Inspection on 11/01/06 for Oaklands Grange

This inspection was carried out on 11th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oaklands Grange 05/09/07

Oaklands Grange 15/11/06

Oaklands Grange 25/05/05

Oaklands Grange 17/11/04

Oaklands Grange 21/06/04

Oaklands Grange 04/03/04

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

CARE HOME ADULTS 18-65 Oaklands Grange 53 Seabank Road Wallasey Wirral CH45 7PA Lead Inspector Peter Cresswell Unannounced Inspection 11th January 2006 8:45 Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 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 Grange DS0000018921.V261768.R01.S.doc Version 5.0 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 Adults 18-65. 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 Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Oaklands Grange Address 53 Seabank Road Wallasey Wirral CH45 7PA 0151 630 5804 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) Pinpoint Developments Limited Iris Pamela Carter Care Home 15 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (15) of places Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 15 Adults (aged 18-64 years) with a mental disorder (excluding learning disability) may be accommodated and may from time to time include up to three persons with a mental disorder aged over 65 years, the total not to exceed 15. 25th May 2005 Date of last inspection Brief Description of the Service: Oaklands Grange provides care for adults who are experiencing mental health problems. The building is a three storey detached house on the main road between New Brighton and Seacombe, within half a mile of Liscard town centre. Shops, a post office and other community facilities are nearby and the riverfront at Egremont promenade is only a short walk away. Buses to New Brighton and Seacombe stop close by. Four bedrooms are shared and five used for single occupancy. Communal space includes a TV lounge, lounge/dining room and a rear garden. A small quiet room on the first floor can also be used for seeing visitors or watching television. There is space for car parking at the rear of the building. The home has a variation in its registration to allow it to care for up to three older people with a mental disorder though only two are resident at the moment. Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this unannounced inspection the inspector spoke to seven residents, care staff who were on duty, the Registered Manager, and, briefly, to both of the owners. The inspector toured all parts of the home. He examined records, including care plans, safety records, menus, training records and staff files and medication administration. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4. Residents are only admitted if their needs have been properly assessed, ensuring that the service provided by the home can meet the residents’ needs. EVIDENCE: The most recently admitted resident had been assessed before admission by the Registered Person and had then visited the home when his suitability was further assessed by the Registered Manager. A copy of the initial assessment was on file as was the assessment document from Cheshire and Wirral Mental Health Services. The assessment documents had been used to prepare a detailed care plan. Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8. Care plans are detailed and are reviewed regularly, ensuring that day to day care is based on up to date information. EVIDENCE: Residents have detailed care plans that are initially based on the assessment documents and are regularly reviewed. Residents are encouraged to take part in the reviews with their keyworker and normally sign the results of the review. The care plans are amended if any changes are decided, but as they are handwritten this is not especially straightforward. Daily reports made by staff are kept on individual files. Life at Oaklands Grange is as informal as possible and the residents are involved in decisions about how the home is run on a day to day basis, including taking part in residents’ meetings. There was evidence in the complaints book of significant issues being raised by residents in these meetings and of the concerns being followed up by the Registered Manager. Most of the residents go out of the home on their own and several went out to day centres, swimming baths or to local shops during the course of the inspection. One was escorted to hospital by a member of staff during the inspection. The Registered Manager should check that staff have appropriate insurance if they use their own car to transport residents. Other residents Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 9 told the inspector that they go out for long walks, to the pub or to the bookies. Residents are asked to sign a book to indicate if they are in or out of the home and when they are expected back; they accept this as a sensible precaution. Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Daily routines in the home are relaxed and residents take part in everyday activities of their choice in the community. The meals in the home offer choice and variety for the residents, who enjoy the food provided, though the variety could be improved further. EVIDENCE: Residents take part in a range of everyday activities in the local community, such as shopping and going to the pub. Staff support residents in these activities when necessary though weekend staffing does not normally allow for this. Some also attend day/drop-in centres and described to the inspector some of the activities they take part in at the centres, including painting, family trees or swimming. Several residents choose to spend most of their time in the home and said that they are happy to do so. In the home they watch TV and films, and listen to music. There is not much emphasis on organised or formal activities. The manager said that some trips out are organised – such as a visit to the pantomime in New Brighton - but these are not recorded. There is in fact little sign that the residents would welcome a large number of organised group activities. Residents make decisions about their own personal lives and are supported in this by the manager and her staff. Families are encouraged to visit and are welcome at any time. Several residents visit their Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 11 families and the home liaises with families over the residents’ welfare where this is appropriate. There is a small ‘quiet’ room on the first floor which can be used to receive visitors, watch television or just spend time alone. Most service users get their own breakfast when they get up and several were doing so on the day of the inspection. The main meal of the day is served in the early evening – round about 5 p.m. – an arrangement which residents say suits them. Those who choose to eat later can do so. Choices are always available and the menu is displayed on a small whiteboard in the dining room so residents are always aware of what is on offer for the day. The residents said that they enjoy the food in the home and they can have alternatives if they want them. The menu is varied regularly to reflect what residents want. Several said that they would like occasional curries or ‘spaghetti Bolognese’ but felt this type of meal was not prepared as many other residents do not like them. This approach can lead to a menu catering for the lowest common denominator and the Registered Manager should consider sometimes providing choices that also cater for those with slightly more cosmopolitan tastes. Lunch during the inspection was described as ‘residents’ choice’, when residents can choose whatever they like, within reason. The residents were having a range of meals, including soup and, interestingly, grilled spam sandwiches. Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Medication is generally well organised, protecting the interests of residents though one or two minor changes are necessary to ensure that an accurate record is always kept. EVIDENCE: Most residents do not routinely need physical personal support but they are given emotional support and encouragement through the home’s keyworker system. The home now has a controlled drug to administer and it is kept in a newly purchased Controlled Drugs cabinet. The administration of the drug is witnessed and signed by a second member of staff in a bound Controlled Drugs Register as well as on the Medication Administration Record sheet. The home uses a system of preloaded plastic NOMAD cassettes for medication. The dispensing pharmacist provides each resident’s medication in individual cassettes. Medication in this system was accurately recorded but there were some minor shortcomings with other medication. One resident administers his own insulin injections – observed by staff – but this was not recorded on the care plan, which stated that the District Nurse administered the injections. This must be updated. The amount of one prescribed drug, which is not included in the NOMAD system, had not been recorded on receipt of the drugs and it was not therefore possible to check precisely if the right amount had been administered. The receipt of all drugs must be accurately recorded. Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 13 One resident retains and administers his own medication. This was appropriately recorded on his individual file and the medication was safely stored in his room. Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. The home has a satisfactory complaints procedure that residents can use to make their views heard. EVIDENCE: Oaklands Grange has an appropriate complaints procedure. There have been three complaints since the last inspection, two of them raised at residents’ meetings. The Registered Manager had dealt with the issues raised and the inspector discussed with her ways of keeping one of those issues under review. Most complaints are dealt with informally. Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. The home provides clean, reasonably furnished accommodation that meets the needs of the residents. EVIDENCE: The home was clean and tidy on the day of this unannounced inspection. The main stair carpet has been replaced, as required in the last inspection report. Bedrooms are highly personalised in most cases and furniture is renewed on a rolling programme. Three of the beds are badly worn and need to be replaced. The chest of drawers in one room needs to be repaired or replaced and some other minor items are reaching the stage when they may need to be replaced. The Registered Person has no plans to admit more than the current 13 residents so it is not proposed to use any more rooms for sharing. If and when single rooms become available they should be first be made available to those residents currently sharing rooms, other than partners who have made a positive choice to share. No residents objected to sharing a room but it seems likely that given a choice some of them may prefer a room of their own. There are two residents over the age of 65 in the home at present and the registration has been varied to reflect this. The lounge/diner is the most popular room and overlooks the garden. The new three-piece suite proposed for the front TV lounge has not yet arrived. This lounge is now a non smoking room and the residents respect this. Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 16 The downstairs toilet floor is badly stained and is in the process of being replaced. The extractor fan in a first floor bathroom was faulty, making an extremely loud noise and must be repaired. The Registered Manager reported this to the handyman during the inspection. Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. The manager is supported by senior staff in providing leadership to the experienced staff group, providing stability and well-planned care to the residents. Training gives staff the skills to provide the care that residents need but there is still a shortage of qualified staff. EVIDENCE: The staff team is stable, and the Registered Manager is supported by two senior care assistants. Relationships between staff and residents are informal and relaxed. A cook now works at the weekend, ensuring that the care staff are free to carry out their main task of caring for the residents. The overall number of care hours meets the required standard but there is only one member of care staff on duty on Sundays, which restricts the time that member of staff can spend on activities. The Registered Manager said that she or one of the owners is always available at the weekends should care staff need support. One new member of staff has been employed since the previous inspection and the proper checks had been carried out before he was allowed to start work. Another new recruit was visiting the home at the time of the inspection, completing his CRB application. Only three members of the care staff have NVQ2 but five other members of care staff are now studying for NVQ2. This still leaves the home well short of the target of 50 staff qualified to NVQ2 by the end of last year but this will be achieved when the staff gain their qualifications. Other recent training includes Moving and Handling, Infection Control and the Protection of Vulnerable Adults. Two further Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 18 members of staff are about to go on Medication Administration training. Staff are regularly supervised by the Registered Manager. Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 42. The home is well managed, with records properly and safely kept, protecting the welfare of the residents. EVIDENCE: Quality assurance is managed informally via residents’ meetings and questionnaires. Some of the residents’ questionnaires did raise issues about catering and whilst they were not specific these might relate to some of the issues of variety raised earlier in the report. The Registered Person visits the home regularly and completes reports on those visits, which are then forwarded to the Commission for Social Care Inspection in accordance with Regulation 26. The Registered Person does not carry out an annual review of the home as part of the quality assurance process and the inspector discussed the possible advantages of using a formal, recognised Quality Assurance tool. Fire safety checks and training were up to date. Gas and electrical safety certificates were in place. The temperature of the fridge and freezers is checked every day and recorded. The Registered Person is in the process of fitting a larger cooker in the kitchen to replace the existing domestic style cooker. The Registered Person decided not to fit radiator guards to protect Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 20 residents but risk assessments are in place and were last reviewed on 17 September 2004. Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 x x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 2 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Oaklands Grange Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x 3 x DS0000018921.V261768.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? 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 YA20 Regulation 13(2) Requirement The Registered Person must make satisfactory arrangements for the recording and safekeeping of medication in the home by: * Ensuring that records concerning self medication are up to date; * Recording accurately the receipt of medicines not included on the monitored dosage system. The Registered Person must provide adequate furniture and bedding and must therefore replace the three identified beds and repair the identified chest of drawers. The Registered Person must repair the faulty extractor fan in the first floor bathroom. Timescale for action 11/01/06 2. YA26 16(c) 01/03/06 3. YA30 23(2)(d) 01/02/06 Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 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. 2. 3. Refer to Standard YA17 YA25 YA32 Good Practice Recommendations The Registered Manager should consider providing extra choices on the menu from time to time to cater for the preferences of all of the residents. Residents in shared rooms should be offered single rooms when they become available unless they have made a positive choice to continue to share. More staff need to be trained to NVQ2 to meet the target of 50 qualified care staff. Oaklands Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Grange DS0000018921.V261768.R01.S.doc Version 5.0 Page 25 - 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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