CARE HOMES FOR OLDER PEOPLE
Oaklands Nursing Home 43 Bodenham Road Hereford HR1 2TP Lead Inspector
Sandra J Bromige Unannounced Inspection 29th June 2006 09:40 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 Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 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 Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Oaklands Nursing Home Address 43 Bodenham Road Hereford HR1 2TP 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) 01432 272775 01432 351596 Oaklands Care Services Limited Mrs Pamela Ann Newman Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability over 65 years of age of places (30) Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Conditions of Registration 1. Oakland Care Services Limited will carry out a review of the heating, surface temperatures of radiators and pipes, water temperature controls and legionella precautions in Oaklands Nursing Home. The review, together with an action plan to rectify any deficits identified, will be submitted to the Commission for Social Care Inspection within 3 months of the date of registration. 2. Oakland Care Services Limited 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. 3. Oakland Care Services Limited will provide a set of architects plans for Oaklands Nursing Home to the Commission for Social Care Inspection within 6 months of the date of registration. Date of last inspection 16th January 2006 Brief Description of the Service: Oaklands is registered to provide nursing care for up to 30 people whose needs arise from the ageing process, or from a physical disability. The home provides accommodation for male & female residents. 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 DS0000059478.V295261.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over 1 day by 2 Inspectors. The purpose of this inspection was to assess the outcomes for residents against the key National Minimum Standards. Information to inform the inspection has been sought from many sources. The Commission gathers information from the date of the last inspection to inform the next inspection. This information comes from notifications that the home sends into the Commission, any concerns, complaints or allegations, written feedback from relatives, residents, visiting professionals and a visit to the home. Shortly after the last inspection in January 2006 the Commission received a complaint about the home relating to injuries to a resident and alleging poor practice. These allegations were referred to the local multi agencies for the Protection of Vulnerable Adults and are still in the process of being investigated All staff were very pleasant and most helpful throughout the visit to the home. What the service does well:
The manager carries out a comprehensive assessment of all residents before a decision is made regarding them moving into the home. A Service User guide is available giving information about the home to prospective residents. Written feedback from the next of kin of a resident said that prior to admission “the family had a long talk with Matron who explained all aspects of the home to us. She answered all our questions fully and we talked to other families without interference and had their views of the home and the care it gives. We were able to choose one of two vacant suitable rooms”. Care plans seen during this visit all contained a detailed and comprehensive health assessment, were being regularly reviewed and updated and there was evidence of family involvement. The outcomes of care for residents are good, and this is supported by written comments from residents, relatives & visiting professionals to the home. An example of a written comment received regarding the care and support given by the staff included “they always inform us of any changes in health and of any needs we can help with”. “My mother certainly receives the support and care that she needs. I am sure that her life has been lengthened by the care she has received”. The homes management of medication is satisfactory. Care staff were polite and caring and their approach to residents was observed to be gentle and caring. The manager and staff welcome visitors into the home at all times.
Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 6 The home provides a daily choice of food that is of a good quality, varied and nutritional. Staff serve and assist residents to eat in a discreet and sensitive manner. Specialist health care & cultural diets are catered for. The manager recognises, records and acts upon any complaints & concerns. Recent investment has significantly improved the appearance of this Home creating a comfortable and safer environment for those living there and visiting. The home is cleaned to a good standard. The home is accessible to residents on all floors through the provision of 2 shaft lifts and a platform lift. The gardens are well maintained and are accessible to residents in wheelchairs. The laundry, although small is functional and a good system is in place for the management of infection control. Residents’ clothes are nicely laundered. A multi-cultural group of staff are employed by the home in sufficient numbers to meet the needs of the residents. The home is being managed by a qualified and competent manager who provides leadership, guidance and direction to staff to ensure residents receive consistent quality care. The overall standard of record keeping in the home is satisfactory. Notifications are being sent into the Commission in line with Regulation 37 and these notifications are very informative. The owner visits the home more than once each month, although there are no written reports available for the manager as required in line with Regulation 26. Systems are now mostly in place to protect the health & safety of the residents living and the staff working in the Home. What has improved since the last inspection?
