Inspection on 12/12/06 for Oakleigh Care Centre

This inspection was carried out on 12th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Oakleigh Care Centre 22/11/05

Oakleigh Care Centre 23/06/05

Oakleigh Care Centre 10/02/05

Oakleigh Care Centre 20/05/04

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

CARE HOMES FOR OLDER PEOPLE Oakleigh Care Centre Oakleigh 89 Benhill Avenue Sutton Surrey SM1 4DJ Lead Inspector David Pennells Key Unannounced Inspection 12th December 2006 11:45a 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 Care Centre DS0000038487.V310862.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 Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakleigh Care Centre Address Oakleigh 89 Benhill Avenue Sutton Surrey SM1 4DJ 020 8770 4919 020 8642 2192 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) London Borough of Sutton vacant Care Home 35 Category(ies) of Dementia - over 65 years of age (35) registration, with number of places Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Oakleigh Care Centre is registered for 35 places, 5 of which are used for respite care. 22nd November 2005 Date of last inspection Brief Description of the Service: Oakleigh Care Centre can provide residential care for up to 35 older people with a dementia (or similar condition) diagnosis; the home is owned and managed by the London Borough of Sutton Community Services Department. The home was built in 1972 to a design familiar in that period, and is now divided into six units with their own lounges, kitchens, dining rooms, toilets and bathrooms. Overall, the home has 29 smaller single rooms and 6 larger rooms (which were previously double rooms but are now in single occupancy). The building is due to be ‘evacuated’ in early 2007 (all service users and staff moving to another care home location) to enable a refurbishment of the building to take place - this including (among other items): the fire alarm system, some flooring, most lighting, the central heating, unit kitchens, lounges, bathrooms and provision of new services in each bedroom (lights / sockets / vanity units and basins) - and the laundry being expanded. No new permanent admissions are being made to the home currently; the smaller (and slowly diminishing) number of current service users will move with staff to their temporary home to allow for the substantial works to be undertaken without risk to themselves. Respite care services are being ‘suspended’ - for the duration of the transfer period. Following this significant refurbishment of the home, the community will return en masse - to the renewed Oakleigh environment - at which point a new manager will be in place. Thirty beds are spread across five units providing permanent residential care, and five ‘respite care’ beds occupy a separate, but not isolated, sixth unit on the first floor. There is also a day centre on this same floor, and the care centre manager is responsible for both services. Some service users, especially those using the Respite Care Unit, use the day care facility during the day. The home also provides carer support in addition to the residential and day care. The home has its own transport, which is used for the benefit of all service users. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 5 Permanent service users are encouraged to have items of their own furniture and personal possessions with them in their rooms. Lounges are small and ‘cosy’ - and all have the ubiquitous TV, sound system and other furnishings. Dining areas are quite intimate, with ‘kitchenette’’ food-preparation areas attached - allowing a domestic, ‘home-cooked’ approach to food provision. A wide variety of assisted bathing facilities - and a shower - are available for personal hygiene, and the home is kept clean and odour-free. A separate room is provided for service users to use the telephone. Movement around the home is open - though staff members encourage service users to relate to one area where familiar faces of both service users and staff are present. Keypad security systems operate at all final exit doors and between floors on the staircases, to ensure the safety of the service users. On the ground floor, there is access to two secure garden areas, to the front and rear. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit was conducted from lunchtime through to the middle evening of a weekday; the home being already decorated for the expected Christmas festivities. The inspector spent some time reviewing documentation and evidence of maintenance and safety precautions at the home, attended the staff handover meeting, spent some time with the interim manager, Laura Miller, and enjoyed some time with both staff and service users, on the different units within the home, as they went about their general daytime and evening routine. Service users were noted to be generally content and many in a positively cheerful and ‘fun’ mood. There was no sense of anxiety within the establishment; clearly service users felt safe. The inspector is grateful to the interim manager, staff and service users for their welcome, hospitality and cooperation throughout the visit. The inspector also obtained from the interim manager an up-to-date list of relatives / carers of those remaining service users at the home, and they were all circulated with a questionnaire to elicit their current views on the service in the home. Due to the reduction in numbers of service users at the home - in preparation