CARE HOMES FOR OLDER PEOPLE
Oakwood Radcliffe Park Crescent Radcliffe Park Road Salford M6 7WQ Lead Inspector
Elizabeth Holt Key Unannounced Inspection 28th November 2006 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 Oakwood DS0000006717.V293335.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. Oakwood DS0000006717.V293335.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Oakwood Address Radcliffe Park Crescent Radcliffe Park Road Salford M6 7WQ 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) 0161 745 8119 0161 745 8840 maggie@raja.co.uk Mr M.K. Raja Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (29), Physical disability (1) of places Oakwood DS0000006717.V293335.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Minimum staffing levels as specified in the notice issued in accordance with Section 25(3) of the Registered Homes Act 1894 on 20 May 1991 shall be maintained. The service must employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. One named service user is currently accommodated who is under 65 years of age. When this person leaves or reaches the age of 65, the category will revert to OP for people over 65 years of age. 17th February 2006 Date of last inspection Brief Description of the Service: Oakwood Hall Nursing Home is a care home providing nursing care for up to 30 older people. The home can also accommodate up to three people who do not require nursing care but need personal care only. Oakwood is a large Victorian house situated in its own grounds at the end of a cul-de-sac within a quiet residential area of Salford. The home is close to Hope Hospital. The accommodation is provided in a combination of double and single rooms over two floors. The dining room is situated in the basement. A passenger lift allows access to all floors. The home is close to local facilities and it is close to the Motorways. There is adequate car parking space at the home. The weekly fees are from £310.17-£355.52. Extra charges are made for hairdressing, chiropody and magazines. Oakwood DS0000006717.V293335.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place on the 28th November 2006. All the key National Minimum Standards (NMS) were reviewed during this inspection. Information was gathered as part of the inspection process which included a questionnaire completed by the manager which gave information about the residents, the staff and the building. Information held by the Commission, for example notifications of significant incidents was also reviewed. Time was spent talking to the residents, visiting relatives, the acting manager and the staff team about day to day life in the home and to establish what the home was like for the residents living there. A partial tour of the premises was undertaken and examination of documents and care files for the individual residents. The Registered Manager had left their employment with the home two weeks prior to this inspection visit, however a former manager had taken up the position on a temporary basis to provide management cover. What the service does well:
The relationships between the residents and the staff appeared warm and friendly. During the inspection it appeared that the privacy and dignity of the residents was respected. Residents and relatives visiting during the inspection said that they were happy with the way the staff treated them and one resident said, ”the staff listen to me and are very kind.” The home has an open visiting policy and relatives spoken to confirmed they could visit at any time. One resident’s daughter said that between herself and her sister they visited very regularly and she felt the home cared for her mother very well. Assessments were carried out on each prospective resident before they are admitted to the home to make sure the home can meet the needs of the resident. Residents who could express a view were happy with the food provided by the home. If a resident did not want the food on the menu other reasonable requests for alternative choices were made available. The home encouraged the staff to undertake National Vocational Qualifications (NVQ) level 2 training and said staff spoken to said they were encouraged to attend study days as appropriate. Oakwood DS0000006717.V293335.R01.S.doc Version 5.1 Page 6 Medication administration charts were accurately recorded with codes used appropriately. What has improved since the last inspection? 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. Oakwood DS0000006717.V293335.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 Oakwood DS0000006717.V293335.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 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this home. Prospective residents were fully assessed before an offer of a place is confirmed. EVIDENCE: The files of three residents recently admitted to the home were reviewed and pre-admission assessments were in place. Pre admission assessments were carried out by a senior staff member or the manager. One resident’s relative had visited the home before an offer of a place was accepted. One resident spoken to who had recently been admitted said she had visited the home before they offered her a place and she was settling into her new environment well. Residents who were admitted under Care Management arrangements had copies of assessment information.
Oakwood DS0000006717.V293335.R01.S.doc Version 5.1 Page 9 One resident confirmed she had received a written contract and a signed copy was held by the home. A copy of the Service User Guide was available in the residents’ bedrooms providing residents with information about the home. The home did not provide intermediate care. Oakwood DS0000006717.V293335.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this home. Each resident had an individual plan of care. Some areas of the care plans required improvements to ensure residents’ health, personal and social care needs are met fully. The medication procedures were adequate and appropriate. EVIDENCE: A random sample of care plans were examined. Generally the care plans were detailed and gave staff the information required for them to carry out the care identified. There was evidence that the plan of care had been drawn up with the involvement of the resident/relative where possible. There was evidence in the care plans of promoting the privacy and dignity of individuals. The daily statements completed on each resident were not always clear and detailed. It is recommended these statements contain more detail to accurately reflect the nursing care provided to the residents.
