Inspection on 26/07/07 for Oaklands Care Centre

This inspection was carried out on 26th July 2007.

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 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 Care Centre 13/05/09

Oaklands Care Centre 16/06/08

Oaklands Care Centre 20/09/06

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 Lisa Evitts Key Unannounced Inspection 26th July 2007 09:00 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 DS0000024872.V340522.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. DS0000024872.V340522.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 0121 449 6662 0121 449 3097 oaklandsnh@schealthcare.co.uk www.schealthcare.co.uk Exceler Healthcare Services Limited 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) Elaine Lancelott (Acting Manager) Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46) of places DS0000024872.V340522.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. (Currently under review) 20th September 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 nearby, and a number of bus routes are within a short walking distance of the home. There is off road car parking to the front of the property. There are lounges and dining rooms situated on two of the three floors of the home and the third floor has bedrooms only. Bedrooms are a mixture of shared and single rooms, which are spread over three floors. There are no en suite facilities provided by the home. There are assisted bathroom and shower facilities. The home has hoists and pressure relieving equipment for use with people who are assessed as requiring this assistance. There is a passenger lift to all floors, a nurse call system and handrails, which would assist residents with limited mobility. The home has a main kitchen, laundry and office space. There is a pleasant garden area to the rear of the home and this is accessible to wheelchair users. Inside the home there are various notice boards, which display information about forthcoming events and other articles, which may be of interest. The last inspection report is available in the reception area, and this enable residents and visitors to the home to access this information if they choose to read it. The current scale of charges for the home range from £240 - £781.36 per week, depending on the type of room, the care required and who funds the care. Some rooms have a “top up” fee payable. Additional charges include, hairdressing, toiletries, newspapers and chiropody. DS0000024872.V340522.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The visit to the home was undertaken by one inspector over nine and a half hours and was assisted throughout the day by the Acting Manager. The home did not know that we were visiting. There were 39 residents living at the home and comments received on the day of the visit were all very complimentary about living there. Information was gathered from speaking to four residents and observing residents, as it was not possible to speak with a number of residents due to communication difficulties. One relative and three staff were spoken to and staff were observed performing their duties. Four residents were “case tracked”. This involves discovering individual experiences of living at the home by meeting or observing them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files and health and safety records were reviewed. Questionnaires were sent out to relatives and healthcare professionals but these had not been returned at the time of writing the report. Prior to the inspection the Acting Manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to CSCI. This gave information about the home, staff and residents, improvements and plans for further improvements, which was taken into consideration. Regulation 26 and 37 reports pertaining to accidents and incidents in the home were also reviewed in the planning of the visit to the home. A random visit had been undertaken in March 2007, to monitor progress since the last key fieldwork visit to the home. Details of this visit are referred to in the report. No immediate requirements were made on the day of the fieldwork visit. What the service does well: DS0000024872.V340522.R01.S.doc Version 5.2 Page 6 Residents who use the service have access to a range of Health and Social care professionals and this ensures that any healthcare needs are met. Residents are offered a choice of meals, which meet any dietary, cultural needs or personal preferences. Residents are involved in menu planning. The home creates a friendly and welcoming atmosphere where residents can personalise their rooms to reflect preferences and tastes. A core group of staff is maintained which ensures that residents know who will be assisting them to meet their needs. Residents and relatives are encouraged to voice their opinions and are actively involved in making decisions about the home and activities. Personal allowances can be held safely by the home if requested by the residents. Maintenance checks are completed to ensure that equipment is in full working order and is safe to use. Comments received included: “Its nice community, you get to know each other well and make friends”. “I’m very happy with the care my mother is receiving” “I’m going to have a go with the newsletter” “The activities are picking up” “Its quite good food” “I would speak to the manager if I had a problem” “My bedroom is a nice size, I am settled there, its comfortable” “The garden is lovely” “Staff are very good” “It’s gone from good to very good” What has improved since the last