Inspection on 23/03/06 for Oaklands Residential Home, Barnstaple

This inspection was carried out on 23rd March 2006.

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

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

Other inspections for this house

Oaklands Residential Home,... 06/02/07

Oaklands Residential Home,... 05/10/05

Oaklands Residential Home,... 02/03/05

Oaklands Residential Home,... 26/07/04

Oaklands Residential Home,... 03/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Oaklands Residential Home, Barnstaple Oaklands Westfield Avenue Sticklepath Barnstaple Devon EX31 2DY Lead Inspector Douglas Endean Unannounced Inspection 23rd March 2006 10:30 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 Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Oaklands Residential Home, Barnstaple Address Oaklands Westfield Avenue Sticklepath Barnstaple Devon EX31 2DY 01271 374231 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 John Patrick Hall Mrs Ruth Edith Matthews Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25) of places Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th October 2005 Brief Description of the Service: Oakland’s Residential Home is located in a residential area on the outskirts of the market town of Barnstaple. It is registered to provide personal care and accommodation for up to 25 people over 65 years of age who have general care needs and needs associated with a dementia type illness. The home is a large detached building that has been extended and adapted in order to meet the residents needs. There is ample parking provided from both the Westfield Avenue entrance and the entrance at the end of Oakland’s Avenue. This parking is shared by the occupants of the close care bungalows that share the grounds of the home. Some rooms have views of the Taw estuary and there are accessible areas outside of the home for residents. The accommodation includes a large lounge joined to a large dining room. The majority of bedrooms are on the ground floor and are single occupancy only. There are three bedrooms on the first floor that is part of the original house. These are reached either by stairs or, if necessary, the stair lift. Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report should be read along side of the previous report in order to establish the homes performance against the National Minimum Standards during this inspection year. This unannounced inspection was carried out by D Endean on the 23rd March 2006. It began at 10:30 hrs and was completed at 16:15 hrs. In that time the inspector looked at and discussed a variety of documentation including the care planning process (using a sample of two of the clients files), accident book, fire log book, and the Statement of Purpose, with the Registered Manager and the Registered Person. Three staff files were looked at for evidence of recruitment practices. He also toured the home and spoke with five individual service users and one staff member. A small sample of maintenance information was also shown to the inspector. What the service does well: What has improved since the last inspection? The manager has made a lot of effort to improve the presentation and information held in the Statement of Purpose. This does require a little more work to make it complete. The change in the Registered Manager working day has made her more accessible to those who wish to see her and improved her ability to have an over view of the work of her staff. The home has some quality assurance systems that both obtain the views of the clients and those that visit them. They also have a monthly audit of the premise to identify work that needs to be done to maintain the good standard Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 6 of the premise. The are of quality assurance has scope for further development to capture more information to see how others view the service. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 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 Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 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 The home manager has improved the Statement of Purpose and other documentation but further development is needed to meet the standard and Regulations and benefit the clients, particularly in the area of pre-assessment. EVIDENCE: The inspector was shown the draft version of an updated Statement of Purpose. This was read fully and it’s content compared with the Care Homes Regulations and Schedule 1. This version of the Statement of Purpose has improved the information that is available to clients and their advocates but does require a small amount of work to make it fully comply such as a description of the relevant experience of the registered provider and manager. A copy of a clients contract was seen by the inspector who found it to hold the level of detail that is necessary for the protection of the client and also the home. It had information about the fee to be charged, the room to be occupied and how a contract may be terminated by either party. The manager provided evidence of the pre-admission assessments that are now being undertaken on prospective clients. The one sample was hand written and did cover problem areas of need that the assessor had been Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 9 informed of. However it was not comprehensive enough to give a good indication of the clients abilities, and disabilities, which would allow an initial comprehensive care plan to be drawn up from it. It did not cover all the areas of “Activities of daily living” or detailed information on nutrition, mental state and social care needs. Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 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 care planning process is not sufficiently structured to provide useful information about needs and the planned delivery of care. The medication procedures are good thanks to a good training arrangement that is ongoing. The arrangements for medical, nursing and other health care of clients by external services is well organised by the home manager. EVIDENCE: The inspector saw examples of the “Life Profile” that is written on all clients where this is possible. This is a record of the clients personal life history that is beneficial to all carers in providing knowledge of the real identity of each of the people they are providing care to. The case files were also seen to have “Falls Assessments” that are as a result of staff attending “Preventing falls and fractures in care homes” training during 2005. The actual care plans only identified issues of risk and did not go on to clearly show how care will be offered to reduce the risk or deal with a problem that may have occurred as a result of an unchecked risk. There was no structure that informed the care provider how to achieve a planned outcome. The areas Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 11 of need such as mobility, cognition and nutrition need to be just part of the care that is planned. The manager told the inspector that the home has a good relationship with care providers external to the home. The General Practitioner carries out 6 monthly health care reviews of the clients and will also visit the home on request. District Nurse’s will attend the home when asked to and the home has direct access to there service. The Community Psychiatric Nurse’s carry out follow up visits and will also attend the home to provide advice when requested. The home has regular visits from the Chiropodist. Clients can attend their community Dentist via appointments. The Optician and Audiologist will visit the home on request. The home also has follow up visits from the Occupational Therapist who will also visit on request. The home does not have any client who has a need to be hoisted and do not admit clients who have a need to be hoisted. They do however have a disabled bathing facility with integral hoist, handrails where needed and raised toilet seats for clients. The supplying pharmacist had carried out an inspection on the homes medication activities immediately prior to this inspection and the report was seen by the inspector. It was a positive report that had just small items of advice to offer the home. All the care staff who deals with medication has received formal training from an experienced trainer employed by a major pharmaceutical provider that relates directly to their circumstances. There are certificates displayed that provide evidence of this training having occurred in July 2005 and the manager told the inspector that more is planned for April 2006. The Statement of Purpose refers to the issue of offering the client a choice of whither they have locks for their bedroom doors and the wishes of the clients on this matter are recorded in the care records. There are commodes in clients bedrooms and staff are made aware of the issue of privacy and dignity in training and by the policy and procedure that was seen on this subject. Staff were heard to refer to clients by what seemed to be an acceptable name and they also were seen to knock on bedroom doors before entering. The home has its own laundry with an industrial washing machine that has a sluicing cycle. The clients wear their own cloths and relatives are asked to label all items for identification purposes. There is a telephone available for the clients to use and if they wish they may have their own telephone line installed in their room at their own expense. During the tour of the home the inspector noted that there was no working locking device on one toilet and this was brought to the attention of the manager and the Registered Provider. Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 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): EVIDENCE: These standards were fully reported on during the previous inspection and the inspector saw no evidence that there has been any change to the outcome of that report. Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home has taken adequate steps to protect clients from abuse of any sort through staff training, good recruitment and appropriate policies and procedures. EVIDENCE: The inspector saw evidence that the majority of the staff have received Vulnerable Adults Training that was provided by an external training company. Certificates were displayed at the entrance of the home that gave the name of the training institution, and the names of individual staff who had already attended the training as recently as 3rd February 2006. There was also evidence provided that showed that the staff who has not yet received this training will be attending a training session before the end of this month, March 2006. The homes arrangements for the safe keeping of small amounts of money and valuables are satisfactory. The method of accounting for this was shown to the inspector and it included receipts for any purchases on behalf of a client. Only the manager and her deputy deal with money and valuables held on behalf of the clients. The inspector saw adequate policies relating to gifts, management of allegations of abuse and whistle blowing. Staff files provided evidence that the recruitment process of staff is robust and provides safeguards for clients from unsuitable characters being employed. Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 26 The home is warm, comfortable and well decorated. There are appropriate types and levels of furnishings in communal areas and bedrooms, some of which are the property of the clients themselves. For good infection control reasons hand washing facilities need to be improved in the ground floor bathroom. EVIDENCE: The home is well presented, uncluttered, clean odour free and attractively decorated. During the tour of the home the inspector looked at several bedrooms with the permission of the occupants. Each room was furnished to their individual approval and one client did ask the manager to removed an items as she did not require it. The manager showed the inspector copies of risk assessments that have been carried out on every bedroom. She also provided information relating to the four weekly inspection of the whole home to identify any problem areas, Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 15 repairs or requests for items that have not been seen or dealt with in the normal course of the homes working day. The issue of door locks has been reported on in a previous standard and in the previous report. Generally around the home there has been more double glazing fitted giving almost fully coverage around the home. New curtains have been made and put up in the dining room and the lounge and the dining room has been redecorated since the last inspection. The Registered Person informed the inspector that he has had quotes for the installation of a wash hand basin in the bathroom that was identified as needing one during the last inspection. The homes laundry has a washing machine that does have a sluicing facility within its programming. This is a good infection control arrangement. There is also a disinfecting sluice that was seen working during the inspection. Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 & 30 The arrangements for preparing staff for their duties through National Vocational Qualification and other training are good. The recruitment procedures provide the clients with an acceptable level of protection from the employment of unsuitable individual. EVIDENCE: The home employs 16 social care staff and 65 of these hold a National Vocational Qualification at level 2 or above. In addition to this the home can clearly show that they have a commitment to additional training that meets with the induction and foundation requirements. The evidence seen on certificates and in staff files indicate that all the staff receives a minimum of three days of paid training per year. The Community Psychiatric Nurse has been approached to deliver training in relation to the care of individuals who have Dementia. This is planned to commence in the near future. Three staff files were selected at random and read by the inspector. They included the documentation expected of them including application forms, two references, Criminal Records Bureau results, and information that the interviews addressed the requirements of equal opportunities. The manager told the inspector that all staff have received the General Social Care Council code of conduct and practice booklet and spare copies were seen by the inspector whilst discussing recruitment procedures. Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 17 Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 18 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 The Registered Manager has obtained the qualifications required by the National Minimum Standards. This and additional training has provided her with skills that now show in the way she has organised the work of the home. The quality assurance system is in its infancy but it does provide valuable information about how clients and others view the service. EVIDENCE: The Registered Manager has worked in the independent health care industry for in excess of 9 years. She has progressed through the different levels of responsibility and was made manager of this home soon after it was purchased by the present owner/Responsible Person. The inspector was informed that the Registered Manager has now achieved the National Minimum Standards qualification by attaining the National Vocational Qualification in management and care at level 4. She is awaiting her certificate as evidence of this. Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 19 In addition to this qualification the Registered Manager has also completed a course of study entitled “Excellence as a First Time Manager or Supervisor” that has introduced her to such issues as assertiveness. There is also evidence that she has maintained other learning by attending courses relating to care. Following a review of her role with the Registered Person the Registered Manager now functions mainly during office hours Following a review of her role with the Registered Person the Registered Manager now functions mainly during office hours and is not directly on care task duties. She communicates directly with the Registered Person and has a Deputy Manager who is more involved in the delivery of care. The home does not manage the affairs of any of the clients but does handle small amounts of pocket money for which they provide good accounting records for the inspector to look at. Some of the clients do have relatives or solicitors who act as their Power of Attorney. The home has a variety of methods of measuring the quality of their service. They have a record of the work that has been undertaken over the financial year to improve the environment. There is a questionnaire that seeks the views of the clients on an annual basis and the inspector was shown copies of the responses that have been obtained. There is also a visitors comments book in the front entrance. The inspector looked through this to gauge the level of satisfaction expressed by visitors to the home with the service they observe being provided. There are also cards from relatives again giving comment on the level of satisfaction they have had with the service provide to past and present clients of the home. The views of visiting professionals have not been captured and the home has not shown how the views that have been obtained have been used to improve the future planning of the service. There was evidence of a room by room audit of the homes physical state that results in work being undertaken to remedy any faults that may have gone unnoticed in the normal day by day work at the home. The manager provided written evidence that she now has in place formal supervision with the staff. The records show dates of supervision and brief notes of subjects that were discussed. She made it clear that outside of the formal supervision appointments she operates and open door policy so that staff can come to her to discuss issues as they arise. Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 20 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 3 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X 3 X 2 STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X X Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4(1)(c) Schedule 1 Timescale for action Some further work must be 31/05/06 undertaken to improve the draft Statement of Purpose that was submitted to the Commission for Social Care Inspection to make it comply with the Regulations The home must produce an 31/05/06 adequate assessment format for use by a suitably qualified or trained person to assess the needs of prospective service users before agreeing to provide them with accommodation. Requirement 2 OP3 14(1) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP10 OP26 Good Practice Recommendations The lock to an identified ground floor toilet should be repaired or replaced to ensure privacy and dignity for those who choose to use this facility. A wash hand basin should be provided in the ground floor bathroom where one does not exist, so as to improve the DS0000057690.V271493.R01.S.doc Version 5.1 Page 22 Oaklands Residential Home, Barnstaple 3 OP33 homes infection control arrangements. The quality assurance system should be further developed to include the view of visiting professionals and also to show how the information that has been gathered has been used in future planning of services. Oaklands Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Residential Home, Barnstaple DS0000057690.V271493.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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