Inspection on 15/11/06 for Oaklands Grange

This inspection was carried out on 15th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 1 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 11/01/06

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 Key Unannounced Inspection 15th November 2006 12:00 pm Oaklands Grange DS0000018921.V311164.R01.S.doc Version 5.2 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.V311164.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 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.V311164.R01.S.doc Version 5.2 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.V311164.R01.S.doc Version 5.2 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. 11th January 2006 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. The residents have 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.V311164.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit for this inspection was unannounced. The inspector spoke to six residents, the Registered Manager, care staff who were on duty and a visiting Community Psychiatric Nurse. The inspector toured all of the home and examined records, including care plans, safety records, menus, training records, 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.V311164.R01.S.doc Version 5.2 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.V311164.R01.S.doc Version 5.2 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, 4. Quality in this outcome area was good. Residents are only admitted if their needs have been properly assessed, ensuring that the service provided by the home can meet their needs. EVIDENCE: The Registered Manager had assessed the two most recently admitted residents before admission. Copies of the initial assessments were on file as were the assessment documents from Cheshire and Wirral Mental Health Services. The assessment documents had been used to prepare detailed care plans. Prospective residents are encouraged to visit the home before making a final decision on whether to move in. Oaklands Grange charges £340.04 a week. Oaklands Grange DS0000018921.V311164.R01.S.doc Version 5.2 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, 10. Quality in this outcome area is good. Care plans are detailed and are reviewed regularly, ensuring that day to day care is based on up to date information. Care needs to be taken to include all relevant details so that the residents’ needs can be met. EVIDENCE: Detailed residents’ care plans 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. This process would be easier if records were kept on computer but Oaklands Grange does not have one. Staff make daily reports – often quite detailed - on residents’ individual files. A shift handover/message book is used but staff take care to ensure that it does not contain any confidential information. 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. Most of the residents go out of the home on their own and several went out to day centres and local shops during the course of the site visit. Other residents Oaklands Grange DS0000018921.V311164.R01.S.doc Version 5.2 Page 9 talked about the things they do, including going to local pubs, drop-in centres or shops, visiting friends and relatives. Residents are asked to sign a book to indicate if they are in or out of the home and when they are expected back; several did so during the inspector’s visit and they accept this as a sensible precaution. One resident had not returned home the previous night and the Registered Manager had advised the police and his CPN. It had been difficult to contact the family as the relevant details were not on file. This was a significant omission as the file said that the resident did like to keep in touch with his family. Care needs to be taken to ensure that details of relatives are kept on file. The Registered Manager did find a relevant phone number during the site visit. Files are securely stored in the Registered Manager’s office, which is never left unattended unless it is locked. Oaklands Grange DS0000018921.V311164.R01.S.doc Version 5.2 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. Quality in this outcome area is good. 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. 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 when necessary though weekend staffing does not normally allow for this. Some also attend day/drop-in centres and talked to the inspector about some of the activities they take part in. 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. Since the last inspection the Registered Manager and her staff have introduced a central programme of activities for residents can join in if they want to do so. The schedule includes local outings, bingo, walks, card games and cookery. The Tuesday pub lunch and walks with George the boxer dog are especially popular. Oaklands Grange DS0000018921.V311164.R01.S.doc Version 5.2 Page 11 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 families and the home liaises with families over the residents’ welfare where this is appropriate. Most service users get their own breakfast when they get up. The main meal of the day is served in the early evening – round about 5 p.m. – which residents say suits them, and anyone who wants to eat later can do so. An alternative is always available though a formal choice is not always set out on the menu. The menu is usually displayed on a small whiteboard in the dining room so residents are aware of what is on offer for the day, though this had not been done on the day of the site visit. Residents did comment that this omission was unusual. The residents said that they enjoy the food in the home and they can have alternatives if they want them. One of the residents showed the inspector the menu, which is varied regularly to reflect what residents want. The current menu includes chicken curry and the option of lamb hearts on one day. This latter dish was introduced at the request of certain residents. ‘Polly’s soup’ – named after a member of staff – remains a favourite lunch, as do bacon butties. Oaklands Grange DS0000018921.V311164.R01.S.doc Version 5.2 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, 21. Quality in this outcome area is good. Medication is generally well organised, protecting the interests of residents. EVIDENCE: Most residents do not routinely need physical personal support but they are given emotional support and encouragement through the home’s keyworker system. Most of the residents have Community Psychiatric Nurses (CPNs), one of whom visited the home during the site visit and briefly spoke to the inspector. Care plans and files include details of relevant health care professionals. The home keeps one controlled drug and its administration 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. This medication is stored in a secure controlled drugs cabinet. The dispensing pharmacist provides each resident’s medication in individual NOMAD cassettes. Medication was checked for a number of residents and was found to be accurately recorded. One resident administers his own insulin injections – observed by staff – and this should be on the Medication Administration Record sheet as well as in the care plan. It would be good practice to introduce ‘PRN protocols’ for those drugs which are to administered ‘as required’, so that staff Oaklands Grange DS0000018921.V311164.R01.S.doc Version 5.2 Page 13 know the exact circumstances when the medication should be used (see paragraph 