Inspection on 17/11/08 for Oakview

This inspection was carried out on 17th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oakview 14/11/07

Oakview 24/04/06

Oakview 29/11/05

Oakview 17/05/05

Oakview 03/11/04

Oakview 04/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oakview 19 Oakwood Avenue Gatley Stockport Cheshire SK8 4LR     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Fiona Bryan     Date: 1 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Oakview 19 Oakwood Avenue Gatley Stockport Cheshire SK8 4LR 0161-4910106 F/P01614910106 assrafally@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Bibi Toridah Assrafally Type of registration: Number of places registered: Mr Mohedeen Assrafally,Mrs Bibi Toridah Assrafally care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: Service users can be under the age of 65 years but not under the age of 50 years in both categories 12 MD(E) and 3 DE(E). The home is registered for a maximum of 12 service users to include: *up to 12 service users in the category MD(E) (Mental Disorder over 65 years of age). *up to 3 service users in the category of DE(E) (Dementia over 65 years of age). Date of last inspection Brief description of the care home Oakview is a care home owned by Mr and Mrs Assrafally and managed by Mrs Assrafally. The home can accommodate 12 older people who may have or had a mental health problem and including up to three people with a dementia type illness. The home is semi-detached with lounge, dining room, kitchen, bathrooms, toilets and Care Homes for Older People Page 4 of 27 Over 65 3 12 0 0 Brief description of the care home four bedrooms on the ground floor; and two bathrooms and six bedrooms (two of which are shared) on the first floor. There is no passenger lift between floors. The home is located in the Gatley area of Stockport and is close to local shops and other amenities, such cafes, restaurants, public houses, banks and post office. There are churches of most denominations, a library and a selection of health centres, dentists and opticians. Motorway network and public transport are easily accessible. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection which included a visit to the home took place on Monday 17th November 2008. The staff at the home did not know that the visit was going to take place. The manager was not available on the first day so we went back to the home on 28th November to complete our inspection and speak to the manager. All the key inspection standards were assessed and information was taken from various sources, which included observing care practices and talking with residents, staff and the manager. Key standards are those that we consider to be the most important in promoting the health, safety, welfare and quality of life for people living at the home. The care for two residents was looked at in detail looking at their experience of the Care Homes for Older People Page 6 of 27 home from their admission to the present day. A selection of staff and care records were examined, including medicine records, staff duty rotas and training records. Before the inspection we asked for surveys to be sent out to residents and staff, asking what they thought about the care at the home. One resident returned their survey and their feedback has been included in this report. We also asked the manager to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well and what they needed to do better. This helps us to determine if the management of the home see the service they provide in the same way that we do. We feel the AQAA was completed well and gave us a good view of how the home was running. What the care home does well: What has improved since the last inspection? What they could do better: Some medicine policies need to be more robust to ensure the safety of residents. The Care Homes for Older People Page 8 of 27 storage of controlled drugs (medicines that may be misused) was not secure enough and the storage of other medicines was also not good enough. Records of receipt of medicines into the home must be kept so staff can account for all the medicines held at the home. Staff should consider how to ensure that residents are able to actively choose alternatives to the main menu if they dont want the meal on offer. Only one choice is on the menu and residents were not very clear if there was a system for asking for another option. Although there has been some refurbishment of the home since our last inspection ongoing upgrading does need to continue as parts of the home look worn and shabby. 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were assessed before they were admitted to the home to make sure their needs could be met. Evidence: Information in the form of a statement of purpose and service user guide was displayed in the reception area of the home. The information had been updated since the last inspection and appeared to be a fair reflection of the services the home could provide. The care of two residents was looked at in detail. We looked at their care files and could see that they had been assessed before they came into the home. One resident had been admitted from a distance away but the owner said the manager had been to see them twice before they were admitted to ensure that all their needs were identified and could be met. Care Homes for Older People Page 11 of 27 Evidence: Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff worked well with other health care professionals to ensure that residents health care needs were met. Evidence: The care of two residents was looked at in detail. Assessments had been carried out for each person that covered all their activities of daily living such as communication, nutrition, hygiene, mobility, mental health and social interaction. These assessments were recorded using a scoring system to denote the level of dependency the resident had in each area. Additional comments were sometimes made to clarify residents abilities and preferences. Care plans had then been written to address specific needs and these had improved from the last inspection, in that they were less generalised and contained more information about the individual residents needs and abilities. The owner said staff had been working on