Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 09/09/05 for Oaklands Nursing Home - KWD

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

This inspection was carried out on 9th September 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

There was good evidence available that the views of residents and relatives are sought about the quality of the service provided and in general levels of satisfaction were high. Complaints are well investigated. Relatives have recently indicated in writing that `I`m very happy with the standard of care` and `thank you for being caring and understanding`. The feedback from residents in respect of how staff treated them was overall very positive with comments about staff including "very good, polite, respectful", "staff always very positive in their attitude", "staff treat me ok". Some of the record keeping was found to be well kept, of particular note the records relating to residents valuables, which were accurate.

What has improved since the last inspection?

Some progress has been made towards meeting previous requirements issued to ensure improvement. Some aspects of medication practice have improved along with some aspects of kitchen hygiene management. Some measures have been taken to improve safety within the premises. Care plans have improved since the last inspection with the overall layout of case files easier to follow. There were no concerns, as at the time of the last inspection in regard to excessive hot water temperatures, with hot water now within acceptable ranges. There has also been some noted improvements in some of the homes policies and procedures. Staffing levels have improved since the previous inspections.

What the care home could do better:

A lot of work remains to be done with many outstanding requirements including medication, kitchen hygiene and major works required to improve the premises. Some issues were identified also at this inspection with respect to meals. Feedback from service users indicates that levels of dissatisfaction are highest with respect to activities provided within the home the general feeling being that activity is insufficient. Three relatives indicated that they are not aware of the complaints procedure. Whilst the home is obtaining the views ofresidents, these comments are not shown to influence the service provided. There remains some inconsistency between what care plans say and the views of the residents to whom they relate, with no documented evidence of resident`s involvement with these plans. Of major concern was that some staff are still using drag-lifting techniques, which possibly endangers residents and at the very least could hurt them (as one resident stated was the case).

CARE HOMES FOR OLDER PEOPLE Oaklands Nursing Home - KWD 82 Wartell Bank Kingswinford Dudley West Midlands DY6 7QJ Lead Inspector Mr Jon Potts (accompanied by D.Sharman) Unannounced Inspection 9th September 2005 09:00 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 - KWD DS0000004881.V250094.R01.S.doc Version 5.0 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 - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Oaklands Nursing Home - KWD Address 82 Wartell Bank Kingswinford Dudley West Midlands DY6 7QJ 01384 291070 01384 291070 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) Mr. Richard Perkins Mr. Charles Fraser Macnamara Janice Williams Care Home 62 Category(ies) of Old age, not falling within any other category registration, with number (62), Physical disability (13), Physical disability of places over 65 years of age (3), Terminally ill over 65 years of age (12) Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 13 PD, 3 PD(E), 12 TI(E) and up to 62 OP One service user identified in the variation report dated 23 June may be accommodated at the home in the category of MD(E). This will remain until such time that the current service users placement is terminated. 6/4/05 Date of last inspection Brief Description of the Service: Oaklands is a care home that can provide both nursing and personal care to older people in separate units on one site. The building is divided up into two distinct sections, The Lodge and the Manor. The former offers personal care only whilst the latter offers personal care and nursing services. The home also offers accommodation to service users with a physical disablement and terminal illness (Manor only). The staff groups for each side of the home work as separate teams under the supervision of one manager. Accommodation consists of 38 single and 8 double rooms. Whilst registered for 62 beds the home is only able to offer 54 places currently. There is one large communal space within the Manor, this shared by the Lodge, which also has a separate communal area. The home is sited close to the centre of Kingswinford in the centre of a residential area. There are plans to extend the home on the Lodge side so as to enable the home to offer sufficient beds so as to fulfil its registered number. The CSCI have not been given any firm dates for the commencement of this work, although the Lodge side of the home is now sealed off with exploratory works underway. Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over one day between 9.35am and 5.54pm by two inspectors. Methods used to gain evidence including case tracking three residents’ care, discussion with management and staff, sampling of numerous records, and a tour of the premises. Residents and staff are to be thanked for their assistance with the carrying out of this inspection. What the service does well: What has improved since the last inspection? What they could do better: A lot of work remains to be done with many outstanding requirements including medication, kitchen hygiene and major works required to improve the premises. Some issues were identified also at this inspection with respect to meals. Feedback from service users indicates that levels of dissatisfaction are highest with respect to activities provided within the home the general feeling being that activity is insufficient. Three relatives indicated that they are not aware of the complaints procedure. Whilst the home is obtaining the views of Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 6 residents, these comments are not shown to influence the service provided. There remains some inconsistency between what care plans say and the views of the residents to whom they relate, with no documented evidence of resident’s involvement with these plans. Of major concern was that some staff are still using drag-lifting techniques, which possibly endangers residents and at the very least could hurt them (as one resident stated was the case). 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 - KWD DS0000004881.V250094.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 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 the following standard(s): 1,2,3 & 4 Information about the home is readily available to residents and their representatives. Residents have written contracts that do contain areas where there are omissions in the information required. Residents needs are assessed prior to admission, but no written assurances as to the home being able to meet their individual assessed needs is given. EVIDENCE: The home was seen to have a statement of purpose/service users guide, this on display and accessible to visitors to the home as well as the residents. There has been some amendment of this document since the time of the last inspection although the service users guide would benefit from a summary of the resident’s views as could be drawn from the homes satisfaction questionnaires. There was evidence within case files of contracts being supplied to residents or their representatives although there were noted to be omissions within this document including: Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 9 - Who pays the fees (i.e. resident, representative, social services or health authority)? - Clearer information as to the rights and obligations of the service user and who is liable if there is a breach of the contract by the registered provider/service user (the home has a separate document detailing residents rights which could be amended and included within the contract); -For those residents in receipt of free nursing care a statement as to how this impacts on the fees charged and the proportion of the service that is free, dependent on the level of financial assistance. There was seen to be copies of assessments carried out by funding bodies on residents case files, these supported by assessments carried out by the home with information carried through to the care plans seen. There was however no evidence of the home confirming in writing to the resident or their representatives, that based on these assessments they were able to fully meet the residents needs. Reviews of residents care by funding bodies was seen to be taking place with copies of these available on residents case files. Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 10 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 The residents health, personal and social care needs are set out in individual plans of care, these at times inconsistent and not signed by resident or representative. Most of the resident’s health care needs are fully met. There are practices in respect of medication handling and recording that need improvement, as does the homes policies in this area. Some of the practices at the home compromise residents’ privacy and dignity. EVIDENCE: There were care plans in place for all those residents that were case tracked these documents fairly well laid out and carrying information drawn from assessments although there were some inconsistencies highlighted through the case tracking exercise (i.e. activities recorded were not those the resident stated they preferred, one plan stated the residents preference was a shower where as elsewhere it stated bath, resident brushes own teeth where resident stated that staff do this task). There was clear evidence of monthly reviews of Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 11 the care plans. None of the care plans were signed by residents or their representatives this necessary to show that they have been fully involved with their formulation. There were clear records of residents contact with health services (including G.P, district nurses, consultants etc) this showing that access to these was maintained with the exception of dentists and opticians in some instances. There was good recording in respect of tissue viability and nutritional risk assessment these clearly identifying areas of high risk. Control measures to reduce this risk were seen to be in place for those residents case tracked. The medication policy that