The home’s terms & conditions have been amended since the last inspection to ensure that they contain all of the information required through regulations. The manager and staff have made a good start regarding the provision of activities in the home. Multi-denominational religious services are provided on a regular basis. Regular exercise sessions to music are now provided and a ‘Residents group’ has now been set up in the home. Further training has taken place for staff regarding the local procedures for safeguarding vulnerable people. A risk assessment has been written regarding the use of portable fires. Staff are receiving fire training upon employment and at regular intervals throughout the year.
Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 7 The kitchen has been partly upgraded and procedures and systems have improved for food hygiene & the storage of chilled & frozen foods. A risk assessment has been undertaken regarding the changing of the heavy milk purgal in the kitchen. The manager’s time is now supernumery to the registered nurses directly caring for the residents. The manager has completed a recognised external Fire Awareness course in line with her conditions of registration and has attended additional clinical courses since the last inspection. Formalised staff supervision has commenced since the last inspection and this is being recorded. NVQ training for staff is now being sourced through the Primary Care Trust Chemical information sheets are provided for the products in use in the home. The health & safety poster providing information for staff has been completed and is now prominently displayed in a staff area. Portable electrical equipment has been tested for safety. What they could do better:
The undersized lift is to be replaced in line with the agreed condition of registration. This and the increase in day space for residents have been subject to written communication between the Commission and the Provider since the last inspection. The Provider has indicated that plans are being drawn up and will be submitted to the Commission. An extension to the timing of this Condition of Registration has been requested by the Provider and will be considered by the Commission once the plans have been submitted. Residents must be individually consulted about their hobbies and interests and this must be recorded in their care records. The temperature of the medicine store must be monitored and recorded daily to ensure that it does not get too hot and cause harm to the medicines. Staff need more training about Adult Protection and Whistle Blowing. A risk assessment must be carried out by the owner to make sure that the residents; staff and visitors to the Home are not at risk from Legionella and the temperature of storage and distribution of the cold water must be checked on a regular basis. Employment references relating to the persons last period of employment must be obtained for all staff prior to them starting work at the Home. Enhanced Criminal Records Bureau checks must be obtained for all staff employed and information must be held in the home for all staff showing that results of the disclosure. Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 8 The policy and induction training programme must be further developed for new staff employed to ensure that the care & safety of residents and the staff is promoted. All care staff must receive formal supervision from a senior member of staff at least six times each year. The owner must visit the Home at least once a month unannounced and write a report of the findings. The report must be given to the manager and be available for inspection. All staff must receive training how to move and handle residents and equipment prior to employment and must receive annual updates thereafter. A first aider must be on duty at all times in the home. Staff preparing food must undertake a food hygiene course. The report also made 2 recommendations. Criminal Records Bureau checks should be carried out by the home every 3 years for all staff either by asking the employee to make a written statement relating to any cautions or convictions or by sending a new application for an enhanced Criminal Records Bureau check. The ‘bug killer’ in the kitchen should be fixed to the wall as at the moment it is stood on a shelf. This was highlighted at the last inspection. 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 DS0000059478.V295261.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 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 the following standard(s): 2 & 3 (S6 is not applicable to this service) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have good information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that people’s diverse needs are identified and planned for before they move to the home. EVIDENCE: Records of 2 residents admitted to the home since the last inspection were seen and confirmed good practice. The manager prior to admission carries out comprehensive pre-admission assessments. Another resident spoken with who had moved into the home in the last 6 months said that her son came to visit the home before she moved in on her behalf and “everything is good here, she wouldn’t change anything”. Written feedback from the next of kin of a resident said that prior to admission “the family had a long talk with Matron who explained all aspects of the home to us. She answered all our questions fully and we talked to other families
Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 11 without interference and had their views of the home and the care it gives. We were able to choose one of two vacant suitable rooms”. Another relative has written that their experience of moving into the home is “the home helped us greatly and gave us every assistance”. Written feedback from 15 people confirmed that they received enough information about the home before they moved in. The home’s terms & conditions have been amended since the last inspection to ensure that they contain all of the information required through regulations. A sample contract was seen. The contract had been amended to give detail about the nursing care and had not yet been returned by the resident’s next of kin. Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a comprehensive care planning system in place to provide staff with the information they need to meet residents care needs. The health needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. The social care plans need further development to ensure that the individual social care needs of residents are met. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Care records of 4 residents were seen. They all contained a detailed and comprehensive health assessment, were being regularly reviewed and updated and there was evidence of family involvement. All care staff spoken with had a good understanding of the care needs of the residents. At each handover the care staff are informed of any changes to the care needs of the residents. At the lunchtime handover each day the registered nurse identifies one care record and they discuss the resident’s health care needs in greater depth as part of the ongoing training for staff. Since the last inspection a good start has been made regarding the provision of social care needs, but there are few
Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 13 individual activities and these need to be identified as part of the individual care plans. Comments within the surveys from residents & relatives stated that they were very satisfied with the standard of care. Written comments regarding the care and support given by the staff are that “they always inform us of any changes in health and of any needs we can help with”. “My mother certainly receives the support and care that she needs. I am sure that her life has been lengthened by the care she has received.” “My mother is unable to speak. The staff recognise her needs and look after her carefully”. “She is content and her health is improved (although frail) since admission to the home. “My mother is treated with great care, kindness and respect and we are more than satisfied with the standard of care given”. Comments within surveys from visiting healthcare professionals to the home indicate that there is now a high standard of care provision. Professionals are contacted by the home for advice on specialist healthcare related issues and instructions are followed by the home. All residents spoken with confirmed their satisfaction with the care provided by the home. All residents seen were clean, tidy and very well dressed. The management and administration of medication is satisfactory. Medication is being recorded upon receipt, administration and disposal to enable a complete audit trail of medicines. The night staff carry out weekly audit checks of medicines. Random checks on the day of the inspection indicated that these were not always accurate and the findings were not routinely being reported to the manager. This was addressed by the next day. Medication Administration Records are well written with no gaps. The temperature of the medicine fridge is being checked and recorded each day. The temperature of the medicine store is not being checked and recorded each day. The medication policy is in the process of being reviewed. The registered nurse on duty was not aware of the guidance referred to in the National Minimum Standards from the Royal Pharmaceutical Society of Great Britain. The Inspector provided a copy of this guidance for care homes the next day. There were two occasions during the visit that the Inspectors identified staff showing a poor regard for dignity and privacy of residents. Some carers were observed entering residents rooms without knocking, but most staff did knock the door first. A nurse was observed to approach a carer and a resident to enquire what was happening and then went up to them and said loudly to the resident “you’ve wet yourself darling”. Apart from these examples all conversations with care staff were polite and caring and their approach to residents was observed to be gentle and caring. Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to choose their lifestyle and keep in contact with family and friends. Further development is needed regarding the provision of planned group and individual social opportunities in the Home to provide stimulation and interest for the people living at the Home. Residents receive a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: The manager and staff have made a good start regarding the provision of activities in the home. The manager recognises that the social side of the care needs development and they have advertised for an activity person to be employed 2 days each week. The home now offers regular exercise sessions whereby they do ‘movement to music’; religious services for Roman Catholic residents are offered weekly and every 3 weeks for Church of England residents. A ‘Residents Group’ was formed approximately 3 months ago and is attended by the manager and 3 relatives. Residents were asked to join but none offered. Residents have been asked what they would like to do for recreational activities. The home recognises that male residents might benefit from a range of activities not shared with female residents. The home is trying to arrange a trip on a barge in Gloucester with ‘The Willow Trust’. Residents
Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 15 were observed reading the newspaper and large print books. A resident said that he enjoyed watching the World Cup Football on television and weather permitting likes to go out in the garden after dinner to sit on the patio. The resident confirmed that the staff are always willing to take him out in his wheelchair, he is offered things to do, but likes sitting in the garden best. A carer told the Inspectors that she had been allocated that morning to take an identified resident out in her wheelchair. Comments in surveys from residents indicate that some residents do not wish to take part in any activities that the home provides. The surveys generally recognised that there are sometimes activities in the home and this is an area that needs further development. A resident commented, “It is very pleasant to sit out in the garden here”. Two surveys made a special mention about last Christmas. They commented “a special mention should be made re the efforts to make Christmas “special” e.g. decorations in patients rooms, special Christmas day meal & attractiveness of the decorations in the public rooms”. Another person “congratulated Oaklands on the wonderful Christmas the staff put on for the patients, it was very, very nice”. Care staff also reported that the provision of activities in the home is an area that needs developing. The home receives many visitors throughout the day and evening. Comments in surveys from relatives all indicate that the staff welcome visitors in the home at any time and “the family is encouraged to visit at any time”. “ I feel welcome every time I enter”. “Visitors are welcome at all times”. Residents were just finishing breakfast in the dining room when the Inspectors arrived at the home at 09.40hrs. At 10.30hrs residents were being served morning tea/coffee and they all had a cold drink to hand. Jugs of cold drinks were available in the communal and individual bedrooms. Some residents were drinking high protein milk drinks, which they said that they liked. Menus are on display in a folder at the entrance to the home. The cook who came into the dining room to speak to the residents before starting to serve the meals served lunch at 12.15hrs. The meals were served working to a list of menu choices for each resident. Residents were served steak & kidney pie, stewing steak in gravy or liver with mashed potatoes, fresh cauliflower & carrots, followed by a desert of rice pudding. The cook confirmed that all meals are homemade with the exception of the fish & chips on a Friday. Residents ate in the dining room or in the privacy of their bedrooms. The dining room is very nicely presented with linen tablecloths and residents sat 34 to a table. One gentleman was served a glass of wine with his meal. Staff assisted residents who needed assistance to eat. This was done very discreetly either in the dining room or in their individual bedrooms. Staff were observed ensuring that the residents were sitting in the correct position to eat their meals and were offered and given the level of assistance needed. Staff were observed talking to the resident as they were assisting them with their
Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 16 meal. Soft diets were provided for residents who have difficulty chewing and swallowing and specialist diets were provided for diabetics or people needing high protein meals. Comments in surveys indicated that the residents ‘always’ or ‘usually’ liked the meal at the home. Relatives have commented that when visiting “I always am impressed with the nutrient value of the meals – they are attractively presented and in a suitable form e.g. mashed, chopped for a very ill patient to manage. Patients are helped with feeding and additional liquid nutrients ‘Ensure’ given when necessary”. “My mother has special meals prepared for her. These are what she likes and nutritionally designed for her”. The menus provided by the home prior to the inspection show that residents are offered a varied and nutritional diet. Staff from the home have recently attended nutritional training provided by the Community Dietician for the Primary Care Trust regarding the use and implementation of a new nutritional assessment tool. This tool was being implemented by the home at the time of the inspection. Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system with some evidence that residents feel that their views are listened to and acted upon. Further staff training has taken place about Adult Protection providing a safer environment to protect residents from abuse. EVIDENCE: The home has a written procedure for complaints, which is included in the homes Service User guide. Comments in surveys from residents indicated that they all know how to make a complaint and felt able to do so. Written comments from relatives indicated that 77 were aware of the homes complaints procedure. Comments from a relative said “Matron is always ready to give her time to answer questions although she is so busy giving the same care to other patients and relatives”. The homes complaints/concerns records shows contact from a relative 2 days before the inspection and the action being taken by the manager. Shortly after the last inspection in January 2006 the Commission received a complaint about the home relating to injuries to a resident and alleging poor practice. These allegations were referred to the local multi agencies for the Protection of Vulnerable Adults and are still in the process of being investigated.
Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 18 Further training has taken place for staff regarding the local procedures for safeguarding vulnerable people. The manager confirmed that 3 staff are still to complete this training. Staff spoken with had an awareness of the procedures for safeguarding the people living in the home, although the Inspectors were invited into the home by a carer without their identification being checked. Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 19 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 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recent investment has significantly improved the appearance of this Home creating a comfortable and safer environment for those living there and visiting. Further investment is needed to enhance the comfort and facilities of the Home for residents and staff. Systems and procedures for the control of Legionella need urgent attention to ensure that residents’ safety is maintained at all times. EVIDENCE: The home is cleaned to a good standard. The rooms of those residents whose care was case tracked showed individuals had been able to personalise their rooms, and they were satisfactorily clean and well presented. Service users felt their rooms were comfortable. Comments in surveys from residents confirm that the home is fresh & clean. Written comments support this by saying the home “is scrupulously clean &
Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 20 always smells fresh & pleasant” and there is a high standard of cleanliness, the room is cleaned thoroughly every day”. Comments in surveys from relatives report that “the atmosphere is fresh & attractive, the premises clean and attractively furnished”, “everything is clean, everywhere smells fresh”. The home is accessible to residents on all floors through the provision of 2 shaft lifts and a platform lift, although one lift broke down during the inspection. Records show that a service contract is in place for the maintenance of these lifts. The undersized lift is to be replaced in line with the agreed condition of registration. This and the increase in day space for residents have been subject to written communication between the Commission and the Provider since the last inspection. The Provider has indicated that plans are being drawn up and will be submitted to the Commission. An extension to the timing of this Condition of Registration has been requested by the Provider and will be considered by the Commission once the plans have been submitted. The gardens wheelchairs. are well maintained and are accessible to residents in The home has received a visit from the Environmental Health Officer since the last inspection. Requirements were made and have been complied with by the home. The kitchen has been partly upgraded with the provision of some stainless steel work surfaces. The sink unit is also scheduled to be replaced. The pre-inspection information provided by the manager confirms that the Fire Officer is due to visit the home on the 18th July 2006. The new provider has done extensive upgrading work & redecoration since they took over in May 2004. Further work was identified in the last report to enhance the staff facilities, visitors’ toilet, and sluice areas. This upgrading work has not commenced. The access to the lower ground floor was secure as a coded lock was in use by the staff. Weekly water temperature checks for baths/showers & toilets were recorded and were within the required range. The owner confirmed that coldwater storage temperatures were not being checked. A copy of the guidance from the Health & Safety Executive was provided on the day of the inspection. The home has one cold-water tank which was replaced last year. There is no Legionella risk assessment in place and no contract in place for the management of Legionella, although the owner reported that a contract for Legionella testing would be in place next month. The laundry, although small is functional and a good system is in place for the management of infection control. Residents’ clothes are nicely laundered.
Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers of staff provided are sufficient to ensure that the residents care needs are met. The procedures for employment of staff have not improved since the last inspection, are not sufficiently robust and do not offer protection for the people living at the Home. The homes induction policy & programme needs further development to ensure the safety of residents and staff. A programme of training is in place for trained & care staff to ensure that they have the clinical & care skills to meet the needs of the residents. EVIDENCE: Comments in surveys from relatives showed that 86 were of the opinion that there are sufficient numbers of staff on duty. Surveys completed by residents showed that 61 said that staff are always available when needed and 38 said staff are usually available when needed. All residents spoken with during the visit had high praise for the staff saying, “staff are very nice” and “staff are fun”. Written comments say “very caring Matron & staff”, “Matron & all staff are always very helpful”, “the staff are polite, welcoming and caring of their patients”. Since the last inspection the hours worked by the manager are supernumery to the rostered hours to enable her to carry out her managerial duties. A multicultural group of staff are employed by the home. On the day of the inspection the manager was on duty with a registered nurse, an adaptation nurse working
Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 22 alongside the registered nurse and 5 care staff to care for 30 residents. Ancillary staff included a domestic, a cook, a kitchen assistant and a laundry assistant. Rotas provided by the manager prior to the inspection show that the usual staffing levels Monday to Sunday each week are 1 registered nurse & 5 carers in the morning, 1 registered nurse & 4 carers in the afternoon and 1 registered nurse and 2 carers at night. Discussion with staff indicated that at a recent staff meeting, the staff team highlighted a need for an additional carer first thing to assist with getting residents up for breakfast. The owner & manager are currently considering this request. Information provided by the manager shows that 8 of the care staff has NVQ level 2 or equivalent. NVQ training for staff is now being sourced through the Primary Care Trust. Staff have day release for study time and the Assessor visits the home very 2 weeks to supervise the practice of the candidates. Two staff files of recently employed staff were inspected. At the last inspection in January 2006 a requirement was made about the home obtaining a reference relating to the employees last period of employment. One of the files seen did not contain a reference relating to the most recent employment. Information provided by the manager shows that the home do not have any evidence of Criminal Records Bureau checks for all staff employed, although most of these, but not all relate to staff that were already employed by the previous owners. A discussion took place with the owner relating to the guidance to renew Criminal Records Bureau checks after 3 years and/or obtaining a written declaration from the staff re any cautions or convictions since that last Criminal Records Bureau check. Guidance was sent to the owner about risk assessing outcomes of Criminal Records Bureau checks. A copy of the structure of the current induction programme for staff was seen. This needs further development in line with “Skills for Care” induction programme content. There was no documentary evidence of any induction on the one file inspected. A programme of training is in place for trained & care staff. Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is being managed by a qualified and competent manager who provides leadership; guidance and direction to staff to ensure residents receive consistent quality care. Systems for the review of the quality of the service including consultation with residents, relatives and visiting professionals need to be implemented, sought and acted upon. A system for the supervision of care staff has been implemented to ensure that the staff have the skills and competencies to meet residents care needs. Systems are now mostly in place to protect the health & safety of the residents living and the staff working in the Home. EVIDENCE: The manager’s time is now supernumery to the registered nurses directly caring for the residents. The manager has completed a recognised external
Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 24 Fire Awareness course in line with her conditions of registration. She has also attended training in nutrition & the MUST nutritional assessment tool, wound & incontinence care. She has set up a Residents committee in the home and now holds monthly meetings with trained and care staff. All residents, relatives and staff spoke very highly of the manager. Comments on surveys from relatives & visiting professionals to the home say Mrs Newman “has made such a great difference to the home”, she is “very experienced and a good communicator”. “There has been a great transformation since the new management have taken over”. “Matrons care and direction are superb”. The home has not got any formal system in place for measuring the quality of the service provided, although it is recognised that some audits are in place for the purpose of monitoring certain aspects of care. Pre-inspection information confirms that the home do not hold any monies on behalf of any residents in the home. Formalised staff supervision has commenced since the last inspection and this is being recorded. 