for the refurbishment programme - there were only twenty-one permanent service users remaining in the home at the time of the inspection. The Commission received seventeen responses from the twenty-one relatives / friends contacted - this giving the inspector a clear idea of opinions about the service actually provided at the home. Associated professionals were also given the chance to respond to separate questionnaires; four Community Psychiatric Nurses and the principal GP to the home kindly fed back their professional opinion on the quality of the service at Oakleigh. What the service does well: Significantly, the entire group of relatives / carers (and also the GP and majority of CPNs) who responded to the Commission’s questionnaires, stated that they were satisfied with the overall quality of care provided at the home, and stated they were welcomed by staff into the home at any time. This majority opinion was also applicable to questions to relatives & carers concerning being kept involved in decision-making on behalf of their relative / friend (15/17), and being kept informed about matters relevant to their relative / friend (15/17). All but one relative or carer also reported they were able to visit their relative / friend in private (16/17). Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 7 Opinion was split 2:1 on whether there were enough staff provided - 11 were satisfied in this area. A similar number were familiar with the home’s complaints procedure (4 had made a complaint of some kind in the past) indicating that a number need to be briefed on the Borough’s complaints procedure. Qualitative feedback indicated that especially the permanent staff members were greatly appreciated: “friendly & welcoming” / “staff do listen”. The standard of care from permanent staff was singled out: “excellent care for my [relative]” / “very satisfied with the care and attention my [relative] is receiving” / “Generally pleased with the care”. Concern about the use of agency staff, particularly at weekends, was associated with a perceived decline in the standard of service. What has improved since the last inspection? What they could do better: From the relative / friend survey, the home clearly needs to ensure that the Borough’s complaints procedure is prominent to all who use the service - and this will be particularly vital at ‘local’ level as the community moves off to their temporary lodgings during the refurbishment programme. The home also needs to ensure that relatives and friends are appraised of the role of the Commission; by explaining its role, how to access inspection reports and how a relative can make contact with the local Commission office. A greater focus on activities for service users organised by staff - especially if not engaged with the day centre - is called for, and better activity space is needed. The auditing of fire drills - using a matrix to check all staff members are regularly updated is needed, alongside the records of fire drills being improved to ensure that all possible learning is absorbed from these opportunities. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 8 Feedback from the CPNs suggested that the home - and they - could work together more cooperatively to ensure the best outcomes for service users; the manager is encouraged to explore this interface. Various small recording recommendations are made. Ultimately, (and whilst recognising the positive work undertaken by the interim manager and the staff) a requirement must be made that a registered manager be established urgently for the home - to ensure both continuity and the best possible ‘fresh start’ for Oakleigh as it returns to Benhill Avenue, the building having been very well refurbished. 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 Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users now receive an adequate care plan package provided within the house - including respite care users – based on full assessment information obtained, or demanded from other professionals, by the home. The Home does not provide intermediate care; therefore standard 6 does not apply in this inspection. EVIDENCE: No service users have been admitted to the home on a permanent basis for some while - this due to the imminent temporary transfer to alternative accommodation while the premises are refurbished. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 11 Access to the Borough’s social services database system now allows better accumulation of information concerning individuals referred to the home; this is especially vital with regard to service users coming to Oakleigh on a ‘respite care’ basis. The home is also assertive in accessing up-to-date information from care management – quite rightly refusing to accept out-of-date assessments. This allows a more focused assessment of need initially on referral, and then if a service user is assessed as potentially appropriate, leads on to the senior staff visiting a service user at home prior to admission. Current service users have been at the home for upwards of five years; two being admitted in late 2001, one in 2002, four in 2003, seven in 2004 and eight in 2005. This situation meant that the current admission process could not be directly assessed, due to lack of new incomers. A full assessment of the home’s admission processes will be undertaken at the home on their return to Oakleigh, post-refurbishment - once service users are being admitted afresh. Standard 6 does not apply, as the home does not provide intermediate care. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can expect to have their needs mapped out in a plan of care – and they can be confident that their general health care needs will be met through the home providing regular access to medical, paramedical and psychiatric / psychological services as appropriate. Service users can expect to be assisted with their medication by staff trained to administer and monitor the medication. The home has a structure and policy / procedures which clearly protects the service users and ensures their protection in this regard. Service users can expect staff to relate to tem in a dignified and respectful manner. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 13 EVIDENCE: Care notes are kept in 7-day ‘tranches’ - this enabling the entire week to be easily reviewed and held on the Unit in easily accessible ring-binders, until such time as they move to the first level of archiving in the ‘Resident’s Personal File’. The practice of holding the current, active care plan in the resident’s personal file should be ceased, with this information being held alongside the day-to-day notes in the 7-day unit-based accessible ring-binders. Day-to-day notes were still somewhat physically / bodily-function orientated the suggested juxtaposition of the care plan alongside the day-to-day notes should encourage a more rounded reporting of the achievements, satisfactions and social engagement enjoyed by service users, alongside the fact that they had been washed, fed and exercised. Work has begun on ensuring that all assessments and care planning are based on the ‘person-centred care’ principle (‘PCP’). This approach places the service user at the centre of the planning focus - and ensures that all actions are undertaken with the person’s being - from their perspective - central to decision-making. Clearly with people with dementia, this can often involve relatives and friends, as the ‘whole’ person includes their history and personality - as well as the present circumstances. Whilst all 17 respondents to the Commission’s questionnaire confirmed they were involved in care planning with staff - and involved in reviews, two had personal qualifications about some points of contact - a couple reporting that they only ‘found out’ about changes to their relative’s lifestyle subsequent to the event (one report stated ‘after many weeks’). This response re-emphasises the need for staff to keep relatives / carers up-to-date at all times. The inspector would also ask that, in report-writing, expressions such as “no problems” are eliminated from such day-to-day records - they give no information and suggest, negatively, that individuals are / do have ‘problems’. Some auditing was difficult where the day-to-day notes recorded (for instance): “Seen by optician” - but no other record was available to qualify this record. Such encounters must be fully written up - preferably in, or nearby, the day-to-day notes, to enable the ‘full story’ of such important encounters to be adequately communicated and the person’s ‘story’ to be interconnected. The monitoring of a service user’s wellbeing also extends to regular ‘weigh-ins’ - such ongoing activity is commended, especially in respect of the home’s specific client group, but the monitoring is only as good as the outcome it produces. One set of records for a specific service user was noted to vacillate between imperial weights to metric, then return to imperial measures, before another metric weight was noted, and then, for the last four months, appearing in imperial measures again - leading to a set of figures nigh on Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 14 impossible to interpret. The service should establish one measure and stick to it; variations are difficult to monitor otherwise. For the benefit of service users (& probably staff), the system used should probably be the familiar ‘imperial’. The ‘handover’ attended by the inspector evidenced that staff pass on the necessary information to ‘hit the floor running’ with any updates concerning a service user’s health / welfare. Issues discussed showed that concerns were being brought to light and discussed to try to find appropriate solutions to problems as they arose. Discussion of service users showed that an holistic approach to care was being adopted - their previous circumstances being taken into account to understand reactions / behaviours. Overall, the recording of information and risk assessments was substantial and service user reviews were evidently taking place. On top of the basic contact details for each service user’s personal network, the initial assessment, a separate personal ‘pen picture’, a care plan, various risk assessments, charts and records were all accessible in the file. In answer to the Commission’s questionnaire, all seventeen responses from relatives / carers indicated they were satisfied with overall care provided at the home. Sixteen confirmed that they could visit their loved-one in private. GP and other medical services are provided, and contact with Community Psychiatric Services is available through regular visits of the local PsychoGeriatrician accompanied by a Community Psychiatric Nurse, or on request. CPN responses indicated that the home’s staff needs to work more closely with these professionals - they should be seen as a positive resource, and be approached to assist to develop a closer partnership; both