6.2.2 of the Royal Pharmaceutical Society’s Administration and Control of Medicines in Care Homes and Children’s Services). Although residents are, on the whole younger adults, details of, for instance, funeral wishes are kept on file. Oaklands Grange DS0000018921.V311164.R01.S.doc Version 5.2 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. Quality in this outcome area is good. The home has a satisfactory complaints and adult protection procedures to protect residents and enable them to make their views heard. EVIDENCE: Oaklands Grange has appropriate complaints and adult abuse procedures. Since the last inspection there have been two episodes which have required referral to social services and the police. One is the subject of action under adult protection procedures. Neither incident reflects on Oaklands Grange or its staff, relating to alleged incidents outside the home. The Registered Manager took the appropriate action in both cases and they were properly recorded. As described earlier, a resident had failed to return home the night before the site visit and the Registered Manager had taken all of the appropriate action. Other residents showed their concern at this situation and offered helpful advice as to the resident’s possible whereabouts, underlining the sense of community at Oaklands Grange. Oaklands Grange DS0000018921.V311164.R01.S.doc Version 5.2 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, 30. Quality in this outcome area is good. 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 site visit. Bedrooms are highly personalised in most cases and furniture is renewed on a rolling programme. Some minor items of maintenance such as chipped paintwork needed to be carried out. Three of the beds had been replaced since the last inspection. The Registered Person has no plans to admit more than the current thirteen 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. The Registered Manager said that when single rooms recently became available, those existing residents in shared rooms were offered the chance of a single room but did not want to move. It remains important that these choices are recorded in some detail and that residents are given the clear option of moving to a single room, rather than being asked if they ‘mind’ sharing. Oaklands Grange DS0000018921.V311164.R01.S.doc Version 5.2 Page 16 The lounge/diner, which has French windows leading on to the garden, is the most popular room. The new three-piece suite proposed for the front TV lounge had still not arrived and the old one is definitely showing its age. This lounge is a non smoking room and the residents respect this. There was no lampshade in one resident’s bedroom. The manager was aware of this as the light fitting had been changed, and said that the matter was in hand. There were a number of minor issues in the kitchen. The freezer tops are old and cannot easily be kept clean; some tiles were cracked and need to be replaced, especially by the sink; some floor tiles were chipped and pitted; some cabinets were damaged; a knob was missing off the cooker. These matters all need to be attended to and it may be best to wholly refurbish the kitchen as minor problems like this are likely to recur. A new electronic insect killer has been installed following a recent visit from the Environmental Health Officer. Oaklands Grange DS0000018921.V311164.R01.S.doc Version 5.2 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. Quality in this outcome area is good. 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 remains stable, and the Registered Manager is supported by two senior care assistants. Relationships between staff and residents are informal and relaxed. A cook and cleaner work at weekends, enabling care staff 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. A new member of staff has been employed since the previous inspection and the proper checks had been carried out before she was allowed to start work. Eight members of the care staff have NVQ2 or above so the home now meets the national standard of 50 staff qualified to NVQ2 level. Other recent training has included Food Hygiene, Health and Safety at Work, Managing Challenging Behaviour, Infection Control and the Protection of Vulnerable Adults. Staff are supervised every two months by the Registered Manager who records these sessions and also carries out staff appraisals. Oaklands Grange DS0000018921.V311164.R01.S.doc Version 5.2 Page 18 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): 38, 39, 42. Quality in this outcome group is good. 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. One of the questionnaire returns said ‘I love my home, it’s like having somebody by your side 24 hours a day.’ The Registered Person visits the home regularly in accordance with Regulation 26 of the Care Homes Regulations 2001 and forwards reports on those visits to the Commission for Social Care Inspection. The Registered Person does not carry out an annual review of the home as part of the quality assurance process and does not yet use a recognised Quality Assurance tool. Fire safety checks and training were up to date. Gas and electrical safety certificates were in place. An out of date packet of suet – apparently bought in by member of staff - was in the kitchen cupboard and the use-by date had been removed from two packets of powdered milk (kept for emergencies only). No other food was Oaklands Grange DS0000018921.V311164.R01.S.doc Version 5.2 Page 19 beyond its use-by date, and staff need to regularly check foodstuffs to ensure that nothing is unfit for use. The temperature of the fridge and freezers is checked every day and recorded. The Registered Manager has a copy of the Food Standard Agency’s programme Safer Food, Better Business but has not yet had the chance to prepare a schedule to put it into practice. This programme enables homes to set up a system for monitoring and regulating their own food safety procedures. Oaklands Grange DS0000018921.V311164.R01.S.doc Version 5.2 Page 20 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 Standard No Score 1 x 2 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 x 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 x 3 3 x x x 3 Oaklands Grange DS0000018921.V311164.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA30 Regulation 16(2)(j) Requirement The Registered Person must make suitable arrangements for maintaining satisfactory standards of hygiene in the home and must therefore make the following repairs in the kitchen: *Repair the cracked tiles by the sink; *Repair any damaged floor tiles; *Repair or replace damaged work surfaces and doors; *Replace the damaged freezer tops; *Replace the missing knob from the cooker. Timescale for action 31/12/06 Oaklands Grange DS0000018921.V311164.R01.S.doc Version 5.2 Page 22 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. Refer to Standard YA6 YA20 Good Practice Recommendations Case files should include all relevant details such as contact details for close relatives. Care plans should include details of the circumstances in which PRN (“as required”) medication should be administered. Foodstuffs should be regularly checked to make sure they are still fit for consumption. Anything beyond its use by date should be disposed of. 3. YA42 Oaklands Grange DS0000018921.V311164.R01.S.doc Version 5.2 Page 23 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. 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