Inspection on 13/07/10 for Oaklands North Care Home

This inspection was carried out on 13th July 2010.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 10/04/05

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 08/06/2011.

Key inspection report Care homes for older people Name: Address: Oaklands North Care Home North Road Whaley Thorns Langwith Derbyshire NG20 9BN     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rob Cooper     Date: 1 3 0 7 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Oaklands North Care Home North Road Whaley Thorns Langwith Derbyshire NG20 9BN 01623744412 01623748759 oaklands@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Care Homes No 2 Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: Southern Cross Care Homes No.2 Limited may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder - Code MD, MD over the age of 55 years and over. Dementia - Code DE 60 years and over. Mental disorder - Code MD, age 55 years and over. Dementia - Code DE, age 60 years and over. The maximum number of service users who can be accommodated is 40. Date of last inspection 2 3 1 0 2 0 0 9 20 20 Over 65 0 0 Care Homes for Older People Page 4 of 31 Brief description of the care home Oaklands North Care Home is a purpose built forty bedded care home set on the outskirts of the village of Whaley Thorns. People who live at the care home are situated on two floors, each with its own lounge and dining areas. The care home is registered to provide nursing care for people with dementia (twenty places) and mental disorder (twenty places.) The ground floor is dedicated to caring for people with dementia with the first floor housing people with mental health needs. The home is within walking distance of the few local shops and GP surgery. The range of fees charged at the home are £364.07 to £819.84 per week with extra charges made for Chiropody, toiletries and newspapers. This information is taken from documents in the home during this key inspection visit, on 13th July 2010. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced visit as part of the key inspection process, so that no one at Oaklands North knew that the inspection visit was going to take place beforehand. The visit took approximately six hours through the middle of the day, with two Inspectors present. In preparing for this inspection, the information that the Commission holds about this care home was reviewed, this included looking at the last inspection report, the inspection record, considering any complaints or concerns that have been made about the service, and reviewing any notifications made relating to incidents that affect the well being of people living at Oaklands North. The methods used during this key inspection were to visit the care home, where a method called case tracking was used; this involved identifying four people who live there and looking at their individual files and making a judgement about the quality of Care Homes for Older People Page 6 of 31 care they are receiving, and if their needs are being met. This was followed by a partial tour, looking at the activities on offer, and talking to three people who live there, one relative and three members of staff about the quality of the service, and their experiences of living and working at Oaklands North. We also sent out an Annual Quality Assurance Assessment (known as an AQAA), which allowed the care home to carry out a self-assessment; and provide a range of information relating to their service. The AQAA was not returned before the inspection, so did not help to form the judgements in this report. We also sent out ten questionnaires asking for views and information to people who live at the home, and five to relatives. Of these, no questionnaires were returned. The home does not currently have a registered manager. There is an acting manager called Dawn Maris, who has only recently started working at the care home. Dawn provided much of the information during this key inspection visit. On the day of this inspection there were twenty-five people living at Oaklands North. People who might want to live at Oaklands North can obtain information about the home direct from them, and this would include seeing previous inspection reports prepared by the Care Quality Commission. In addition information about the care home and the services it provides can be found at Southern Cross web site: www.ashbournesl.co.uk. Previous inspection reports for this care home can also be seen at the Care Quality Commissions web site: www.cqc.org.uk. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People, who would want to live at this care home, have access to information about the services on offer. However that information is not up to date. People receive an assessment of their needs, which allows them to make an informed decision about whether the home can meet their needs. Key information is missing from the assessments held on file. Evidence: Both the statement of purpose and service user guide were seen. These documents were not up to date, with the contact details for the Commission showing the Cambridge office, which closed a year ago, and also the name of the previous manager who left in March. One relative who was spoken with said that they had visited the home, and been involved in the decision to place their mother there. The care files of four pople who live at the home were seen. Each of the four files contained an assessment of need. The assessments had all been completed in-house, Care Homes for Older People Page 10 of 31 Evidence: and covered areas such as: the risk of falls, continence, dependency, and nutrition. The assessment forms all had areas which had been left blank, with no explanation as to why. In addition several of the assessment forms in each file had not been signed, despite there being an area of the form where a signature is required. There was also no evidence of the assessments having been audited by management. The relative who was spoken with, said that someone had come out to see their mother in hospital and carried out an assessment before she moved into the home. Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans that are in place do not sufficiently detail peoples needs which may result in individuals care needs being unmet. Medication management and adminstration is unsafe and therefore places people at risk. Evidence: One person who lives at the care home does not have English as their first language, in their care file there was a communication care plan, and a list of common words and phrases in English and their own language is attached to the wardrobe in their bedroom, to help staff communicate with this person. In addition there are a series of flash cards available with common words in both languages. A review of the care plans showed that this person centred approach is however the exception rather than the norm. There were examples of information being recorded and not followed through, for example: a care plan stated that a person could be challenging physically and verbally to staff but gave no details of the approach that staff should take to manage this. The care homes care planning system is based around the activities of daily living which results in the whole care planning system Care Homes for Older People Page 12 of 31 Evidence: not being person centred, but encourages staff to focuss on processes rather than the individual involved. One piece of documentation seen in many of the files was a: Service users weekly report. This was being filled in on a monthly basis, and in many cases was a very brief report, which gave little insight into the persons progress. All of the files contained health care information, with documentation to record professional input and visits, along with any hospital admissions or treatment. Some specific care plans relating to diagnosed medical conditions were seen, however in many cases these were very brief, with for example: a person with a specific mental health problem, that was not mentioned at all in their care plan, while another person was noted as having paranoia, hallucinations and bizarre behaviour in the daily notes, but there was no record in their specific care plan, and no detail of how these would be managed. One persons daily notes indicated a recent chest infection and doctors visit with antibiotics prescribed, however there was no note of this in the care plan or record of a professional visit. A review of the medication systems showed that: The room where medication is stored was very cluttered, with opened boxes and packaging in amongst essential supplies. There was vast overstocking of food supplements, as evidenced by four large containers, with no clear stock rotation, as containers with different dates were all mixed together. The medicines refrigerator which should have its temperature checked daily, had no recorded temperature reading since 28th June 2010. An inspection of the Medication Administration Records (MARs) showed that: thick and easy had been ticked but not signed for; there were examples of hand written sheets, with no double signatures, and in one case no signatures at all. Spelling mistakes, and medication with no frequency recorded, but being given four times a day. Regular recorded refusal of medication, but staff unsure how this was being managed, and the refusal not having been recorded in the care plans. One person is receiving medication which requires regular blood tests, as it may become toxic if levels of the drug rise in the blood, however this person did not have a care plan to record this. During the course of the inspection visit, an Agency Nurse was observed to make a medication error by giving medication to the wrong person, a photograph was available to help identify the individual, but the error occured in spite of this. The medication error was discussed with the acting manager who stopped the nurse from administering any further medication, and submitted a Regulation 37 notification to the Commission to detail the actions taken. Eye drops where found with no date recorded of when they had been opened - eye drops have a short life after opening, so recording the date when they were opened is crucial. Discussions with three people who live at the care home, and observations showed Care Homes for Older People Page 13 of 31 Evidence: that people were treated with respect and dignity. This included observing staff knocking on peoples doors before entering, and speaking in a respectful manner. However when an inspector spoke with a relative, a member of staff lingered close by, and was listening to the conversation, having made no attempt to give them some privacy. Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care home attempts to meet peoples cultural, social and religious interests, and needs, however people who live at the care home perceive problems with the level of choice and the quality of the food. Evidence: Oaklands North employ an activity co-ordinator who discussed activities, at the home. The local Clowne and District Community transport is available (with a driver) and occassional trips are arranged, with a trip to the seaside planned in a few weeks time. Evidence was seen during the inspection of arts and crafts produced by people living at the home out on display. The differing and varied needs of people at Oaklands North does mean that activities are targetted, and often arranged on an individual basis, and the activity co-ordinator keeps clear records, of both the individual and group activities. There is a small monthly budget which allows resources to be purchased. One of the people who lives upstairs said: We are waiting for the appointment of new hairdresser as the last one left. Also a member of the clergy was seen to visit one person during the inspection. There was activity seen in the garden, where a number of raised beds are being built, and a wooden workshop has been erected, in addition there are a number of animal runs, and once the work has been completed the activity co-ordinator said that rabbits, guinea pigs and chickens are Care Homes for Older People Page 15 of 31 Evidence: going to be bought, and people