CARE HOMES FOR OLDER PEOPLE
Oakside Main Street Northiam Rye East Sussex TN31 6BN Lead Inspector
Caroline Johnson Unannounced Inspection 28th February 2006 10:20 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 Oakside DS0000021395.V273602.R01.S.doc Version 5.1 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. Oakside DS0000021395.V273602.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Oakside Address Main Street Northiam Rye East Sussex TN31 6BN 01797 252165 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) Peasmarsh Place (Country Care) Limited Mrs Barbara Anne Clark Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Oakside DS0000021395.V273602.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users must be older people aged sixty-five years or over on admission. The maximum number of service users/individuals to be accommodated is seventeen (17). 12/10/05 Date of last inspection Brief Description of the Service: Oakside is a building of wooden construction situated in the village of Northiam overlooking the village green. Village shops and local amenities are a short distance from the home. Main bus routes run close by. Accommodation for service users is provided on three floors. The upper floors can be accessed via stair lifts. The home is registered to accommodate seventeen older people. Oakside DS0000021395.V273602.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the second inspection in the year running from April 1 2005 to March 31 2006. The inspection lasted from 10.20am until 15.30pm. The registered manager facilitated the inspection. During the inspection there was an opportunity to meet with three residents in private and with two residents in the lounge. Three staff members were interviewed during the inspection. A number of records were examined including preadmission assessments for two residents and plans for the care to be provided for three residents. Record keeping in relation to fire safety and health and safety was examined and a number of policies were also read. A full tour of the building was not undertaken. However, four bedrooms and the communal areas were seen. Since the last inspection of the home a new General Manager has been appointed. The general manager will provide line management support to the registered manager. What the service does well: What has improved since the last inspection?
The home responded very well to the requirements of the last inspection. They now write to prospective residents or their representatives following the preadmission assessment to confirm the outcome. A detailed evaluation is now also carried out following each fire drill held. They also carried out a very thorough review of their fire risk assessment. As a result they purchased new lightweight extinguishers, had three fire doors fitted and three new door guards. In addition they now have a fire safety box at the entrance of the building with essential equipment and documentation so that it is to hand in the event of a fire. Staff continue to study for National Vocational qualifications and some of the staff that have completed level two are now enrolling for level three. In relation to the building, the external works to the building, which involved replacement of some of the wood and windows and painting has almost been completed. In addition a new roof has been fitted on
Oakside DS0000021395.V273602.R01.S.doc Version 5.1 Page 6 the kitchen, one bedroom has been redecorated and another is in the process of being redecorated. The carpet on the stairs has been replaced and a new stair lift fitted on the top floor. The programme to replace all the bedroom curtains is well underway. 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. Oakside DS0000021395.V273602.R01.S.doc Version 5.1 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 Oakside DS0000021395.V273602.R01.S.doc Version 5.1 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, There are very good procedures in place to ensure that the home carry out detailed assessments for prospective residents. EVIDENCE: Preadmission documentation was seen in relation to two residents recently admitted to the home. The manager met with one of the residents and their relatives in their own home as part of the assessment process and she carried out a detailed assessment of their abilities and needs. The second resident came as an emergency placement. Following admission the manager carried out a detailed assessment of their individual needs and abilities. In both cases Social Services also provided an assessment of needs. The home wrote to either the placement officer or to families confirming that having carried out the assessments they were able to meet the needs highlighted. In one case the home contacted age concern to seek an advocate for the resident. The home does not cater for intermediate care. Oakside DS0000021395.V273602.R01.S.doc Version 5.1 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 Overall the quality of care planning is good and there is detailed advice for staff to follow to ensure that residents’ needs are met. However, there should be greater monitoring of care plans to ensure that all are to the same standard. The procedures for the safe handling of medication are good and the home are good at reviewing their procedures to ensure best practice. The additional codes to monitor reasons why medication is not given on occasions will improve the system in place. The addition of a homely remedies policy will also be of benefit to residents. EVIDENCE: Care plans were seen in relation to two of the newly admitted residents and in relation to one other resident. They included detailed information for the staff team to ensure that each individual’s needs were met. In one of the care plans there were no risk assessments. There was a care plan in place in relation to diet and the need to ensure that the resident had a healthy diet. However, the information provided was too broad and not easily measurable in terms of progress made. The manager agreed with this and confirmed that the care plan would be made more explicit. All other care plans seen were more explicit in terms of the action required by staff.
