Inspection on 23/06/05 for Oakleigh Care Centre

This inspection was carried out on 23rd June 2005.

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 12/12/06

Oakleigh Care Centre 22/11/05

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 89 Benhill Avenue Sutton Surrey SM1 4DJ Lead Inspector David Pennells Announced 23 & 24 June 2005, 09:30 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 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 G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Oakleigh Care Centre Address Oakleigh, 89 Benhill Avenue, Sutton, Surrey, SM1 4DJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8770 4919 020 8642 2192 London Borough of Sutton Mrs Pauline Jean Emmerson Care Home 35 Category(ies) of Dementia - over 65 (35) registration, with number of places Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 10/02/05 Brief Description of the Service: Oakleigh Care Centre provides residential care for up to 35 older people with a dementia diagnosis; it is owned, run and managed by the London Borough of Sutton. The home is 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. Five respite care beds all occupy a separate unit. Service users are encouraged to have items of furniture and their personal possessions with them in their rooms at the home. A wide variety of assisted bathing facilities and a shower - are available for personal hygiene, and the home is kept clean and odour-free. Movement around the home is ‘open’, though staff members encourage service users to relate to one area with familiar faces. There is access to two secure garden areas, front and rear. Visitors are always welcomed. There is a day centre on the same site, and the care centre manager is responsible for both services. The home provides carer support in addition to the residential and day care provided for direct service users. The home has its own transport, which is used for the benefit of all service users. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was previously announced; Only 25 service users occupied the home at the time of the visit; there had been an admissions embargo (not applicable to the respite care service) whilst some issues of concern - raised as complaints by relatives - were independently investigated. During this period, the registered manager, had been ‘refrained from work’ and the assistant manager, Jeanne Wickramsinghe, was ‘holding the fort’ whilst the Interim Service Manager addressed the need to provide a strong, supportive management arrangement. Three staff members were acting into Senior Care positions to compensate for the loss of a number of other senior staff. Sixteen questionnaires were received back from relatives – all singular in their praise for the service provided by staff, although there is a perception from a minority (such a concern often encountered in homes where there is ‘Unit Living’, especially) that staffing is sometimes insufficient, and a concern was expressed by two about the number of agency workers employed. Despite these concerns, expressions such as “well cared for”, “very special care”, “staff are very courteous and friendly” were echoed by the vast majority. As a consequence of the ongoing management investigation, an Action Plan has been drafted to address issues arising from the above-mentioned investigation. This wide-ranging document looks at communication, documentation, premises issues, staffing issues (including training, support and monitoring, roles and responsibilities), risk assessments – both of individual service users and also premises audits, policies and procedures, workload distribution, job descriptions and computer system usage. It is understood that the registered provider is committing to implementing this action plan within a short timescale – bringing direct benefit to the home and its daily conduct almost immediately. What the service does well: The home is generally well staffed, with an excellent training profile indicating a well motivated and skilled staff team. The general conduct of the home is relaxed and comfortable; staff members value each other, though the investigation being conducted at the time of the inspection had clearly challenged staff members’ perception of the service they provide. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 6 Relative’s opinions state clearly that they are well satisfied with the care and attention their loved ones receive; service users themselves appeared relaxed and seemed to enjoy their lifestyles The daily routine and engagement of service users and staff was warm and mutually appreciative. The home’s attitude towards concerns expressed by relatives is clearly shown by the importance afforded to current investigations being independently undertaken by an external consultant. The willingness to take on board the outcomes of an independent investigator speaks of the borough’s determination to ensure that things are right for the future. This is reflected by the general ethos of the home – which is clearly one of concerned care. What has improved since the last inspection? What they could do better: One area, which needs corporately addressing, is that of gaining as much current information concerning anyone moving into the home prior to their admission; this will ensure that a newcomer has an appropriate initial care plan in place. The regular and systematic updating of care plans beyond this start is also an issue; the home should have clear standards set as to the maximum time allowable between revisions. Premises issues arising were few, with the need to ensure that the public telephone room is kept clear, and that a review of the lift and call-bell facilities be undertaken, with a view to replacement. