Inspection on 19/04/06 for Oaklands Care Home Limited

This inspection was carried out on 19th April 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 Home Limited 30/04/07

Oaklands Care Home Limited 30/08/06

Oaklands Care Home Limited 12/12/05

Oaklands Care Home Limited 23/06/05

Oaklands Care Home Limited 06/01/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Oaklands Care Home Limited 34A/B Church Road Brightlingsea Essex CO7 0JF Lead Inspector Pauline Dean Key Unannounced Inspection 19th April – 12th May 2006 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 Limited DS0000055180.V289050.R01.S.doc Version 5.1 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 Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Oaklands Care Home Limited Address 34A/B Church Road Brightlingsea Essex CO7 0JF 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) 01206 305622 Oaklands Care Home Limited Mrs Lalita Devee Cahoolessur Care Home 14 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (14) of places Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 14 persons) One named person, over the age of 65 years, who requires care by reason of dementia The total number of service users to be accommodated in the home must not exceed 14 persons 12th December 2005 Date of last inspection Brief Description of the Service: Oaklands is a care home, registered for fourteen older people. The category of dementia, for one specific service user only, is included in the homes conditions of registration. The providers of the service have made an application to the Commission for Social Care Inspection (CSCI) to extend their registration so that they can accommodate more people with dementia. The current range of monthly fees, as detailed in an Inspection Questionnaire completed on 18th March 2006, are £340 - £358 per month. Additional charges were listed as £10 for chiropodist every six weeks, hairdressing £6.50 every six weeks and toiletries £6 a month. The home is in the town of Brightlingsea, Essex. The property is situated on the main road into the town and close to all amenities, the seafront and the beach. Mr & Mrs Cahoolessur are the Directors, and Mrs Cahoolessur is the Registered Manager. The home has fourteen single rooms, with the bedrooms located on the ground floor and the first floor. Access to the first floor is by stairs, a chair lift and a passenger lift. Communal areas are situated on the ground floor and consist of a large lounge and a dining area. The home also has a smaller lounge and a conservatory dining room. Both the kitchen and laundry areas are located on the ground floor in the central area of the property. There is driveway access to the property, with some parking areas and garden areas at the front of the home. Gardens to the rear of the home are large, mainly laid to lawn, with some garden seating. Access is through the conservatory, dining room and some ground floor bedrooms. Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over the period of 19th April to 9th May 2006. In addition to the one day unannounced site visit, for a total of 10 hours, a record of inspection was collated prior and during the inspection process. Documentation relating to staffing levels and the Residential Forum Guidance calculations were requested at the visit and these were sent to the Commission for Social Care Inspection (CSCI) for inclusion in this report. Throughout the day there was discussion with the registered manager, Mrs Lalita Devee Cahoolessur, and senior care staff. All care staff on duty, including the Activity Co-ordinator were spoken with during the inspection and service users were spoken with on a tour of the premises. More in-depth conversations were had with two service users, one of whom had recently moved into the home. Within the service user group there were a limited number of persons who were able to verbalise their views and feelings and therefore the inspector also relied on evidence gathering through observation on the site visit. Where possible, the site visit focussed on the experience of a sample of four service users, a process known as case tracking. Both care and staff records were sampled and inspected, as were some policies and procedures. All key National Minimum Standards and National Minimum Standards detailed in the last inspection’s Requirements and Recommendations were inspected at this inspection. Overall, the service provided by the home was considered to be satisfactory. There is however, plenty of room for improvement such as in care planning, controlled drugs storage and administration, policies and procedures on complaints and adult protection, health and safety issues around the home and staff and management training. Of the twenty-six National Minimum Standards inspected on this occasion, one was not applicable, seven were met, thirteen were nearly met and five gave sufficient concern to warrant a rating of 1 (significant shortfalls). Eleven of these National Minimum Standards were requirements in the last inspection report and only two of these requirements were met. Four of these requirements were from the last three inspections. In addition, one recommendation also remains outstanding. It is very concerning to note that so few of the requirements from the last inspection had been addressed and similarly the recommendation from the last report has been carried forward. The provider should be aware that continued non-compliance with the Care Homes Regulations 2001 could lead to enforcement action on the part of the Commission for Social Care Inspection (CSCI). What the service does well: Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 6 As at the last two inspections Oaklands continues to have a core of dedicated senior care staff, which provide the backbone of the care home. The home continues to be seen as part of the local community; with the majority of the resident group having lived or having their relatives live in the Brightlingsea area. The home is therefore fortunate to have frequent visitors and support from these relatives. Service users spoke well of staff, their home and the care they received. What