Inspection on 30/08/06 for Oaklands Care Home Limited

This inspection was carried out on 30th August 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 19/04/06

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 30th August 2006 09:15 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.V307750.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 Limited DS0000055180.V307750.R01.S.doc Version 5.2 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.V307750.R01.S.doc Version 5.2 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 19th April 2006 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.V307750.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection, covering the key National Minimum Standards, took into consideration all recent records relating to the service, including information sent to the Commission by the Provider. A record of inspection was collated prior and during the inspection process. It also included a site visit to the home on 30/08/06, which lasted 9 hours. 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. 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 three service users, a process known as case tracking. Of the twenty-seven National Minimum Standards inspected on this occasion, one was not applicable, thirteen were met, ten were nearly met and two gave sufficient concern to warrant a rating of 1 (significant shortfalls). Four of these standards had been raised as a requirement over the last two to four previous inspections and five of these requirements were outstanding from the last inspection. It is concerning to note that whilst some slight improvement has been made this is not reflected in meeting requirements in full. 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: What has improved since the last inspection? Oaklands Care Home Limited DS0000055180.V307750.R01.S.doc Version 5.2 Page 6 Six out of the sixteen requirements from the last inspection were found to have been met. These were with regard to the complaints procedure, adult protection procedure, evidencing that service users’ preferences and capacities are taken into account in their care planning, an audit of bedroom accommodation, fixtures and furnishings, staff recruitment practices and induction and foundation training. Further improvements noted were the improvements in the external appearance of the home, particularly at the front of the premises with regarding the garden and the external paintwork. An application for a category of dementia registration has been made. Consideration has been given to gaining knowledge and information on dementia care and training in dementia awareness has been introduced for four care staff members with further short courses planned for September 2006. What they could do better: Whilst it is acknowledged that some thought has been given to dementia care training and National Vocational Qualification (NVQ) training, basic training requirements such as fire safety, first aid, infection control and moving and handling are outstanding. Medication administration training is also required for the management of Controlled Drugs still requires attention. The registered manager must source appropriate training as a matter of urgency. At this inspection an immediate requirement was left at the home regarding the management and storage of Controlled Drugs. Action was taken to comply with requirements within the twenty-four hours timescale. Overall, improvements were to be found in the accommodation, services facilities of the home. An assessment of the premises and facilities is required, as is the need to complete risk assessments relating to premises equipment used in the home for individual service users. Care planning, assessments and reviews still require attention. and still and risk Some work has been undertaken with regard to clarification as to whether the services and facilities within the home comply with the Water Supply (Water Fittings) Regulations 1999. Further action is required to complete this work. Further work is required with regard to the management of the home. As detailed earlier in this section, there are shortfalls in training. Staff supervision also requires attention. Whilst it is acknowledged that there were some records relating to staff supervision. These were brief and did not form part of an established formalised supervision programme. Oaklands Care Home Limited DS0000055180.V307750.R01.S.doc Version 5.2 Page 7 The need to adopt a quality assurance and quality monitoring system is also outstanding. Whilst some survey work has been completed previously, the need to establish a cycle of quality assurance and monitoring to reflect service users views and their implementation is required. As stated in the last inspection report, 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. 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.V307750.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oaklands Care Home Limited DS0000055180.V307750.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Oaklands provided sufficient information for people living there, or prospective service users to make an informed choice about where to live. Documentation ensures that service users move into the home knowing that their needs will be met. Oaklands does not offer intermediate care. EVIDENCE: The Statement of Purpose as sent to Commission for Social Care Inspection (CSCI) on 7th July 2006 was reviewed with Mrs Cahoolessur at this inspection. Some shortfalls and amendments were noted and it was agreed that Mrs Cahoolessur would review this document, making the changes and a copy of this document would be sent to the Commission by Thursday 7th September 2006. This revised copy was received and reviewed. Overall this document Oaklands Care Home Limited DS0000055180.V307750.R01.S.doc Version 5.2 Page 10 met requirements although reference to those service users with dementia needs re-wording to ensure sensitivity. Two service users’ files were sampled and inspected with regard to an initial needs assessment. These were found to be detailed covering a wide range of needs assessment, which gave consideration to personal care needs, health care and mobility and social interests and family involvement. As at the last inspection, Mrs Cahoolessur confirmed that no intermediate care is offered at Oaklands Care Home Ltd. Oaklands Care Home Limited DS0000055180.V307750.