Inspection on 09/01/06 for Oaklands North Care Home

This inspection was carried out on 9th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Oaklands 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 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 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 9th January 2006 09:20 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.V277318.R01.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.V277318.R01.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.V277318.R01.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. 14th June 2005 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.V277318.R01.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 5 1/2 hours. During the inspection 2 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: 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.V277318.R01.S.doc Version 5.1 Page 6 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.V277318.R01.S.doc Version 5.1 Page 7 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): 1,2,3 Service users were not being given full and adequate information regarding the home and the terms and conditions of residency. EVIDENCE: The Statement of purpose available in the reception area required updating to reflect changes in the company and Manager. This is an outstanding requirement from previous inspections. At this visit a Service User Guide was available. This did not contain all required information for example the complaint procedure was not included. The latest inspection report was made openly available to service user and visitors in the reception area. A copy of the Terms and conditions of residency contracts was in service users files but the service user or their representative had signed none of these. Some contracts were in place and signed where the Local Authority funded service users. Oaklands North Care Home DS0000058022.V277318.R01.S.doc Version 5.1 Page 8 The care file of a recently admitted service user was examined. This confirmed staff from the home had completed a pre admission assessment. Oaklands North Care Home DS0000058022.V277318.R01.S.doc Version 5.1 Page 9 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): 7,8,9,10,11 Whilst care plans were generally well written and descriptive there some examples identified of incomplete care planning or inaccuracies which had the potential to affect the care received by service users. EVIDENCE: A sample of three service users care files were examined in full with other files being sampled in part to establish how standards were being met. Care files were found to be well organised and contained a range of risk assessment tools for tissue viability, nutrition, falls, moving and handling and continence. Cross referencing of log notes, weights and risk assessment tools indicated that staff were not always referencing available information relating to the risks therefore giving an underestimation of risk. A care model was in use to organise the structure of planned care. Generally it was found that it was detailed how assessed care needs were to be met. There were examples however of some assessed needs not being not being included as part of the plan of care for example one service user with diabetes did not have a care plan in place to detail how this was to monitored. Oaklands North Care Home DS0000058022.V277318.R01.S.doc Version 5.1 Page 10 There was evidence within care plans of visits being made to GPs, outpatient appointments and service users receiving a chiropody and optician service. The storage and administration of medicines was examined. This revealed some gaps on the medication administration records where no code or signature was recorded. For one complete drug round no medication administration records had been signed indicating poor practice and lack of adherence to administration procedures. A drug reference book dated March 20003 was available. Some requirements from last inspection were found to have been addressed. There was no evidence of consultation with service users regarding their plan of care or a record to state that this was not considered appropriate. There was no section on the plan of care for service users to sign. This is an outstanding requirement from previous inspections. Observations of service users confirmed they appeared to appropriately dressed and clean. Staff on duty were observed to address service users appropriately. Care files examined did contain post death wishes where service users were able to express this or recorded that this had been considered and that service users did not have the capacity to make decisions regarding this. Oaklands North Care Home DS0000058022.V277318.R01.S.doc Version 5.1 Page 11 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 Whilst there is provision of activities in and out of the home there was poor documentation of this to demonstrate that this was meeting service users assessed needs. EVIDENCE: An activities co coordinator was employed at the home and kept records of what activities service users ad participated in. A notice board was available The care plans relating to social and leisure activities were found to be vague and not personalised to the service users abilities and preferences. The activities which appeared to be taking place from the records appeared to bingo, coffee morning