Random inspection report
Care homes for older people
Name: Address: Oaks Court Oaks Crescent Wolverhampton West Midlands WV3 9SA two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sara Gibson Date: 2 4 1 1 2 0 0 9 Information about the care home
Name of care home: Address: Oaks Court Oaks Crescent Wolverhampton West Midlands WV3 9SA 01902715266 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Quality Homes (Midlands) Limited care home 41 Number of places (if applicable): Under 65 Over 65 34 41 dementia old age, not falling within any other category Conditions of registration: 0 0 The maximum number of service users accommodated is 41 The registered person may provider personal care to service users of both sexes whose primary care needs on admission to the home are within the following categories: Older People (OP) 41 Dementia over 55 years of age (DE)(E) 34 Date of last inspection Brief description of the care home Oaks Court is a purpose built residential home for 41 older people that was originally intended, and run for a short time, as a nursing home. It is situated in a quiet residential cul-de-sac close to Wolverhampton city centre. The building is on three floors, which are serviced by a couple of lifts. All the bedrooms have en-suite facilities. The home has an enclosed garden at the side of the building and a large car parking area at the front.
Care Homes for Older People Page 2 of 15 Brief description of the care home The fees are in accordance with local authority rates. Care Homes for Older People Page 3 of 15 What we found:
Oaks Court was rated as 2* good at the last key inspection in February 2008 since then we have received a number of safeguarding referrals, as a result we have completed a random inspection. Two inspectors carried out the inspection over nine hours. During the inspection we looked at a number of documents including careplans, infection control procedures, safety procedures, staff training records, accident records and regulation 37 notifications. We spoke with the Manager, both Deputy Managers and four care staff, plus four service users. We also looked around the building at bathrooms, toilets, bedrooms, the laundry and communal areas. We found a number of areas of concern including poor infection control practices, poor service user safety, lack of detail in care plan documentation, non-reporting of accidents and deaths, lack of staff training and poor medication administration practices. The home is registered with the Care Quality Commission to provide care for 41 elderly persons, to include 34 persons with dementia. The homes Statement of Purpose and Service Uer Guide which is given to prospective service users states: The home is registered to provide care for elderly and elderly mentally ill persons. This is incorrect and misleading for potential users of the service, and should be rectified. Throughout the inspection we asked individual members of staff how many service users were living at the home, we were given different answers by each member of staff. Of most concern was the fact the staff member in charge was unsure how many service users resided in the home. She stated: 35 or 36 at a rough guess. This of concern and may affect the safety of people using the service in the event of a fire. We looked at the care plans of two people who were being cared for in bed, and who required full assistance from staff with eating & drinking, positioning (2hrly turns), toileting and personal care. It was of concern that not all the individuals specific needs are recorded properly in the care plans seen. It was established on talking to staff that both service users were on a soft diet, there is conflicting information in the care file. Staff have written the individual likes toast and fish, this information has not been updated since 24/01/07. Then there is a letter dated 12th May 2009 from the GP stating that the individual is to have a liquid diet only. There is no evidence to show that a dietician has been consulted for advice, nor has nutritional screening taken place, there is a potential risk of the individuals choking and a risk of lack of nutrition. Weight charts are on file but there are gaps, so it is not clear if the service user has gained or lost weight. This means that staff can not be sure if people living in the home are receiving adequate nutrition to help them maintain their weight. Recording of daily food and fluid intake is poor, with entries missing and entries made stating small amount of dinner taken. It does not show what was eaten, how much was eaten, how the individual should be assisted to eat or how they should be positioned to ensure they dont choke. Again, there are potential risks of choking and inadequate