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans were not reviewed by care staff in the home at least once a moth. They did not sufficiently reflect the management of risk assessments within care planning. Medication storage and administration of Controlled Drugs did not protect service users. This needs to be reviewed to ensure that the health and welfare of service users is protected. 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: Two care plans were sampled and inspected. These documents had been revised and reviewed and were a great improvement on previous documentation. Approximately sixteen care plan objectives had been drawn up, detailing the support needs, the implementation and the outcome Oaklands Care Home Limited DS0000055180.V307750.R01.S.doc Version 5.2 Page 12 required. The introduction of monthly reviews of care plans was discussed with the home and record sheets had been devised for this purpose, but had not been implemented. Some risk assessments were in place. These were brief and did not fully cover the level of risk and the implications that these would have on the service user’s care plan. Discussion took place as to the need to link the risk assessments into care planning objectives e.g. use of the hoist, use of bedsides and risk of choking. See Environment Section of this report. Record keeping held on service user’s files detailed visits and appointments with chiropodists, doctors and district nurses. Care planning objectives consider health care needs with reference to the pressure sore and continence management. All of the service users at the home have doctors from a local GP surgery in Brightlingsea. Many have been able to retain their original doctor has they had continued to live in the town. Medication administration was sampled and inspected for four service users. All of these service users have Controlled Drugs. Oaklands has installed a Controlled Drug cabinet and introduced record keeping in a Controlled Drug register. Overall the record keeping with regard to the administration of these drugs was compliant. Initially it had been muddled and confused, but this had been rectified. Some recommendations were made as to further improvements regarding detailing the drug name on each page and completing the register’s index. A major shortfall was found in the storage and administration of two Controlled Drugs. These had been decanted into medication containers for ease of storage in the Controlled Drug cabinet. These containers had then been labelled by the home. This was found to be entirely unnecessary and presented as a serious concern. An immediate requirement was left with the home and remedial action was required within twenty-four hours. At the time of writing this report, conformation of the action taken to rectify this matter has been received and new medication has been dispensed by the GP and pharmacist. Further shortfalls were noted in the Medication Administration Records (MAR) sheets. Whilst notes on the folder spoke of changes to medication as advised by the GP, there were no records or evidence held on the individual’s MAR sheet. In addition the practice of holding staff signatures and initials on record had ceased. Mrs Cahoolessur was advised of the need to re-introduce this practice. As highlighted in previous inspections, the home must look to all staff involved in medication administration receiving accredited training to ensure that Oaklands Care Home Limited DS0000055180.V307750.R01.S.doc Version 5.2 Page 13 medication administration, storage, handling and record keeping are managed in the correct way. Mrs Cahoolessur said that she had made approaches with regard to medication training and she has been told that courses are planned for September and October 2006. These must be pursued without delay. Within care planning records there was evidence of service users informing the home of the term of address that they prefer. During the site visit, a service user took a call on the home’s telephone and they were handed the cordless phone to take the call where they wished. During the site visit, the inspector noticed staff working with service users and thought was given to privacy and dignity issues. Care staff were heard to give explanations and guidance as they attended to service users. Oaklands Care Home Limited DS0000055180.V307750.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs and preferences were taken into account in the organisation of daily schedules. Service users were supported to maintain contact with family and friends. Service users were able to exercise choice and control over their lives. Overall, mealtimes were a positive experience for service users. EVIDENCE: Within sampled care plans and record keeping the inspector noted that service users are given opportunities to exercise choice with regard to some leisure and social activities, routines of the day, food, meals and mealtimes. Two service users spoken to said that they enjoyed the activities arranged by the home’s activity co-ordinator. They were pleased to be able to show the inspector some of their work, which included cross-stitch sewing. Both service users confirmed that the activity co-ordinator comes into the home twice a week and they were able to join in as they wished. From observation on the Oaklands Care Home Limited DS0000055180.V307750.R01.S.doc Version 5.2 Page 15 day of the site visit, it would appear that staff are aware of the need to plan the routine and activities of the home which meets the choice and wishes of service users. Oaklands has open visiting arrangements, which are clearly detailed in the home and in the home’s visiting policy. Mrs Cahoolessur said that visitors are encouraged and service users may meet with their visitors in the communal areas or in their bedrooms. She said that some relatives choose to take their relative out and on the day of inspection a service user was taken out by a relative for lunch. Mrs Cahoolessur said that where possible, service users are encouraged with the help of their relatives to manage their own money. She said that the home was not holding any money for service users at the time of the inspection. Service users are able to have personal possessions in their room. Within the bedrooms seen, there was evidenced of this. The majority of these items were small personal items such as photographs, pictures, books and ornaments with the occasional small item of furniture. Weekly menu planning detailed two choices of meals at lunchtime and teatime. Nutrition record keeping detailed the meals served and eaten, with records kept of liquidised meals eaten. As at the last inspection, service users spoken to were unable to tell the inspector what meals they had chosen during the day. Mrs Cahoolessur said that the home was looking towards enabling service users to make a selection and this is to be added to a newly created record sheet. Regular drinks and snacks are available and were served during the inspection. Oaklands Care Home Limited DS0000055180.V307750.