Inspection on 05/12/05 for Oakridge House Nursing Home

This inspection was carried out on 5th December 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Oakridge House Nursing Home 09/05/07

Oakridge House Nursing Home 16/05/06

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Oakridge House Nursing Home Oakridge House Nursing Home Jefferson Road Basingstoke Hampshire RG21 5QS Lead Inspector Debbie Oliver Unannounced Inspection 5th December 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oakridge House Nursing Home DS0000062987.V271323.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. Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Oakridge House Nursing Home Address Oakridge House Nursing Home Jefferson Road Basingstoke Hampshire RG21 5QS 01256324357 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) Hampshire County Council Miss Caroline Elizabeth Flower Care Home 47 Category(ies) of Dementia - over 65 years of age (47), Old age, registration, with number not falling within any other category (47) of places Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A Brief Description of the Service: Oakridge House Nursing Home is a purpose built home for forty seven older people, some with Dementia set on a housing estate in Basingstoke. Hampshire County Council is the registered provider and the home is accessible to local services and facilities. Each service user has their own bedroom with en-suite facilities and plenty of communal space is available. The home also has a large garden area creating additional recreational space. Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the homes first inspection, was unannounced and took place over seven hours, involving speaking with two service users and discussions with five individual staff members. A tour of the premises also took place and various records were inspected. Written feedback was also obtained from twelve relatives. Additional information has been supplied by the agency within the pre-inspection questionnaire. The registered manager is currently on long term leave and there is a registered manager from another service overseeing the Nursing Home. What the service does well: What has improved since the last inspection? What they could do better: Some plans need to clearly explain what care is needed and why bedrails are being used; also decisions on how to reduce risk needs to be documented better and reviewed regularly. Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 6 More activities are needed within the home to ensure service users recreational interests are maintained within their capabilities and wishes. Better evidence of choice over lifestyles is required. The complaints procedure must be displayed prominently to ensure service users have the information should they have any concerns. Staff can be abrupt and lack common courtesy and so require the appropriate support, training, pre-employment checks and leadership to ensure they support service users appropriately. Health and safety must be promoted in the home to further protect service users. 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. Oakridge House Nursing Home DS0000062987.V271323.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 Oakridge House Nursing Home DS0000062987.V271323.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 and 6 The home does have a system of assessment, which identifies prospective service users needs and how they will be met adequately. EVIDENCE: Sampling of four files evidenced that all service users living in the home had an assessment completed prior to moving. A person qualified to do so including social services or the senior nurse completed these assessments. They cover all aspects of a persons’ life including personal care, eating, health and cultural needs. The senior nurse confirmed the home does not provide intermediate care. Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Service user’s health, personal, and social care needs are met and set out in an individual plan of care but these plans need to include all relevant information relating to an individual with regular reviews ensuring the information remains current. The correct policies and appropriate training in relation to medication protect service users. Adequate support is given to ensure service users have choices and make decisions about their lives. Service users were not always seen to be treated with respect. EVIDENCE: Individual plans of care are available and generally give information to ensure all aspects of health, personal and social care needs are met including how two service users sometimes prefer to sleep on the floor and how this is supported. Four were sampled but it was discussed with the senior nurse that some areas have been left blank in three files and this needs to be completed if relevant or removed if not. Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 10 It was also discussed with the senior nurse that more information is needed in one plan detailing exactly what support a person needs rather than stating ‘needs assistance’. One service user requires the use of bed rails; the relevant documentation was not in place as to why this is necessary neither was the agreement of all involved. Risk assessments were also completed but again it was discussed with the senior nurse these need to detail clearer instructions for staff on how to minimise or eliminate the risks. Both the care plans and risk assessments have reviewing sheets in place but these have not been completed even though it indicates this needs to happen on a monthly basis. One staff member spoken to said the care plans are useful in understanding individuals’ needs. It is detailed in the daily notes that service users receive visits from their doctor. Information