CARE HOMES FOR OLDER PEOPLE
Oakleigh 22 Great North Road Alconbury Weston, Huntingdon Cambridgeshire PE28 4JR Lead Inspector
Dragan Cvejic Unannounced Inspection 11th August 2006 10:00 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 Oakleigh DS0000015107.V310858.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. Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Oakleigh Address 22 Great North Road Alconbury Weston, Huntingdon Cambridgeshire PE28 4JR 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) 01480 890248 01480 896308 Mr Styllianakis Styllis Celia Ann Harris Care Home 27 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (27) of places Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th October 2005 Brief Description of the Service: Oakleigh provides accommodation, care, and support for up to 27 older people, 2 of who have a degree of dementia. The home is in the small village of Alconbury Weston, which has a shop, public house and church, and is within easy reach of Huntingdon and Peterborough. The building was originally a private bungalow but it has been extended a number of times and now offers accommodation in 24 rooms on the ground floor, and one room on the first floor which is accessed by a stairs or a stair lift. All 25 rooms have en-suite facilities; the two double rooms are currently used as superior singles. The building surrounds an attractive central courtyard; residents have a choice of communal accommodation, including 3 lounges and a dining room. The gardens surrounding the house are attractive, well maintained and frequently used by the residents and their families. The home is staffed 24 hours a day, with 2 staff on duty overnight. Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a planned, unannounced inspection with a site visit that was carried out during 6 hours during the day. On arrival, the staff opened the door to a service user returning from an early morning walk in the local area in the village and to the inspector. The main methodology used for this inspection was case tracking, whereby 3 service users were case tracked. The other methods for collecting evidence were document reading, talking to two visiting persons, talking to the manager and to a new deputy as well as a tour of the building. The medication process was observed at lunch time and care practices throughout the site visit. Reports of the provider’s visits from the previous two months were also used to inform the evidence for this report. What the service does well: What has improved since the last inspection?
The home responded to requirements from the previous inspection and used them to improve the service. The manager introduced a register for all falls, to understand the reasons better and protect service users with appropriately introduced measures to reduce risk. Recruitment for four more staff was in process and it was hoped this would improve and widen activities when the new staff start.
Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 Page 6 The new deputy manager reduced management pressure on the manager and improved the overall running of the home even in this phase while on basic induction. A bathroom was put into use since the previous inspection, as was required. Door guards were purchased to allow service users who wanted to keep their bedroom doors open to do so while adhering to fire safety measures. 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. Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 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 Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 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): 1,3,4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Despite the lack of updated documents about the home, the initial assessment and admission procedure ensured that service users could make an informed decision and that the home would accept them when sure that their fully assessed needs could be met. EVIDENCE: The manager was reviewing and updating the statement of purpose. Contracts for service users were held in the owner’s office and were not available for this, unannounced inspection. Assessment of newly referred service users was carried out appropriately. The files checked demonstrated that external professionals were also involved in assessments. Families were asked to provide background information for the admission assessment. Service users spoken to confirmed that their needs were met. The home presented documentation showing how they met users’ needs. Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were well looked after and their health care needs were appropriately met. EVIDENCE: Three users’ files were checked. The home used their own assessment form that was sent to referring initiator. Than, the manager went out to visit a potential user and carry out the home’s initial assessment. Care plans appropriately addressed all relevant areas of users’ life: history and background, reason for admission, personal, physical, social, emotional, cultural and religious needs. The home carried out monthly assessments for each individual using a tick off form. The form addressed health aspects covering among other needs, continence, weight monitoring chart, falls, emotional state and mobility. Families were invited and contributed to the assessment, care planning and monthly reviews. A service user stated: “They discuss care plans with us”. The manager stated that she was happy with the medication procedure and considered it safe. The visiting district nurse helped staff understand and
Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 Page 10 implement medication procedure safely, in addition to the training. Four staff were listed to attend medication training. Staff were observed administering lunch time medication and they followed the procedure. Medication records were accurate. All service users spoken to confirmed that privacy and dignity were respected. Some service users had privately installed phones in their bedrooms. The home had three male service users and no users were bothered that there were no male carers at the time of the inspection. There were no service users from culturally different backgrounds, but the manager stated that the home would try to respond to different needs if the need arise. Individual files contain records of service users wishes in case of death. Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite the home’s efforts, the service users were not fully satisfied with the programme of activities organised in the home. However, the food quality, choice and taste were highly praised and appreciated by service users. The home could provide better protection of service users if they obtained signatures on the private possessions brought into the home. EVIDENCE: Several service users spoken to during the site visit commented on the reduced quality of activities since the activity person had left the home. The home tried to respond to the change and introduced some new activities, such as “Jump with beans”. However, service users and some staff shared the opinion that activities were not stimulating enough. A service users wished out loud: “I wish we would go out on trips, as we have used to. There are people here who would join and go out, although not all would be able to go.” The manager hoped to improve the activity programme when new 4 staff, recently interviewed, join the team. Meal times and the quality of food were praised by many service users. Even those users who did not comment on other aspects of care and life in the home, stated that food was excellent, that they could choose what they wanted to eat and that the menu was appropriate not only for their needs, but
Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 Page 12 for their taste, too. The manager covered the cook’s absence on the day of the site visit. Two users stated that food quality did not change when other staff, including the manager covered for cook’s absence. Even the visitor, a girl, was pleased with the food provided in the home. The location of the home in a small village demonstrated good community contacts. Users were pleased to see visitors in the home: a young girl and a staff’s family member, who regularly visited the home developed a nice, friendly relationship with many users. The autonomy of able users was visible throughout the site visit. A user came in at the same time when inspector arrived, from a walk in a village. Several users were independently coming to the garden. The home’s financial policy also encouraged users to remain in control of their finances, or to delegate the responsibility themselves to their relatives. The home recorded possessions brought into the home, but the records were not signed and dated. Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were protected by the home’s complaints procedure and other policies created to protect them. The manager ensured better protection by addressing all potential issues through appropriate recording and analysis of events. EVIDENCE: A service user stated: I know how to complain, I would say if I was not happy”, confirming that the home had an effective and clear complaint procedure. A visitor also stated that she did not have any complaints, but could express any concerns to the manager. The home did not deal with service users’ money or any financial matter related to users. The manager stated that, if there was a need for the home to get involved, the owner would be the only person to find the solution. A service user’s telephone bill came on the day of the site visit and was delivered unopened to the service user. The manager introduced recording system for falls to ensure all possible actions were undertaken to ensure better protection of service users. Accidents/incidents records were accurate and were reviewed by the manager to minimise reoccurrence. Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided a comfortable and well maintained environment where service users needs could be met. EVIDENCE: The environment was appropriate for the service users’ assessed needs. The home was well maintained and the manager stated that all faults were dealt with immediately. A service user commented that she wanted a bigger bed and her wish was passed on to the manager. The home was regularly inspected by other relevant inspecting authorities. Infection control measures and cleanliness of the home were appropriate. Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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. Although the service users were happy with staffing, the terms and conditions for staff, contracts and induction after promotion were not clear and did not give staff a clear picture of their duties, responsibilities and rights. EVIDENCE: Staff were employed in the home based on calculation of a shifts principle, ensuring that all shifts were covered. Most staff were part-time workers and offered flexibility in covering for absences. A service user commented on staffing: “They work very hard. They are well trained, they cannot do better. They respond when we call them 100 ”. Staff spoken to stated that they were happy working here. A staff member said: “Training is very good. Support offered to us is very good. The staff atmosphere is very good. We have to work hard, I can tell you, but we cover all shifts. It is not easy to cover a shift when someone calls off sick late.” Mandatory training was up to date and staff attended users’ specific conditions training including Dementia, Continence training, skin care and stroke care training. The manager and newly introduced deputy did not have a structured induction programme. Staff’s contracts were basic and did not list responsibilities in detail. Inductions of promoted staff were not recorded. Staff files checked contained required documents, apart from a detailed description of their roles, responsibilities and rights.
Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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): 31,33,34,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were protected by safe working practices, regular reviews of potential effects on health and safety in the home and skilled management of the home. EVIDENCE: The manager had the experience and skills to run the home. However, there was not a clear line of responsibility and duty for the manager and for the newly introduced deputy manager’s position. The home had an established quality assurance system in place. The review through questionnaires was due in August and the manager was aware that she needed to analyse the results, create an action plan, feed back and to send the plan to the registration authority. The manager stated that she had no access to a set budget, but the owner was closely involved in the running of the home and was covering financial aspects.
Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 Page 17 The home did not deal with service users’ money. The service users were encouraged to either deal with money themselves, or to get their relatives involved in financial matters. Staff stated that they felt well supported and supervised. Records of supervision were in staff’s files. The home ensured that safe working practices were in place and implemented in the home. Accidents/incidents were recorded. The manager recently introduced a new falls chart to monitor and analyse falls and to undertake appropriate actions to minimise the risk when appropriate. Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 3 X 3 Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 Page 19 Are there any outstanding requirements from the last inspection? no 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 OP12 Regulation 16 Requirement Timescale for action 30/10/06 2 3 OP14 OP29 Schedule 4 Schedule 4 The home must provide adequate, stimulating activities based on the wishes and preferences of service users and in consultation with them. The service users must be informed in writing of the organised activities. The list of service users private 30/10/06 possessions brought into the home must be dated and signed. Staff must be issued with clear 23/12/06 terms and conditions that include responsibilities for each particular role. The manager and deputy manager must in particular have specified responsibilities in a written format. Missing contracts for particular roles must be drawn up and given to all staff. Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 Page 20 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP24 OP30 Good Practice Recommendations The home should consider replacing a service user’s bed as she required with bigger one. Staff induction should be specific, in a written form and cover the staff’s position, including the manager and deputy’s position. Oakleigh DS0000015107.V310858.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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