and massages. There was found to be documenting of in service users files to indicate what service users had participated in and how this met individual need. This is an outstanding requirement from previous inspections Some service users attended local community groups accompanied by staff from the home it was noted that this group appeared to be the more physically and mentally able service users. Oaklands North Care Home DS0000058022.V277318.R01.S.doc Version 5.1 Page 12 The serving of the lunchtime meal was observed. One staff member did not know what the meal was on the plate they were about to serve to a service user. Staff should be aware what foods they are assisting service users to eat. There was a choice of main meal available and staff were heard to be offering a choice to service users. Presentation of meals was good with portions served according to appetites and the homogenised diet served with foods liquidised separately. One visitor was spoken to who said they had got to known the staff and was always made welcome by them. They expressed that they were happy with the care delivered in the home. Regarding activities the relative said that their relative had been taken this is an outstanding requirement from previous inspections in a wheelchair locally but had limited capacity to participate. Oaklands North Care Home DS0000058022.V277318.R01.S.doc Version 5.1 Page 13 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): The Provider has not ensured that previous requirements relating to the Protection of vulnerable adults has been met. EVIDENCE: Previous requirements only were checked at this visit. There were copies of the whistle blowing policy in staff files which had been signed by staff to record they had read them. Discussions with the Manager and examination of the training matrix confirmed that not all staff had received training on the Protection of vulnerable adults procedures. This is an outstanding requirement from previous inspections. The complaints procedure displayed in the entrance hallway was one intended for staff and was long and not user friendly. This did not include the address of the Commission for Social Care Inspection for complainants to access if they wished to. One relative spoken to said they felt able to discuss any concerns if they had any with staff at the home. This is an outstanding requirement from previous inspections Oaklands North Care Home DS0000058022.V277318.R01.S.doc Version 5.1 Page 14 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): 19,21,26 Whilst the home was found to be generally well maintained there has not been prompt action to ensure all identified are rectified promptly. Some of these delays have affected service users. EVIDENCE: The home was found to be generally well maintained with décor in good order. A handyman was employed by the Provider to ensure ongoing maintenance. Some repairs had been completed to plasterwork in one bathroom and adjacent bedroom. Part of this repair had involved removal of the shower with a new one on order according to staff. Staff spoken to said that this was being missed by service users. During discussions with staff it was revealed that there was a problem with the provision of hot water in one half of the building, This had been ongoing for a number of weeks with no hot water being available later in the day in bathrooms and sink outlets. This was checked and confirmed during the visit with the water running cold. An immediate Oaklands North Care Home DS0000058022.V277318.R01.S.doc Version 5.1 Page 15 requirement was issued at the time of the visit to this to assessed by a specialist within 24 hours and rectified as soon as was practicable. All areas of the home were found to be clean with gloves and aprons being available for staff to use. One regular visitor spoken to said they always found the home clean without any odours being present. Oaklands North Care Home DS0000058022.V277318.R01.S.doc Version 5.1 Page 16 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 Whilst the provision of staffing was considered appropriate there is work required to ensure that staff were receiving training appropriate to their role. EVIDENCE: Staffing levels were examined and these were considered to be appropriate which organisation of staff to work on the different floors of the home to meet the varying dependencies of service users. Two staff personnel files were examined. These contained all required checks however there were some gaps in employment histories that were not documented as being explored. Three staff in the home out of 22 had completed NVQ (National Vocational Qualification) level 2 in care. Three more staff were enrolled on courses. This falls significantly short of the required 50 of staff that the National Minimum Standards describe as being required. Training records were examined. It was established that the record keeping of training completed was poor. The Manager confirmed that whilst some training had taken place there were not always records or certificates to confirm this. An audit of staff training was underway. It was evident that whilst some training was being planned some mandatory training was overdue. Oaklands North Care Home DS0000058022.V277318.R01.S.doc Version 5.1 Page 17 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): 3133,35,36 A new Manager is fairly