with regard to working on specific care plans with those service users they visit (especially those exhibiting challenging behaviour), and in regard to, perhaps, agreeing how to brief and assist staff to more fully understand / appreciate the problems the service users (and they) are facing (see ‘Management’ section). Most CPNs (though not the home’s GP) also expressed concerns about whether the home dealt appropriately, and in a timely manner, with those service users to whom it was decided Oakleigh could no longer provide adequate care. Medication processes were audited and assessed in two separate units at the home. Both checks showed clearly the care taken in managing medication - be it storage, administration or recording. It was noted that both medication cupboards and medication fridges were regularly monitored for safe temperatures, and all audit trails completed satisfactorily, save for one incident, where a medication regime had been changed that very afternoon, and the recording of this change had not found its way to the medication profile. Before the inspector left the unit the updating had been competently completed. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 15 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can expect to enjoy a lifestyle which seeks to reflect their cultural / social background, through the provision of a varied and appropriate programme of social engagement both within and outside the home, though focused activities could be more concentrated on. Service users are encouraged to maintain contact with their relatives, friends and colleagues through the positively ‘open house’ approach that the home has, this encouraging visitors to engage with the home and their loved ones. Service users can expect a good level of nutritious and well-presented food suited to their needs, and served in a pleasant and homely environment. EVIDENCE: Activities are focussed on the individual units – ensuring that such engagement is not too threatening – Music, Sing-alongs, Ball games, Bingo, Quizzes, and Painting and colouring is engaged in - as well as watching the TV. Each lounge area was noted to have leisure equipment provided in their sideboards, etc. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 16 Relatives and carers fed back a concern that the focus on activities could be improved - especially if their relative is not engaged with the day centre activities; both a stronger staff initiative, and activity ‘space’ is needed. The distribution of single staff members to units does not encourage this focus. There is a monthly Evangelical Church Service organised by a congregation local to the home, and both Roman Catholic and Anglican priests visit to administer Holy Communion as appropriate and requested. Trips out into the local town centre / market are arranged, as well as meals out to restaurants, local cafes and pub lunches are popular. Summer trips to the seaside and places of interest are also arranged. Evening or matinee trips to the local theatre are also undertaken and enjoyed. Outside entertainers are also invited into the home, the day centre space being useful for such occasions. These events are often shared with relatives and carers. Relatives and friends reported that they felt positively welcomed in the home by staff, and indeed the home does have a pleasant informality about it service users are free to wander along corridors and meet with others - even on other units - though it is important that they return ‘home’ for familiar events such as mealtimes. As reported above, the home was noted for the lack of anxiety felt in service users; this is clearly a sign of service users feeling safe and comfortable. It is good to report that a group of staff and service users in the evening were found sitting down having a ‘good laugh’ - something the inspector joined in with - and everyone sensed the prevailing ‘bonhomie’. A relative also stated in their questionnaire, returned just after the inspection visit, that they had really appreciated the “excellent Christmas party” put on by the home. Service users take meals on their individual units; food appeared tasty and well presented. A choice is offered daily, with dietary needs such as vegetarian and low fat diets being catered for. Staff members were clearly concerned to ensure that everyone took sufficient nutrition. Fluid charts are used where necessary. Care staff undertake the service of meals, and any appropriate assistance to individuals, where required. Signage is an all-important aspect of both communication and enabling in an environment for people with dementia. The appropriateness of signs openly visible in Units ensuring that certain service users received specific dietary needs, and old notices concerning steps to be taken during a heat wave were both inappropriately displayed for differing reasons. The passenger lift also provided myriad information about varying topics - including dementia - again, the inspector asks the home to develop clear rationales around information displays - to ensure that the establishment’s ‘homeliness’ and especially an individual’s ‘privacy’ and ‘dignity’ is not offended. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Relatives and service users can be confident that expressions of complaint will be taken seriously, and fully addressed through the home’s – and the Borough’s - comments and complaints procedure. Service users can confidently expect that the service they receive is based on an ethos of adult protection, seeking to protect the dignity and rights of each vulnerable individual. EVIDENCE: The home has handled seven complaints relating to the service in the past twelve months, of which five were substantiated, and two not. In line with the Borough’s policy, all complaints were dealt with within the stated timescale of 28 days. The Commission’s questionnaire revealed that relatives / friends still need informing about the Borough’s complaints procedure - almost a third were unaware of it. This is especially important as the service temporarily transfers out of the home to enable the refurbishment programme. Information about the Commission (CSCI) for relatives / carers is also important - the role of the Commission, accessing inspection reports and contacting the local Croydon office should be covered in such information. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 18 Due to previous concerns about the conduct of the home, the management has ensured than any issues raising significant concerns have been carefully scrutinised by external commentators - as a consequence, four PoVA (Protection of Vulnerable Adults) investigations have been carried out in the past year; these resulting in revised approaches to care practices, recording, and procedural approaches. These investigations have benefited the service, ensuring that areas of concern were properly addressed and focused upon. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can rely upon the home being clean and well maintained to a safe and comfortable level, with adequate facilities to meet their individual needs - and to promote their health and safety – through adequate, ongoing, input from the home’s staff and other professionals. EVIDENCE: This section was intentionally inspected to the minimum at this inspection, due to the imminent closure of the home for refurbishment. The expectation is that the home will feel quite different on the return (the work is projected to last about four months) - with best practice in design for people with dementia being ‘built in’ to the specification. The Commission has been consulted / involved in discussions at every stage of the planning of this project. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 20 The building is due to be ‘evacuated’ in early 2007 (all service users and staff moving to another care home location) to enable a refurbishment of the building to take place - this including (among other items): the fire alarm system, some flooring, most lighting, the central heating, unit kitchens, lounges, bathrooms and provision of new services in each bedroom (lights / sockets / vanity units and basins) - and the laundry being expanded. This refurbishment should bring the home’s assessment to at least ‘good’, if not ‘excellent’, standard of accommodation. One issue had arisen during the visit: the apparent ease of access from the lift to the laundry, empty mid-floor unit and the day centre environment during ‘out of hours’ time. This concern was drawn to the attention of the Provider Service Manager, who undertook to ensure that these areas would be secured. The refurbishment of bathrooms - which is within the planned programme during the closure of Oakleigh - will enable them to be furnished appropriately to ensure that the warm, ‘homely’ ambience is most prominent in these rooms - rather than feeling more like storage cupboards. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staffing input at the home is provided in numbers and skills-mix to a level that should generally meet the assessed and recorded needs of service users. The registered provider supports the home through its recruitment and employment procedures and practices to ensure that equal opportunities are promoted and that service users are protected from potentially abusive staff. Staff members are trained - both in local and vocational disciplines - to ensure that the service users are in safe and competent hands at all times. EVIDENCE: Staff vacancies were being filled - by appropriate competitive interview - and the full establishment is being targeted to ensure that as many of the permanent staff are present to escort service users on the journey to their temporary home at Bawtree House. At the time of the inspection, a senior care worker has been appointed, and another similar post was to be advertised. Three night care workers had also been appointed. Other daytime care worker posts were also still being recruited to. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 22 With the diminishing numbers of service users at the home, the situation was not so acute as to have all posts filled, however the greatest benefit to those service users expecting to move would be to be able recognise as many staff throughout the entire process of the removal and return as possible. The permanent staff team consisted of: Interim Manager, Assistant Manager (2), Senior Care Worker (3), Day Care Worker (18), Night Care Worker (7), Day Carer / Driver (3) Cooks / Kitchen Domestics (3), Domestic (3), Administrator, Laundress, and Handyperson. Of the twenty-five care staff (night and day) twenty-one have their NVQ at minimally Level 2 or above. Agency cover over the previous eight weeks including the week of the inspection, accounted for six additional staff - two working full time weeks (including some nights), three covering half time weeks and one covering nights exclusively. Some relatives expressed