supports practice is not complete or sufficient. Two policies exist which contradict each other, one stating self-administration by service users is not allowed, the other stating this is respected. In practice nobody self-administers. Controlled drugs are stored and recorded appropriately. Stocks were checked and tally with the records held. Records of returned drugs are held appropriately. Medication administration was observed and whilst the administration was discreet and consultative the qualified nurse used fingers to administer to and from the tot of which there was not a sufficient supply. Many previous requirements to improve medication systems and practice have not been met. The supplying pharmacist is now contracted to provide support to the home but there are no records to evidence a support visit for 7 months since February 2005. Medication administration records were assessed. In the period since August 13th 2005 there were eight gaps identified for one service user which does not reassure service users that their medication needs are well managed. Some of the residents spoken to about arrangements for privacy indicated that this was satisfactory although one resident who was accommodated in a shared room was clearly unhappy with this arrangement. There were also some shared rooms without privacy screens although this issue was addressed at the time of the inspection. Staff were seen to knock doors to bedrooms and wait prior to entry, residents were addressed by their preferred titles (which were documented) and residents spoken to also confirm satisfaction with the way staff spoke to them (this further confirmed by satisfaction questionnaires). There were issues raised by two residents in respect of not being able to lock their bedroom doors, one stating they were unable to and the other saying that they wanted staff to lock their door when they were out of the room. The homes satisfaction questionnaires indicated that access to the telephone was not problematic, although this was contradicted by one resident’s statement that they were not able to access the telephone easily. Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 12 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, 15 Residents do not always find that their expectations in respect of recreational interests are met by the home. An adequate diet is provided to residents but choice in respect of the foods offered can be limited. EVIDENCE: There were no concerns expressed by any resident in respect of their not being able to follow their chosen daily routines, some stating that they could chose when to get up, go to bed etc, but there was some dissatisfaction expressed in relation to the levels of available activity and stimulation, this summarised in the following statements: “Would be better to have more (activities)” “Like to draw a lot, not done much (recently)” There was also reference to an activity organiser no longer attending the home and the inspectors saw little in the way of activity and stimulation in the time that they were at the home. The menu is varied and offers 3 meals per day. The menus were posted upon the notice board in the dining room but the menu was high up, in small writing and as 4 weeks menus were posted it was unclear which week was being Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 13 followed. Upon enquiry the Inspector was informed that it was week 3 but the food being served fresh salmon, mashed potatoes and cauliflower followed by rhubarb and custard sponge did not correspond with the menu on the wall that stated Battered or breaded roe, chips and peas followed by jam roly poly with custard or ice cream. The Inspector was told that the deviation from the menu was because they have to have what the fish man brings. One service user was not given mash potato, as staff were aware that he does not like it. He was not provided with an alternative, as ‘he had not asked’. The menu is not sufficiently accessible or accurate to empower service users to ask. Not all service users are able to ask. However there was sufficient staff who were appropriately dressed with protective clothing available within the dining room to ensure that service users were served speedily and there was sufficient staff to support those who needed it to eat at their pace without being rushed. Drinking aids were available. New tablemats as previously required have not been provided. One resident told the inspector she was enjoying the meal and portions were observed to be generous. Those residents who completed quality assurance satisfaction surveys were complimentary about the meals with one service user stating that s/he has never had to refuse a meal, another stating that alternatives are always offered and in response to the question ‘are you satisfied with the choice of menu and quality of meals. Are you offered alternatives?’ the service user written response was ‘yes, yes, yes, yes’. Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 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 the following standard(s): 16 and 18 There is some indication that some service users are aware of, and confident that their concerns will be dealt with, although not all residents are aware of the home’s complaints procedure. Incorrect lifting methods employed by some staff could expose residents to injury. EVIDENCE: Complaints guidance is on the wall in the entrance to the home and includes the appropriate timescales for complaint investigation and resolution. It does not include the contact details of the Commission for Social Care Inspection in the event of dissatisfaction. Records of complaints are appropriately kept and in the previous 12 months there have been 7 complaints recorded in respect of laundry, meals and for example staffing levels. Investigation has shown the complaints received to be a mix of substantiated, part substantiated and not upheld. The Inspector case tracked through record keeping, outcomes for a service user following a complaint about lack of dental and aural health care. Appropriate action had been taken to ensure a positive outcome for the service user. Questionnaires completed by relatives indicated that 3 relatives are not aware of the complaints procedure, but a questionnaire shows that a service user is satisfied that her complaint was appropriately managed. Some residents did indicate that they knew who they could complain to if there were issues. Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 15 The home was seen to have procedures and policies in respect of adult protection, this included in one folder that is accessible to staff. This folder also includes the local authorities procedures for the protection of vulnerable adults. There was a list of staff names against their signatures to indicate that they had read and understood these policies and the manager is known to have a working knowledge of the same. There are still ten staff to complete training in adult abuse, this as detailed on the homes training plan. There was evidence on resident’s case files of inventories being completed at the time of admission to the home, these updated as necessary. There was concern however that staff were seen to use drag lifting techniques to lift and assist residents to move, this an issue that has been raised on previous inspection. Use of these techniques could expose residents to the risk of injury and must cease. There are notices on display in the home that instruct staff not to use this practice, these clearly not been taken notice of. The manager has since informed CSCI that any staff seen using these practices will be disciplined in future. Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 16 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): 19,24 & 26 Residents are living in an environment that needs to be better maintained, safer, cleaner and more hygienic. EVIDENCE: The premises are poor and are in urgent need of improvement. Whilst the grounds are tidy and safe the internal premises are in urgent need of redecoration as wallpaper is dirty and ripped throughout the home. Wheelchairs have damaged doorframes; carpets are dirty and frayed with action plans for improvement not provided as previously required. Bath and shower rooms are stark, not homely and in need of refurbishment. A recent Food Safety Inspection by the Environmental Health Department identified 4 urgent improvements and 2 recommendations for improvement. Some previous requirements for improvement to items of equipment in the kitchen have been met. However the standard of cleanliness in respect of the oven and grill was not acceptable with excessive baked on food debris increasing the risk of food borne illness amongst vulnerable service users. Most previous requirements relating to the improvement of the premises have not been met Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 17 with the exception of securing toilet frames and wardrobes. It is planned to undertake building works imminently and this includes the Inspectors were told refurbishment of existing premises but a written plan with timescales was not available An odour was apparent in communal areas including corridors however the odour subject to previous requirement in shower rooms was not in evidence during the course of this inspection. Systems for infection control within the laundry meet the national minimum standard with the exception of the availability of protective gloves and soap. The manager provided soap when its omission came to her attention. The laundry would benefit from a ‘now wash your hands’ sign to serve as a prompt for staff. The laundry was clean and well ventilated. Privacy screens provided in double rooms were clean complying with a previous requirement with the exception of one that was very dirty and compromised the health of residents and staff. The trained nurse was observed to handle medication in and out of the dispensing tot. He was not wearing gloves. Staff were appropriately wearing protective equipment when serving food at meal times. Many previous requirements addressed at improving the cleanliness of identified kitchen utensils have been met. A recent (August 05) Food Safety inspection by the Environmental Health Department identified dirty equipment e.g. food debris on the can opener and the top of the microwave which were clean at this inspection. However the standard of cleanliness in respect of the grill and oven were not acceptable and presented risks to the health of service users. Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 18 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 There are sufficient allocated care staff and nursing staff to meet the needs of the residents accommodated at the time of the inspection. The safety of the staff recruitment process is compromised by the lack of POVA 1st checks for all new staff before employment. On going training is necessary to ensure staff are sufficiently trained to be competent to do their jobs and that residents are in safe hands at all times. EVIDENCE: Based on the required number of care staff hours needed to satisfy the staffing calculation from the department of health recommended residential forum staffing tool there are sufficient allocated hours. There was however only thirty residents accommodated at the time of the inspection and care needs to be taken to ensure that when these numbers and the dependency levels increase staffing levels reflect this. The allocated nursing hours were not used as part of the total care staffing calculation. The provision of a domestic late afternoon or early evening to assist with cleaning up after and during serving of the tea time meal would however be advisable as this would ensure that care staff are not taken away from direct care. The current staffing hours translates into one nurse over the 24hr period, five care staff during the morning/early afternoon, four care staff early Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 19 afternoon/evening and 2 overnight. Ancillary staff includes laundry assistants, domestics and cooks. An audit of the staff files for two recently recruited staff showed that the checks carried out were appropriate with the exception of one member of staff that was employed prior to receipt of a POVA (Protection of Vulnerable Adults) list check. No staff are to be employed without a satisfactory POVA check. If the staffing situation dictates that staff are needed prior to receipt of a suitable enhanced disclosure this is permissible (where the home may contravene staffing requirement without the new staff), but only following discussion of the risk assessment carried out by the home with the CSCI. The home was seen to have a training plan this showing that there were some staff that required training input as follows: Out of a total of 26 staff; 6 need food hygiene; 22 health and safety; 5 first aid; 12 moving and handling; 4 infection control and 10 adult protection (see later comments regarding fire training). The training plan must identify the projected dates by which these staff will receive this training. The training plan also needs to identify which staff have NVQ level 2 as it was not possible to establish whether the home has the 50 ratio of NVQ level 2 trained staff required. There was evidence that new staff are undertaking induction training that meets national standards but not within the required six week timescale. Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 20 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): 33, 35 & 38 The views of the residents are not always acted upon and those of other stakeholders are not sought. Residents’ financial interests are safeguarded. The health, safety and welfare of the residents’ are not fully promoted due to some practices carried out by the home. EVIDENCE: The home was seen to have appropriate procedures in respect of the residents’ financial interests and a spot check on records related to these were found to be satisfactory. The home does not have a professionally recognised quality assurance tool but there is evidence that service user and relative views about the standard of care are formally sought. This should now be extended to include other Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 21 stakeholders. Service user written comments were largely complimentary about the service with service users identifying activity provision as being in need of the most improvement. The opinions collated are not being published or made available to interested parties. Case tracking showed that service user feedback and wishes identified through the quality assurance system are not being acted upon. For example in June 2005 four residents identified that they would like to go to the park. These residents have not been taken to the park. There is not a development plan in place to ensure that such improvements are made. There is a good range of risk assessments in place to reduce risks identified within the environment covering slips, trips and falls, electrocution, clinical waste, cuts due to sharps, chemical storage, drowning, falls from bed, use of the mini bus and lifting of clients etc. However one inspector observed unsafe lifting practice confirmed to the Inspector by the service user as causing discomfort. The second Inspector observed a hoist being safely used by 2 staff to transfer a resident into an easy chair. Practice is therefore inconsistent. Maintenance and service documentation was assessed and the following omissions were identified: • • • • • A 5-year total installation electric test certificate LLOLER test last undertaken in May 2004 with the ‘next examination due before November 2004’ and not evidenced. No services for the assisted baths only repair call outs. Weekly fire practices established by the home not undertaken since March 2005. The fire risk assessment has been reviewed as per previous requirement but is insufficient in detail and not accurately representing the risk of service users who wish to have their doors propped open. In addition there are concerns about the viability and safety of the lift, which has