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall, service users were well treated and listened to, with robust complaints and adult protection procedures in place. EVIDENCE: Oaklands have reviewed and revised their complaints procedure to incorporate the role of the Commission for Social Care Inspection (CSCI) as a regulator. A staff member spoken to had an understanding of the home’s complaints procedure and said that should they have any concerns they would raise them with the manager. The home has a complaint logbook. The most recent entry was in 2003. This was considered and discussed with Mrs Cahoolessur. The home is reminded of the need to ensure that all complaints are logged and considered within the home’s procedure for investigating complaints. The home’s adult protection procedure has been reviewed and revised since the last inspection. This policy now clearly references local authority guidance and copies of this guidance were to be found in the home. Four care staff have attended adult protection training arranged by the local authority in June 2006. Evidence was seen of certificates of completion with detail of the units of competence completed on the training course. Mrs Cahoolessur said that she looking to the remainder of her staff attending adult Oaklands Care Home Limited DS0000055180.V307750.R01.S.doc Version 5.2 Page 17 protection training in the near future. She said that she is actively pursuing this. In addition a DVD Training Pack as developed by Essex County Council has been received and this is to be reviewed and used as a training package. Two service users said that if they had concerns they would raise them with the manager and they felt safe and supported by the care service. A staff member said that they would also raise any concerns with the registered manager and they acknowledged the need to ensure that service users’ rights are respected at all times. Oaklands Care Home Limited DS0000055180.V307750.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24, 25 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall, the home provides a safe, well-maintained environment that is accessible to service users, homely and meets individual needs. EVIDENCE: At the site visit a tour of the premises was conducted and overall the premises were found to be well-maintained. A planned maintenance programme with records of completed work was seen. Since the last inspection, the front garden has been tidied and replanted and is now a low maintenance garden. In addition both the external rear and front window frames have been repainted. Service users spoken to said that they were pleased with their rooms. One service user was keen to show the inspector their room. Whilst this was a Oaklands Care Home Limited DS0000055180.V307750.R01.S.doc Version 5.2 Page 19 little sparse and there was no carpet on the bedroom floor, the service user said that did not wish to add any more personal possessions. They said that they were happy with the composite flooring, although they would like a bedside rug. This was raised with Mrs Cahoolessur, who said that this had been considered, but had presented as a hazard. Further discussion with the service user is therefore required and this will need to be clearly detailed in the service user’s care plan and in their risk assessment. As at previous 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 have been considered at previous inspections. As at the last inspection, the requirement to have an assessment of the premises and facilities by a suitably qualified person such as a qualified occupational therapist is still outstanding. This is long outstanding and does require immediate attention. An inventory of bedroom furniture and furnishings was to found in each care plan folder. This was seen on the sample of three service users’ files. Currently none of the bedroom doors have locks fitted. Mrs Cahoolessur was advised of the need to review the current position and consideration given to the installation of bedroom door locks and risk assessments implemented if service users are not provided with keys. The majority of radiators have radiator covers fitted or have guaranteed low temperature surfaces. Two small radiators located in a service user’s bedroom did not have covers and this was considered with Mrs Cahoolessur. It was acknowledged that the location presented difficulties with fitting covers, but there is a need to complete a risk assessment to highlight the risk and the detail the measures to be taken. Hot water temperature record checks are kept and logged monthly. were between 43˚ & 44˚C. These Oaklands has an in-house laundry. There are two washers and one dryer, with care staff completing laundry tasks during the day and night. Mrs Cahoolessur said that she had contacted the local water board for an inspection with regard to the Water Supply (Water Fittings) Regulations 1999. Some shortfalls had been noted and the inspector was informed that action was to be taken. Oaklands Care Home Limited DS0000055180.V307750.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff were roistered in sufficient numbers to keep service users safe and address their basic needs. Although the home has an experienced and dedicated staff team, service users were not protected by the home’s training programme. EVIDENCE: At the time of the site visit, Oaklands had full occupancy of fourteen service users. As at previous inspections, the home operates with two care staff on duty throughout the daytime hours with a third carer from 10:00am to 2:00pm. These hours are set aside for management tasks or catering duties. Mrs Cahoolessur said that the home is looking to employ a cook five days a week and this is seen as ensuring additional management hours are available. Night staff arrangements continue as previously with care staff operating a ‘Night Share’ arrangements. With this arrangement during the night there is one awake care worker and one asleep care worker. The hours a carer is awake are to be find in the night reporting log. Mrs Cahoolessur said that the Residential Forum Guidance is taken into account when calculating staff hours. Oaklands Care Home Limited DS0000055180.V307750.R01.S.doc