concerns about the apparent reliance on agency staff in units at weekends especially; suggesting the level of input was not as consistent as from permanently employed staff. Relatives / carers did report, however, that staff were friendly and welcoming, and provided excellent care and attention. “Staff members do listen” one respondent stated. Relatives / friends also commented the question of adequacy of staff on duty at the home: eleven (of the seventeen) felt there were sufficient staff members available, and six questioned this. Staffing is allocated at one carer to each unit with a carer floating and being available for assisting carers where necessary. There is also a ‘duty’ manager / senior available at all times. CPN feedback suggested that, while the overall care service was satisfactory, more training input with regard to working with people with dementia should be focused on. As a reply to this, the home has provided training for carers this last year in Dementia Awareness, Moving & Handling, Care of Medicines, First Aid, Food Hygiene, Infection Control, Risk Assessments, and Fire Training. The plan is to continue to ‘roll out’ this training to cover all at the home. Staff meetings minutes were seen from the most recent meeting in November and previous meetings, and all areas of concern with regard to the move, as well as day-to-day issues were discussed. Minutes are types and distributed for all staff to see. Staff spoken to informally felt that the situation concerning morale and management at the home was positively improving; staff were enjoying a more positive feeling of team working and finding the work was more enjoyable - the atmosphere was more friendly and welcoming. When specifically asked about how they felt the plans for the move were being undertaken, they stated they felt well consulted - that their opinions and Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 23 suggestions had been taken on board, and that they were now ‘quite happy’ with the move. This ongoing involvement with the forward planning process has clearly paid dividends. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 24 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, 32, 33, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and ethos of the home serves the best interests of service users; the home’s philosophy of care & staff members’ approach is appropriate and sensitive; there is clearly a strong concern for service users’ wellbeing. Cooperative working with other professionals, however, should be focused on. The management of change - which is currently confronting the home, is being handled well, with both staff and relatives being confident that service users will be well supported throughout this challenging phase. The home benefits from good line management – ensuring that issues arising are appropriately addressed and staff members are supported to provide the best service. The home is also subjected to unannounced visits to examine, independently, the conduct of the home. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 25 Service users can be confident that their financial interests will be safeguarded by the home’s thorough management and accounting / financial procedures. The registered provider positively promotes the health & safety of both service users and staff - through regular maintenance and checks of facilities, and through the intention to refurbish the premises to modern standards. EVIDENCE: The interim manager, Laura Miller, is the second person appointed to cover the vacancy created by the previous manager’s departure from the home. Due to certain circumstances around this departure, the post has been vacant for some while - cover beginning in July 2005 and continuing with Mrs Miller’s arrival in July 2006. Prior to this role, Mrs Miller was the head of the Borough’s Domiciliary Care Service. The substantive manager’s post had been advertised nationally - and at the time of the inspection, interviews were imminent. It is understood that an appointment is due to be announced relatively soon (the Commission are aware of progress) - however this may well leave the Interim manager supported by the provider services manager - to manage the translation of the service to the temporary care home location at Bawtree House in Worcester Road, West Sutton. It is hoped that the freshly appointed manager will be in post in good time to manage the service user’s return to Benhill Avenue. CPN feedback to the Commission expressed a problem of consistency of feedback / communication / understanding about the specific dementia care approaches needed between / from staff members. Whilst being generally satisfied with the overall care provided, the CPNs indicated that a greater effort to work with them cooperatively would be appreciated. This is a clear challenge to the management of the home. Planning for the significant changes that are imminent in the home is a substantial job, and the stability provided by having Mrs Miller as the interim manager to ‘bridge this gap has allowed an ongoing focus for planning & agreement of the works, and on consultation & action regarding the temporary transfer of service users and staff. Group meetings have been held for all relatives / carers of the service users affected - and all have also been offered 1:1 meetings with the interim manager and the provider service manager (if wished) to address questions and to allay fears. Thirteen of the [then] twenty-three service users expecting to move took advantage of the individual consultation process. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 26 It is highly significant and a commendation to the home that, with this planning, support and ongoing information being given to relatives / carers, not one service user is being moved onto another care setting (an option made available to all) to minimise the effects of the ‘double move’. All service users are planned to go on the temporary move, and then return to Oakleigh. ‘Home’ - clearly - is more than just the bricks and mortar. Quality Assurance is underpinned by the Borough meeting its regulatory obligation by various management representatives undertaking unannounced visits to the care homes in its ownership. A new system had just been introduced and the inspector was able to see the new report format, which had recently been used for the first time. It is hoped that the detail will be more substantial in future - it is suggested that perhaps a ‘prompt’ sheet - to ensure that a variety of areas are covered - is created. General maintenance and servicing of equipment within the house is constant and all necessary documents are available to evidence the highest levels of safety for Oakleigh as both a home and a workplace. The maintenance of the fire alarm panel, discussed at the last inspection, and a concern for the maintenance engineer visiting, who stated that the fire alarm panel should be replaced ‘asap’ - is to be resolved by an entirely new system being installed during the refurbishment. The passenger lift has also seen substantial work undertaken more recently - and this work will be completed to modern standards at the refurbishment. Fire Drill records were still needing to be better recorded; their frequency had substantially increased; the manager must also ensure that all staff are regularly involved in such a drill - the reinstatement of a staff training matrix in this regard is strongly recommended - to ensure that ALL staff do, in fact, engage with such an initiative. The Borough had also recently provided some specific Fire Training to a number of staff. One relative also expressed concerns about the distress caused by the lengthy ringing of the [fire?] alarm bells - with no explanation or reassurance being given. This is an area for the management to cover more carefully when drills / tests are taking place. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 X X 2 Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans must be held as close to the provider / recorder of care interventions as possible - i.e. on the daily file. The focus on service user activities must be improved especially if they do not engage with the day centre activities; both a stronger staff initiative, and activity ‘space’ is needed. A full time and appropriately qualified manager must be appointed to the Oakleigh service and proposed to the Commission for registration as soon as is practicable. Fire Drill records must be kept in sufficient detail to ensure that the actual drill is described; with leaning points noted and subsequently cascaded to those staff members who were no present at the drill. Timescale of 15/09/05 & 29/11/05 not met. Timescale for action 15/03/07 2. OP12 16(2)(n) 15/03/07 3. OP31 8&9 30/04/07 4. OP38 23(4) (d) 15/03/07 Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Day-to-day notes should be carefully written and contain all objective and important information relating to a service user’s achievements, satisfactions and social engagement. Management should undertake monitoring of such content. The service should establish one weight measuring system and consistently stick to it; for the benefit of service users (& most staff), the system used should probably be the familiar ‘imperial’ weight system. Signage within the home should be carefully considered taking into account both the right to privacy and the dignity of service users. Regular monitoring of the currency of notices will also ensure that redundant notices do not remain inappropriately. That relatives / friends be informed about the Borough’s complaints procedure - almost a third were unaware of it. This is especially important as the service temporarily transfers out of the home to enable the refurbishment programme. That information about the Commission (CSCI) for relatives / carers is also important - the role of the Commission, accessing inspection reports and contacting the local Croydon office should be. That work should be undertaken with the CPNs who provide a service to the home to work out how both sides can cooperate more positively to achieve the best support and service for service users. That the detail in Regulation 26 visit reports will be more substantial in future - it is suggested that perhaps a ‘prompt’ sheet - to ensure that a variety of areas are DS0000038487.V310862.R01.S.doc Version 5.2 Page 30 2. OP8 3. OP10 4. OP16 5. OP18 6. OP33 7. OP33 Oakleigh Care Centre covered - is created. 8. OP38 That a matrix should be devised to assess the ongoing attendance at Fire Drills within the house; without this, there is little way to ensure that all staff have had the necessary training necessary to properly support service users with dementia in a crisis. Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Oakleigh Care Centre DS0000038487.V310862.R01.S.doc Version 5.2 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. 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