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Inspection on 24/05/05 for Oaklands Nursing Home

Also see our care home review for Oaklands Nursing Home for more information

This inspection was carried out on 24th May 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home manager provides leadership, guidance and direction to staff to ensure that service users receive consistent quality care; the manager ensures that staff have the skills and knowledge to fulfil their roles and also can access training needs. The manager and her staff worked hard at addressing the requirements made on the last Inspection that are within her control, they have either fully addressed the issues or progressing towards these being completed. The home has a good atmosphere and service users are able to wander around the home safely, those service users spoken to liked the home and felt that staff worked hard to improve things within the home, and stated "nothing was too much trouble for them" has staff put a lot of effort into the care they deliver.

What has improved since the last inspection?

The home have completed further refurbishment, installed a new sluice facility on the upper floor that improves infection control and in keeping with relevant guidance. Double sockets in all bedrooms on the ground floor, ensures that service users do not have to use extension leads has some had numerous electrical equipment. A new bath is on order for one of the bathrooms, which as a hoist facility, this ensures that the home has suffiencent facilities to meet service users needs.

What the care home could do better:

Each service users or prospective service users must be given a contract/statement of terms and conditions with the home, so that they have a understanding of what there fees are and their rights. Ensure that care plans are audited on a regular basis, and continue to improve the quality in documentation. Continue with the refurbishment and any upgrading of the home, and continue with the installation of double sockets to improve the facilities for service users.