Version 5.2 Page 21 Currently two care workers hold a National Vocational Qualification (NVQ) Level 2 in care. Mr Cahoolessur said that two care staff are to attend an Induction Day in September 2006. This was confirmed by a staff member spoken to, who was keen to attend this training. Staff recruitment paperwork were sampled for two care workers. These were found to be in good order and they met requirements. Recently two care workers had completed National Training Organisation (NTO) induction and foundation training. Completed workbooks for these two carers was seen. A third care worker is working through this workbook and is nearing completion. Training in dementia care has being accessed by the majority of care staff. All care staff are completing a one-day two-hour introduction to dementia care for the elderly. A course is booked for September 2006. Four staff members are also working on a distance-learning course on Dementia Awareness. It is acknowledged that there is a need to develop individual training and development assessments and profiles for all care staff as required. See Management Section of this report. Oaklands Care Home Limited DS0000055180.V307750.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered manager needs to ascertain the status of their nursing qualification with regard to National Vocational Qualification (NVQ) Level 4 in care. 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.V307750.R01.S.doc Version 5.2 Page 23 EVIDENCE: Both Mrs Cahoolessur and a senior care worker are currently on the Registered Manager’s Award. They said that they hope to complete this course in July 2007. Guidance was sent to Mrs Cahoolessur to enable her to ascertain the status of her nursing qualification with regard to National Vocational Qualification (NVQ) Level 4 in care. The inspector was told that quality assurance survey work has recently been completed with service users and their families. Mrs Cahoolessur said that this work needs to be reviewed and the results corporate into the home’s Statement of Purpose, as had been done previously. Insurance cover was seen to be in place, with renewal imminent. Cahoolessur said that this had been actioned. Monies held by the home were sampled for two service users. receipts were in place with secure storage of the monies held. Mrs Records and There was some evidence of supervisions held in February, May and July 2006 found on two staff files sampled. The record keeping however was not sufficient to ensure that all aspects of practice, training and career development and the philosophy of care in the home were covered. Mrs Cahoolessur was advised of the need to develop this record keeping further and introduce a programme of supervisions to ensure that formal supervisions are conducted six times a year. As at the last inspection, basic training requirements need to be reviewed. Records showed that fire safety training still requires updating, for the last course was in 2004. In addition training in moving and handling, infection control and first aid also require updating. Mrs Cahoolessur is advised of the need to review all training to ensure that the home follows safe working practices. There is a need to develop individual training and development assessments and profiles for individual care staff. Safety certification was sampled and inspected. Current certification was seen for fire alarm, emergency lighting, and smoke detectors dated May 2006; gas safety and servicing was seen dated October 2005 and electrical safety certification was seen which was valid until April 2008. Maintenance checks and certification for the Nurse Call system was not found. Mrs Cahoolessur said that she believed that this was completed as part of the fire company checks and she would contact them for clarification and confirmation. Oaklands Care Home Limited DS0000055180.V307750.R01.S.doc Version 5.2 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 1 X 2 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Oaklands Care Home Limited DS0000055180.V307750.R01.S.doc Version 5.2 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 13(2) Requirement The registered person must ensure that service user’s plans are reviewed by care staff at least once a month. 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 three inspections. Previous timescales of 28/07/05, 27/01/06 and 03/07/06 were not met.) 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. (This is a repeat requirement from the last inspection. Previous timescale of DS0000055180.V307750.R01.S.doc Timescale for action 05/10/06 2. OP9 05/10/06 3. OP9 13 05/10/06 Oaklands Care Home Limited Version 5.2 Page 26 4. OP22 OP24 OP25 5. OP26 6. OP31 7. OP33 03/07/06 was not met.) 12 (4)(a), The registered person must 13 (4)(a)– demonstrate that an assessment (c), 23 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. Individual risk assessments relating to the use of a hoist, radiator covers, bedsides and choking need to be implemented. (This is a repeat requirement from the last three inspections. Previous timescales of 28/07/05, 27/01/06 and 03/07/06 were not met.) 23 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 four inspections. Previous timescales of 09/08/04, 28/07/05, 27/01/06 and 03/07/06 were not met.) 18, 19 The registered manager must be qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. This is with regard to a NVQ Level 4 in care or equivalent. 24 The registered person must (1)(a)(b) develop effective quality (2)(3) assurance and quality monitoring systems to ensure that the best DS0000055180.V307750.R01.S.doc 05/10/06 05/10/06 05/10/06 05/10/06 Oaklands Care Home Limited Version 5.2 Page 27 8. OP36 18 (2) 9. OP38 23, 18 interests of the service users are met. The registered person must ensure that staff receive regular, formal supervision. (This is a repeat requirement from the last inspection. Previous timescale of 03/07/06 was not met.) 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. (This is a repeat requirement from the last inspection. Previous timescale of 03/07/06 was not met.) 05/10/06 05/10/06 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 OP15 Good Practice Recommendations 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 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. OP28 Oaklands Care Home Limited DS0000055180.V307750.R01.S.doc Version 5.2 Page 28 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.V307750.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. 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