Oakwood DS0000006717.V293335.R01.S.doc Version 5.1 Page 11 It was noted that when residents had been assessed as having a High Waterlow score, the care plan did not always record the detail of the pressure relieving mattress in place. This information should be recorded in the care plan. The risk assessments and the monthly evaluations regularly stated “no change” and the reviews were not dated. The evaluations should show any changes over the previous month. A sample of medication administration records (MARS) were examined and these were accurately recorded. From observations made during the inspection and discussions with members of staff, relatives and residents it appeared that the nurses and care staff treated the residents with respect and dignity. One relative said that “the staff are always friendly and do listen to any concerns I have”. Another relative said” my mother receives excellent care and her health has improved 100 . She is always happy and kept clean and tidy”. The manager said and the pre inspection questionnaire confirmed that there were no residents with pressure sores at the time of this inspection visit. Oakwood DS0000006717.V293335.R01.S.doc Version 5.1 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities were provided and residents were able to maintain contact with family and friends. Residents were encouraged to exercise choice over their lives and residents enjoyed the meals provided. EVIDENCE: A plan of activities was in place and it was pleasing to see staff members playing cards with two residents. The entertainment/leisure activities provided by the home included aromatherapy, quizzes, bingo ,reminiscence, games, videos, beauty sessions and music and movement. The home had an open visiting policy and relatives spoken to said they were made to feel welcome. The hot meal served at lunchtime looked appetising. A discussion with the manager highlighted that, the dining room was not used to its full potential and it is strongly recommended that use be made of the available dining room. Oakwood DS0000006717.V293335.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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has policies and procedures in place for managing complaints, however the home does not have in full the systems and procedures in place that allow residents to be fully protected from abuse. EVIDENCE: An investigation has been conducted by Salford Social Services with the involvement of the Commission for Social Care Inspection into concerns raised under Adult Protection procedures concerning allegations of verbal abuse. Although the management of this was conducted prior to the former manager ceasing employment at the home, it was concluded that the concerns were not upheld, however staff at the home did not have a full understanding of Adult Protection procedures. Examination of training records showed that not all staff had received Adult Protection training and a requirement was made to ensure all staff are confident on the action to take in the event of an allegation of abuse. The home’s procedure and policy required reviewing and updating. A Whistle Blowing policy was available and the homeowner said staff were to be issued with a copy of this. Oakwood DS0000006717.V293335.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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence and including a visit to this service. The home was clean and homely. The high temperature of the home may lead some residents and staff to feel uncomfortable. EVIDENCE: The home provides a homely environment and there was evidence of a programme of redecoration in place. The resident’s bedrooms were seen to be comfortable and personalised. Some concerns were raised in relation to the staff being able to access the residents’ beds from both sides if they were being nursed in bed. The temperature of the home felt “uncomfortably warm” and it was recommended this is monitored and action taken as required. Oakwood DS0000006717.V293335.R01.S.doc Version 5.1 Page 15 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number of staff appeared in general sufficient to meet the residents’ assessed needs, however the deployment of staff needs revising to ensure residents are fully protected. The procedures for staff recruitment were robust. The home was unable to demonstrate that all staff had completed the required training to meet residents’ needs. EVIDENCE: Following the serious concerns raised (See Complaints and Protection) it was pleasing to see on the day of the unannounced inspection visit the homeowner was in the process of interviewing all staff, and proposed to consider introducing a system of internal rotation so staff from day shifts moved to night duty and vice versa. A sample of staff files were examined. These contained evidence of the appropriate information in line with the regulations. Staff said they received training and one staff member said she had followed a period of induction. The home shows a commitment to staff training. The home employs 19 care staff with 7 members of staff having successfully completed NVQ level 2 and 4
Oakwood DS0000006717.V293335.R01.S.doc Version 5.1 Page 16 staff members were in the process of applying to undertake this. Although plans were in place some bank staff and new starters had not undertaken Moving and Handling training. The home must ensure staff receive the specialist training needed to assist them to do their work appropriately and to meet the residents’ identified needs. Oakwood DS0000006717.V293335.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, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and welfare of residents’ was promoted, however residents’ safety may be at risk due to inadequate means of escape. The home has the systems in place to monitor the service based on people’s views. EVIDENCE: The former manager had left employment at the home prior to this inspection, however the homeowner had a recruitment plan in place. As an interim measure a staff member/former manager of the home that had a number of years experience at the home had taken on the management responsibility. Policies and procedures were in place to manage the residents’ personal allowances as necessary.
Oakwood DS0000006717.V293335.R01.S.doc Version 5.1 Page 18 A system had been developed for staff to receive regular formal supervision. Fire safety checks were being carried out on a regular basis however a requirement was made following the Fire Service inspection report carried out in June 2006. A number of bedroom doors were wedged open on the day of the inspection and action must be taken to ensure doors effectively self-close. Other maintenance checks were confirmed in the pre inspection questionnaire. Oakwood DS0000006717.V293335.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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Oakwood DS0000006717.V293335.R01.S.doc Version 5.1 Page 20 No Are there any outstanding requirements from the last inspection? 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 OP18 Regulation 13 Requirement Evidence must be provided that all staff have undertaken the necessary training in order for the home to ensure it provides suitably qualified, competent and experienced staff to ensure the health and welfare of the residents are met. Training must include the actions to be taken in the event of an allegation of abuse. To ensure the health and safety of residents appropriate advice must be sought and action taken in relation to the provision of effective self closing fire doors following the Fire Officers inspection of June 2006. Timescale for action 30/03/07 2. OP38 23 31/01/07 Oakwood DS0000006717.V293335.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 OP25 OP27 Good Practice Recommendations It is recommended that the temperature of the home is monitored to ensure it is at an ambient temperature. It is recommended that the staffing rotas are reviewed to ensure the deployment of staff is appropriate to meet the needs of the residents. Oakwood DS0000006717.V293335.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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