Oakside DS0000021395.V273602.R01.S.doc Version 5.1 Page 10 The manager advised that the home’s procedure in relation to the safe handling of medication is under review. The format for recording the medication administered to residents is generally clear. If medication is refused this is entered on a sheet at the front of the MAR (medication administration record) charts folder. There is no code to record any other reason why medication is not given. The home keeps a record of all changes made to medication over the course of a month and the general practitioner signs this document every month. There is no homely remedies procedure in place. At the time of inspection the district nurse was visiting the home regularly to see one resident and the respiratory nurse was visiting another resident. Oakside DS0000021395.V273602.R01.S.doc Version 5.1 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 There is a good choice of activities available for residents and the home is trying to encourage residents to have more of a say about the type of activities that they would like to see in the home. Residents spoken with were happy with the activities provided. Residents need to know the menu for the day prior to the main meal so that if it is not to their liking they have time to choose an alternative. Records need to be kept of all alternatives served. EVIDENCE: Monthly activities include keep fit and music and movement. The `land army girls’ are also invited to the home regularly. There is a reminiscence group and occasionally bingo and arts and crafts. Staff are hoping to introduce baking sessions in the afternoons. This would involve a staff member supporting one resident at a time to do a baking activity. One resident stated that his main hobby is letter writing. Others spoken with stated that they enjoy the activities arranged by the home but that they also enjoy the television and radio. Some of the residents attend a coffee morning run by age concern in the village. One of the residents enjoys regular trips to a local pub. Staff assist in providing transport for these outings. Staff also advised that they occasionally take residents on outings to Rye and Hastings. Oakside DS0000021395.V273602.R01.S.doc Version 5.1 Page 12 The manager stated that one of the residents has recently agreed to speak with residents to seek their views about activities in the home. He will then meet with the manager at regular intervals to discuss the outcome. There is a four-week menu in place, which was under review at the time of inspection. Staff ask residents on a daily basis what they would like for their supper. There is a set menu for the main meal although the cook advised that alternatives are always available. Residents spoken with stated that the food served is very good but that they do not always know in advance what the main meal is until they go to the dining room. If residents request an alternative to the main menu this is not recorded. Oakside DS0000021395.V273602.R01.S.doc Version 5.1 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): 16,18 There is a detailed complaint procedure in place. Staff spoken with were aware of the procedure to be followed should they suspect abuse. EVIDENCE: Records showed that there was one complaint logged. This complaint related to the building works and was passed directly on to the owners to deal with. As recommended at the last inspection of the home the complaints procedure now includes reference to the complainant being able to contact CSCI at any stage of a complaint process. All of the staff are expected to watch a video on adult protection and prevention of abuse. Two of the staff spoken with during the inspection stated that they had received formal training on the subject and that this training is then cascaded to all the staff team. Oakside DS0000021395.V273602.R01.S.doc Version 5.1 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): 19,20,24,25,26 Oakside offers a pleasant and homely environment. The programme of refurbishment has been continuous since the last inspection and the standard of work carried out is good. EVIDENCE: The scaffolding surrounding the front of the building is due to be removed in the near future. Work carried out included the replacement of some of the wood, some windows were replaced and the building was repainted. In addition other works carried out in recent months included, a new roof on the kitchen, three new fire doors fitted, three new door guards, the stairs was recarpeted and a new stair lift fitted to the top floor. One of the bedrooms has been redecorated and another was being redecorated at the time of inspection. New curtains have been fitted in eight of the fourteen bedrooms and the remainder of the rooms will also have new curtains fitted. Oakside DS0000021395.V273602.R01.S.doc Version 5.1 Page 15 As required at the last inspection the bolt lock has been removed from the lounge door. The manager advised that a new kitchen would be fitted in the next few weeks. Three of the bedrooms were seen along with the lounge and dining rooms. All areas of the home seen were clean and there were no unpleasant odours. Bedrooms were personalised and residents stated that they had brought small items of furniture with them on admission and liked having photos of family and friends. One of the residents had lots of plants in her room and she advised that having the plants made her feel more at home. Oakside DS0000021395.V273602.R01.S.doc Version 5.1 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): 27,30 Staffing levels are satisfactory to meet the needs of the residents. Having so many staff trained or training for an NVQ has been of great benefit to the home and to the residents. Staff are more aware of the need for good record keeping. There is a good team spirit