CARE HOMES FOR OLDER PEOPLE
Oaklands Nursing Home 43 Bodenham Road Hereford HR1 2TP Lead Inspector
Sandra Bromige Unannounced 28 July 2005 11:00 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 E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Oaklands Nursing Home Address 43 Bodenham Road, Hereford, HR1 2TP 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) 01432 272775 Oaklands Care Services Ltd Care Home 30 30 30 Category(ies) of Physical Disability over 65 registration, with number Old Age of places Oaklands Nursing Home E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Oaklands Care Services Ltd will carry out a review of the aids, adaptations and equipment available in Oaklands Nursing Home. The review, together with an action plan to rectify any deficits indentified, will be submitted to the Commission for Social Care Inspection within three months of the date of registration. 2. Oaklands Care Services Ltd will carry out a review of the heating, surface temperatures of radiators and pipes, water temperature controls and legiionella precautions in Oaklands Nuring Home. The review, together with an action plan to rectify any deficits indentified, will be submitted to the Commission for Social Care Inspection within three months of the date of registration. 3. Oaklands Care Services Ltd will increase the amount of day space provided for service users and will fit a new passenger lift to replace the undersized lift within 2 years of the date of registration. 4. Oaklands Care Services Ltd will provide a set of architects plans for Oaklands Nursing Home to the Commission for Social Care Inspection within 6 months of registration. 5. Oakland Care Services Ltd will ensure that a representative is present on site at Oaklands Nursing Home on a daily basis until a manager has been recruited. 6. Oakland Care Services Ltd will review the clinical skills, training and experience of the trained staff against the Statement of Purpose for Oaklands Nursing Home. The review, together with an action plan to rectify any deficits identified, will be submitted to the Commision for Social Care Inspection within one month of the date of registration. 7. Oakland Care Services Ltd will review the staffing arrangements to assess their adequacy to meet the needs of the service users. The review, together with an action plan to rectify any deficits identified, will be submitted to the Commission for Social Care Inspection within 1 month of the date of registration. Date of last inspection 30 September 2004 Oaklands Nursing Home E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 Page 5 Brief Description of the Service: Oaklands is registered to provide nursing care for up to 30 people whose needs arise from the ageing process, from a dementia illness or from a physical disability. The home was taken over by new providers Oaklands Care Services in May 2004. Oaklands is a large Victorian house with 2 modern, purpose built extensions. The accommodation is on four floors and there are 2 shaft lifts and 1 platform lift to access these. Oaklands is situated in an established residential area less than a mile from the centre of Hereford city, where the majority of local facilities are based. There are 14 single bedrooms and 8 shared bedrooms. On the ground floor there are 3 lounges and 1 dining area for communal use. The gardens are large and some areas are accessible to the service users Oaklands Nursing Home E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. An unannounced visit was made to the Home on the 21st April 2005 due to a complaint that had been received by the Commission about an identified resident. At the end of the visit the Inspector was advised by the Provider and manager (designate) of a health care issue for another resident. The issue had been reported to the manager (designate) 4 days previous and related to poor care practice for the prevention of skin breakdown due to pressure from lying or sitting. This was a serious concern. The Home has failed to provide appropriate care and equipment for the identified resident. This concern was shared with other agencies responsible for the care of residents in the Home through using local Herefordshire procedures for the protection of vulnerable people. The multi-agencies after consideration of the information made a decision that no further admissions would be made to the Home until practices at the Home had improved to a satisfactory standard agreed by all agencies. The owners agreed not to admit any privately funded residents without seeking agreement from the Commission. The Commission sent a letter to the owners of the Home telling them of the serious concerns and telling them the action they were required to take to improve the standards of care practice for residents. A meeting was held with the owners the following day. On the 26th May 2005 an unannounced visit was made to the Home to follow up the requirements made from the previous inspection. The findings of the inspection were shared with the other multi-agencies responsible for the care of the residents in the Home. The Home had made progress towards meeting the requirements from the last visit and the identified resident’s skin damage was responding to the treatment being given. The multi-agencies after consideration of the information provided after the inspection visit made a decision that residents would continue