will be encouraged in getting involved in activities outside. One relative was spoken with during this inspection visit, they were positive in their comments, and said that they were made to feel welcome, and that the staff were friendly and approachable. Visiting was not a problem, and they felt able to come when they wanted. Staff were observed to see how well they interacted with the people who live at Oakland North, and whether choices were being offered. Observations showed staff to be friendly and choice was seen being offered particularly around drinks and activities. Staff demonstrated how choices were both offered and recorded at meal times, and the activity co-ordinator talked about how activities were organised, and choice was offered, including taking feedback from people about activities. Discussions with three people indicated that they thought there was choice available, but not always the best, particularly in relation to food (see below). With regard to the Deprivation of Liberties Safeguards (DoLS) people living within the home do have their movements restricted, by use of locked doors and keypads, however there is no documentation in the case files to evidence the reasons behind these restrictions, which would normally be tied to a Mental Capacity assessment, which were also not in place in any of the care files that were seen. Three people were asked about the food, and said: I do not like the food. Its not good and terrible. People also said that there is barely any meat in some dishes. The dining rooms are large functional rooms rather than homely, pleasant places to eat. Prescription food supplements were found in the sideboard in the dining room, where anyone might have access to them, these should be stored under lock and key, as they have been prescribed for individual people. There was a menu on display, however this was a typewritten menu, and many of the people living at Oaklands North would have difficulty with written English, so alternative formats should be considered. The Environmental Health Officer has visited the home within the past few months, and made recommendations and requirements in his report, a copy of which is available at the home. In the kitchen there is a need for redecoration, with damaged tiling and flaking paint in some areas. Care Homes for Older People Page 16 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies, procedures and systems in place at Oaklands North designed to protect people and keep them safe. However the high number of complaints, concerns and safeguarding referrals over a significant period of time indicate that people living at the care home are potentially at risk. Evidence: Oaklands North have received a number of complaints and concerns since the last key inspection in May 2008. A review of the complaints showed that they had been dealt with in line with the homes complaints procedure, which is on display in the foyer, and also forms part of the service user guide. Currently only one complaint remains open, and is being dealt with by the management. Discussions with a reative indicated that they knew who to complain to, and how to complain, although so far had never needed to. A review of the staff training records in relation to safeguarding adults, and a review of the statistics showed that 62 of the care staff had undertaken this training in the last twelve months. The training is aimed at raising staff awareness of abuse, and issues around abuse and through raising those issues, offering people greater protection against abusive practice, while also making sure that the staff understand the correct policy and procedure to follow if abusive practice is found. Three members of staff were asked about safeguarding adults training and they said they were aware of the issues, and had undertaken this training. However Oaklands North have made Care Homes for Older People Page 17 of 31 Evidence: numerous safeguarding adults referrals since the last key inspection. and currently there are five safeguarding referrals open. The high number of safeguarding referrals, indicates that people are potentially at risk at the care home. Care Homes for Older People Page 18 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A number of improvements have been made to the environment, and the development plan does focus on environmental issues, however some areas could still be improved further to ensure that people live in a safe, comfortable home. Evidence: A partial tour of the care home showed that some areas were newly refurbished, for example a walk in shower/ wet room on the ground floor, while others were showing signs of wear and tear, as in the wallpaper by the lift was torn, and paintwork was chipped and marked. There is a handyman employed at the home, who carries out decorating and minor repairs around the home. Several bedrooms were seen, and these were well personalised, and all of the people who were spoken with said they felt they had everything they needed, and that they thought their bedrooms were comfortable. None of the bedrooms have en-suite facilities. The home stands in its own grounds, with ample car parking space to the front and side. At the rear of the property, work is currently underway to make the garden area more accessible. Discussions with Southern Cross senior managers in January, identified that all of the bathroom areas would be upgraded, but this has not yet happened to the extent identified at that meeting. It was also noted that the light fittings in the corridors have bare flouresent tubes, with many of the plastic protective diffuser covers missing. Domestic staff were seen cleaning in different parts of Oakland North during this Care Homes for Older People Page 19 of 31 Evidence: inspection visit, and discussions with staff showed that there were systems in place for cleaning, and that the care home had a good supply of cleaning materials. however there was a noticable odour in the entrance hall, and in several bedrooms. Care Homes for Older People Page 20 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have been