previous inspection. (Completion due by 01/02/06) The Registered Person must ensure: • Care plans are comprehensive, holistic and outline in detail how resident’s needs are to be met by staff. • Care plans must demonstrate evidence that residents, families or other representatives have been involved in the process. • Care plans must be reviewed in a meaningful manner and updated where there are any changes or shortfalls. • Records of all reviews must be kept in the home. • Care plans must be consistently signed and dated. • Arrangements are in place for the care plans to be implemented as stated. • Staff are provided with training in respect of care plans where necessary. The Registered Person must ensure: • All areas of concerns in daily records are followed up and records maintained. Unmet from the previous inspection. (Completion due by 16/12/05) The Registered Person must ensure personal care is undertaken to an acceptable standard. The Registered Person must DS0000024872.V311847.R01.S.doc 30/11/06 30/09/06 30/09/06 30/09/06 Page 28 Oaklands Care Centre Version 5.2 13(1) 9 OP8 12(1) 10 OP8 12(1) 11 OP8 13(3) 12(1) 12 OP8 12(1) (13)(2) 18(1) 13 OP8 13(4) 12(1) ensure • An appropriate referral is made when a resident is deemed to be at risk or there are changes in their condition. • A proactive approach to care with early identification of concerns and follow up. The Registered Person must ensure a call bell is accessible to all residents when in their rooms and there is a more timely response. The Registered Person must • Review and enhance the communication systems in the home ensuring that all staff are aware of residents needs and what is required to meet them. • Systems are in place to ensure they are implemented. The Registered Person must ensure all staff are aware of catheter care and mouth care, it is implemented to prevent risk of infection and there is a consistent approach. The Registered Person must ensure: • All residents with chronic diseases such as diabetes, hypertension asthma are monitored appropriately. • All residents have opportunity to see dentist, optician and chiropodist on a regular basis and records are maintained. • Advice is sought from the G.P. about the use of aromatherapy oils. • The Registered Person must ensure an appropriate professional DS0000024872.V311847.R01.S.doc 30/09/06 30/09/06 20/10/06 30/11/06 20/11/06 Oaklands Care Centre Version 5.2 Page 29 14 OP8 12(1) has referred all residents who use a wheelchair for an assessment. The Registered Person must ensure: • Any resident who requires moving in bed has an individual sliding sheet. • Crash mats are suitable and always in place when residents are in bed who have been identified at risk. • Rubbers are replaced on walking frames if worn. • All residents are provided with appropriate seating and are adequately supported when sitting in a chair. Unmet from the previous inspection. (Completion due by 16/12/05) The Registered Person must ensure evidence that required therapies are being provided must be available. Unmet from the previous inspection. (Completion due by 16/12/05) The Registered Person must ensure residents with dysphasia have an eating and drinking plan and choking risk assessment. Unmet from the previous inspection. (Completion due by 16/12/05) The Registered Person must ensure a full plan of care is provided for all residents with diabetes. The Registered Person must ensure • A robust system in respect of medication to include: DS0000024872.V311847.R01.S.doc 20/10/06 15 OP8 12(1)(a) 13(1)(b) 20/10/06 16 OP8 12(1)(a) 13(4)(c) 20/10/06 17 OP8 12(1)(a) 13(4)(c) 30/11/06 18 OP9 13(2) 30/09/06 Oaklands Care Centre Version 5.2 Page 30 • • • • • • • 19 OP10 12(4) The correct administration and recording of all medication. The drug fridge and room is maintained at the correct temperatures. Eye drops are dated when opened and discarded after one month. Creams are dated when opened and discarded after one month. Handwritten medication details must be countersigned. There are guidelines for the administration of rectal diazepam. Suction equipment is provided. 30/09/06 20 OP12 16(2m-n) The Registered Person must ensure residents dignity is respected at all times to include: Residents appropriately dressed, appropriate foot wear, bibs removed after meals etc. Unmet from the previous inspection. (Completion due by 01/02/06) The Registered Person must ensure systems are in place for the stimulation and engagement for residents with higher dependence levels. The Registered Person must ensure: • The menus are reviewed in consultation with residents and choices are always available. • Cultural options are provided on a regular basis. • An early morning hot drink is offered regularly to residents. DS0000024872.V311847.R01.S.doc 30/10/06 21 OP15 16(2)(i) 30/10/06 Oaklands Care Centre Version 5.2 Page 31 22 OP16 22 23 OP18 13(6) 24 25 OP19 OP19 13(4)© 23(4) 26 OP19 23(2)(n) 27 OP19 16(2)(j) 28 OP21 23(2)(b) (j) There are adequate amounts of food at all times. • Incorporate fresh vegetables. The Registered Person must ensure all resident and their representatives are informed of the complaints procedure. The Registered Person must ensure all staff are fully conversant with the adult protection and whistle blowing procedures. The Registered Person must review the security arrangements for the home. The Registered Person must ensure all fire doors are kept closed. If there is a need to keep them open they must be linked into the fire alarm system. The Registered Person must ensure ramped access is provided to rear and side doors and paving slabs are made even. The Registered Person must ensure adequate hygiene conditions in the kitchen: • All decanted foods are clearly dated and disposed off after the expiry dated. • Foods that are opened in the fridge are dated. • Replace worn chopping boards. • Ensure adequate hand washing facilities in the kitchen. • Ensure the kitchen is kept clean. Unmet from the previous inspection. (Still within timescale. Due for completion 01/03/06) The Registered Person must ensure the toilets and bathrooms in the home are improved and DS0000024872.V311847.R01.S.doc • 30/10/06 30/10/06 30/09/06 30/09/06 20/01/07 30/09/06 30/01/07 Oaklands Care Centre Version 5.2 Page 32 meet the needs of the residents. 