Care Homes for Older People Page 4 of 15 nutrition for the person. Pressure area care is poor. The local district nursing team treat and dress pressure sores accordingly, but staff at the home did not know the size or grade of the pressure sore, the treatment given or the dressings used. The Deputy Manager said: I know shes got a nasty sore on her bottom. There is no mention in the service users care file of the pressure sores, how they are to be treated or how staff are to ensure optimal healing with additions of pressure relieving equipment or positioning. The district nurses record everything about the pressure sore and current treatment in an assessment file kept in the service users bedroom. Staff at the home stated they dont look in the file, nor do they really communicate with the district nursing team. This is of great concern as the home has a duty of care to their service users, and must maintain professional working relationships with visiting health care professionals to ensure optimal care is given to prevent and treat pressure sores. Turning charts are kept in the individuals bedrooms to show that they are repositioned two hourly to prevent pressure sores developing and to ensure optimal healing of existing sores. The two charts we looked at had big gaps in times and dates. Either staff are not recording entries correctly or people are not being turned. Risk assessments seen were lacking in detail, for example. when hoisting a person it does not state which hoist or sling to use, or give any clear instructions to staff. This places both the person being hoisted and the staff at risk of potential injury. Entries made by staff in the daily records were not comprehensive, there were no entries to say how the persons changing needs had been met during the shift. During the inspection we saw some poor medication practice. A member of staff carried medication in a pot, then went opened the front door for visitors, she then went and signed the medication chart and told us she was going to give the medication to the person. We also found a medication chart in a persons bedroom, all medication charts should be kept in the treatment room A tube of medicated cream was found in a bedroom. The directions state it should be applied 4 times a day. The home must ensure that medication is being stored appropriately, administered safely and at the correct times. We saw staff interacting well with people living in the home but did observe that staff did not knock on bedroom or bathroom doors before entering, and no apologies were made for disturbing people in their rooms. This showed that the privacy and dignity of people living in the home was not respected. When hoisting a person in the communal lounge, staff did not preserve her dignity in front of other people. The lady herself was pulling her skirt down to protect her modesty. Staff need to be made aware that privacy and dignity must be maintained at all times. Lunchtime was observed. There was a general lack of direction for staff. At times there were no staff in the dining room to supervise and give assistance where needed. An individual was seen trying to cut her food with a spoon, and struggling to get the food to her mouth. No assistance was given to her by staff, and she therefore only ate a small amount of her meal.
Care Homes for Older People Page 5 of 15 The homes complaints policy is available to people living in the home. A register of complaints is kept with actions taken and outcomes listed. The home has a policy on safeguarding. Staff have not received training on safeguarding, although when asked they stated that they would report any concerns to the Manager, and when prompted they were able to say that CQC and social services should be informed of any concerns. Accident and incident records were seen. These lacked detail and did not give a full picture of what had happened, and some entries were missing. Daily records did not always correspond to the accident forms, this shows that not all staff were aware of accidents occurring to people in the home. It is a legal requirement that the home reports any serious accidents, deaths and events affecting well being of residents on a Regulation 37 notification form to CQC as soon as possible. CQC know that in the last 6 weeks there have been a number of serious incidents that have not been reported to CQC. When asked, the Manager confirmed these had not been reported and stated she was unsure of what to report. We advised the Manager that she was in serious breach of Regulation 37 of the Care Homes Regulations 2001 Act for failure to notify CQC of these incidents. A code B was served to the Manager. We were shown around the home by a Senior Carer. Three toilets and two bathrooms were out of order. The carer stated that they had been out of use for at least two weeks as the toilets were blocked, and a chair seat was to be fitted in one of the bathrooms. The Manager later confirmed that the bathroom was not out of use, and it was to be used by able bodied persons. Communication with staff must be improved so they are aware of what facilities they can safely use. Where facilities are out of use, doors should be locked and have appropriate signage. The home must ensure that all facilities are repaired and in good working order for the use of the people living in the home. Mattresses seen on beds were covered in a plastic material which had ridden up and lay in ridges on top of the mattress, very uncomfortable to touch. Linen was in poor condition, sheets were thin and had a washed out appearance, pillows were lumpy and would be very uncomfortable to lie on. A full audit of the mattresses and linen should take place and replacement items purchased to ensure people using the beds are comfortable, safe and protected from injury. We saw unsafe areas in the home. The laundry room and the ground floor toilet contained cleaning materials, equipment and exposed electrical wires. These could have caused injury or harm to people wandering around the home. We asked staff to secure both rooms immediately. Fire doors were propped open with chairs. Some bedrooms were missing call buzzers so people in there had no way of summoning assistance. Wheelchairs were inappropriately stored. Two were seen in a persons bedroom, staff said he didnt actually use a wheelchair. Two were seen in a bathroom blocking access to the bath. The hoist chair over the bath was cracked and chipped, and dried faeces was seen on the arms and back of the chair. Infection control practices are extremely poor. We saw no evidence of staff using gloves or aprons, and there were none seen in sluice rooms or bathrooms. There was a general lack of handwash and paper towels throughout the home. The Senior Carer stated that the home provides personal toiletries for people living in the home. We saw very few
