Inspection on 28/09/07 for Oaklands Care Home

This inspection was carried out on 28th September 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 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 Home 19/01/07

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

CARE HOMES FOR OLDER PEOPLE Oaklands Care Home Weston Lane Oswestry Shropshire SY11 2BQ Lead Inspector Pat Scott Unannounced Inspection 28th September 2007 09:30 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 Home DS0000068187.V346027.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 Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oaklands Care Home Address Weston Lane Oswestry Shropshire SY11 2BQ 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) 01691 652543 Sure Care (UK) Ltd vacant post Care Home 18 Category(ies) of Dementia - over 65 years of age (18) registration, with number of places Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th January 2007 Brief Description of the Service: Oakland’s is a service that provides personal care to meet the needs of eighteen elderly people with dementia. The home is situated in a quiet residential area within easy reach of the centre of Oswestry with gardens at the rear for use by service users. The home is owned by Sure Care (UK) Ltd. The accommodation is an adapted large family house, perhaps not ideally suited for its purpose it has a mixture of single and double rooms on three floors. Access to the first and second floor for those who cannot use the stairs is provided by a stair lift. Fees range from £334 to £450 and are reviewed on an annual basis. Information about the service is contained in the statement of purpose and service user guide. Inspection reports are available from the home. Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, staff records kept in the home, discussion with people who use the service where feasible, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance process, Fire Authority reports, Environmental Health Office reports. What the service does well: What has improved since the last inspection? What they could do better: Infection control could be better managed by providing improved handwash facilities, storage for communal towels and reviewing the laundry service. To Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 6 minimise cross infection associated with the method of disinfecting commode pots by hand it is recommended that a thermostatic sluice disinfector is installed to improve the existing facilities. A management infection control audit would assist identify and prioritise improvement. The manager stated that the care plan formats are ‘ a work in progress’. They could be completed in a more person centred way providing staff with clear directions for individual care and demonstrating consultation with service users. The manager should implement her stated intention to audit care plans, to assess whether the staff consistently provide an indication of care provided and progress made by individual service users. Where service users have chosen to share a room, screening should be provided to ensure that their privacy is not compromised when personal care is being given or at any other time. The provider should install a Controlled Drugs cabinet to safeguard staff from allegations of misuse and mishandling. The service could demonstrate the effectiveness of activities by recording outcomes of each activity in more detail within the care plans. Service users with dementia should be enabled to choose an option from the daily menu. 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. Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The records for the admission of new people to the service demonstrate that the process is personalised so that consideration has been given to all aspects of care. EVIDENCE: From records seen, the admission of new service users takes into account the individual needs, concerns and anxieties of the prospective service user and their families. The manager consults the assessment information to see if the home can meet the prospective service user’ needs before they make the decision to accept the application for admission and offer a placement. Evidence shows that prospective service users have a needs assessment carried out before they are admitted to the home. The manager has received copies of the summary, and Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 9 care plans, from those assessments carried out through care management arrangement for most of the service users. Staff training to ensure that they have the necessary skills and ability to care for residents who are admitted is improving. The service’s annual quality assurance assessment states that the service intends to improve further by conducting an audit of admissions. This is to ascertain if the procedures are working and providing good quality outcomes for service users during the admission process. It also states it intends to review the admission documentation. Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 10 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): Key Standards 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ care needs and risk assessments are set out in their individual plans of care which ensures that all care needs have been addressed and will be fully met. The manager understands the need to comply with safe medication systems and staff practice has improved so that service users health matters are now more safely addressed. The actions of staff and their approach to care ensures that service users are treated with respect and their right to privacy is upheld. EVIDENCE: Two care plans were examined. The practice of involving residents in the development and review of the plan is not clear. The plans include the basic information necessary to plan the individual’s care but lacks consistency, e.g. Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 11 one plan did not have the need or problems recorded but actions and outcomes were. The manager stated her intention to audit care plans in the future, to assess whether the staff consistently provide an indication of care provided and progress made by individual service users. There is recorded evidence of updating information and changing actions in the care plans. Service users have access to health care services that meet their assessed needs both within the home and in the local community. Service users have access to dentists, opticians and other community services. The service users’ health is monitored and appropriate action taken. The home seeks professional advice on health care issues, acts upon it and generally is able to provide the aids and equipment recommended. However, one service user has been assessed as needing bed rails but has two chairs either side of his bed as an interim measure until they are in place. The service should act swiftly to enable safe care to be provided to this service user. There is written evidence in the daily notes of health care treatment and intervention, and a record of general health care information including weight monitoring, and nutritional information. The manager has been working towards improvement in medication practice following the inspection by the CSCI Pharmacist on 23.3.07 and 27.9/07. However, there are still some areas to improve on within receipt, administration and storage of medicines and the manager needs to develop a formal process for assessing the competency of the staff to handle medicines properly. The service has a training plan and has trained its staff in medication health care. A new medication policy has been introduced. A drugs trolley is now used and the manager took the trolley with her to administer medication close to service users. Staff were seen to be aware of the need to treat residents with respect and to consider dignity when delivering personal care. The service provides mobile screens for privacy in shared rooms. The type of screening does not provide total privacy. Service users all appeared well groomed with their hair, nails and clothes looking clean. Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Key Standards 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service’s efforts to provide activities enables service users to have an organised, active social life. The provision of meals, although lacking in choice, ensures service users have a wholesome meal. EVIDENCE: There is a programme of activities but no dedicated activity co-ordinator in charge of this. The provider stated that the person in post at one of their other registered care homes will come in for 2 days a week. Staff complete activity sheets which give minimal information about the response of service users to activities they engage in. The service has identified that this could be much more descriptive in its content. The service provides a reminiscence book, cuddly toys, bean bags etc and are seeking more ideas so that service users engage in meaningful activities i.e. by developing ‘life stories’ of service users. getting entertainers to visit the home and accessing external pursuits. Menus seen did not display a choice of meals. The manager held a service user meeting recently during which meal provision was discussed. She also stated Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 13 that service users can have an alternative to the menu but it is not yet displayed as an option. Staff assist service users to eat their meal in a dignified way. Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 14 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): Key Standards 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure which is accessible to relatives so that people who visit the service have information of how to make complaints about the home. Adult protection training is provided for staff so that service users are protected from abuse and have their legal rights protected. EVIDENCE: The service has not received any complaints recently. One adult protection issue has been identified by the service since this key inspection and appropriate action taken. The Manager has completed adult protection training and reported that all staff have also been booked on this course. The manager stated the service intends to train staff in how to deal with complaints. Good interaction is observed between staff and service users. They are relaxed in their company and showed no signs of distress. Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 15 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): Key Standards 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some of the furnishings of the home have improved to enable service users to live in a better-maintained and comfortable environment. EVIDENCE: The refurbishment plan has been to upgrade the main communal area and re decorate some bedrooms. The lounge has new chairs and curtains. It is the service’s stated intention that all the bedrooms will be refurbished, which, while looking shabby and worn, aren’t dirty or unsafe. Generally, areas seen around the home are clean and rooms personalised but there is a stale odour present. Discussion with domestic staff identified the cleaning routines and that sufficient products are used. Bath towels are kept in a service user’s bedroom, which is not good practice. There is a lack of assisted bathing facilities in this home. There is a plan for a new shower room to replace the current sit in bath, which is old and stained. Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 16 The two bathrooms on the upper floors are unusable because of a lack of heat in one and no hoist facility in either. One of these bathrooms also has a very stained bath. Then toilets did not have toilet roll holders. There is a lack of hand washing facilities in service user bedrooms and communal toilets/bathrooms for staff and service users to use. The laundry arrangements are inappropriate for the service user group with two domestic washing machines that do not have a sluice facility for dealing with foul linen. The noise of the laundry can be heard through the walls of bedroom 10. Bedrooms do not have en-suite toilet facilities and many commodes are used. The manager has identified that some commodes are in need of replacement. Commode pots are emptied in the toilets and then cleaned in the sluice room. Whilst the addition of the separate sluice sink is an improvement, commode pots are disinfected by hand which is not good infection control practice. There have been no reported outbreaks of infection. Externally the gardens are in need of attention. Redundant furniture has been left in the garden which impinges on the service users’ view of it. A new room has been created on the first floor. It had been intended to use this as a shared room. It does not meet the requirements of a new room and must only be used for a single following approval by building control and the fire authority. The service is working towards meeting the recommendations from the fire authority, i.e. putting magnetic strips on fire doors. A new call bell system is in place. A new stair lift is in place. When balancing these pieces of evidence against other more positive parts of this outcome group and improvements made since the new providers took over, an overview of the environment is seen as adequate. Much work has been done but there remains a lot of upgrading to do to make the premises a dignified place to live. Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 17 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): Key Standards 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. The service has not had enough waking care staff on at night which does not ensure that health and welfare of service users with dementia is safeguarded. The recruitment steps ensure the service secures suitable staff and that service users are in safe hands. EVIDENCE: Care staff have to carry out duties that include washing laundry during the day and ironing at night. Care staff should only carry out direct care tasks. One waking staff at night is insufficient to meet the numbers, need and maintain the safety of all service users on three floors of the home. Another care staff assists from 8pm-10pm and again in the morning from 6am-8am, in between times this person is on sleep-in duty. This person also fulfils domestic duties during the day. The CSCI has, since this key inspection, been notified on 3/10/07 that two waking night staff are now on duty at night. Common induction standards are provided for new staff. Records show that all staff have received medication training, fire, manual handling and food hygiene. All staff are participating in NVQ qualifications and will achieve the 50 level required. Dementia training is planned for February 2008. The Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 18 manager agreed that an update in infection control would benefit staff because of having to deal with the laundry and commodes. Staff files seen of two new recruits showed that all required checks are conducted before start of employment. Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 19 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): Key Standards 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home intends to implement quality assurance systems and audits so that service users are more assured that the service is closely monitoring its own practice and that the overall conduct of the home is being better managed. EVIDENCE: A new manager is in post who will be applying for registration in due course. She is keen to improve and develop systems that monitor practice and comply with the plans, policies and procedures of the home, for example audits for infection control, medication and care plans. Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 20 Records for the management of health and safety are maintained. Fire records show that tests and drills take place. Supervision has commenced with a record of those undertaken and a separate document on staff files detailing areas discussed. Quality assurance processes are starting to happen. Service user meetings are to be held regularly. The manager is considering conducting a relatives and visitor survey soon. This would assist the management in obtaining an overall picture of the views of people who are involved in the home. Staff have had the opportunity to air their views through meetings. Reports under Regulation 26 reviewing the conduct of the service take into account the views of staff and service users. The systems for the safekeeping of service user personal monies has been reviewed and safety improved. Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 1 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 2 Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13(2) Requirement Accurate, complete and up to date records must be kept of all medication received, administered, taken out of the home when residents are on leave and disposed of to ensure that medication is accounted for, is available and is given as prescribed. Staff who administer medication must be competent and their practice must follow written policy and procedures to ensure that residents receive their medication safely and correctly. Medication must be stored within the temperature range recommended by the manufacturer to ensure that medication does not loose potency or become contaminated. A Controlled Drugs cabinet must be obtained and installed correctly in order to comply with new legislation and ensure that Controlled Drugs are stored safely Timescale for action 30/10/07 2 OP9 13(2) 30/10/07 3 OP9 13(2) 30/10/07 4 OP9 13(2) 30/01/08 Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The manager should implement her stated intention to audit care plans, to assess whether the staff consistently provide an indication of care provided and progress made by individual service users. Where service users have chosen to share a room, screening should be provided to ensure that their privacy is not compromised when personal care is being given or at any other time. Activity care plans could be more informative as to how the service user responded to any particular activity. Service users should be able to choose an option from the daily menu. The provider should continue with the planned programme of renewal of the fabric and decoration of the premises. The provider should continue with the plan to provide assisted bathing facilities. The provider should consider using an odour management system. The manager should remove all communal towels stored in a service user’s bedroom. The provider should install handwash facilities (handwash, paper towel dispensers and foot operated pedal bins) in service user toilets and bedrooms. The provider should consider installing a thermostatic sluice disinfector due to the large amount of commodes used. This would reduce the possibility of crosscontamination through disinfecting by hand. The provider should consider re-siting the laundry. The provider should consider installing a washing machine with a sluice programme for foul linen. Care staff should not be dealing with the laundry. The manager should implement her stated intention to audit the systems and processes of the service i.e medication, infection control, admissions. DS0000068187.V346027.R01.S.doc Version 5.2 Page 24 2 OP10 3 4 5 6 7 8 9 10 OP12 OP15 OP19 OP19 OP26 OP26 OP26 OP26 11 12 13 14 OP26 OP26 OP27 OP33 Oaklands Care Home 15 OP33 The provider should conduct a quality survey of relatives and others associated with the home. Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Oaklands Care Home DS0000068187.V346027.R01.S.doc Version 5.2 Page 26 - 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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