received an excessive amount of repair call outs (7 in 18 months). The Inspectors also expressed concern about a gas warning notice issued in respect of the boiler pressure as ‘the gas main is too small’ in March 2005 although a gas Landlords certificate has been subsequently obtained. The manager has since confirmed that engineers have since been called in to address this issue. A full first aid box not furnished with scissors was available within the kitchen but not elsewhere within the home. The manager said that 2 should have been available. Fire training has been provided in January and June 2005 and whilst attended by most staff the manager must ensure that all staff receives training twice in 12 months. The home has recorded a high number of accidents – 71 in 9 months since January 2005. Accidents are however audited by the manager monthly. The one previous requirement to repair or replace the seal on the chest freezer in the kitchen has been met. Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 X X X X 2 X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 2 Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 23 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 OP2 Regulation Requirement Timescale for action 31/12/05 5(1) b The registered provider must revise the contract/statement of terms and conditions so as to include: • Fees payable and by whom (for example the service user, representative, social services or health authority). A clear statement as to the rights and obligations of the service user and who is liable if there is a breach of the contract by the registered provider/service user. • A clear statement for those service users that receive free nursing care as to how this impacts on the fees charged and what proportion of the service is free, dependent on the level of financial assistance. • This is a repeated requirement 2 OP3 14(1)d The Registered person must confirm 31/10/05 in writing to the service user, prior to admission, that having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his/her DS0000004881.V250094.R01.S.doc Version 5.0 Page 24 Oaklands Nursing Home - KWD health and welfare. This is a repeated requirement 3 OP7 12(3) 15(2) Service users care plans must be signed either by the resident or their representative to evidence their involvement. This is a repeated requirement 31/12/05 4 OP8 13(1)b The residents must be offered consultations with opticians and dentists at least annually. This is a repeated requirement that has been partially met 31/10/05 5 OP9 13(2) 6 OP9 13(2) All medication must be signed 09/09/05 out at the point of administration (This was an immediate requirement issued on the date of inspection). To investigate why service user 31/10/05 MA did not receive her morning medication on 8 occasions between 13.8.05 and 9.9.05 with written outcomes to CSCI The Home ensures that the medication policies and procedures are reviewed and expanded to include: - Clarity about self administration for residents; - Homely remedies; - Medicine errors; - Residents taking medicines away from the home. To ensure handling of medication 16/09/05 by staff is minimised More tots were ordered for this purpose on the day of inspection To ensure contracted pharmacy visits take place The Home ensures that all administration of medicines and variable doses is recorded DS0000004881.V250094.R01.S.doc 7 OP9 13(2) 31/10/05 8 OP9 13(2) 9 10 OP9 OP9 13(2) 13(2) 30/11/05 31/10/05 Oaklands Nursing Home - KWD Version 5.0 Page 25 (including creams and inhalers). This is a repeated requirement 11 OP9 13(2) 31/10/05 The Home ensures that any alterations made by the prescriber are recorded on the Medication Administration Record and in the care plan. Details of the doctor who made the change along with the date should be recorded. The member of staff making the change should initial this alteration (preferably witnessed). There must be no gaps in the administration records of medication. This issue above are repeated from the last inspection The manager to regularly audit the medication records keeping a record of findings and action taken. 12 OP9 13(2) The Home ensures that opening dates are added to all medicines that become short-dated on opening and date checking is carried out regularly. This is a repeated requirement 31/10/05 13 14 15 OP10 OP10 OP12 12 16(2)a/b 16(2) m Residents views in respect of sharing bedrooms must be sought and acted upon Residents must be aware of the arrangements for access to telephones. The registered provider must make suitable arrangements to allow residents to engage in activities, as is their choice. This is a repeated requirement 30/11/05 31/10/05 30/11/05 16 OP15 12 16(2)i 17(2) 17 OP16 22(5)(7) To adhere to the homes stated menu and ensure this menu is accessible to all residents. Also to ensure the service user who does not like mash potato is always provided with the option of an alternative The Complaints information on display in the home must include DS0000004881.V250094.R01.S.doc 20/10/05 30/11/05 Oaklands Nursing Home - KWD Version 5.0 Page 26 contact details for the CSCI and the manager is to take steps to ensure that all relatives are aware of the complaints procedure 18 OP18 13 Steps must be taken to ensure that staff do not use drag-lifting techniques at any time. 09/09/05 19 OP19 23 (This was an immediate requirement issued on the date of