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 7 With regard to staffing, the home is currently undertaking a recruitment drive to reduce the acknowledged high level (about 30 ) of agency workers used at the home. Whilst some cover may be provided for training, holidays and sickness, filling vacant posts will dramatically reduce the reliance on ‘casual’ workers. The need for formal records of the registered provider’s representative visits to the home must be started and copied in to the Commission, and Fire Drill recording should be more thoroughly focussed; the details of what happened and outcomes – particularly learning points - must be recorded and such information cascaded to those who were not present at the drill itself. 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 G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 9 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 standard(s) 3 & 6 Whilst most service users receive an adequate care plan package once admitted and familiarised with the house, some - especially respite care users – are not admitted initially with an adequate care plan in place, thus jeopardising their chance to receive a suitable service from the outset. The Home does not provide intermediate care; therefore standard 6 does not apply in this inspection. EVIDENCE: Concerns were raised that at times service users were being admitted or returning for further respite care periods with no, or little, or (at best) ‘old’, information being provided by care managers (some assessments being nearly a year old when sent to the home) - or without subsequent updating of information. This makes it very difficult for the home to create an active care plan for that person based on present day functioning – leaving the home ultimately to ‘find out’ about a person once admitted - rather than having a discrete plan ready in place to respond to the person’s needs. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 10 The home is reminded that the Care Homes Regulations are clear that a service user should not be admitted unless the home has confirmed that they can meet the needs of the individual; care management therefore must be required to provide up-to-date information concerning the individual - unless the home has a mechanism for gaining that information themselves. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 11 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 standard(s) 7, 8, 9, & 10. Service users generally have their needs mapped out in a plan of care – though the frequency of updating requires more consistent application, with timescales attached to each part of the documentation to ensure that staff have the most relevant information with which to meet the service users needs. Service users can be confident that their general health care needs will be met through the home providing regular access to medical and paramedical services. Service users are assisted with their medication through staff trained to administer 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 be confident that their dignity will be protected through the ethos and practices generally at the home, including the conduct of the staff. The issue of privacy is also held in generally high estimation and this can be further enhanced by ensuring that the public telephone room is properly accessible. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 12 EVIDENCE: Each service user is allocated a named member of care staff as a Keyworker. The Assistant manager described the service approach provided as ‘working towards person-centred care with elements of validation’. Carers are designated to Units throughout the home on a long-term basis, thus allowing the development of familiarity and relationships between service users and those particular staff members. Care plans are in place for each service user and updates are undertaken - but perhaps not as systematically as would be most advantageous and beneficial to each individual. In some places amendments were ‘penned in’ alongside an existing plan, and in others the plan had clearly been fully renewed. Risk Assessments were, in some instances, over a year old – they should be more regularly reviewed than this. A more consistent approach to revision and amendment of care plans would be appropriate – and minimum frequencies for the reviews of risk assessments / etc., would ensure a consistent approach. GP and other medical services are provided through local practitioners, and contact with Community Psychiatric Services is available through a six-weekly visit of the local Psycho-geriatrician accompanied by a Community Psychiatric Nurse, or on direct request. Medication is provided to individual service users by staff on the Units in which they reside. Medication is appropriately stored and recording was seen to be consistently appropriate. Staff members receive training concerning such issues prior to being designated with such responsibilities. Hairdressing is provided at a reasonable price – dependant on the service provided - and an Aromatherapist visits offering hand massage or more again on a sliding scale. Chiropody is available either (infrequently) from the NHS practitioner or through a private consultation – again very reasonably priced. Senior and care staff members are to be trained soon in basic foot care – supplied with the recommended equipment – to undertake the ‘straight forward’ service themselves. Relatives reported that their loved ones were treated with dignity and respect; overall, all respondents to the questionnaire and those seen on the day were happy for their relative to live at Oakleigh. Sadly, the public telephone room was found again to be inaccessible – a subject of a requirement at the last unannounced visit. Inside this small room – which should be kept comfortable and pleasant for service users to take calls in private - was an Asda shopping trolley, two carpet shampooers and a large stack of toilet rolls stored inside it. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 13 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 standard(s) 12, 13 & 15 Service users can expect to enjoy a lifestyle which matches their expectations and cultural / social background, through the provision of a varied and appropriate programme of activity and social engagement. Service users may maintain contact with their relatives, friends and colleagues through the positive ‘open house’ approach that the home has to encouraging visitors to engage with the home and their individual 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, as it can be in a larger group – Music, Sing-alongs, Ball games, Bingo, Quizzes, and Painting and colouring is engaged in - as well as watching the TV. Craft activity and conversation – and using reminiscence techniques both formally and informally add to the sense of ‘community’ at the home. Each lounge area was noted to have leisure equipment provided in their sideboards, etc. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 14 The Day Centre often provides entertainment – to which residents at the home are invited. Barbecues are enjoyed and social afternoons are enjoyed. A previously-provided smoking room has now been transformed into a ‘relaxation / sensory’ room for the use of individuals who seek some ‘time out’. The ‘Friends of Oakleigh’ organisation, it was understood, was currently ‘in abeyance’. Throughout their lifetime the ‘Friends’ have raised something over £60,000 for the benefit of the home. It is hoped that a new set of Trustees will soon be found to continue this remarkable supporting role. 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 where appropriate. Meals taken by the inspector – on the units with the service users - were 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. Care staff provide the service of meals and appropriate assistance to individuals where required. It is recommended that stools be provided in the small dining rooms to enable staff to sit (with ease) alongside service e users needing assistance; at present the use of dining chairs is difficult and presents health and safety problems moving them around when service users are already seated. The inspector would also recommend that the focus on the meal is emphasised; the need to clear plates and stack the dishwasher seemed somewhat a priority – whereas the majority of this could be undertaken once all service users have finished, and enjoyed, their food and the company / social engagement this time brings. Due to the excessively hot weather encountered during this 2005 summer, the home had decided to place all service users on fluid intake monitoring records to ensure sufficient liquid intake, thus avoiding dehydration. The charts are being monitored and checked by the senior carers. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 15 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 standard(s) 16 & 18. 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 a clearly documented complaints procedure, which is taken seriously, and all level of complaints are investigated with outcomes being heeded and resulting action points being taken ‘on board’. The home has faced a time of significant challenge through some serious challenges presenting themselves as complaints in the past few months; these complaints have been the subject of concentrated scrutiny from independent investigations, and action plans arising from them are due for intensive implementation. The majority of respondents to the Commission’s questionnaire indicated they were aware of the Complaints Procedure - and some, encouragingly, indicated that they had actively been used it in the past. The Borough is lead agency in the Protection of Vulnerable Adults (PoVA) process and complaints suggesting such connections have been rigorously followed up. The safe recruitment of staff and use of volunteers are covered through thorough referencing, CRB and PoVA checking mechanisms. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 16 An ‘Oakleigh’ disclaimer document (presumably signed at the point of admission) requiring a signature of a service user and a witness stating: “I understand that Oakleigh will not be responsible for any loss or damage incurred, either personal or financial during my stay.” has a dubious provenance and the inspector would request that such a disclaimer is checked out for legal validity and appropriateness. Financial records and transactions for service users were seen and all crossreferenced / corresponded well with other receipt records. The Borough has an internal auditing process, which ensures that finance records are scrutinised from time to time to ensure financial probity at the home. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 17 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 standard(s) 19, 21, 22, 23, 24, 25 & 26. 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: Unit kitchens and a number of bedrooms have been redecorated recently; a number of carpets – especially in bedrooms - have been replaced. The permanently employed handyman ensures that regular maintenance jobs and other small items for attention do not remain waiting for long. Both the indoor environment and the external areas have been assessed for compliance with the Disability Discrimination Act and the main front, and side, entrances (into Primrose Unit) were being fitted with ramps and rail bars – and the front door was being provided with an automatic door opener. The paving in the front courtyard was also due for replacement. Ongoing upgrading of the home continues with a focus on the specific client group living at Oakleigh. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 18 Bathrooms are provided with a variety of hoisting and assisting mechanisms, seeking to make a bathtime an enjoyable experience. Unfortunately - possibly due to lack of storage space elsewhere – the bathrooms on some units seem to be receptacles for storage of many different items, their purpose almost becoming storage rather than being a pleasant bathroom environment. The inspector recommends that such areas be properly cupboarded - to store out of sight, and more hygienically, items that are not appropriate to a service user’s bathing experience. The home is – for the purposes of the Care Home Standards an ‘existing home’ – which allows the current premises to be counted as adequate despite not fully meeting the National Minimum Standards set for ‘new build’ homes. The majority of the services provided within the house are sufficient – though bedrooms are on the whole, quite small. The home has now taken steps and reduced all its rooms to single occupancy – the six previous ‘doubles’ are now used for people who have high dependency needs where, perhaps, bulky equipment is required to provide appropriate / safe assistance. Many service user rooms were seen, and most had their own particular ‘character’ reflecting the occupant’s taste. It was obvious where a family had close interest in a service user, their rooms being more personalised and intimate than some others. Following an unusual and most unfortunate accident, the home will soon, it is understood, be provided with an electronic coded ‘key-pad’ system - for ensuring that the doors leading to stairwells are effectively sealed off from those who do not understand or recognise their environment so well. New incontinence pad macerators have recently been installed, thus getting rid of the problem of storing soiled pads prior to collection from the home. The home was clean and odour-free on the days of the inspection visit. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 19 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30. The staffing input at the home is provided in numbers and skills-mix to a level that generally meets the assessed and recorded needs of service users. Staff members are sufficiently trained - both in local and vocational disciplines - to ensure that the service users are in safe and competent hands at all times. 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. EVIDENCE: Staffing input is provided within the home on the basis of a minimum of nine care staff (a ratio of 1:5 service users), with a senior on duty, at all times during the waking day. Staffing at nighttimes provides, minimally, for one care worker per floor, and a senior on duty in the home but asleep on call. Ancillary staff included the following posts: Senior Cook, Cook / Kitchen Assistants (3), Handyman, Floor domestics (2), Laundry person. Three staff members separately provide care (and drive) for the Day Centre on site; up to five of the respite service users attend this facility each day, accompanied by their carer. A couple of other permanent service users who used the Day Centre before admission continue to attend as it has been identified as beneficial for them to maintain such contacts. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 20 There had been very little movement in the staff team over the last twelve months – save for the comings and goings of agency staff covering vacancies (currently 225 care hours were vacant) and sickness. Agency staffing input to the home was running at quite a high level; usually a figure of about 350 care hours per week (out of a total of 915) were being provided (though a 1:1 care input for a service users had currently pushed this figure up). Agency staff are used in a determinedly ‘consistent’ way, to ensure that only staff familiar with the home and the service users are regularly used. The Borough was undertaking a recruitment drive at the time of the inspection – including participating in a ‘Job Fair’ – which had, apparently, reaped significant numbers of expressions of interest. The Borough must now expedite recruitment to ensure the best stabilisation of the staff team on a permanent basis, and to reduce the number of agency workers employed. Staff training continues to be high on the agenda for both care staff and ancillary workers; 23 of the 29 care staff currently have or are attaining their NVQ at minimally Level 2, meaning that the home is well above the 50 standard requirement and will be so even if all the newly recruited care staff have no relevant qualifications. In-house training over the past year has also been significant; the last announced inspection report in 2004 awarded a ‘four’ score to this aspect and the home’s projected staff training programme for 2005 evidenced an ongoing focus on individual and corporate staff needs. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 21 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35, 36, 37 & 38. The ethos of the home positively serves the best interests of the service users; despite recent issues encountered at the home, the home’s philosophy of care is appropriate; staff members clearly have a strong concern for their wellbeing. Service users can be confident that their financial interests will be safeguarded by the home’s appropriate management and accounting / financial procedures. Staff members receive appropriate supervision from their seniors and recent attention to this process will ensure a ‘tighter’ focus on this important area of staff practice development – for the overall benefit of the service users. The registered provider is currently updating all their volumes of policies and procedures at this moment – thus ensuring the best most current practice is adopted over the ensuing months based on this new documentation. The registered provider positively promotes the health & safety of service users and staff through regular maintenance and checks of facilities. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 22 EVIDENCE: The management situation at Oakleigh at the time of the inspection was changing – the registered manager was not currently working at the home, and the consequence of this was that all junior staff were generally ‘acting up’ one level, until a satisfactory arrangement could be agreed with the Commission about the future management arrangements for the home. The independent management review undertaken at the home has recommended that the manager’s job description is reviewed and ‘modernised’; this is already taking place - and will include all aspects of modern management – including IT competency, personnel issues, and the expectations of the Commission and the Care Standards Act. Service users have access to monies held on their behalf at the home; each has a small book, which records the balances and is maintained at the point of transaction. Such monies are accounted for thorough the petty cash system, thus ensuring regular auditing of the figures. Sums handled for respite service users are just held as cash sums, as the short-term nature of such stays do not lend itself to fuller accounting processes. The assistant manager had commenced ensuring that staff supervision and support was in place and continuing; a monitoring sheet had been introduced to ensure that the support to staff was provided in this way. Senior staff meetings were being held very regularly to again ensure that communication (both ways) was maximised. The Interim Service Manager was also regularly visiting the home providing support, a ‘listening ear’ and monitoring the conduct of the home. It is noted that the Regulation 26 visits by the representative of the person-incontrol of the home – copies of which should be sent to the Commission had clearly not been in place – though it was acknowledged that the Interim Service Manager had, indeed, been visiting the home on a very regular basis and was acutely aware of the conduct of the home. The formalisation of these visits must now be consolidated. Policies and procedures have been assessed as decidedly ‘dated’ in previous inspection visits and an initiative to renew all policies and procedures is currently being undertaken by the Borough for all its care homes for older people. An independent consultant is undertaking this labour-intensive project and the Borough is to be commended for taking this task on. Concerns expressed about the passenger lift and the call bell system are expressed in two requirements to ‘review and replace under standard 38; both, if modernised, could serve the home better. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 23 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x 3 3 3 3 3 3 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 Standard No 16 17 18 Score 3 x 3 x 3 2 3 3 3 3 2 Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 24 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 3 Regulation 14(1) (2) Requirement The home must be clear that it can provide an appropriate service before admitting service users to the home; this requires access to accurate and up-todate infiormation either from care management or from inhouse staff conducting assessments. Timescale for action 15.09.05 2. 7 15 Care Plans and Risk Assessments 15.09.05 must be regularly updated and the resultant plan of care clearly set out for the information of staff and with service users agreement where possible. A minimum timescale for reviews should be agreed as a convention throughout the home. The public telephone room which provides privacy for service users to receive calls must be kept tidy and uncluttered at all times. Previous timescale of 01.06.05 not met. Regular monthly unannounced visits to inspect the conduct of G53-G53 S38487 oakleigh V185876 230605 stage 4.doc 3. 10 16(2)(b) 15.09.05 4. 33 26 15.09.05 Page 25 Oakleigh Care Centre Version 1.30 the home - by a representative of the registered provider - must be undertaken and recorded, copy being sent to the Commission. 5. 38 23(4) (d) 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 thiose staff who were no present at the drill. Recent surveys have indicated that the passenger lift at this home is due for replacement and steps must be taken to ensure this advice is heeded as soon as practicable. The call bell system used at the home must be reviewed to take into account the level of communication possible between staff (especially at nightimes) and to maximise the effectiveness of the facility. 15.09.05 6. 38 23(2) 30.10.05 7. 38 23(2) 30.10.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 15 Good Practice Recommendations That small stools should be provided for staff to sit down easily with service users when they require help / assitance with feeding. The small dining rooms are not spacious enough to accommodate extra full chairs at the table. That the ‘Oakleigh’ disclaimer document requiring a signature of a service user and a witness stating: “I understand that Oakleigh will not be responsible etc...” has G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 26 2. 18 Oakleigh Care Centre a dubious provenance and should be checked out for legal validity and appropriateness. 3. 21 That bathroom areas be cupboarded - to store both out of sight, and more hygienically, items that are not appropriate to a service user’s bathing experience. Oakleigh Care Centre G53-G53 S38487 oakleigh V185876 230605 stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection 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. 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