CARE HOMES FOR OLDER PEOPLE OAKLANDS NURSING HOME 82 Bawtry Road Doncaster South Yorkshire DN7 6JL Lead Inspector Janet McBride Unannounced 24 May 2005 11.30. 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 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 NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Oaklands Nursing Home Address 82 Bawtry Road Doncaster South Yorkshire DN7 6JL 01302 535386 01302 535726 fourseasons@fshc.co.uk Leeland Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Elizabeth Potts CRH N Care Home with Nursing 34 Category(ies) of OP Old Age: 34 registration, with number PD(E) Physical Disability over 65: 34 of places OAKLANDS NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 19 January 2005 Brief Description of the Service: Oaklands Nursing Home is a care home providing residential and nursing care and accommodation for 34 older people. Originally registered in 1996 the home is now owned by Four Seasons group, a company that has other homes with similar categories in the area. The home is located in Bessacarr, which is on the outskirts of Doncaster. It is a converted two-storey property that has been extended to provide accommodation for service users in the category of old age, 26 of the bedrooms are single with most of them with ensuite facility. Set in well established gardens the home is within easy reach of local facilities including pubs, the Dome leisure centre and a supermarket. Bus services pass close by and the town centre is a short ride away. OAKLANDS NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector from the Commission for Social Care Inspection carried out this unannounced inspection at Oaklands Nursing Home, which took place in May 2005. During the Inspection sampling of records, document reading and care plans case tracked, also direct and indirect observation of staff interaction with service users. Individual and group discussions with service users took place, and feedback from relatives and visitors on the day. Any issues or concerns that were raised were discussed with the Manager at the time of Inspection, and verbal feedback session at the end of the day. What the service does well: What has improved since the last inspection? The home have completed further refurbishment, installed a new sluice facility on the upper floor that improves infection control and in keeping with relevant guidance. Double sockets in all bedrooms on the ground floor, ensures that service users do not have to use extension leads has some had numerous electrical equipment. A new bath is on order for one of the bathrooms, which as a hoist facility, this ensures that the home has suffiencent facilities to meet service users needs. OAKLANDS NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 Page 6 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 NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection OAKLANDS NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 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 standard(s) 3 Not all service users care needs and any identified risks had been fully assessed and incorporated into the care plan to protect service users EVIDENCE: During case tracking it was found that a new service users had been admitted and staff had not completed a full assessment of their needs, although their previous placement had supplied lots of information. Various documentation had not been completed that would identify any care needs that were required, including base line observations and risk assessment or any care plans completed. This lack of information could prevent staff from providing a package of care appropriate to this service user. OAKLANDS NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 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 standard(s) 7 8 Service users care needs and any risks that were identified, are not fully met or incorporated into the care plan to protect service users Each service users receives health and personal care based on their individual needs, and are referred to any specialist services when required. EVIDENCE: All service users within the home have nursing needs, with the exception of one service user. The service user’s health, personal and social care needs are set out in an individual plan of care. Risk assessment is undertaken dependant on the individual needs. Two care plans were case tracked and crossreferenced with medication and accident records during case tracking. Evidence that service users are risk assessed, but one care plan did not contain enough information to enable staff to carry out appropriate care with regards to safety. No evidence was found that when service users are involved in an incident, that they are re-assessed or care plan updated. Staff did not always record when service users had their weight checked, or on admission completed their baseline observations. OAKLANDS NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 Page 10 Records show that service users have access to health care services including chiropodist, optician and dental services. Some service users had also been referred to specialist services including tissue viability and continence advisors. One care plan did not have sufficient documentation completed to enable staff to deliver the care to that particular service user who was a new admission. OAKLANDS NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 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 standard(s) 15 The home ensures that service users meals are nutritious and offer a healthy and varied diet, that is suited to each individual assessed needs. EVIDENCE: Each service users have a nutritional assessment undertaken on admission, this is reviewed and monitored, evidence was seen that the home make referrals to dietician and speech therapist when needed. Menus were on display in the dining room, and lunch and tea time was observed, which appeared to be done at a leisurely pace and staff were observed to be encouraging some service users with their meals, other service users were helped with feeding. Comments from service users were positive about meals within the home they state e.g.” we can have a cooked breakfast if required” “good choice always available” drinks and snacks available when required”. OAKLANDS NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 Page 12 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 standard(s) 16 18 Service user and relatives are provided with information to enable them to raise concerns or complaints about the home and their care. Vulnerable adults procedure ensures that service users are protected from abuse. EVIDENCE: Evidence that the complaints procedure, gives clear indications of the timescales a complainant can expect, this is displayed in the reception area of the home. There have been no complaints since the last inspection. The manager stated that she tries to ensure that any issues or concerns are dealt with immediately, both service users and visitors confirmed that the manager is very approachable and when issues or concerns arise they were happy to speak to the manager, but are aware of the complaints procedure and would be happy to use it if necessary. The home has policies and procedures for adult protection, and some staff have commenced on a course at Doncaster College re-Abuse and its Prevention, thereby helping to protect service users. OAKLANDS NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 Page 13 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 standard(s) 21 24 26 The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection. Toilet, washing and bathing facilities are provided to meet the needs of service users and private accommodation is furnished and equipped for comfort and privacy, and meets the assessed needs of the service user. EVIDENCE: Tour of the building provided evidence that the home has a variety of bathroom equipment, including hoists and specialist baths, and some bedrooms have ensuite facilities. Random bedrooms seen had various beds dependent on service users needs, and the home has installed double sockets in all bedrooms on the ground floor, this ensures that those service users do not have to use extension leads for their numerous electrical equipment. OAKLANDS NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 Page 14 Policies and procedures in place for the control of infection, sluice facilities on both the ground floor and the upper floor, premises were found to be clean, hygienic and free from offensive odours. OAKLANDS NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28 30 Staff are trained and have the skills and knowledge to fulfil their roles within the home. On going development of staff was evident by some staff achieving NVQ qualifications. EVIDENCE: The company have introduced in-depth induction and foundation training package for new staff; the Inspector was informed that the company trainer has verified the package and that it meets the TOPSS specifications. The manager is always looking at what training is available for her staff to access, evidence seen that staff has completed training since the last Inspection as records are kept of training needs and when up dates are due. Care staff within the home can access NVQ training and three out of the fourteen care staff has completed their NVQ level 2 and four other staff members are waiting for there work to be verified therefore the home are well on there way to ensure that 50 of care staff will be NVQ trained. All of which will ensure that staff have the expertise and knowledge to care for the service users accommodated. OAKLANDS NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 32 35 37 38 Service users live in a home that is run and managed by a manager that tries to run the home in the best interest of service users, and ensures so far as is reasonably practicable the health, safety and welfare of service users and staff are protected. EVIDENCE: The registered manager is qualified, competent and experienced to run the home, evidence that she continues her development by completing the registered managers award. Comments received expressed satisfaction of the homes manager by staff, service users and relatives stating, “She was very supportive and approachable”,” she’s made a difference to the home”. Records required by regulation were up to date and accurate, with the exception of care plans. Safe working practice were discussed with the manager, including observation of staff using wheelchairs and hoist facilities OAKLANDS NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 Page 17 with service users and a number of records checked, all of which was satisfactory and evidence seen that all maintenance checks are carried out on a regular basis and recorded. Although service uses can access any money they need, this is now pooled and kept in one account so the Inspector could not audit individual service users money. OAKLANDS NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION x x 3 x x 3 x 3 STAFFING Standard No Score 27 x 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 3 x x 2 x 2 3 OAKLANDS NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5(1)(b)(c) Requirement The Registered person must ensure that;Each service user is provided with a statement of terms and conditions/ contract at the point of moving into the home. New service users are admitted only on the basis of a full assessment e.g.baseline observations,Dependency assessed and care plans formulated. Timescale for action 1stAugust 2005 2. OP3 14(1) 1st June 2005 3. OP7 15(1)(2) Care Plans;Staff must record 1st June service users medical history and 2005 current problems,also weight monitoring. Records required by regulation for the protection of service users are maintained, up to date and accurate. 1st June 2005 4. OP37 17(1) OAKLANDS NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP24 OP28 Good Practice Recommendations Continue to ensure that service users have two accessible double sockets if requested. A minimum ratio of 50 trained members of care staff (NVQ Level 2 or equivalent) is achieved by 2005, excluding the registered manager and/or care manager, and in care homes providing nursing, excluding those members of care staff who are registered nurses. The registered manager achieves NVQ 4 in management by 2005. Good practice; All services users money kept in the home should be kept in individual wallets 3. 4. OP31 OP35 OAKLANDS NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 Page 21 Commission for Social Care Inspection First Floor Barclay Court Heavens Walk Doncaster South Yorkshire DN4 5HZ 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 NURSING HOME CS0000015868.V186123.R01.doc Version 1.30 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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