inspection). There must be a planned 30/11/05 programme for the routine maintenance and renewal of the fabric and decoration of the premises, this reviewed at least every 12 months. To submit an action plan with timescales for redecoration, renewal of damaged doorframes, recarpeting, refurbishment of shower and bathrooms, kitchen equipment cleaning schedule and any other matters detailed in the body of this report. Where fire doors are to be kept open in accordance with the wishes of the resident then the details of the risk assessment must be included in the homes fire risk assessment This is a repeated requirement 20 OP19 23 31/10/05 21 OP24 16 To provide the following in service users’ bedrooms where not already present and in accordance with any risk assessment and service user choice: • Bedside lighting which when combined with overhead lighting provides 150 lux (an assessment of the lux should be 31/01/06 Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 27 undertaken) • Adjustable beds for any service user receiving nursing care. The above issues are repeated from the previous inspection report • To offer door locks and keys where risk assessment allows 31/01/06 22 OP26 23 13(3) An additional sluice must be fitted in the Manor side of the home to prevent having to carry full commode pots between floors. This is a repeated requirement 23 OP26 23 13(3) 13(3) That all privacy screens are cleaned on a regular basis. To ensure the availability of liquid soap and gloves in the laundry at all times. To provide a hand wash sign in the laundry 31/10/05 24 OP26 31/10/05 25 OP29 19 All new staff have a protection of 15/10/05 Vulnerable Adult list (POVA 1st) check prior to their commencement of work. If the staffing situation dictates that staff are needed prior to receipt of a suitable enhanced disclosure this is permissible (where the home may contravene staffing requirement without the new staff) but only following discussion of the risk assessment carried out with the CSCI. This is a repeated requirement 26 OP30 18 The homes training plan must include dates by which any gaps in training provision will be fully DS0000004881.V250094.R01.S.doc 30/11/05 Oaklands Nursing Home - KWD Version 5.0 Page 28 27 OP33 24 28 OP36 18 met. The plan must also identify want number of staff have achieved their NVQ level 2 in care (not including nursing staff). To produce a business/ annual development plan, a copy to be available to the CSCI. This plan should show areas where the home is to develop over the next twelve months with basis on information gained from service user satisfaction questionnaires and other sources of internal information gathering. This plan is to show how issues raised by services users in feedback forms are to be acted upon. To (continue to) implement a formal supervision system, ensuring care staff receive a documented supervision session at least six times every year. Not assessed at the time of this inspection To ensure all omissions in service records identified within this report are addressed with copies provided to CSCI To seek a report on the safety and future viability of the lift providing a plan to replace if appropriate with timescales To seek the advice of the West Midlands Fire Service re the sufficiency of the risk assessment and to take appropriate action. To deep clean the oven section and the grill in the cooker in the main kitchen so as to remove all baked on food debris. The grill and oven are thoroughly cleaned. (This was an immediate 31/12/05 31/01/05 29 OP38 23 30/11/05 30 OP38 23(2)d 31/10/05 Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 29 requirement issued on the date of inspection). Tablemats are replaced (as required at the time of the last inspection). To ensure there is a robust cleaning schedule for all items of kitchen equipment and to ensure that this is adhered to. 31 OP38 23(2)c 23(5) To confirm what actions have been taken to address the concerns raised by the engineer on the 7.5.05. If there is any doubt as the safety of the gas supply to the home Environmental Services or appropriate health and safety enforcement agency (Health and Safety Executive) must be notified immediately. (This was an immediate requirement issued on the date of inspection). Open packets of food are stored in pest proof containers. This is a repeated requirement that is partly met. Sugar needs 31/10/05 32 OP38 13(3) 31/10/05 to be stored in appropriate containers. 33 OP38 13(3) The home has new chopping boards and additional colour coded knives. This is a repeated requirement that has been partly met 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000004881.V250094.R01.S.doc Version 5.0 Page 30 Oaklands Nursing Home - KWD 1 2 3 4 OP1 OP27 OP30 OP33 A summary of the residents views should be incorporated in the service users guide To provide a domestic to assist with ancillary tasks during the provision of the tea time meal New staff must complete their induction training (that is to skills for care standards) within six weeks. To include all stakeholders when seeking feedback To publish the results of feedback surveys to all interested parties Oaklands Nursing Home - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 31 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 - KWD DS0000004881.V250094.R01.S.doc Version 5.0 Page 32 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!