recruited professionally, and staff training is available, however the records show that not all staff are receiving the training they should. Which means that the people who live at the care home are potentially at risk, and do not have staff who are necessarily able to meet their needs. Evidence: The staffing rota for Oaklands North was seen, and this showed that there are enough staff currently employed to meet peoples needs. Two people living at the care home were asked about staffing levels, and they said that they thought there were enough staff, and observations throughout the day indicated that there were sufficient numbers of staff. Oaklands North is a registered nursing home, and must therefore have qualified nurses working on each shift, the rota shows currently there is a heavy reliance on Agency nurses, rather than Oaklands Norths own qualified staff. The care industry considers National Vocational Qualifications (NVQ) to level II in care to be the basic qualification for staff working in residential care. A review of the staff training records showed that currently there are twenty-four care staff at Oaklands North, of whom there are sixteen staff with NVQ level II, and three with NVQ level III qualifications. In addition there are qualified nurses working at the care home. The files of six members of staff were seen, to check that they contained all of the Care Homes for Older People Page 21 of 31 Evidence: information that would show that staff at Oaklands North had been recruited in a safe manner, namely that applicants had filled out an application form, provided two written references and had completed a Criminal Records Bureau check. The documentation showed that the homes recruitment policy and procedures had worked to protect the people living there, and all of the necessary documentation was in place. Discussions with three members of staff about their recruitment showed that they had gone through all of the pre-employment checks, and had not started working until those checks had been completed. The staff training records showed that Oaklands North has a training plan for its staff, and the training records showed that training was available to help staff to do their jobs. However the statistics show that staff training levels are quite low in the past twelve months, for example: 44 of staff have received fire training, 38 Health & safety training, 62 safegusarding adults training, and 62 Infection control. Some of this training is mandatory and should be updated for all staff on an annual basis (fire, food hygiene, and manual handling - 92 ) but the statistics show this is not happening. Discussions with three members of staff about training identified the training courses staff had attended, which was supported by documentary evidence in the training files. Staff also told us that there is a review of training underway and that staff have been offered a range of courses, some specific to working on the mental health unit of the home. Care Homes for Older People Page 22 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of Oaklands North over the past twelve months has raised concerns, and those concerns have left people potentially at risk, and raised doubts over whether their needs are being adequately met. Evidence: Oaklands North does not currently have a registered manager, and there has not been a registered manager in post since February 2009. The current manager has only been in post five weeks, and has not yet started the process of being registered with the Care Quality Commission, although she was previously the registered manager at another care home. An Annual Quality Assurance Assessment was requested with a return date of 9th June 2010. This document did not arrive at the Commission, and despite a request on the day, a copy of the completed AQAA was not produced. The newly appointed manager, did forward AQAA that she had partially completed, but being new in post this was of limited use. At the same time as the AQAA was requested, a number of Care Homes for Older People Page 23 of 31 Evidence: questionnaires were sent out for people who live at Oaklands North and their relatives, none of these questionnaires have been returned either. With no current AQAA in place, it has not been possible to access up to date statistical information, or to judge the homes self assessment of their performance. Oaklands Norths quality assurance system relies on questionnaires being filled in by people who live at the home, relatives and visitors. Copies of these questionnaires were seen together with evaluation of the results. The home also hold meetings for the people who live there, and copies of minutes were seen. Regulation 26 visits (these are monthly audits by a representative of the owners management team) are taking place, and copies of these reports were also seen; these form part of the homes quality assurance system. In addition there is a comments book in the foyer, and the care home does produce a development plan. Oaklands North has a system for peoples small cash needs. This is operated on behalf of some of the people by the staff (dependent on individual choice and their ability to manage their money, or relatives involvement). Four peoples finances were checked at random. All of the cash tallied with the records, and receipts were seen, which enabled a clear audit trail of the individuals financial expenditure to be followed. The care home has a formal staff supervision system in place, in which staff receive supervision, either with the manager or with one of the other senior members of staff. This is usually in a one to one meeting. Formal supervision offers staff support and guidance in carrying out their work, and is seen as an essential management tool in residential care. The supervision records of four members of staff were seen, these showed that the National Minimum Standard of six formal supervision sessions per year for all staff were not being met. Three members of staff were asked about formal supervision, and they were receiving supervision sessions, although the