not to be admitted to the Home. The Commission sent a letter to the owners telling them of the findings of the inspection and telling them the action they were required to take to improve the standards of care practice for residents. On the 14th June 2005 the Pharmacy Inspector visited the Home following a request by the manager (designate). A letter was sent following the visit giving advice about the Home’s proposals for changes in the storage arrangements for medicines in the Home. On the 28th July 2005 an unannounced inspection took place over 5.75 hours by two Inspectors. This report contains the findings of this inspection. Inspectors looked around some parts of the building and a number of records were inspected. Residents were seen, and the manager (designate), some care staff, ancillary staff and one visitor were spoken with. Oaklands Nursing Home E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 Page 7 What the service does well: What has improved since the last inspection? What they could do better:
There are some areas that have not been re-assessed during the last visit and any previous requirements have been included in this report to be assessed at the next inspection. These include the following, the need for the Home’s terms and conditions to be reviewed, the provision of a risk assessment for Legionella and induction training and supervision for staff. The Pharmacy Inspector intends to follow up the provision of a revised medicine policy through separate correspondence with the Home. Areas that need improving that have arisen from this visit include the need for residents moving and handling assessments to be reviewed every month by
Oaklands Nursing Home E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 Page 8 the trained nurses. The social care needs of residents need developing after discussion with the residents on an individual basis. Staff need more training about Adult Protection and Whistle Blowing. The owners need to review the numbers of care staff provided during the afternoons. Staff must be employed correctly so that people living in the Home are protected from people who should not be working there. The forms used for assessing the use of bedrails should be reviewed to include a form for review each month. Following the investigation of a complaint it is recommended that residents should be asked if they prefer a bath or shower and this should be written in their care plan. 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 E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 Page 9 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 E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 Page 10 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) EVIDENCE: Oaklands Nursing Home E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 Page 11 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, 10 Considerable progress has been made on improving arrangements to ensure that the health care needs of residents are identified and met so that residents are not placed at risk. Procedures are in place to ensure that resident’s privacy and dignity is maintained. EVIDENCE: Individual plans of care are available and considerable progress has been made towards ensuring that the health, personal and social care needs are identified and planned for. The management of residents with sore skin caused by pressure from sitting or lying is now satisfactory. In April 2005 an identified resident had developed a very bad sore area on their body. This has now been appropriately treated by the Home and is now healed. Residents seen and spoken to were clean, tidy and well dressed. Resident’s privacy and dignity is respected by staff when assisting residents to wash, dress and use the toilet. Staff were heard having warm and cheerful conversations with residents whilst assisting them to bathe. Care plans need some further work to ensure that when problems are identified and recorded, the follow up care also needs to be recorded. Moving and handling risk assessments need to be regularly reviewed. Bedrail risk
Oaklands Nursing Home E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 Page 12 assessment documentation would benefit by using an evaluation sheet. Social care plans need developing. Oaklands Nursing Home E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 Page 13 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) EVIDENCE: Oaklands Nursing Home E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The Home has a satisfactory complaints system to ensure that resident’s views are listened to and acted upon. Training is needed for staff in Adult Protection issues to ensure that the Home provides a safe environment to protect residents from abuse. EVIDENCE: The Homes complaints procedure is on display in the Home. Since the last inspection the Commission has received five complaints about the Home. Three complaints were about care practice. Two were referred to the Provider for investigation and one was investigated by the Commission. The complaint investigated by the Commission alleged poor practice. Due to the nature of one of the elements of the complaint, the allegation and outcome of the investigation carried out by the Commission was considered by the Protection of Vulnerable Adults multi-agency forum. This allegation was not upheld. In total, six elements of the complaint were unresolved and two