inspection? Pre admission assessments are completed and provide sufficient information for the staff to determine if the home can meet the individual needs of the residents prior to admission. Care plans have improved and include good details for staff to follow in order to assist residents to meet their identified needs and preferences. A new assisted bathroom and toilet area has been created to ensure that all residents have access to these facilities. A new hairdressing room has been created so that residents can benefit from a salon experience, and a new hairdresser has been employed. DS0000024872.V340522.R01.S.doc Version 5.2 Page 7 A number of areas have been redecorated in order to provide a homely and clean environment for the residents to live in. A sluice disinfector has been installed so that staff do not have to manually clean commode pots and this should minimise the risk of infection at the home. 85 of staff have completed a National Vocational Qualification (NVQ) Level 2 in care and the remaining staff are working towards achieving this. This should ensure that the staff have the knowledge and skills to care for the residents individually and collectively. One relative commented, “The manager has made so much improvement” and this suggests satisfaction with the service being provided. 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. The summary of this inspection report can be made available in other formats on request. DS0000024872.V340522.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 DS0000024872.V340522.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have information to enable them to make an informed decision about whether they would like to live at the home. Pre admission assessments are undertaken to ensure that the home and the residents know that individual care needs can be met prior to admission. EVIDENCE: The organisation has produced a comprehensive statement of purpose and service user guide, which contains all the information required. This ensures that prospective residents are given information about the home, which will enable them to make an informed decision about whether they would like to live there. These documents were on display in the reception area and a service users guide is given to residents upon admission to the home. This document is available on audiocassette to enable people who have sensory impairments to access the information. DS0000024872.V340522.R01.S.doc Version 5.2 Page 10 The certificates of registration and liability are on display in the reception area of the home, which enables anyone to view these when visiting. A copy of the previous inspection report is available in reception for anyone to read if they choose to. Comprehensive pre admission assessments are undertaken prior to residents coming to live at the home and this ensures that the home and the residents know that their individual assessed needs can be met upon admission to the home. At the visit to the home in March 2007 a resident said, “Its nice community, you get to know each other well and make friends”. The home does not offer intermediate care. DS0000024872.V340522.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans provide sufficient information for staff to assist residents to meet their needs and promote independence while respecting dignity. The management of boxed medications does not ensure that residents receive their medications as prescribed. EVIDENCE: During the additional visit to the home in March 2007, one care plan was found to be very detailed but a second plan reviewed had some gaps in the information provided. Information from visiting healthcare professionals had not been recorded on the professional visits record for ease of retrieving information. On the day of this visit, four residents files were reviewed. Each resident had a written care plan. This is an individualised plan about what the person is able to do independently and states what assistance is required from staff in order for the residents to maintain their needs. DS0000024872.V340522.R01.S.doc Version 5.2 Page 12 The plans were found to provide good information for staff to follow to meet the identified needs and preferences of the residents. Manual handling assessments gave details of the type of hoist and sling to be used so that residents and the staff are safeguarded from harm. Monthly risk assessments were completed for skin sores and nutrition and residents are weighed monthly so that staff can monitor weight loss or gain and take the appropriate action. There was evidence that a resident had been referred to the dietician following significant weight loss and this ensures that residents receive specialist advice. There was a detailed plan in place for a resident who was at risk of skin soreness and this included what equipment should be used to minimise the risk. The care plan had been updated when the mattress had been upgraded so that it reflected the current care being delivered. Another file had a care plan for sore skin, which stated that it should be reviewed in three days, however no review had taken place and this did not ensure that the skin had not deteriorated further. It is recommended that reviews take place as indicated. A detailed plan was in place for a resident who required feeding through a tube, and staff had updated this when the resident had recently returned home after being in hospital. An opened syringe was seen in the bedroom but this had not been dated so that staff knew when it should be disposed of in order to minimise the risk of