new in post and there is significant work to be addressed particularly relating to staff supervision and training, and development of external quality assurance systems to ensure standards are met. EVIDENCE: A new Acting Manager has been appointed since the last inspection subject to the Commission for Social Care Inspection fit person process, this is underway. The Manager appointed stated that they are approximately halfway through completing a recognised managerial qualification. Some monies were kept in the home safely on behalf of service users. A sample of records relating to these was examined. Not all transactions had 2 signatures to check and verify transactions. Receipts for purchases were held. Audits of financial records were evident and some ongoing investigations were Oaklands North Care Home DS0000058022.V277318.R01.S.doc Version 5.1 Page 18 underway regarding some irregularities so far the investigation has been handled appropriately. There were some internal quality assurance systems in place with Managers of sister homes undertaking audits and scoring the home on a range of aspects. The Providers monthly visits were also being completed with a report generated from these visits. There was little documentary evidence of the views of service users, relatives and visiting professionals being sought this requires development. Staff supervisor was discussed with the Manager. A cascaded system was in its infancy of being developed and there were not records available at this visit to confirm an established plan was in place ensuring that staff were appropriately supervised. This is an outstanding requirement from previous inspections. Oaklands North Care Home DS0000058022.V277318.R01.S.doc Version 5.1 Page 19 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 2 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 17 x 18 2 3 x 2 x x x x 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 x 3 2 x x Oaklands North Care Home DS0000058022.V277318.R01.S.doc Version 5.1 Page 20 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 Requirement A statement of purpose containing all the required aspects of Schedule 1 must be available in the home to residents. Previous timescales 31/03/04 & 31/07/05 2 OP1 4&5 A Service User Guide must be developed and made available to residents; this must include information regarding the recent inspection report. 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 Care plan must be made available to residents, records should be kept to record it as been assessed if residents lack the capacity to understand care plans Previous timescales 30/08/04 & Oaklands North Care Home DS0000058022.V277318.R01.S.doc Version 5.1 Page 21 Timescale for action 31/03/06 31/03/06 3 OP2 5 31/03/06 4 OP7 15 31/03/06 5 6 OP7 OP7 15 15 7 OP9 13 31/08/05 Care plans must be in place to describe how all assesed care needs are to be met Where risk assessment tools are utilised these must be accurately completed utilising all available information Topical preparations must be stored securely and dated when opened Previous timescales 30/7/04 & 31/8/05 Medication administration records must include a code to indicate administration or reason for non administration for all medications which are due to be given The provision of leisure activities must be based on individual assessed needs Previous timescale 30/09/05 The complaints procedure must contain timescales Previous timescales 8/02/04 & 31/07/05 All staff must receive training in the protection of vulnerable adults Previous timescale 30/09/05 The shower must be replaced in the upstairs and the repair made good The hot water system must be repaired and fully functional at all times Immediate requirement issed for assessment of system within 24 hours and repair as soon as was practical The Provider must ensure that at least 50 of care staff hold at least NVQ level 2 in care DS0000058022.V277318.R01.S.doc 30/01/06 30/01/06 28/02/06 8 OP9 13 30/01/06 9 OP12 16 30/04/06 10 OP16 22 31/03/06 11 OP18 13 & 18 30/05/06 12 13 OP21 OP21 23 23 30/03/05 10/01/06 14 OP28 18 30/05/06 Oaklands North Care Home Version 5.1 Page 22 15 OP29 19 16 OP30 18 Previous timescale 30/09/05 Any gaps in employment histories on staff application forms must be expored and evidence of this recorded All staff must receive annual statutory training updates. Previous timescale 30/07/05 The registered person must ensure that persons working at the care home are appropriately supervised Previous timescales 30/08/04 & 30/07/05 The Manager must attain a relevent managerial qualifaction Qulaity assurance systems must be developed to ascertain the views of service users, relatives and visiting professionals 28/02/06 30/04/06 17 OP36 18 30/03/06 18 19 OP31 OP33 9 24 30/06/06 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 2 3 Refer to Standard OP9 OP15 OP35 Good Practice Recommendations It is recommended a drug reference book not dated more than one year old is obtained Staff should be aware what foods they are assisting service users to eat Financial transactions made on service users behalf should include 2 signatures Oaklands North Care Home DS0000058022.V277318.R01.S.doc Version 5.1 Page 23 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.V277318.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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