Care Homes for Older People Page 6 of 15 toiletries, just bars of soap and in one case a mouldy toothbrush. In the bathroom there was a bottle of shampoo and some talcum powder which seemed to be used for all, and a used catheter bag was found on the floor of an ensuite. We asked staff the procedure for taking soiled linen from the bedrooms to the laundry. Varying answers were given, one carer said they use open baskets, a second carer said she uses bags to transport the soiled linen to the laundry. We had conflicting answers from staff when they were asked about disposing of soiled continence pads. The Deputy Manager was unsure of the procedure and two other members of staff gave different answers. The toilets in the communal areas contained plastic dustbins not pedal bins for disposing of waste. One bin was lined with a black bag, the other wasnt. A pack of opened clean pads was seen on top of one of the bins. In two of the bedrooms opened boxes of continence aids and dressings were sat on the floor, not stored away. Equipment seen such as hoists, wheelchairs, commodes and bedside bumpers were dirty, stained and had dried faeces on them. One bedroom had dried faeces on the wall and bedrails, another bedroom had fresh stains on the carpet where faeces had been wiped away but not cleaned properly. We saw care staff wearing cardigans over their uniforms when assisting individuals. A bottle of handwash seen in one of the communal toilets was smeared with blood, this was removed when pointed out to a member of staff. Staff did not wear aprons when serving lunch until 15 minutes into the service, and then they had to ask if they should be wearing blue or white aprons. All of these observations show that infection control practices are extremely poor and people living in the home are at risk of injury from accessible unsafe areas. We advised the Manager that there was a serious breach of Regulation 13(3)(4)(a) of the Care Homes Regulation 2001 and a code B was served to the Manager. There were five staff on duty plus the Manager and two Deputy Managers, one carer was off sick and had not been replaced. There were sufficient staff on duty to meet the needs of the people living in the home, but due to a lack of direction and leadership from the management team, and systems and procedures were not in place, staff were unsure of correct procedures. At times there were no staff supervising lunchtime, nor were there any staff in the main lounge. Three people were seen sitting in the lounge for over 40 minutes after lunch started, they were not transferred to the dining room, and a meal was not given to them in the lounge. It was evident from looking at staff recruitment files that induction and training had not taken place. In the files seen induction checklists were in place but the supervision records showed that mandatory training had not taken place for new staff. The staff training matrix showed that all staff had undergone moving and handling training the week before the inspection. Prior to this training had not taken place for over two years in some cases. There had been no training on dementia care which given that the home is registered for people with dementia would be beneficial to all. Staff spoken to confirmed that they had not had fire training or training on safeguarding for a long time. The Manager later confirmed that dates had been set for training in the New Year. It was evident from talking to staff that they have insufficient understanding of correct
Care Homes for Older People Page 7 of 15 procedures particularly with regards to infection control, disposal of waste, pressure area care and accident reporting. This puts people living in the home at risk. Overall, it was evident that a lack of direction and leadership from management, and systems and procedures not being followed combined with a lack of staff training has led to people living in the home receiving poor outcomes. What the care home does well: What they could do better:
The statement of purpose should be changed to reflect the homes current registration with the Care Quality Commission, dementia not elderly mentally ill. This will ensure potential service users have up-to-date relevant information. Care plans need to reflect all the specific needs of the individuals, with comprehensive actions listed to enable staff to meet all needs safely. The home must work closely with the District Nursing team to ensure optimal healing of pressure sores. All staff need to undergo training o pressure area care to understand how to prevent and treat pressure sores. Risk assessments need to be more detailed showing how potential risks are to be managed safely by staff. Entries in daily records should be more detailed to give a full picture of the individual at the time of writing. To include any information or advice given by other health care professionals. Staff should receive training on medication procedures to ensure people living at the home receive their medication safely, and medication should be stored