is also available in relation to specific needs including diabetes and skin infection. One service user spoken to said staff are there to help them in any areas where they need support. The home has the monitored dosage system in place for medication and the relevant documentation is available including a detailed medication policy. It was suggested to the senior nurse they obtain a copy of The Royal Pharmaceutical Society Guidelines to support staff further. Staff have completed medication training and the training records for this were seen by the inspector. Once medication has been administered this is recorded but with ‘as required’ medication a running total must be recorded. As some service users suffer with Dementia there also needs to be information in care plans as to how service users show they are in pain. On occasions service users’ dignity seemed to be maintained such as closing toilet doors when in use and asking if a service user wanted their hair done and accepting when they said ‘no’. However there were also issues in the abruptness of some staff when addressing service users as observed by the inspector. It was seen during the visit that some staff were talking over service users and were not using common courtesy such as ‘please’ and ‘thank you’. The senior nurse stated this was improving but is an ongoing process, she felt this because many staff are not from the United Kingdom and so have very Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 11 different cultures. The inspector said that further values training would be useful. Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The home does not satisfy the social and recreational interests of service users. There are limited activities on offer to ensure service users are appropriately engaged and so it cannot be said that service users exercise choice within their capabilities. Contact with families and friends are encouraged. Service users are offered plenty of fresh food to enable a balanced and healthy diet but the choice is limited. EVIDENCE: It was documented in one of the plans that a service user likes reading newspapers and dancing. However throughout the visit no activities were being undertaken and on speaking with the senior nurse and other staff it was confirmed there are limited activities with the exception of puzzles and some board games. One staff member was spoken to and due to them having an inadequate command of the English language they were unable to verbalise how they assist service users to complete puzzles. It was difficult to talk with service users due to the nature of their Dementia but on observation were seen to be inactive and not motivated. The one Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 13 service user spoken said they would like trips out or see some entertainment being brought into the home. Additionally staff were sat with service users during the morning for a period of an hour and during this time limited interaction was seen. Throughout the inspection service users were being offered choices such as where they wanted to eat their lunch and whether they wanted to use the hairdressers. During the visit service users were being visited by their family and those spoken to were happy with the support their family members were receiving. One relative said ‘my mum has improved tremendously since living here’. It was also detailed in the plans sampled what family contact individuals receive. Due to the current refurbishment on the residential care home a portable kitchen is being used. There is limited space in this kitchen and only one fridge, one freezer and one dishwasher to accommodate 47 service users. The food is then transported to the home using a trolley and staff serve the meals themselves. However none of the staff on duty had received food hygiene training. It was also discussed with the senior nurse that food should be tested to ensure it is the sufficient temperature once served to the service users. As there is limited space there is one choice available and if a service user wants an alternative there is either tinned soup or tinned macaroni available in the kitchen areas within each flat. This will be resolved once the residential care home has been refurbished as the kitchen in this home is being improved to accommodate the eating arrangements for both homes. The menu seen on the day of the visit did not correspond with the food offered. Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 14 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 and 18 Arrangements for protecting service users and responding to their concerns must be improved with clear procedures in place and staff being clear on the reporting process. EVIDENCE: The home has a complaints procedure but it needs to include the timescale for responding to complaints and the procedure needs to be prominently displayed. One service user spoken to said they had no complaints about the home but would go to any staff member if they ever had a worry or concern. The senior nurse confirmed all staff have received training in abuse and the staff training files confirmed this has happened. However the two staff spoken to were unclear on the process if they were on duty and an allegation of abuse was reported to them. It was discussed with the senior nurse a suitable mechanism needs to be in place ensuring staff have understood the training they have attended. The home also has the relevant policies and procedures on adult protection such as the Hampshire adult protection policy and a whistle blowing procedure but needs to obtain the ‘no secrets’ guidance. Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 15 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 and 26 A comfortable and safe standard of accommodation is provided for the service users, which meet their needs. EVIDENCE: The home has only been opened since July and was newly built for the purpose. The inspector toured the home and it is well maintained and suited to the service users’ needs. It is decorated to a standard that creates a comfortable and homely ambience. On discussion with the senior nurse there are no issues with the building and the service users liked where they are living. The laundry room was viewed and this again is limited until the refurbishment of the residential care home laundry facilities has been completed, as both homes will be using the facilities. Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 16 Currently the laundry room only has one washing machine and one tumble drier to accommodate 47 service users. There is also limited space within the room. This will improve once the refurbishment has been completed. Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Staffing levels are maintained and there is generally a robust recruitment system although further work is needed for staff that have come from outside the European union. Shortfalls in mandatory training and specialist training does not ensure staff have the appropriate skills or are competent to meet peoples needs. EVIDENCE: The staff rota sampled showed five staff on a morning shift, four on an afternoon shift and four on a waking night. It was discussed with the senior nurse that the rota did not reflect the staffing on duty during the inspection. It is a rolling rota but no changes were indicated when staff were on annual leave or sick or when agency staff are being used. The senior nurse confirmed there is an advertisement out for another senior nurse and another staff nurse is waiting to start. It was discussed with the senior nurse to ensure the staffing levels enable appropriate activities are undertaken to promote recreational interests and needs. Three files were seen and although they contained the majority of the information, the two files of staff that were born outside of the European union did not have documentation in place to show they are permitted to work in the United Kingdom, even though it was confirmed this had happened. Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 18 Two staff on duty during the visit were seen to be talking over the service users and the intonation used was quite abrupt. This was discussed with the senior nurse and she said that although this is improving it still remains difficult due to the level of some staffs’ understanding. It was also discussed that more training is needed especially within challenging behaviour and dementia to further support staff to assist service users appropriately. Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 The home must be managed efficiently with attention being given to ensure more support is given to the senior staff and the long term issue of the manager is resolved. Service users’ views are sought to ensure they are involved in the selfmonitoring, reviewing and development of the home. Further work is needed to fully promote the health, safety and welfare of service users. EVIDENCE: The registered manager is currently on long term leave and there is a registered manager from another service overseeing the Nursing Home, with the senior nurse managing the clinical side of the home. However on speaking Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 20 with the senior nurse more support is needed. The senior nurse feels a lot has fallen to her and she needs more support in relation to the general administration of the home. Questionnaires have yet to be sent as the home only opened in July but the senior nurse stated this was currently being looked at and will be viewed during the next inspection. Additionally regulation 26 visits are undertaken and copies of this report are sent to the Commission. Service users are involved and this is documented in these reports. The home also has a policy on quality assurance. All financial records and cash for service users are individually kept with the relevant receipts available. Current maintenance certificates were available for the equipment in the home with the exception of emergency lighting and fire alarm checks, it was agreed this would be actioned. All staff have received an initial induction on fire training but need to undertake a more formal training session. There are policies and procedures in place relating to health and safety but these are locked in the clinic room and so are not readily accessible to staff on duty. Three staff records seen showed they have received training in health and safety. Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 21 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 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP12 OP14 Regulation 16(2)(m) 12(2) Requirement The registered person must ensure service users receive meaningful activities. The registered person must ensure there is better evidence of choice over lifestyles. The registered person must ensure the complaints procedure is prominently displayed. The registered person must ensure the relevant documentation is in place to show staff are able to work within the United Kingdom The registered person must ensure staff are appropriately trained, including in relation to Dementia care.. Timescale for action 05/03/06 05/03/06 2 3 OP16 OP29 22 18(1)(a) 05/01/06 05/01/06 4 OP30 18(1)(a) 05/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000062987.V271323.R01.S.doc Version 5.0 Page 23 Oakridge House Nursing Home Standard Oakridge House Nursing Home DS0000062987.V271323.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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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