frequency varied.. A range of different health & safety records were seen, including the fire safety records, water temperature checks and the Control of Substances Hazardous to Health (COSHH) records, all were found to be correct and up-to-date. Evidence was seen that routine health & safety checks are also being carried out. Care Homes for Older People Page 24 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must provide staff 31/12/2009 with direction, so that they are able to meet individuals needs, and also capture relevent information to ensure that appropriate monitoring of those needs is in place. To ensure that people are safe and that their needs are being met competently by the staff team. Care Homes for Older People Page 25 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 6 The Service user guide and 31/08/2010 statement of purpose must be kept under review and up to date. This will mean that people who live at the care home, and those who might wish to in the future have access to accurate and up to date information about the care home. 2 7 15 The care plans for each person must identify how that individuals needs will be met. Clear instruction within the care plan will help ensure that staff can meet peoples needs. 24/09/2010 3 8 12 People who have specific 16/09/2010 health conditions, must have a care plan to record information and direct staff in managing that health condition. Page 26 of 31 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This will help staff to meet peoples specific health care needs. 4 9 13 Hand written Medication 26/08/2010 Administration Records must have two staff signatures. This will demonstrate safe practice. 5 9 13 If medication requires a blood test to monitor its levels, and safety, there must be a care plan in place to record the necessary information. This will help staff to monitor, and keep individuals safe. 6 9 13 Medication Administration Records must specify the frequency of the medication as prescribed by the doctor. This will ensure that the doctors prescription is being followed accurately. 7 9 13 The Medication 26/08/2010 Administration Records must be signed by the person administering the medication. Medication will include anything taken orally that is prescribed by a doctor. This 26/08/2010 26/08/2010 Care Homes for Older People Page 27 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action will ensure a clear audit trail and accountability. 8 10 12 Staff must respect peoples privacy, and not listen in to private conversations. people living at the care home have a right to private conversations. 9 15 23 The flaking paint and damaged tiling in the kitchen must be repaired and refurbished. This will ensure that the care home is kept in a good state of repair, and not present a risk to people living and working there. 10 19 23 The strip lights in the corridor should have plastic diffusers fitted, as per the manufacturers instructions. Diffusers will protect the light fitting from damage, and will distribute the light evenly along the corridor. 11 19 23 The upgrading of the bathrooms, which was identified in January, must be completed, and the Commission informed of the schedule for the work to be carried out. This will ensure that the 15/09/2010 26/08/2010 15/09/2010 26/08/2010 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action people living at the care home have good quality bathing facilities which meet their needs. 12 30 18 Staff training schedules 24/09/2010 must be reviewed to ensure that staff receive the necessary training, including mandatory training to be able to do their jobs. This will ensure that staff have the necessary skills, knowledge and experience to be able to meet the needs of the people who live at the care home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 All documentation relating to assessments of need should be completed fully, and signed and dated when and where required. Documentation in the care files should be completed fully. The temperature of the medication refrigerator should be checked daily, and the results recorded. The room where the medication is stored should be kept tidy, and a stock rotation system should be introduced for the food supplements. If an individual refuses their medication, this information should be recorded in their care plan. Care should be taken to ensure that Medication Administration Records do not have spelling mistakes. 2 3 4 8 9 9 5 6 9 9 Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 8 9 14 Eye drops should be dated when they are opened. To improve the choice available, consideration should be given to producing the menu in an alternative formats, for example with pictures, so that people who have difficulty with written English can still make choices. Everyone living at Oaklands North should have a Mental Capacity Assessment in line with the Mental Capacity Act (2005). Everyone living at Oaklands North should have a Deprivation of Liberties Safeguards statement where ever their free movement is restricted, and if appropriate an Independent Mental Capacity Advisor (IMCA) should be involved. The negative comments about the food made by people living at the home, should be investigated and appropriate action taken where necessary. Staff training in safeguarding adults should be given a higher profile, in an attempt to reduce the number of safeguarding referrals and ensure that people living at the care home are safe. The unpleasant odour in the entrance hall should be investigated, and attempts made to remove it. The unpleasant odour in several bedrooms should be investigated and attempts made to remove it. The number of qualified nurses employed to work at Oaklands North should be reviewed, so that there is less reliance on Agency Nurses who may be unfamiliar with the people who live at the care home. All staff should receive six formal supervision sessions per year in line with the National Minimum Standard. 9 14 10 14 11 15 12 18 13 14 15 26 26 27 16 36 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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