infection. The syringe was disposed of at the time and a new one opened and the manager stated that she would implement a system where all syringes were changed at the same time each week so that everyone knew when they needed to be changed. Detailed plans were seen for catheter care and details of catheters used were recorded. There was a good care plan in place for staff to provide mouth care, which gave instructions how to gently persuade the resident to release her bite on the sponge. Plans were in place for residents who had diabetes and these gave details of the acceptable ranges of sugar levels and how often to check them. The plans referred to low and high blood sugar attacks but did not give staff indicators of how to recognise if this was occurring and the manager added this information at the time. The manager audits a sample of care plans each month to ensure that they reflect the care requirements and give the necessary information for staff to assist the residents to meet their needs. Healthcare professionals, including General Practitioner, dietician, tissue viability nurse, occupational therapist, physiotherapist and speech and language therapist visit the home to give advice for individual residents as required. Residents can keep their own GP (If the GP is in agreement) or they can be registered with the visiting GP. DS0000024872.V340522.R01.S.doc Version 5.2 Page 13 Daily records were very detailed of activities undertaken, visitors, changes in condition and any accidents. Some of the weekly reports by key workers had not been completed and the manager advised that new key workers had just been allocated. There was evidence that relatives are involved in the care, and there was evidence of care reviews taking place with the residents and their family. One of these reviews stated “I’m very happy with the care my mother is receiving” and a relative said that she was happy with the home as her relatives general health had improved. Residents were well presented and were supported to wear clothing, which reflected their personal choices. Hair was neat and fingernails were clean. The management of medication was reviewed and residents had identity photographs to minimise the risk of a drug error. Photocopies of prescriptions are kept and this enables staff to check that the correct drug has been received into the home as prescribed. Medication Administration Records (MAR) were signed when medication was administered and Controlled Drugs were appropriately stored and recorded. Eye drops and insulin were labelled with the date that they were opened and this ensures that they are discarded at the appropriate time in order to minimise the risk of cross infection. Fridge temperatures are recorded to ensure that medication is stored correctly and in line with its product licence. One nurse upon receipt signs medication into the home and it is recommended that two nurses complete this to ensure that they have the correct medication. Some boxed medications did not provide an accurate audit trail, as medications were not always carried over. This was discussed with the manager at the time of the inspection as does not ensure that residents are receiving medication as prescribed. It is required that staff carry forward or discard medication left over so that a clear audit trail can be followed. There is a payphone available in the home for residents to use and residents can have their own telephone line installed at an additional cost so that they can make and receive calls in private. There is a post box in reception for residents to collect their mail from. DS0000024872.V340522.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to exercise choice regarding the activities they choose to participate in which promotes their individuality and independence. Residents are offered a choice of meals, which meet any dietary or cultural needs and preferences. EVIDENCE: A new activity coordinator had started employment three days before the visit, for twenty hours per week and she had good ideas about how to improve the activities within the home. An external activity person visits the home on Saturdays to assist residents to undertake activities and be stimulated. The home has a weekly activity programme which includes food tasting, movements to music, manicures, sing a longs, arts and crafts, bingo, games and reminiscence. The library visit once a month to change books for residents who like to read and some residents have chosen to have a newspaper delivered. The hairdresser visits once a fortnight to tend to hair needs and the priest and vicar visit the home so that residents can continue to follow their chosen religion. A gospel church visits the home to meet the needs of the Afro DS0000024872.V340522.R01.S.doc Version 5.2 Page 15 Caribbean residents who live at the home. It had been a resident’s birthday the previous day and it was nice to see balloons and birthday banners in celebration. A clothes party had been held and the activity coordinator had spoken with residents individually to determine their interests. At the residents meetings, there had been discussions about trips outside of the home however these had had to be postponed due to the continuous rain. A coffee morning was advertised and relatives were invited to attend. A local chemist comes into the home with products for sale and this enables residents the opportunity to purchase their own items. One resident had expressed an interest in helping with office work and stated “I’m going to have a go with the newsletter”, which is produced