Inspection on 10/04/05 for Oaklands North Care Home

This inspection was carried out on 10th April 2005.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Oaklands North Care Home 13/07/10

Oaklands North Care Home 23/10/09

Oaklands North Care Home 08/05/08

Oaklands North Care Home 07/06/07

Oaklands North Care Home 09/01/06

Oaklands North Care Home 08/07/04

Oaklands North Care Home 14/04/04

Oaklands North Care Home 22/01/04

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

CARE HOMES FOR OLDER PEOPLE Oaklands North Care Home North Road Whaley Thorns Langwith Derbyshire NG20 9BN Lead Inspector Bridgette Hill Unannounced Inspection 10th April 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 North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Oaklands North Care Home Address North Road Whaley Thorns Langwith Derbyshire NG20 9BN 01623 744412 01623 748759 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) Southern Cross Care Homes No 2 Limited Vacant Care Home 40 Category(ies) of Dementia - over 65 years of age (40) registration, with number of places Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That all 40 beds can be used for service users aged 60 years and are provided that each individual care is agreed in writing by the CSCI. That 3 named service users resident at the time of registration may remain in residence for the duration of their need. As each of the named service users move from the home then the place will revert to that of Care Home with Nursing for (Dementia over 65 years of age (DE(E)) That 1 named Service User under the age of 65 years is admitted to the home in the category of dementia. The agreed variation to registration will not transfer to any other Service User and is for the duration of the care of the Service User named in the Proposal of Registration Notice dated 29 September 2005. 9th January 2006 3. Date of last inspection Brief Description of the Service: The Oakland’s North Care Home is a purpose built 40 bedded home set on the outskirts of the village of Whaley Thorns. Residents’ rooms are situated on two floors, each with its own lounge and dining areas. The home is registered to provide nursing care for residents with mental health problems over the age of 65. With prior agreement from the National Care Standards Commission the conditions of registration allow that residents aged 60 years and over with dementia can be accommodated. The home is within walking distance of the few local shops and GP surgery. Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced one which took place over 6 1/4 hours. During the inspection 4 staff members and 2 residents and 1 visitor were spoken with. Various records including care planning records were examined the findings are recorded in the body of this report. The Acting Manager Karen Lonsdale was on duty at the time of the inspection. What the service does well: What has improved since the last inspection? What they could do better: The only shower available in the home is not working and requires refitting. This has been ongoing for some time and has been identified on the previous inspection report. The loss of this shower affects the basic provision of facilities that the Provider must provide in relation to the number of service users the home is registered for and directly affects the choice that service users have as this is the only shower fitted in the home. The provision of social and leisure activities appeared to be variable. Whilst more able service users had opportunities to participate and attend local clubs and social events there was nothing recorded to evidence what was offered to those service users who had more limited abilities. Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 6 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 North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5 It is consider that a range of information is openly available to service users and their families. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: A Statement of purpose was located in the entrance hall. This contained all required information. The Service User Guide was also in the entrance hallway but did not contain a sample copy of the Terms and conditions of residency contract. The preadmission documentation of a recently admitted service user was examined. This confirmed that a qualified nurse and undertaken and documented the preadmission assessment. This was a comprehensive document that included some risk assessment tools. An appendix document was also completed regarding assessment of dementia. This ensured that all service users were assessed appropriately and met the registration category that the home is registered to accept. Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 9 One completed Terms and conditions of residency contract was seen in one file. The service users next of kin had signed this. Some Terms and conditions of residency contracts were not at the home. The Manager said that these had been sent to Social services for signing where service users did not have the capacity to sign meaningfully. The Manager said that some service users did not have representation for themselves where they lacked capacity. Some work was also discussed where service users had lost contact with relatives and contact was trying to be re established where this was possible. Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Service users assessed care needs were documented within a structured format which gave adequate information on how care needs were to be met. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: A sample of three service users care files were examined to assess how standards were being met. The basic details were evident such as dates of birth and admission date, preferred name and photographs. The care plans were individually written and appeared to include a comprehensive approach to the range of needs service users had. Risk assessment tools were in place to identify potential difficulties and these were reviewed on a monthly basis. Many service users did not have the capacity to be involved in the care planning process and forms were in place to demonstrate that this had been assessed. Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 11 The storage and administration of medicines was examined. Medication administration records were fully completed. The storage area was acceptable and an up to date drug reference book was available. Topical preparations were dated on opening. The controlled drug administration record was found to be out of date as some drugs had been disposed of but this was recorded in the book. Staff spoken to were not fully conversant with the recently changed disposal methods for medicines and policies for this did not reflect the practice. Nursing and senior care staff took on the role of key worker to service users and one service user was able to say who this was. One relative said the name of the key worker was available in the service users bedroom and they did ring when required to request additional toiletries, clothing and such. All service users appeared to clean and well dressed. A payphone was available for service users to use. Post death wishes were recorded on some files but not all; this was partly due to service users not always having the capacity to make decisions for themselves. Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Leisure and social activities are not being equitably catered for all service users. A choice of foods was routinely offered to service users by staff that were knowledgeable of service users likes and dislikes. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service EVIDENCE: Of the three care plans examined two had no part of the recreational section of the form completed. Care plans relating to provide social/leisure activities were vague just stating that social needs were to be met. Therefore there was no information on service users abilities and preferences regarding social/leisure time. Some activities were being offered but within the care plans it was evident that these were mainly offered outside the home to local clubs such as the ‘Darby and Joan club’ or local tea dance. Little appeared to be on offer to service users with high dependency needs. Staff also expressed concerns regarding the way activities that structured and their suitability for some service users. This was discussed with the Manager who was exploring training options, networking with activities coordinators to resolve this. Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 13 The local community is easily accessible and during the visit one service user asked to go to a local shop and staff obliged. A choice of lunch was served on the day of the inspection. This appeared to be appetising with a good choice of vegetables. Service users spoken to said they enjoyed their lunch. Staff were observed feeding service users who required help. Teaspoons were used and staff were seated with service users and wore protective clothing. Plate guards were observed being used for some service users. The kitchen staff had weights of the service users in the kitchen to make them aware if there was any significant loss or gain. A relatives meeting has been recently scheduled but only one relative attended this. The assessment considered service user typical sleep patterns and preferences. Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Robust procedures for handling complaints and allegations are in place and are being implemented. Ongoing staff training is required to consolidate this fully. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: The complaints procedure was on display and had been amended to include timescales for the resolution of complaints. One relative spoken said they knew who to approach (the Manager) if they had any concerns and said they would be happy to do this is they felt a need to. A Managers surgery where an appointment could be made to discuss concerns was held each week. The Manager reported that so far no one had taken up the offer of this. Two complaints had been received since the last inspection with one currently being investigated. One Protection of vulnerable adults procedure has been instigated since the last inspection. This is still in the process of being resolved. Appropriate procedures were used by the Manager when accessing Protection of vulnerable adults procedures. Some staff have received training in the Protection of vulnerable adults but not all. This is ongoing and more sessions were planned. Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25,26 The home is generally well presented and clean with routine maintenance being completed and relevant checks being documented to ensure the safety of the environment. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: The accommodation of the home is arranged onto two floors with each floor having its own dedicated communal areas. Staffing is also arranged for each floor. A lounge allocated as smoking area was available on the first floor; this was being redecorated at the time of the visit. The dining rooms and lounges were found to be in reasonably good decorative order with just some peeling of the wallpaper and one border in one area. The furniture in place was of good quality. Bedrooms were not examined at this visit. Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 16 It is of concern that the one shower room in the home is still not functional. This is a long-standing issue and was commented on at the last inspection visit. This affects the provision of service the Provider is offering and is directly affecting the choice that service users have, as this is the only shower facility in the home. This is an outstanding requirement from previous inspections. Radiators covers were fitted and restrictors fitted on upstairs windows. The handyman checked water temperatures monthly at source and at outlets to ensure the risk of scalding was minimised, as was the risk of legionella. The home was found to be clean and no odours were evident. Domestic staff were spoken with who said that they considered there was sufficient time allocated to complete all tasks. One relative said they had always found the home to be clean. The laundry was tidy and considered suitable for purpose with two washers and two dryers. The laundry service was positively commented on by relatives in some review notes examined. All fire equipment and alarms were serviced and checked regularly by the handyman. Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Service users are being cared for by a staff group in sufficient numbers who are beginning to receive supervision and improved structure to the training opportunities offered to them. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service EVIDENCE: Staffing rota’s were examined which indicated sufficient staffing levels with staff being allocated to work a particular service user group on either the ground or first floor. There were 21 care staff employed of these 5 have achieved at least NVQ (National Vocational Qualification) level 2 in care. 12 staff have now registered to start NVQ (National Vocational Qualification) training. The current level of staff does not meet required standards of at least 50 of staff having achieved at least NVQ (National Vocational Qualification) level 2 in care. A good atmosphere was evident with jovial banter observed between staff and service users. One regular visiting relative spoke positively of the staff and said they were happy with the care received at the home. A sample of three staff personnel files were examined. Some key aspects were missing such as references (one being required from most recent employer), proof of identity, and photographs. Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 18 The provision of staff training was more organised at this visit than previous with a matrix available of when staff had completed training. A range of training had been completed including fire safety, Protection of vulnerable adults, first aid, pressure care, moving and handling, and health and safety. Whilst not all staff had completed required updates and Protection of vulnerable adults it was positive that there has been more training offered to staff than previous and it is hoped that this continues. Signed induction checklists were seen in the files of new staff. Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,35,36,37,38 There are sufficient management and administration procedures in place to ensure service users are receiving a self-evaluating and improving service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: The Acting Manager of the home is not yet formally registered with the Commission for Social Care Inspection A valid public liability certificate was displayed in the home. Records for establishing financial liability were not requested at his visit. A range of quality assurance audits were completed by the Manager on a monthly basis. These were scored and an action plan was developed to attend to any issues. Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 20 Questionnaires were available for service users or their families to be complete. One relative was observed to be completing one of this. This system was a recent introduction and no feedback had yet been received. Discussions were held with the Manager regarding ascertaining the views of visiting professionals as no work has yet been put into achieving this. The last Providers monthly visit report available in the home was dated January 2006. The Manager said a visit had been made last week but there were records to evidence. A new system for recording any monies held at the home had been implemented since the last inspection. This was a computerised system that was found to not be up to date with the actual monies available. The storage of monies was acceptable and receipts for purchases made were available. The system in place does not allow all staff to update it and as it is an online system this was not available on the day of the visit, as the system was not working. The records did not indicate in the form of a signature (written or electronic) to confirm who had undertaken the transactions so was not therefore fully auditable with respects to accountability. Staff supervision records were examined. These confirmed that some work had been completed to ensure staff had received appraisals. These showed an input from the employee and included training needs. A planner to introduce supervision on a regular basis had been developed and implementation had begun. This is an improvement from previous visits and if the planner is adhered all requirements will be continue to be met. Records in the home were to be securely stored in lockable cabinets. Service records for equipment and installations available and acceptable. Regular checks on wheelchairs and window restrictors were completed. Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 2 X 3 X 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 3 2 3 3 3 Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4&5 Requirement A Service User Guide must be developed and made available to residents; this must include information regarding the recent inspection report Previous timescale 31/03/06 2 OP2 5 All residents must be issued with a contract from the proprietors which meets the requirements of Standard 2 Previous timescales 31/08/03, 31/07/05 & 31/03/06 The administration procedures for controlled drugs must be robustly implemented The medication disposal policy must be reflective of actual practice in the home All staff responsible for drug administration must be knowledgeable of procedures to be used The provision of leisure activities must be based on individual assessed needs 30/05/06 Timescale for action 30/06/06 3 4 5 OP9 OP9 OP9 13 13 13 30/05/06 30/05/06 30/05/06 6 OP12 16 30/04/06 Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 23 Previous timescale 30/09/05 7 OP18 13 & 18 All staff must receive training in the protection of vulnerable adults Some staff have received training but not all, timescale of 30/05/06 not yet reached Previous timescale 30/09/05 8 OP21 23 The shower must be replaced in the upstairs and the repair made good Previous timescale 30/03/06 9 OP28 18 The Provider must ensure that at least 50 of care staff hold at least NVQ level 2 in care Previous timescales 30/09/05 & 30/05/06 10 OP29 19 All required pre employment checks described by Regulation 19 must be in place for all staff prior to commencement of employment All staff must receive annual statutory training updates. Previous timescale 30/07/05 Timescale of 30/04/06 not yet reached 12 OP31 9 The Manager must attain a relevant managerial qualification Timescale of 30/06/06 not yet reached 13 OP33 24 Quality assurance systems must be developed to ascertain the views of visiting professionals DS0000058022.V288292.R02.S.doc 30/05/06 15/05/06 30/08/06 30/05/06 11 OP30 18 30/04/06 30/06/06 30/05/06 Oaklands North Care Home Version 5.1 Page 24 Timescale of 30/05/06 not yet reached 14 OP33 26 The provider must ensure that a minimum monthly visit is made to the home in accordance with Regulation 26 and this is documented and made available at the home A system for the storage of valuables and monies must be in place that: • Provides accountability for transactions • Is fully auditable • Is able to be maintained accurately at all times 30/05/06 15 OP35 16 Schedule 4 30/05/06 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 OP35 Good Practice Recommendations Financial transactions made on service users behalf should include 2 signatures Oaklands North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 North Care Home DS0000058022.V288292.R02.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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