has improved since the last inspection? What they could do better: Care planning and record keeping require attention. Discussion took place as to how these documents can fully reflect the changing needs of service users and consideration was given as to the format and presentation of these documents. The importance of the assessment process and care planning was highlighted to ensure that appropriate care is delivered to the individual service user. Whilst it is acknowledged that some progress has been made with regard to the security, storage and record keeping relating to Controlled Drug (CD) administration, this had not been fully implemented. Record keeping requires immediate improvement and training must be sought. Within record keeping and from speaking with service users and care staff including the Social Activities Co-ordinator it was clear that some attention is given to service users’ preferences and choice. However, further information, and policies need to be in place to ensure that service users are kept fully aware of activities on offer and meals planned. Oaklands should consider ways Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 7 of enabling service users with dementia to be more involved in the menu planning and selecting from available choices. A more robust approach is needed to complaints and adult protection. The home’s complaints procedure needs to be reviewed and revised and the adult protection policy and procedure is incomplete. The home does not have a complete adult protection policy and procedure as outlined by Essex County Council. In addition the need to obtain appropriate training on adult protection and Protection of Vulnerable Adults (POVA) referrals was highlighted at this inspection. Shortfalls continue to be found in the accommodation, services and facilities in the home. An assessment of the premises and facilities is still required, as is the need to complete risk assessments to inform a planned programme of the fitting of radiator guards and the use of bedside rails. Clarification as to whether the services and facilities within the home comply with the Water Supply (Water Fittings) Regulations 1999 is also still required. Times scales for completion of these requirements range from 09/08/04 and 28/07/05. A number of gaps were found in staff recruitment records sampled at this inspection. This indicated serious omissions in the home’s recruitment practice. In addition whilst it was said that care staff undertake induction training which complies with the standard set by the Skills for Care organisation, no records were seen and there was only evidence of an in-house induction checklist on the four sampled staff files. Oaklands needs to develop a staff training and development plan to ensure that all training needs and requirements are met. Omissions were noted in basic health and safety training courses and care and management training for the registered manager. From sampling the files of four staff members the practice of having staff supervision appears to have ceased. Only one entry was found for one staff member dated 07/10/05 and the need to follow appropriate employment policies and procedures is highlighted as a requirement. The category of registration as detailed on the current registration certificate no longer accurately reflects the number of service users who have developed dementia. The registered provider has given this some consideration and a major variation application for a dementia category had been submitted prior to this inspection. This application is currently being considered. 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 Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 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 Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 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): 3 and 6. Quality in this outcome area is adequate. Documentation ensures that service users move into the home knowing that their needs will be met. Oaklands does not offer intermediate care. EVIDENCE: Of the four service users’ files sampled, all had an initial assessment of needs completed on admission. Whilst not completed in great detail these documents should ensure that their individual needs will be met. Oaklands does not offer intermediate care and therefore National Minimum Standard 6 does not apply. Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is poor. Care planning documents did not fully detail all health, personal and social care needs and records did not fully evidence all aspects of care required. Medication storage and record keeping does not protect service users. This needs to be reviewed to ensure that the health and welfare of service users is protected. This is requirement is with particular regard to Controlled Drugs. Overall service users are treated with respect and dignity and are actively supported to maintain control of their care and health needs, as appropriate. EVIDENCE: Both the initial assessment process and the development of care plans were sampled and inspected for four service users at Oaklands. One of these was for a recent admission to the care home. Omissions and shortfalls were found in the care planning documentation. Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 11 Whilst care plan objectives were set to cover the majority of care needs assessments as highlighted in the initial assessment process, omissions were noted, namely care needs relating to personal hygiene needs, management and history of falls, health care issues and social care needs. This was highlighted in the paperwork of the most recent admission to the home. In addition, the care plans did not provide sufficient detail of the action required to ensure that care needs are met. In three of the four care plans sampled there was evidence that they were not reviewed monthly and therefore the home had failed to update plans to reflect changing needs and current objectives for health, personal and social care needs. Furthermore, there was little evidence of the involvement of the service user and/or their representative in the drawing up of a care plan. All of these matters were raised and considered on the site visit with both the registered manager and a senior care staff member who has responsibility for drafting the care plans. Discussion took place as to the changes required and the format of the care plans. Particular attention is required with regard to the care and management of service users who have dementia to ensure that their individual care needs are highlighted and met. Records seen evidenced contact with health care professionals such as the doctor, district nurse and the chiropodist. Two service users confirmed that the home requests a doctor’s visit, as required. Discussion with staff also confirmed that they were generally proactive in obtaining medical advice and appointments. This was not however, always noted in care planning record keeping and care plan objectives. Medication administration, storage and record keeping was sampled and inspected for four service users. The records for two of the service users were in good order as was storage and administration. Clarification was required for the dosage of a medicine for the third service user; for it was unclear as to whether they received one tablet or two. The fourth service user who’s medication records and administration were sampled was found to have a Controlled Drug, which was not stored or administered in the correct way. Following the last inspection, Oaklands had purchased a Controlled Drug metal cupboard, which must be installed as detailed in the Misuse of Drugs (Safe Custody) Regulations 1973 and the National Minimum Standards – Standard 9.5. In addition, record keeping must be completed as detailed in the National Minimum Standards – Standard 9.7 & 9.8 in a Controlled Drugs register. Whilst it is acknowledged that the registered manager and senior care staff had some understanding of this practice, the home must seek out accredited and recognised training for all staff that administer medication. This training should cover the management, security and handling of all medication including Controlled Drugs. Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 12 Service users spoken to expressed satisfaction with the way they were treated. Two service users said that staff knock on the door before entering their room and this was the usual practice. Within the initial assessment paperwork a note was made of the term of address preferred by the service users. Service users asked confirmed this was the case and their wishes were respected. Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 13 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 and 15. Quality in this outcome area is adequate. Whilst there were some records and plans of activities, it was not possible to ascertain whether service users were able to ensure that the lifestyle experienced in the home matched their expectations and preferences. The home’s policy on visiting needs to be revised and reviewed to reflect current practice. Service users were able to exercise choice and control over their lives. Overall, mealtimes were a positive experience for service users, but more needs to be done to help service users make informed menu choices. EVIDENCE: Service users said they have some flexibility in their routines. Two service users spoken to said that they got up and went to bed when they pleased, although this was not clear for all service users as several service users were in their night clothes at teatime and before the inspection ended at 7:30pm. The inspector was unable to confirm with these individuals as to whether this was their choice. Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 14 At this inspection, the Activities Co-ordinator was present. They said that they were able to offer two-hour sessions twice a week. The activities offered included craft sessions, musical sing-a-longs and hairdressing. During the inspection two service users were keen to show some of their handy work and they spoke very positively of these sessions. In addition, detailed records are kept by the Activities Co-ordinator of the activities offered and of those taking part. Whilst it is acknowledged that these records do give a flavour of the activities on offer, it was not possible to acertain whether service users were able to ensure that the lifestyle experienced in the home matched their expectations and preferences. For example one service user showed the inspectors examples of her artwork prior to moving into Oaklands, but they said that they had not painted since coming to the home. For this service user and others this aspect of their care had not been included in their individual care plans. Service users and staff said that visitors are made very welcome and they said that they can choose to see whom they wish. The registered manager said that relatives and friends are given written information on the home’s policy on maintaining involvement with the resident. However, the only information found was a policy on visiting the home. This was dated July 2004 and was different to the current arrangements for visiting e.g. visitors are requested not to call during mealtimes. A notice to this effect was on display at the home’s front door. The registered manager was advised of the need to review and revise this policy to ensure that it reflects current practice at the home, clearly detailing mealtimes if this is appropriate. Records and monies for three service users were sampled and inspected and they were found to be in good order. The registered manager said that one service user had an advocate, whilst others maintain their own financial matters or have assistance from their relatives. Records were seen of personal possessions brought into the home by three service users. For the most recent admission, an audit and record is to be created, for their belongings had been moved into the home that day. Menus are planned for two to three weeks in advance. Normally there are two choices at the main meal of the day – lunchtime, with several choices at teatime. Records are kept of meals served and this evidenced a variety. An omission in these records related to the liquidised meals. The records for these meals did not detail the content and the foods which were liquidised or not. Meals served comprised of easily prepared meals using convenience foods. Oaklands does not employ a cook or catering staff and care staff therefore perform these duties. Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 15 Whilst it was said that there was some consultation about the lunch time and tea time menu, service users who were asked were not aware of the menu in advance. However, overall service users were positive regarding the food served and said that it was to their liking. Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. On the whole, service users were well treated and listened to, but a more robust approach was needed to complaints and adult protection. EVIDENCE: Oaklands has a Complaints Procedure, which is included in the Statement of Purpose and the Service Users’ Guide under the title of ‘Complaints and Protection’. Whilst it has been found to meet requirements in the past, the home needs to review and revise the statement regarding complaints referral to the Commission for Social Care Inspection (CSCI) for it should be understood that the prime investigator of complaints is with the care home. CSCI would wish to monitor and regulate practice in this area through inspection and registration. As at the last inspection, the registered manager said that there had been no complaints, however records were not evident to confirm this. Following discussion at the last inspection, a revised Adult Protection Procedure was sent to CSCI. Whilst this was found to meet requirements at the time, on further reading it was found to be confusing and difficult to understand. Much of the document had been drawn from the Essex County Council’s information and procedures and as Oaklands does not have the complete set of guidance’s issued by the local authority it lacked clear guidance and structure. The registered manager was advised of the need to obtain these publications and review and revise the home’s adult protection procedures. From speaking to Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 17 care staff it was not clear that they had a full understanding of adult protection, forms of abuse and Protection of Vulnerable Adults (POVA) referral procedures. From discussion and records there was no evidence of staff attending Adult Protection training. The registered manager was advised of recent Adult Protection training events and recommended to seek out Adult Protection training for all care staff. Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 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, 22, 24, 25 and 26. Quality in this outcome area is poor. Overall, the home provides a safe, well-maintained environment that is accessible to service users, homely and meets individual needs. EVIDENCE: A tour of the premises was conducted on the day of inspection and overall the home was found to be well maintained. A planned maintenance programme is now in place, with records kept of work completed. Current planned work is the installation of the remaining radiator covers mainly in the corridors and communal areas and the painting of the external window frames. A premises inspection had been completed by environmental health on 31st January 2006. Within the report, some recommendations were made regarding a risk assessment policy for moving and handling, water temperature checks, radiator covers and Control of substances Hazardous to Health Regulations (COSHH) 1988. The registered manager said that these were being acted upon. Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 19 As at the last two inspections, bedsides were used within the home. The registered manager was reminded of the need to review these arrangements, undertaking detailed risk assessments and arrangements for the management of these bedsides. Formats and the detail of these risk assessments were considered. This risk assessment must be completed immediately, to ensure the safety and welfare of service users. Furthermore, immediate consideration must be given to an assessment of the premises and facilities by a suitably qualified person, such as a qualified occupational therapist, to ensure that evidence is available that recommended disability equipment is provided and appropriate environmental adaptations are made to meet service users’ needs. This is also outstanding from the last two inspections. An audit of bedroom furniture, fixtures and fittings is still outstanding from the last three inspections. This is a repeat requirement and requires immediate attention to ensure compliance with the National Minimum Standards. As at the last inspection, the majority of radiators now have fitted radiator covers in place, however several radiators, which are sited in communal areas of the corridors and sun lounge, do not have radiator guards fitted. As highlighted at the last inspection, the registered manager was advised of the need to undertake a comprehensive risk assessment process to identify highrisk areas, to assist with the planned programme of fitting the remaining radiator guards. This was not evident and needs to be implemented immediately as the radiator guards are fitted. A copy of this risk assessment is with the planned programme of the implementation of the remaining radiator guards is required to be sent to the Commission for Social Care Inspection (CSCI) within the Action Plan timescale of 3rd July 2006. Hot water temperature record checks are kept and logged each month. These were stated to be close to 43°C. Oaklands has an in-house laundry. Two washers and one dryer are in place. Care staff undertake laundry tasks during the day and night. The registered manager said that she was waiting for a report from a water company, which should ascertain whether the services and facilities comply with the Water Supply (Water Fittings) Regulations 1999. Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. Most of the time staff were roistered in sufficient numbers to keep service users safe and address their basic needs but staffing levels are reduced at night and at weekends when care staff undertake social activities, domestic and auxiliary duties. Although the home has an experienced and dedicated staff team, service users were not protected by the home’s recruitment practices and training programme. EVIDENCE: The number of service users at Oaklands has increased to thirteen. The home usually operated with two staff on the morning shift and two on the afternoon shift, with management hours of 10 00 am – 2 00 pm which cover both management and catering tasks. At the weekend however, rotas submitted to the Commission for Social Care Inspection (CSCI) with the Residential Forum Guidance calculations showed only two care staff on duty throughout the day and no domestic staff on duty. The home has one domestic staff member for two hours a day, early morning, weekdays only. In addition, it was unclear as to night staffing arrangements as the two night staff are detailed as ‘Night Share.’ It is understood that during the night only one care worker is awake, whilst the other care worker sleeps. To clarify the Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 21 waking hours this needs to be detailed on the staff rota and clearly documented in the Residential Forum Guidance. Of a total of nine members of care staff only two care staff have completed a National Vocational Qualification (NVQ) level 2 in care. The registered manager said that a third member of the care staff wishes to complete this training and the registered manager was advised of the need to pursue this training for this care worker and other carers in the home. The home falls drastically short of the minimum ratio of 50 members of care staff trained to NVQ level 2 or equivalent by 2005. Four staff files were sampled and inspected. Some omissions were identified in relation to recruitment practices and documentation, namely two files had no photographs and one care worker had no current contract of employment. The registered manager said that three care staff are completing induction and foundation training to National Training Organisation (NTO) specifications. They were unable to produce evidence of this ongoing training and the staff members concerned were not on duty and could not be interviewed. Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. The registered manager needs to obtain a management qualification to help ensure that the home meets its stated purpose, aims and objectives. The home has an effective quality assurance and quality monitoring system to help ensure that the home is run in the best interests of the service users. Service users’ financial interests were safeguarded through written records of all transactions. Staff were not formally supervised. The health and safety of service users and staff would be afforded greater protection through a more robust approach to mandatory training. Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 23 EVIDENCE: As at previous inspections, Mrs Cahoolessur, a director of Oaklands Care Homes Limited is also the registered manager of the home. She is seen to be in day-to-day control of the home. Mrs Cahoolessur and a senior care staff member said that they were actively pursuing training in management and care qualification equivalent to a National Vocational Qualification (NVQ) level 4. Both had obtained an interview at a college at the end of the week of the site visit. Mrs Cahoolessur however, had failed to inform CSCI by April 2006 of the steps taken regarding this training; therefore confirmation of acceptance on a relevant training course is required by the Action Plan timescale of this report. As stated in the last inspection report, Oaklands has a quality assurance system in place and feedback is given to service users and their families through the Service Users’ Guide. Further consideration of this quality assurance system will be given at future inspections. As stated earlier in this report, records and monies for three service users were sampled and inspected and they were found to be in good order. Structured supervision sessions held at least six times a year had ceased. From sampling four staff files, only one record of supervision was found dated 07/10/05. These records were brief and did not meet requirements as detailed in the National Minimum Standards – Standard 36.3. The implementation of a formalised supervision process was highlighted as needing immediate attention to ensure good care practice is upheld. Some, but not all, staff had attended basic training courses in 2005 e.g. Basic Food Hygiene, Management of Constipation, Moving and Handling, Infection Control and First Aid. In general only four out of ten care staff including the registered manager, had completed this training. Furthermore, fire safety training is overdue for renewal, the last course was held in July 2004. Currently the registered manager and three care staff are undertaking a Dementia Awareness training course through distance learning and completion of workbooks. The need to review and update basic training to ensure that there are safe working practices was raised with the registered manager and must be pursued immediately for all care staff. Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 24 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 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X 1 X 2 2 2 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 1 X 2 Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 25 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 OP7 Regulation 15,17(1a) Sch3 Requirement Timescale for action 03/07/06 2. OP9 13(2) 3. OP9 13 The registered person must review and revise the current service users plan of care and records to ensure that all aspects of the health, personal and social care needs of the service user are met. 03/07/06 The registered person must ensure that there are policies, and staff adhere to procedures, for the receipt, recording, storage, handling, administration and disposal of all medicines. This includes Controlled Drug administration, record keeping and storage. (This is a repeat requirement from the last two inspections. Previous timescales of 28/07/05 and 27/01/06 were not met.) 03/07/06 The registered person must ensure that all care staff involved in medication administration receive accredited training to enable them to store and dispense all medications including Controlled Drugs in the correct way. Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 26 4. OP12 5,12,16 5. OP16 17 Sch 4 22 6. OP18 13 7. OP22 23 The registered person must offer a variety of social activities to suit service users’ expectations, preferences and capacities as detailed in their care plans. (This is a repeat requirement from the last two inspections. Previous timescales of 28/07/05 and 27/01/06 were not met.) The registered person must review and revise the home’s Complaints Procedure to ensure that is fully compliant with complaint investigation procedures and in addition ensure that a record is kept of all complaints, which is, at all times, available for inspection. The registered person must ensure that the home’s Adult Protection Procedure is reviewed and revised to reflect current guidance, with particular regard to the Essex County Council guidance and that all staff have received necessary training in this area. The registered person must demonstrate that an assessment of the premises and facilities has been made by a suitably qualified person, including a qualified occupational therapist, with specialist knowledge of the client group catered for, and provides evidence that the recommended disability equipment has been secured and provided and environmental adaptations are made to meet the needs of service users. (This is a repeat requirement from the last two inspections. Previous timescales of 28/07/05 and 27/01/06 were not met.) 03/07/06 03/07/06 03/07/06 03/07/06 Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 27 8. OP22 23 9. OP24 23 10. OP25 23 11. OP26 23 The registered person must ensure that a detailed risk assessment is completed with regard to the use of bedsides for each individual service user. (This is a repeat requirement from the last two inspections. Previous timescales of 28/07/05 and 27/01/06 were not met.) The registered person must ensure that each service user has accommodation, which is furnished and equipped to assure comfort and privacy, and meets the assessed needs of the service user. An audit of bedroom accommodation, fixtures and furnishings is required. (This is a repeat requirement from the last three inspections. Previous timescales of 09/08/04, 28/07/05 and 27/01/06 were not met.) The registered person must ensure that all radiators are guarded following completion of detailed risk assessments. A copy of this risk assessment with the planned programme of the implementation of the remaining radiator guards is required to be sent to the Commission for Social Care Inspection (CSCI) within the Action Plan timescale. (This is a repeat requirement from the last three inspections. Previous timescales of 09/08/04, 28/07/05 and 27/01/05 were not met.) The registered person must ensure that services and facilities comply with the Water Supply (Water Fittings) Regulations 1999. (This is a repeat requirement from the last DS0000055180.V289050.R01.S.doc 03/07/06 03/07/06 03/07/06 03/07/06 Oaklands Care Home Limited Version 5.1 Page 28 12. OP29 19 Sch 217 Sch 4 13. OP30 18, 19 14. OP31 18, 19 15. 16. OP36 OP38 18 13, 18 three inspections. Previous timescales of 09/08/04, 28/07/05 and 27/01/06 were not met.) The registered person must ensure that staff recruitment procedures are robust and that all the records required by regulation are maintained on staff files. The registered person must ensure that there is a staff training and development programme, which meets the National Training Organisation (NTO) workforce targets, with particular regard to induction and foundation training. (This is a repeat requirement from the last three inspections. Previous timescales of 09/08/04, 28/07/05 and 27/01/06 were not met.) The registered manager must be qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Confirmation of acceptance on a relevant training course is required by the Action Plan timescale. (This is a repeat requirement from the last inspection. Previous timescale of 27/01/06 was not met.) The registered person must ensure that staff receive regular, formal supervision. The registered person must ensure that staff have adequate training in all the mandatory health and safety topics and that their practice does not infringe regulations. 03/07/06 03/07/06 03/07/06 03/07/06 03/07/06 Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 29 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 OP13 Good Practice Recommendations The registered person should ensure that service users are able to have visitors at any reasonable time and links with the local community are developed and maintained in accordance with service user’s preferences. A review and revision of the home’s policy on visiting should be undertaken to ensure that it reflects current arrangements. The registered person should consider ways of enabling service users with dementia to make informed choices about what they eat and contribute to menu planning. Service users should be informed in advance of what is on the menu. The registered person should ensure that staffing levels are reviewed on an ongoing basis, using the Department of Health Residential Forum calculation, to ensure that they meet service users’ assessed needs. Where staff have a dual role as night carers then their awake and asleep hours should be clearly differentiated on the staff rotas. In addition where staff have a dual role as care and auxiliary workers, their separate hours should be clearly noted on the staff rotas. The registered manager should ensure that a minimum of 50 of members of care staff have a NVQ level 2 or equivalent as soon as possible. The recommended date for completion was December 2005. 2. OP15 3. OP27 4. OP28 Oaklands Care Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Home Limited DS0000055180.V289050.R01.S.doc Version 5.1 Page 31 - 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. 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