29 OP22 23(2)(l) The Registered Person must ensure there is adequate storage space in the home for equipment etc. The Registered Person must ensure: • Bedside lighting is accessible to residents in bed. • Frayed worn linen is replaced. The Registered Person must ensure adequate lighting in all areas of the home and suitable electrical devices are used. The Registered Person must ensure suitable infection control measures are in place to include: • Hand washing facilities in all areas where continence or infected materials are handled. • Waste bins in all areas. • Staff to remove gloves/ aprons and wash their hands after dealing with incontinence. • Appropriate disposal of clinical waste products. • The flooring in the sluice is replaced. The Registered Person must ensure sluicing disinfectors are fitted in sluice areas. Unmet from the previous inspection. (Completion due by 16/12/05) The Registered Person must ensure effective odour management is achieved in all areas of the home. The Registered Person must ensure all cleaning materials are kept in a storage area that is locked when not in use. The Registered Person must DS0000024872.V311847.R01.S.doc 30/01/07 30 OP24 23(2)(p) 16(2)© 30/10/06 31 OP25 23(2)(p) 30/10/06 32 OP26 13(3) 05/10/06 33 34. OP26 OP26 13(3) 16(2)(k) 30/11/06 20/10/06 35 OP26 13(4) 30/09/06 36 OP26 23(2)(d) 20/10/06 Page 33 Oaklands Care Centre Version 5.2 37 OP26 12(1) 38 OP27 18(1)(ca 39 OP29 19 40 OP31 9(2)(b)(i) ensure all areas of the home are kept clean at all times. The registered person must undertake a review of the laundry system and ensure all belongings are returned in a timely manner to residents. The Registered Person must ensure there are adequate care staff and ancillary staff on duty at all times. (Unmet from the previous inspections) The Registered Person must ensure a robust recruitment process to include completion of application form, CRB, POVA checks, two written references, proof of identity and evidence that staff from overseas can work in the country plus risk assessments where necessary. Unmet from the previous two inspections. (Completion due by 1/6/06) The Registered Manager is required to obtain a recognised management qualification by 2005. The Registered Person must ensure enhance the quality assurance process to include feedback from a range of stakeholders and draw up a development plan outlining outcomes for residents. The Registered Person must forward a copy to the Commission of the monthly report completed on behalf of the responsible individual. The Registered Person must ensure a record is maintained of all valuables held on behalf of residents. Not assessed at this inspection. All staff must receive adequate DS0000024872.V311847.R01.S.doc 30/10/06 30/09/06 10/10/06 30/10/06 41 OP33 24(1)(b) 30/01/07 42 OP33 26 30/10/06 43 OP35 17(2) 30/10/06 44. OP36 18(2) 30/10/06 Page 34 Oaklands Care Centre Version 5.2 levels of supervision. (Six times per year) 45. OP38 OP6 13(5) The Registered Person must ensure all staff undertake updated training in respect of manual handling and correct procedures are undertaken at all times. The Registered Person must ensure all staff undertake updated training in respect of infection control and correct procedures are undertaken at all times. 30/10/06 46 OP38 OP26 13(3) 30/10/06 47 OP38 23(4) The Registered Person must 30/10/06 ensure all staff undertake updated training in fire prevention and at least two fire drills each year and records must be retained in the home. The Registered Person must ensure all staff undertake updated training in respect of basic food hygiene and records are retained in the home. 30/12/06 48 OP38 16(2)(j) 49 OP38 13(3) The Registered Person must 30/12/06 ensure all staff undertake training in respect of first aid and there must be at least one first aider on duty at all times. Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 35 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 OP12 OP12 OP12 Good Practice Recommendations It is recommended that the programme of activities continue to be developed and increased. (Carried forward) It is recommended that stimulation other than TV be explored. (Carried forward Not assessed at this inspection. It is recommended aids and adaptations to support service users who have visual impairments or physical impairments to undertake activities be explored Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. Extracts may not be used or reproduced without the express permission of CSCI Oaklands Care Centre DS0000024872.V311847.R01.S.doc Version 5.2 Page 37 - 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. 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