and staff support each other in their learning. EVIDENCE: Records show that there is a senior member of staff and three care staff on duty throughout the day. In addition there is cook in the home from 7.30am to 1.30pm daily and a domestic is employed to work eighteen hours a week. There is one waking night staff member each night. Staff spoken with during the inspection stated that `everyone is approachable and there is good teamwork’. The home has exceeded the target of having 50 of the staff team trained to NVQ level two or above. At the time of inspection three staff were due to complete level two in a month and two of the three were hoping to start level three. Another member of staff started level two on the day of inspection. Oakside DS0000021395.V273602.R01.S.doc Version 5.1 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): 31,32,33,36,37,38 The home is well run and the manager is continually looking to develop and improve the service provided. Although not all staff received six formal supervisions since the last inspection staff feel well supported and valued in their various roles within the team. The updated fire safety procedure is very detailed and all staff were encouraged to share their views as part of the review process. Although some of the relatives of the residents have contributed to the quality assurance questionnaire the home should ensure that all relatives are given the opportunity to have their say. EVIDENCE: The registered manager has recently completed the Registered Manager’s Award. A new General manager has been appointed who will be line manager to the registered manager. She has visited the home on a couple of occasions. Staff advised that a cheese and wine evening has been planned. This will be an opportunity for the new general manager to meet with residents, their families and staff. The manager advised that the three main areas that the
Oakside DS0000021395.V273602.R01.S.doc Version 5.1 Page 18 general manager would be working on in the coming months are care planning, policies and procedures and staff supervisions. The manager stated that not all staff have had six supervisions in the past year. Staff spoken with during the inspection stated that they received supervision regularly. They advised that they do not need to wait for formal supervision, if they want to discuss anything with the manager `she is always available and very supportive’. The home’s procedures for the provision of supervision are to be changed. The home’s general manager has arranged to provide training on supervision for the manager and senior staff early in March 2006. In relation to quality assurance the manager advised that a satisfaction questionnaire was sent to residents in November 2005. In many cases relatives assisted residents to complete the forms. She reported that nine responses were received and all were very positive. The outcome was not available for inspection. One resident spoken with stated that Oakside is `home from home’ and that the care staff `are excellent’. Since the last inspection there was a small fire to the front of the building caused by work undertaken in relation to the building works. Records showed that the staff on duty responded quickly and safely in evacuating residents from the building. Since the fire the home has evaluated their risk assessment and as a result they now have a fire box at the front of the building which contains blankets, a first aid box, torches, floor plans and information about each of the residents including their next of kin details, general practitioner and any known allergies. They have also purchased new lightweight extinguishers as staff found the previous extinguishers too heavy to lift. A fire officer visited the home recently in relation to fire safety and no new recommendations were made. Records kept in relation to the recording of tests carried out in the home in relation to fire safety showed that alarms and emergency lights were last tested on 31 January 2006. Eleven staff received training in fire safety in February 2006. The last fire drill held was in February 2006. Records showed that the drill was fully evaluated. Oakside DS0000021395.V273602.R01.S.doc Version 5.1 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 3 3 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X 2 3 2 Oakside DS0000021395.V273602.R01.S.doc Version 5.1 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. 1. Standard OP7 Regulation 15(1) 13(4a,c) Requirement With regard to one resident, the care plan in place in respect of their diet must include explicit advice for staff to follow. Risk assessments must also be carried out. Records must be kept of the actual meal served to all residents. In relation to quality assurance a satisfaction questionnaire must be sent to the residents of all the residents to seek their opinion on the quality of the care provided in the home. All staff must have formal supervision at least six times a year. Fire alarms must be tested weekly and emergency lights monthly in line with the home’s policy. Timescale for action 30/04/06 2. 3. OP15 OP33 17(2) Sch 4 para. 13 24(1) 30/04/06 30/05/06 4. 5. OP36 OP38 18(2) 23(4cv) 30/04/06 30/04/06 Oakside DS0000021395.V273602.R01.S.doc Version 5.1 Page 21 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. Refer to Standard OP9 OP15 Good Practice Recommendations The home should have a code for recording on the MAR chart why medication is not given. In addition they should have a homely remedies policy in place. The home should ensure that all residents are advised early in the day of the main meal so that they can then choose an alternative if it is not to their liking. Oakside DS0000021395.V273602.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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