CARE HOMES FOR OLDER PEOPLE
Oaklodge Nursing Home 2 Silverdale Road Burgess Hill West Sussex RH15 OEF Lead Inspector
Judith Farrell Unannounced Inspection 17th October 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Oaklodge Nursing Home Address 2 Silverdale Road Burgess Hill West Sussex RH15 OEF 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) 01444 243788 Dr Dhananjay Dalmond Dr Dhananjay Dalmond Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th June 2005 Brief Description of the Service: Oaklodge is a care home providing nursing, registered to accommodate up to twenty-five service users in the category OP (persons over 65 years). It is a detached property located in the town of Burgess Hill, close to shops and transport networks. The accommodation is arranged over three floors, which are all served by a passenger lift. Most of the private accommodation is for single occupancy although there are four shared bedrooms. Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six hours on 17th October 2005. This is the second statutory inspection of this year. The purpose of this inspection was to assess compliance with the requirements of the last inspection and to generally monitor care practices. This report must be seen in light of the previous inspection report, which was carried out in June 2005. Two inspectors were involved in the inspection. Mrs Farrell who was the lead Inspector and Mrs Datoo was the second inspector. Mrs Datoo is a specialised inspector in pharmacy and only looked at the regulations and the standard regarding medication. She spent 3 hrs at the home. A tour of the premises took place, rotas and care records were inspected. Thirteen of the residents, three visiting relatives, one visiting professional four staff and the Manager were spoken with. The residents have different levels of communication abilities and therefore it was difficult to ascertain all their views on how their needs are met. Part of the workforce is from oversees. What the service does well: What has improved since the last inspection?
The assessment process has improved which means resident’s who cannot be looked after safely or who do not fall within the homes registration will no longer be admitted. The standard documentation maintained has significantly
Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 6 improved. Care plans are now developing into workable documents that provide meaningful support plans. The homes’ understanding of and response to incidents has improved considerably. Both management and staff now demonstrate a reflective approach to dealing with incidents that occur in the home and discuss with other professionals the action needed to prevent future occurrences. Locks have now been provided for all bathroom’s and toilets. New window restrictors have been fitted to the top floor windows. Feedback from one relative included the comment that they had noticed a lot of improvements at the home over the last year. 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. Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,5,6 The documentation available does provide prospective residents’ with the information they need to make a choice about whether to live at Oaklodge . The home is able to demonstrate that residents’ needs will be met prior to admission. Arrangements are in place to ensure that the health care needs of residents are identified and recorded. The home does not admit any resident for intermediate care. EVIDENCE: A copy of the terms and conditions (contract) was seen and residents and relatives said that it was clear and that they understood what was in it. Four pre admission assessment documents were looked at and they clearly showed that the admission procedure was thorough and well recorded. This procedure ensures that new residents needs are properly assessed and planned for. Six residents spoken to were able to provide significant information about their care needs, these had all been recorded. The staff members on duty were aware of the assessments and were able to fully undertake the care needs. Staff are looking forward to the dementia training they are to receive later this week.
Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 9 In discussion with the manager and documental evidence no person is admitted to the home without a full assessment. In the event of an emergency the manager still goes to see and produces a written assessment before a potential resident is admitted. Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9,10.11 Residents are involved in developing the plans in place to support them. Progress has been made on improving arrangements to ensure that health care needs of the residents are identified and met. Medication is generally managed well. EVIDENCE: Five care plans were examined and it was found that significant improvements had been made since the last inspection. The system of care planning now provides support plans to guide staff in the delivery of most identified care needs. This includes how staff can support the resident’s wishes and their relatives in the event of the resident’s death. One member of staff in particular, has invested a lot of time reviewing and updating care plans. She acknowledges there is still work to be done and indeed it is required that all care plans provide a comprehensive plan of how residents should be supported. Residents who retain responsibility for some or all of their medicines did not have written risk assessments. Pain assessment charts were in use. Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 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): 12,14,15 Residents are encouraged to live healthy and fulfilling lives, although there is still a lack of planned activities. EVIDENCE: Residents told inspectors that they are able to handle their own finances if they wish. They are also able to bring in personal possessions with them to the home if these can be accommodated. Residents have access to personal records if requested, but the nurse in charge told the Inspectors that the current group of people living at the home have not requested to do so. Currently all the residents, have family or friends to assist them, but if advocacy assistance was required this would be sought from an external agency. The Inspectors enjoyed a lunchtime meal with the residents. Each resident is offered three full meals each day, all of which may be cooked according to what they choose. The cook compiles 3-weekly rotating menus, which are changed according to season, and which take into account any suggestions made by the residents. Hot and cold drinks and snacks are provided throughout the day and in the evening. Staff take a list of the main meals round to residents the day before so that they can choose from the alternatives offered for the next day. Meals were seen on the menus to be imaginative, varied and well balanced. The resident’s comments about meals were very positive and they were seen to enjoy their meal.
Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 12 Activities occur in the afternoon’s five days a week. These activities are planed for one hour on Monday, Wednesday, Friday when an activity co-coordinator work’s. On the other two days care staff stated they would see what people wanted to do. One resident stated that they would like to go out but needed to be accompanied. Another resident said they felt they would like more activities but it was difficult as most residents were unable to take part. The manager did say that residents were asked what activities they might want to have in the home. Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 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): 17 The residents right to participate in the political process is upheld. EVIDENCE: Residents are encouraged to vote and postal votes are provided. The two other standards were assessed at met at the last inspection in June. The Commission has received one complaint, which was investigated and found to be not upheld. Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 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): 23,24,25, Residents benefit from an environment which provides choice of space, however, a number decorative issues make some areas less homely. EVIDENCE: Current communal day space amounts to 2.55 square metres per service user. There is a large and small sitting room in the home with a separate dining room. The premises and facilities had been assessed by a suitably qualified occupational therapist in May 2004. The home provides hoists, aids and grab rails in areas required by service users. A passenger lift provides access to all levels in the home. Not all doorways had a clear opening of 800mm but were of sufficient width for wheelchair access. Call bells were provided in service user’s rooms, which were accessible. Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 15 Resident spoken to were happy with their rooms and though some furnishings could do with being replaced the residence and relatives said they did not mind this it was the ‘care that mattered’. Trained staff interviewed were clear on the guidelines for the control of infection. Though it was noted care staff were not as confident, and one member of staff spoken to was clearly not following these practice guidelines. It was noted that two residents were sharing a room. It was difficult to ascertain all their views on how their needs are met, or if it is their choice to share a room was due to communication difficulties. There was no evidence in any of the resident’s assessments or care planning documentation to suggest that there was any discussion prior to the second resident moving into the room. Ten resident at this home have the benefit of adjustable beds even though all residents are receiving nursing care. There has been evidence to show that beds are being purchased. Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 The deployment and number of staff is sufficient to meet the needs of the residents. Service users benefit from an effective team of staff to support them. The procedures for recruitment of staff are now robust and therefore the home provides the safeguards to offer protection to people living at the home. EVIDENCE: The three relatives who provided feedback about the home, said they were happy with the number of staff at the home and found them to be kind and knowledgeable. Residents spoken with confirmed that they were happy with the number of staff and that they felt well cared for. In discussion with the manager it was confirmed that the home currently has ten care staff and five trained nurses. 3 of the care staff hold NVQs in Care and three are working towards their award. I member of staff spoken to is on her last unit and is hoping to finish her award in the next month. Staff talked of the benefit of the NVQ in care system and how it has helped them to understand and help the residents. Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 17 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): 31,33,36,37 Residents 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 responsibilities fully. Training staff who undertake supervision of junior staff could improve practice and potentially reduce risks to the residents. Staff must have regular mandatory training to safeguard residents and themselves. EVIDENCE: The registered manager is very experienced having worked in nursing and residential homes for many years. Staff made positive comments about the management and gave good examples of best practice. Relatives spoken with said the home is run efficiently and they said this they thought was down to the way staff were supported. Dr Dalmond is still completing his registered managers award. Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 18 Staff confirmed that regular meeting, handovers and one-to ones were held where the manager informed them of any changes in legislation. A new quality assurance questionnaire has been designed and will be circulated in the next few weeks. The answers will be audited and then actioned. Eight staff files randomly selected gave indications of induction, supervision, training and development staff had received. Most staff interviewed reported to the Inspectors that they had had supervision and most of their mandatory training. The files indicated that supervision had been started. Trained staff interviewed stated they still have not had any training to do so. It was clear from speaking to staff on the day of inspection that they were aware of the health and safety issues however some poor practices were observed. These included a catheter bag which had not been disposed of in the correct way. Staff wearing jewellery while handling soiled linen. The inspector advised the registered manager to contact the health protection advice team. Records are maintained and kept safe in a locked area. Residents do have access if they wish to any records. Residents interviewed had not requested to see any records but felt that if they wanted to they could. Both inspectors viewed the policies and procedures of the home and found them to be robust, however all policies and procedures must be reviewed annually. The inspector advised that when this happens the policy should be dated and signed by the reviewer. Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 19 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 3 3 3 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 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 3 18 x x x x x 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 3 x 2 3 x Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 20 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. Standard Regulation Requirement Timescale for action 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 3 3 4 5 Refer to Standard OP9 OP9 OP12 OP26 OP36 OP37 Good Practice Recommendations Risk assessments should be recorded for residents who wish to retain responsibility for some or all of their medicines. The home should be aware of CSCI guidance on safe disposal of waste medicines from care homes (nursing). The home should provide a fulfilling programme of activities seven days a week for those resident who would like them. Staff would benefit from Infection control training Staff who undertake supervision would benefit from training to do so. All policies and procedures need to be signed and dated then they are updated. Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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 Oaklodge Nursing Home DS0000024188.V259762.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