each month. A relative commented, “The activities are picking up”. The development of the activities on offer will be reviewed at the next visit to the home, as the coordinator needs time to implement the ideas and suggestions. The home has an open visiting policy, which enables residents to see their visitors as they choose. There is a four-week rolling menu in place and this had recently been reviewed after consultation with the residents. Residents can have a cooked breakfast if they choose and two choices of hot meal are available at lunchtime. Sandwiches or a light meal are available at dinnertime and snacks are available at suppertime. The home has a number of Afro Caribbean residents and a Caribbean choice is also available daily. At the additional visit in March 2007, photographs of the Caribbean food had been taken and placed into a book to show residents what food choices were available and this is seen as good practice. Lunch was observed and tables were nicely presented with condiments and serviettes, cold drinks were available. Staff were sitting down and assisting residents who required help and the atmosphere was quiet and calm. Meals were well presented and requests from residents were attended to. Menus were on the tables so that the residents could see what choices they had. Comments included: “A nice piece of salmon” “I’ve had my lunch and enjoyed it” “Food is all very nice” “Its quite good food” DS0000024872.V340522.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure is comprehensive and accessible to residents and their representatives if they need to make a complaint. There are procedures in place, which should safeguard residents from harm if they are implemented. EVIDENCE: The home has a comprehensive complaints procedure for residents and their representatives to use if they need to make a complaint. This is on display in the reception area and is included in the service users guide. The home has received six complaints, since the last key inspection of the home and these were documented clearly with details of the nature of the complaint, who had dealt with it, the date resolved and the outcomes and action taken. It was of concern that the nature of one of the complaints was potentially of an adult protection nature but this had not been reported to CSCI or to Social Care and Health as the lead agency. This did not ensure the safety of the residents living at the home. This incident had occurred prior to the current manager being in post and senior managers of the organisation have been asked to investigate this matter. The home has an adult protection policy in place and the current manager of the home has reported an allegation of adult protection nature appropriately in DS0000024872.V340522.R01.S.doc Version 5.2 Page 17 order to safeguard residents living at the home. We are confident that the manager will act appropriately in reporting incidents in the future. The home has a whistle blowing policy, which should ensure that staff act appropriately in the event of an allegation, without fear of reprisal. The training matrix showed that all but three staff in the home had received recent training in the Protection Of Vulnerable Adults (POVA) and two staff spoken to were able to state the correct actions to take should an allegation of abuse be made and this should ensure that residents are safeguarded from harm. In the reception area there was an “Action on Elder abuse” poster, which gave contact details of who could be contacted if abuse is suspected. Residents spoken to were able to identify the manager as someone they could raise concerns with. One resident said “she is there to tell problems to” and another said “I would speak to the manager if I had a problem”. A relative commented, “We did have a problem with the laundry but that’s all been resolved now” and this suggests that concerns raised with the manager are dealt with satisfactorily. The manager holds a weekly surgery each Wednesday, where relatives can raise any concerns and this was advertised in reception. In addition a relative stated, “The managers door is always open”. DS0000024872.V340522.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a homely and clean living environment in which they are safe and secure and their privacy is maintained. EVIDENCE: Access to the home is via a bell and a coded door and this ensures that staff know who is entering the building. The reception area is pleasantly decorated and has sofas, which were frequently used by residents throughout the visit. The home has lounges and dining rooms situated on two of the three floors of the home and the third floor has bedrooms only. A quiet room is located on the first floor and this has been redecorated to provide a homely environment, however it was noticed that the chairs had become stained and worn and it is recommended that these are replaced. This enables residents with a choice of sitting areas. DS0000024872.V340522.R01.S.doc Version 5.2 Page 19 Since the last visit to the home a new hairdressing room has been made and a new large bathroom/shower, which is accessible for the disabled, has been created. This has a walk in shower and the assisted bath was due to be fitted the following week. The home has four shower rooms and two assisted bathrooms, which meet the needs of the residents who live at the home. Toilets have handrails and raised seating for residents who require this assistance. The home has four double bedrooms and 32 single rooms none of which have en suite facilities. Bedrooms seen as part of the