13 staff have received a session of supervision, although the manager recognises the need for this format to be further developed. The overall standard of record keeping in the home is satisfactory. Notifications are being sent into the Commission in line with Regulation 37 and these notifications are very informative. The owner visits the home more than once each month, although there are no written reports available for the manager as required in line with Regulation 26. The pre-inspection information provided by the manager shows details of the most recent maintenance & equipment checks carried out in the home. A random sample of these records during the visit included looking at the fire records, 5yr electrical certificate, lift servicing records and the water testing records and the control of Legionella. All these records were satisfactory except the Legionella records. Please refer to the Environment section of this report. There was no first aider on duty at the time of the inspection. No certificates were available for Food & Hygiene training for the catering & kitchen staff. The owner has provided information about a modular course for ‘Food Hygiene for Care Providers’ that is being conducted internally. Further information has been requested by the Commission regarding the qualifications of the internal trainers of this course. The home has received a visit from the Environmental Health Officer since the last inspection. Please refer to the Environment section of this report. The insect killer in the kitchen is not been fixed to the wall. Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 25 A moving & handling risk assessment has been undertaken regarding the changing of the milk purgal in the kitchen. Safety data sheets for chemicals are available in the home. The health & safety poster has been completed and is prominently displayed outside the staffroom. Records show that portable appliances in use in the home were checked in Feb 2006. The person who carried out the checks had undertaken a training course to enable him to carry out these tests and has been issued with a Certificate of Completion of training. One of the staff has undergone training to provide training internally for staff in moving & handling of residents & equipment. The records provided by the trainer show that not all staff have received moving & handling training. Fire records were seen and these showed regular recorded checks at the required intervals of most of the equipment with the exception of the fire equipment handling check and the automatic detection system. Records show that fire drills have taken place. The owner has just completed a Fire Risk Assessment. Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 26 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 X 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X 2 3 STAFFING Standard No Score 27 3 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 2 2 2 Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 Requirement Social care needs of individual residents must be identified and a plan of care put into place in consultation with the resident. Timescale of 31/03/06 partly met. The temperature of the medicine store must be monitored and recorded daily to ensure that it does not exceed 25°C. All staff must receive training on Adult Protection and Whistle Blowing, including the Herefordshire multi-agency procedures for the Protection of Vulnerable Adults. Timescale of 30/09/06 almost met. A risk assessment must be carried out with regard to the prevention of legionella. Appropriate action must be taken based on the findings of the risk assessment. Timescale of 28/02/06 not met. Procedures must be put into place to routinely check the storage and distribution temperature of the cold water to
DS0000059478.V295261.R01.S.doc Timescale for action 30/09/06 2 OP9 13 31/07/06 3 OP18 12 31/08/06 4 OP25 13 31/07/06 5 OP25 13 31/07/06 Oaklands Nursing Home Version 5.2 Page 28 6 OP29 19 7 OP29 19 8 OP30 18 9 OP33 24 10 OP33 26 11 OP36 18 ensure that it remains at 20°C or below. An employment reference relating to the persons last period of employment must be obtained for all staff prior to commencement of employment at the Home. Timescale of 31/01/06 not met Enhanced Criminal Records Bureau checks must be obtained for all staff employed, and information must be held in the home for all staff showing the date of the disclosure, disclosure number and disclosure result. 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 met. Timescale of 31/01/06 not met Policies & procedures must be established to enable the Home to audit all aspects of the standard of the service provided. Timescale of 31/03/06 not met The owner must visit the Home at least once a month unannounced and write a report of the findings. The report must be given to the manager and be available for inspection. The Registered Person must ensure that care staff receive formal supervision at least six times a year. Timescale of 30/04/06 partly met. Staff must receive manual handling training upon employment and this training must be updated annually. Timescale of 28/02/06 not met
DS0000059478.V295261.R01.S.doc 29/06/06 31/07/06 31/08/06 31/08/06 31/07/06 31/08/06 12 OP38 13 31/08/06 Oaklands Nursing Home Version 5.2 Page 29 13 OP38 13 A first aider must be on duty at all times. Timescale of 28/02/06 not met All staff working in the kitchen must undertake a basic food hygiene course. Timescale of 28/02/06 not met Fire systems and equipment must be checked & recorded as defined within the homes records. 30/09/06 14 OP38 13 31/08/06 15 OP38 23 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP29 Good Practice Recommendations Criminal Records Bureau checks should be carried out by the home every 3 years for all staff either by asking the employee to make a written statement relating to any cautions or convictions or by sending a new application for an enhanced Criminal Records Bureau check. Meal serving arrangements should be reviewed as the area used is very cramped for so many staff to be working in & the food trolley partially blocks a door The ‘bug killer’ should be fixed on the wall on the kitchen. 2 3 OP15 OP38 Oaklands Nursing Home DS0000059478.V295261.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Worcester Office The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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