appropriately. Privacy and dignity must be maintained at all times by staff. The home needs to introduce a system to ensure staff are present in the dining room at mealtimes to supervise and assist where needed. All accidents and incidents must be reported and documented appropriately to ensure an audit trail is maintained. As stated in the report all areas accessible to people living at the home must be made safe to prevent injury or harm occurring. Care Homes for Older People Page 8 of 15 There must be an ongoing programme of maintenance to ensure all facilities are accessible and in good working order. An audit of mattressess, linen and pillows should take place, and items replaced to ensure the safety and comfort of the people using them. As stated in the report all infection control practices must be reviewed, and significant changes made throughout the home to prevent the spread of infection. In particular handwash, paper towels and pedal bins to dispose of waste should be put in place at all hand washing areas. All staff must be made aware of the homes procedures on disposal of waste, soiled pads and transporting soiled linen through the home. Suitable storage areas should be found for continence equipment, dressings, hoists and wheelchairs. Peoples bedrooms should not be used as storage areas. The management should ensure sufficient domestic staff are on duty daily to keep the home clean, hygienic and free from infection. A review of staff training should take place. A training and developement programme should be developed for each staff member with specific training on infection control, pressure area care, safeguarding, first aid, food hygiene and fire safety to be addressed as a matter of priority. The Manager must ensure Deputy Managers are competent, aware of the homes policies and procedures, and are supervising staff adequately. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 15 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 10 of 15 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 1 4 The statement of purpose should reflect the homes current registration with the Care Quality Commission. This will ensure potential users of the service have current up to date information about the service. 07/01/2010 2 7 15 Care plans should reflect all 02/02/2010 the specific needs of the individual with comprehensive actions listed to enable staff to meet peoples needs safely. This will enable staff to meet all the needs of the individuals living at the home safely. 3 8 12 All staff should undergo training on pressure area care. To enable staff to understand how to prevent pressure sores and treat developed sores. 07/02/2010 Care Homes for Older People Page 11 of 15 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 4 9 17 Staff should receive training on medication practices. To ensure service users receive their medication safely and to ensure medication is stored appropriately. 07/02/2010 5 18 12 All staff should undertake training in safeguarding. To ensure service users are safe and are protected from harm. 07/02/2010 6 19 23 A programme of maintenance must be introduced. To ensure all areas accessible to people living in the home are safe and free from hazards to ensure people are protected from injury or harm. 07/01/2010 7 26 13 Infection control practices must be reviewed and significant changes made throughout the home. To prevent the spread of infection and ensure people living in the home are safe. 07/01/2010 8 27 18 The home should ensure 07/01/2010 there are sufficient domestic staff employed. To keep the home clean, hygienic and free from infection. Care Homes for Older People Page 12 of 15 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 9 30 18 A review of staff training should take place. All staff should complete mandatory training. To ensure staff are knowledgeable and have the skills necessary to meet individuals specific needs. 07/03/2010 10 32 12 The Manager must ensure that senior staff have the training and skills to supervise and direct staff. Staff require leadership and direction from senior staff to ensure service users are safe, protected from risks, and have all their needs met. 07/02/2010 11 37 37 Regulation 37 notifications must be completed and sent to CQC as soon as possible. To enable CQC to be aware of what is happening within the home. 07/01/2010 12 38 17 Accident and incident 07/01/2010 reporting must be improved, and records documented appropriately. To ensure service users are protected and an audit trail is maintained. Care Homes for Older People Page 13 of 15 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 Daily entries written by staff in service users care plans should be detailed and give a full picture of the care given, needs met and any other relevant information. All staff need to be aware of service users privacy and dignity particularly with regard to entering bedrooms and bathrooms, and when hoisting or transferring service users. Staff should be present in the dining room to assist service users with their meals. An audit of all the mattresses, bedlinen and towels should take place to ensure service users have a clean and comfortable bed to sleep in. Adequate storage areas should be identified to prevent equipment such as wheelchairs, hoists, boxes of dressings and continence aids being stored in service user bedrooms. 2 10 3 4 15 24 5 24 Care Homes for Older People Page 14 of 15 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 15 of 15 - 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!