case tracking were personalised with items, which reflected individual tastes and preferences. Rooms have call bells to summon staff help and lockable facilities to provide space for residents to keep things safely and privately. All of the bedroom doors had numbers, knockers, nameplates and letterboxes to give the impression of a front door. There are two passenger lifts in the home to enable people to access all areas of the home. The home has three hoists and a range of pressure relieving equipment for residents who are assessed as needing this equipment. A sluice machine has been installed on the second floor so that staff can safely clean commode pots and reduce the risk of infection, and a new floor had been laid in the sluice room on the first floor. A dirty mop head was stored in the sluice room and this was removed at the time of the inspection. The home was clean on the day of the visit and odours identified at previous inspections had been resolved. There was one room, which had an offensive odour due to the resident’s condition, and the manager was working through ways to address this. It was recommended that the Infection Control Nurse is invited into the home to complete an audit and to determine if one sluice machine is adequate for the number of residents who live at the home. The garden area is accessible via a ramp for anyone who needs to use a wheelchair. There were seating areas and a range of pleasant flowers for residents to enjoy in the better weather. The laundry area was reviewed and was tidy, infection control measures were in place to minimise the potential of any cross infection from soiled linen. The Environmental Health Department had undertaken an inspection in January 2007, which stated “Overall kitchen premises very clean and tidy”. Comments received included: “They do the cleaning, I’ve got a lovely room” “My bed is very comfortable” “My bedroom is a nice size, I am settled there, its comfortable” “The garden is lovely” “Her room is always clean” DS0000024872.V340522.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate staffing levels are maintained to meet the needs of the residents living at the home. Lapses in recruitment procedures do not ensure that residents are safeguarded from harm. Staff receive training to ensure that they have the knowledge to perform competently within their roles. EVIDENCE: The home has two registered nurses and six care staff on duty throughout the morning, two registered and five care staff throughout the afternoon/evening and one registered and three care staff during the night. The home had some vacancies for care and kitchen staff and agency staff were being used to cover these shifts, or extra care staff were brought in to work in the kitchen only. In addition to care staff the home has domestic, laundry, kitchen, maintenance and administrative staff to meet all the needs of the residents living at the home. There are currently 85 of staff who have completed a National Vocational Qualification (NVQ) Level 2 in care and the remaining staff are working towards achieving this. This should ensure that the staff have the knowledge and skills to care for the residents individually and collectively. Comments received included: “Staff are very helpful, I only have to phone and they are here in a flash” DS0000024872.V340522.R01.S.doc Version 5.2 Page 21 “Staff are very nice” “Staff are very good” Two staff files were reviewed and these were found to contain Protection Of Vulnerable Adults (POVA) first checks and full Criminal Records Bureau checks. Neither of the files had written references from the last employer and one of the files had two verbal references, which had not been confirmed in writing as required. As there has been a low staff turnover, the manager has inherited these files and it is recommended that they are audited to ensure that they have the correct information to ensure the safety of the residents at the home. There was evidence that these staff had received a three-day induction into the home but did not have induction in line with Skills for Care. On discussion with the manager she was not aware of the induction pack that the organisation had but made the relevant enquiries at the time of the visit to order these. It is recommended that these are implemented, to ensure that staff have the knowledge and skills to assist the residents to meet their needs. The home has a training matrix, which showed there had been training this year in fire, food hygiene, moving and handling, Control Of Substances Hazardous to Health (COSHH), health and safety, abuse, infection control, nutrition, dementia awareness and challenging behaviour. First aid training was booked for September. This will assist in the provision of a knowledgeable and skilled workforce. DS0000024872.V340522.