improving the care plans. Care Homes for Older People Page 13 of 27 Evidence: Care plans had been reviewed monthly and from reading the daily records and speaking to residents about the care they received it appeared that staff were providing care as it was written in the care plans. Since the last inspection chair scales had been purchased and all the residents were weighed monthly. This was an improvement from our last inspection and helped staff to identify potential problems with residents nutritional intake. It was noted that staff sometimes recorded peoples weight in metric measurements and sometimes using imperial measurements. it would be easier for staff to recognise weight loss or gain if all staff used one system. Residents had seen their GPs, chiropodists and the district nurse. At the time of our visit the optician called to see 3 residents. We looked at how medicines were managed in the home. A record of staff signatures was available and some medicine records had been completed satisfactorily. However, staff need to be more robust in following some policies. Staff had not signed for the receipt of some medicines into the home; this is important so an audit trail can be kept of all medicines being kept at the home. Where staff had handwritten instructions for the administration of medicines a second member of staff had not checked the instructions and countersigned that they were correct. This is good practice to minimise the risk of errors. A secure cupboard that complies with current legislation was not available in the home so staff could not store controlled medicines (medicines that could be misused) correctly and there was no controlled drugs register. One resident was prescribed temazepam and it is good practice to record this in a drugs register as it is liable to misuse. A small number of medicines were stored in the fridge used for food, in the kitchen. If medicines need storing in the fridge they should be kept in a locked container. Prescribed cream for a resident had been left in one of the bathrooms. All prescribed medications should be stored securely in a locked cupboard. Staff were seen to be interacting with residents in a patient and understanding way and residents said staff were kind. One resident said Staff are great here, I can have a good conversation with them. The girls (staff) keep me going - theyre ever so good. Care Homes for Older People Page 14 of 27 Care Homes for Older People Page 15 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a range of activities and opportunities for social interaction and staff took individual wishes and choices into account so residents lifestyle expectations could be met. Evidence: In the AQAA the manager said that they had worked on providing more opportunities for residents to enjoy social events and a weekly programme of activities was arranged. In each care file a record had been kept of how the residents had spent their time and what social activities they had engaged in. These mentioned activities such as gentle exercises, music and dancing, ball games, quizzes, hand massages and facials. Some residents pursued individual interests, for example one resident went to an art class and several residents went out quite regularly with friends or family. Two residents said the manager offered to take them out although they didnt always want to bother. Care Homes for Older People Page 16 of 27 Evidence: Some residents said they got up at the time of their choice although one resident said she would prefer to stay in bed a little later but thought this would delay staff. Routines appeared to be flexible and the atmosphere in the home was easy going. A new member of staff had fairly recently been employed at the home and the owner said she was enthusiastic about providing the residents with social stimulation. We discussed arranging further training for her in providing activities for older people and activities for people with dementia. This type of training is useful as it offers good ideas for recreational pursuits that can be used as part of an activities programme. In the AQAA the manager said that they had increased the choice for residents at mealtimes but we did not see any real evidence of this when we visited. Menus still only listed one option at lunchtime and a small choice at teatime which was the case at our last inspection. However, from looking at the minutes of staff meetings we could see that staff had been reminded to offer alternatives if residents did not want the meal of the day and the manager (who did most of the cooking) was obviously knowledgeable about residents likes and dislikes. Residents were not clear that there was any choice and were unsure if they did not like a certain meal how they would request something different. However, all the residents spoken to said the food was good and lunch on the day of our visit, roast chicken, potatoes, broccoli and carrots, followed by chocolate sponge and cream, looked and smelled appetising. Examination of the menus showed that residents were offered a balanced diet. One resident needed help to eat and was assisted by one of the carers in a kind and patient manner. Care Homes for Older People Page 17 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures were in place to protect people living at the home and they were confident that any concerns would be addressed. Evidence: The complaints procedure was displayed in the reception area. One resident returned a survey and said they knew how to make a complaint if they needed to. The complaints log showed that 2 complaints had been made. The record showed the details of the complaints and the action taken to resolve them. This showed that the manager had listened to peoples concerns and taken steps to put things right. Two members of staff were aware of the procedures to follow if they suspected abuse. One of the staff was quite new to the home and had not had formal training in this topic yet, but knew where the homes policies and procedures were kept and said she could refer to them. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was mostly clean, warm and comfortable but does need further refubishment to ensure it is a pleasant environment for residents to live in. Evidence: Since the last inspection some investment in the home had taken place.Some new armchairs and new curtains had been provided in the lounge and some windows had been replaced. Two bedrooms had been provided with new wardrobes and it was reported that new curtains had been ordered for them. Chair scales had been bought and externally the rear gate had been replaced. New dining tables and chairs had been bought. In the AQAA it was reported that ongoing maintenance was carried out. Despite the above improvements the home is still in need of extensive refurbishment and upgrading as it does have a worn and tired appearnce in general. A partial tour of the home was undertaken. Most parts of the home were clean and tidy, such as the kitchen and residents rooms. However, some of the bathroom and toilet areas were not so clean and fresh; one bathroom was untidy and uninviting, with communal toiletries and prescribed creams left out on the shelf. Another toilet had empty toilet rolls on the side and tissues on the floor. When we visited the second day these areas were tidier. Care Homes for Older People Page 19 of 27 Evidence: Residents said they liked their rooms, which they had personalised with their own ornaments and mementos. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were enouh staff with sufficient skills and training to meet residents needs. Evidence: Staff and residents spoken to generally thought there were enough staff on duty to meet residents needs. Examination of staff duty rotas for the weeks 17/10/08 to 10/11/08 inclusive showed that there were 2 carers on duty from 8am to 10pm and one carer on duty at night with a second person sleeping in to provide additional cover. From the duty rota it appeared that the owner/manager was present in the home for at least some part of most days, working a full day during the week and shorter hours at the weekends. Staff said that one of the 2 owners was usually at the home. Two staff personnel files were looked at. Both contained the documents and evidence necessary to ensure that the people recruited were suitable to work in a care home. In the AQAA the manager said that 70 of staff had successfully acheived National Vocational Qualification (NVQ) level 2 or above. Training records showed that staff had received training in a range of topics, such as Care Homes for Older People Page 21 of 27 Evidence: moving and handling, safe guarding adults, first aid, and fire safety. Where staff had undertaken training in the safe handling of medicines the manager had also undertaken practical assessments to check they were competent to administer medicines safely. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems were in place to ensure that residents views were listened to and to ensure that their health and safety were promoted. Evidence: The manager (who is also one of the owners) is registered with us and has successfully completed the Registered Managers Award. Residents said they regularly saw the manager around the home and could speak to her whenever they needed to. Staff said that the manager was approachable and supportive. If the manager was not on duty the other owner was often at the home. The manager had undertaken a satisfaction survey and had distributed surveys to residents, relatives, staff and other professionals that visit the home. Some of the Care Homes for Older People Page 23 of 27 Evidence: surveys were undated so it was unclear how recent they were. Other surveys had been completed in August and September 2008. Comments were mainly positive. Residents said they felt they were listened to and felt safe at the home. Staff said they had the support and time to care for residents well. One health care professional commented that the manager was attentive and caring towards residents. Where comments or feedback is received that could be addressed to improve the service the manager needs to consider how she can evidence that she has done this. For example some residents indicated that they were not sure about how to complain; the manager should record if this was later discussed with them or if further information was provided to them so they would understand the complaints procedure in the future. Some residents meetings had taken place and residents had been asked to make suggestions about social events or activities they would enjoy. The manager said that as they had a small home informal communication took place on a frequent basis and she often had a chat with residents after lunch to check that they were happy and ask if they had any ideas for the menu etc. Minutes of staff meetings showed that staff discussed the routines of the home and the individual care needs of residents. The system for handling residents money had not changed from our last inspection. Most residents managed their own money or were helped by family. Sundry expenses were sometimes paid for by the manager and an invoice sent to the resident or their representative. Weekly checks were made on the building and equipment in respect of fire prevention and health and safety. Staff said they had enough equipment to carry out their job safely. Care Homes for Older People Page 24 of 27 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, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 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, Care Homes 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 9 13 A legally compliant controlled drugs cupboard must be available to store controlled drugs. This will help to prevent mishandling and misuse. 27/02/2009 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 9 Staff should record the amount of medication being received into the home so that an audit trail can be maintained to show what medicines are in the home at any time. If staff handwrite instructions for the administration of medicines a second member of staff should check the entry and countersign it to reduce the risk of errors. The manager should consider accessing training in providing activities for older people and people with dementia. Further consideration should be given as to how residents can be made aware of their choices with regard to the meals being offered. 2 9 3 12 4 15 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!