were not upheld. A recommendation was made by the Commission regarding resident’s choice of bathing. The recommendation has been included in this report. Two complaints are in the process of being investigated. Residents and visitors spoken to on the day of the inspection expressed no concerns about the service provided. Staff spoken to had not received any training about the protection of vulnerable people and the policies and procedures for reporting any suspected abuse. Oaklands Nursing Home E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 26 Considerable progress has been made to improve the management of infection control in the Home for the protection of the resident’s. EVIDENCE: The Home is clean and with the exception of one area free from any bad smells. Systems are in place for the management of resident’s with continence problems. Hand washing facilities are provided throughout the Home and gloves and aprons are provided and used by staff. Oaklands Nursing Home E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 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 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) 27 & 29 The numbers of care staff on duty in the afternoons are not sufficient to ensure that resident’s receive consistent care. The procedures for the recruitment of staff are not robust and do not offer protection for the people living in the Home. EVIDENCE: On the morning of the inspection there were 25 residents in the Home. Staff on duty was the manager (designate) and 4 care staff. The staff rotas for the month of July 2005 indicates that the staffing levels are usually 1 registered nurse and 5 care staff in the morning and 1 registered nurse and 4 care staff in the afternoon. The manager (designate) is included in these numbers with the exception of some afternoons each week between 2-4.30pm. There is 1 registered nurse and 2 care staff on duty at night. The care team are supported by a team of catering and cleaning staff. The records for a recently appointed member of staff showed that staff are starting work prior to a POVAfirst check being received. The records for three recently appointed staff showed that no references had been received for one. Testimonial style references had been accepted for another person. Oaklands Nursing Home E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 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 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) EVIDENCE: Oaklands Nursing Home E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 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 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x x x x Oaklands Nursing Home E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 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 2 Regulation 5 Requirement The Statement of Terms and Conditions of Residence must specify the amount of the nursing contribution as detailed in the Care Homes (Amendment No. 2) Regulations 2003. BROUGHT FORWARD NOT ASSESSED. Moving and handling risk assessments must be reviewed each month. Social care needs of individual residents must be identified and a plan of care put into place in consultation with the resident. The Registered Person must ensure that there is a Policy in place for the management and administration of medication. A copy of the latest edition of the British National Formulary must be available for reference. BROUGHT FORWARD NOT ASSESSED. All staff must receive training on Adult Protection and Whistle Blowing, including the Herefordshire multi-agency procedures for the Protection of Vulnerable Adults. A risk assessment must be
E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Timescale for action By 30th November 2004 2. 3. 7 7 13 15 Immediate & Ongoing 31/10/05 4. 9 13 By 30th November 2004 5. 18 12 31/10/05 6. 25 13 30/11/04
Page 20 Oaklands Nursing Home Version 1.40 7. 8. 27 29 18 19 9. 30 18 10. 36 18 carried out with regard to the prevention of legionella. Appropriate action must be taken based on the findings of the risk assessment. BROUGHT FORWARD NOT ASSESSED. The Home must reviewed the numbers of care staff on duty in the afternoons. Staff must not be employed to start work in the Home without a minimum of POVAfirst clearance in addition to obtaining all other elements of Regulation 19 & Schedule 2. AN IMMEDIATE REQUIREMENT NOTICE WAS ISSUED. All staff must receive induction training to TOPSS (Training Organisation for Personal Social Services) specification within six weeks of the commencement of employment. BROUGHT FORWARD NOT ASSESSED The Registered Person must ensure that care staff receive formal supervision at least six times a year. BROUGHT FORWARD NOT ASSESSED 31/08/05 Immediate & Ongoing Immediate & Ongoing 31/03/05 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 7 16 Good Practice Recommendations The bedrail risk assessment forms should be reviewed to include a form for recording the monthly evaluation. Service users should be consulted regarding their preferred form of bathing e.g. bath or shower and this should be documented in their care records Oaklands Nursing Home E52 - E02 S59478 Oaklands N H V241102 280705 State 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Hereford Area Office 178 Widemarsh Street Hereford HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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