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are systems in place to monitor the quality of service on offer and the systems for resident’s consultation are good. EVIDENCE: The Acting Manager has been in post for approximately three months and has a number of years experience in caring for older people. She has previously been the Registered Manager of another home within the organisation and has the Registered Managers Award, which will assist her knowledge to run the home in the best interests of the residents. The manager has also completed other training courses including health and safety, first aid and fire evacuation and this shows that she is keen to keep her knowledge up to date in order to DS0000024872.V340522.R01.S.doc Version 5.2 Page 23 support and guide staff who work at the home. It is recommended that the manager submit an application to CSCI to become the Registered Manager. Comments from both the residents and a visitor spoken to were positive about the new manager and included: “The manager has made so much improvement” “It’s gone from good to very good” “She is down to earth and very approachable” Staff meetings have been held although minutes of these were not available on the day of the visit. Resident and relative meetings are held frequently and these minutes were reviewed. The minutes showed that opinions were sought and acted upon. Residents and relatives thought that the meetings were “a good idea” and these meetings give people the opportunity to discuss and share any ideas or concerns in an open and inclusive atmosphere, while also providing an opportunity to socialise. The manager is supported by external managers who visit weekly and have phone contact on a daily basis. The Operations Manager visits the home and completes a report as per Regulation 26, in order to monitor the quality of service being provided. Prior to the inspection the Acting Manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to CSCI. This gave information about the home, staff and residents, improvements and plans for further improvements. This identified that the manager had a clear vision of how the home could move forward. There are a number of audits in place to monitor the quality of the service provided and questionnaires had recently been sent out to residents to seek their views. These were in the process of being returned and the manager was planning to analyse these and write a report of the findings. The system for recording resident’s personal monies was reviewed and the balance was found to be correct. Individual statements were maintained for each person and these identified all expenditure. Receipts were available for all items purchased and the system was audited regularly so that the finances of people using the service were safeguarded. A supervision matrix is in place with planned and actual dates and this should ensure that staff receive formal supervision at the recommended six times per year. This will ensure that individual staff training needs and competency is monitored to ensure that staff have the knowledge and are working competently in their roles. Records of servicing, tests and maintenance in respect of health and safety for utilities, appliances and equipment were well maintained and ensures that equipment is safe for residents and staff to use. DS0000024872.V340522.R01.S.doc Version 5.2 Page 24 Accident records were detailed and a monthly audit is completed which identifies any trends. There was evidence that these trends are acted upon to minimise the risks to residents and an example of this was a resident who had a number of falls had been referred to the Parkinson’s Specialist Nurse for advice. There are weekly checks in place for the fire system and equipment and staff have received fire training and participated in drills to ensure that they have the knowledge to act appropriately to safeguard residents in the event of a fire. The manager had also devised a disaster plan in case of flooding. During the partial tour, four bedroom doors had been propped open with chairs, doorstoppers and a handbag and the manager stated that this was the four individual residents. Risk assessments pertaining to this were written at the time of the visit and doors closed where possible. The manager ordered door guards for these residents who preferred to have their doors open so that doors would safely close in the event of a fire. A chart was also implemented for staff to check doors every hour and sign so that they knew which residents doors were open. DS0000024872.V340522.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 3 X 3 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 3 DS0000024872.V340522.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation 13(2) Requirement Timescale for action 20/09/07 2. OP29 19 Clear audit trails must be maintained to ensure that residents receive their medication as prescribed. Systems must be in place so that 27/09/07 staff recruitment procedures protect residents from harm. 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. 4. Refer to Standard OP7 OP8 OP9 OP12 Good Practice Recommendations Arrangements should be in place to review care plans so that changes in conditions are identified. Syringes must be changed as identified to minimise the potential risk of infection. A robust system for the receipt of medication into the home should be implemented to determine the correct medication is received. It is recommended that the programme of activities continue to be developed and increased to meet the needs and interests of all residents living at the home. (Previous recommendation) DS0000024872.V340522.R01.S.doc Version 5.2 Page 27 5. 6. 7. 8. 9. OP19 OP26 OP29 OP30 OP31 Chairs in the quiet room should be replaced to enhance the comfort for residents who choose to use this room. The Infection Control Nurse should be invited in to give specialist advice. All staff files should be audited to check correct information is available. The skills for care induction programme should be implemented so that staff have the knowledge to perform competently. An application for the Registered manager should be submitted to CSCI. DS0000024872.V340522.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000024872.V340522.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!