Inspection on 08/02/06 for Oakwood House Residential And Nursing Home

This inspection was carried out on 8th February 2006.

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

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

Other inspections for this house

Oakwood House Residential And... 31/10/07

Oakwood House Residential And... 02/10/06

Oakwood House Residential And... 06/10/05

Oakwood House Residential And... 22/02/05

Oakwood House Residential And... 15/06/04

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

CARE HOMES FOR OLDER PEOPLE Oakwood House Residential And Nursing Home Stollery Close, Off Ropes Drive Grange Farm, Kesgrave Ipswich Suffolk IP5 7PQ Lead Inspector Jane Offord Unannounced Inspection 8th February 2006 09:30 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 House Residential And Nursing Home DS0000024464.V282972.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 House Residential And Nursing Home DS0000024464.V282972.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Oakwood House Residential And Nursing Home Address Stollery Close, Off Ropes Drive Grange Farm, Kesgrave Ipswich Suffolk IP5 7PQ 01473 612300 01473 623933 helen.rollins@anchor.org.uk 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) Anchor Trust Ms Helen C Rollin Care Home 24 Category(ies) of Dementia (24), Mental disorder, excluding registration, with number learning disability or dementia (12), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (12) Oakwood House Residential And Nursing Home DS0000024464.V282972.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th October 2005 Brief Description of the Service: Oakwood House is a care home, owned by Anchor Trust, which provides accommodation and nursing care for twenty-four older people with mental health needs. The house was purpose built in 1993 and is arranged in three units for eight residents each. The home is located on the outskirts of Ipswich in a newly developed area of the village of Kesgrave. It is within easy reach of local shops, churches and the GP surgery. The accommodation is over two floors, which are connected by a passenger lift, with two units on the ground floor and one on the first floor. All twenty-four bedrooms, referred to as flats, have ensuite toilet and shower facilities. Each unit has a lounge/dining area with a kitchenette for making hot drinks and snacks. There is a large communal lounge on the ground floor and some smaller quiet seating areas. There is access to an attractive secure garden with seating. Oakwood House Residential And Nursing Home DS0000024464.V282972.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday between 9.30 and 15.30. The registered manager was on annual leave so the senior nurse on duty and the administrator helped with the inspection process. Three staff files and three residents’ files and care plans were seen. The minutes of staff meetings, the complaints log, the accident/incident records, the staff rotas and maintenance certificates and records were all inspected. A tour of the home was done and all areas were visited including the laundry, the kitchen and each unit. A number of residents and staff were spoken with and the system for managing residents’ personal finances was explained by the administrator. Some medication administration records (MAR sheets) were checked. On the day of inspection the home was clean and tidy. Staff were engaging with residents and there was cheerful conversation in all the units. Although the weather was cold the temperature in the home was comfortable and residents were appropriately dressed. The gardens were tidy and looked attractive with tubs of winter pansies dotted around. What the service does well: What has improved since the last inspection? Following the last inspection a number of risk assessments have been generated for activities undertaken by residents. Care staff have now had training in Protection of Vulnerable Adults (POVA). Oakwood House Residential And Nursing Home DS0000024464.V282972.R01.S.doc Version 5.1 Page 6 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 House Residential And Nursing Home DS0000024464.V282972.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 House Residential And Nursing Home DS0000024464.V282972.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): 6. Does not apply to this service. EVIDENCE: None of the standards in this section were inspected on this occasion. Oakwood House Residential And Nursing Home DS0000024464.V282972.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 People who use this service can expect to have their needs met and a plan of care drawn up to facilitate this but they cannot be assured that the present medication administration practice will protect them. EVIDENCE: Three care plans, called Individual Lifestyle Agreements (ILA), were seen and they all covered a number of areas of care. There were interventions for personal hygiene, management of continence, nutrition, mental health needs, night needs and social needs. Individual needs were recognised such as difficulty hearing, one resident who smoked and care of a small area of broken skin. There was evidence that all the interventions were evaluated and reassessed at least four monthly. All were signed and dated. Each file had a number of risk assessments. Some were for falls or scalding when bathing others were for wandering and getting lost. One risk assessment was for complex drug interactions and the potential side effects that could ensue. Another was for the safe use of a beanbag chair. Oakwood House Residential And Nursing Home DS0000024464.V282972.R01.S.doc Version 5.1 Page 10 Each file had a completed Waterlow score for tissue viability and there was evidence that they were updated. There were also nutrition assessments and regular weight checks recorded and assessments of mobility. One file contained an agreement drawn up with the resident about how to manage their diabetes. One resident was on medication to control their blood pressure and there was a record of regular blood pressure monitoring. Each file had a record of any professionals involved with the resident such as psychiatrist, community psychiatric nurse (CPN), social worker and GP. Social needs were recorded and one file noted that the resident needed regular, frequent contact with their spouse and child. Social activities were also recorded such as ‘went out to Tesco’s today’, Watched all of ‘Breakfast at Tiffany’s’’, ‘Helped to make rock cakes today’. The daily records were full and informative describing the residents’ moods as well as details of care given so ‘happy’, ‘content’ and ‘unsettled’ were some phrases noted. The Medication Administration Record (MAR) sheets from one unit were examined and some signature boxes were not completed with either initials or an appropriate code. The records of application of creams and gels were very poorly signed. One prescription read ‘28 senna tablets to be taken whenever necessary’. This prescription needs to be clarified with the GP. Staff spoken with were clear that any health change or concern about a resident would be reported to the senior nurse in charge. One resident had recently had a fall resulting in a fracture of the upper arm. Due to the site of the fracture it was not possible to apply a plaster cast but a sling to immobilise the arm was in place. During the inspection the resident was observed relaxing on a beanbag chair with a carer giving them a head massage. The carer said it was to keep the resident calm to prevent them wanting to wander and risk falling again as their balance was compromised by the sling. Oakwood House Residential And Nursing Home DS0000024464.V282972.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, 13, 15 People who use this service can expect to be offered appropriate activities, be encouraged to maintain contact with their family and receive a well balanced diet. EVIDENCE: The three personal files seen all contained contact details for the resident’s next of kin, the relationship to the resident and whether they were in regular contact or not. One resident said that their spouse visited every other day and stayed for two hours in the afternoon. A member of staff said that another resident, who has a number of grown up children, frequently had visitors who took them out in the nicer weather. There was evidence in the files of a variety of activities that had taken place over a period of time. It was noted for one resident that they ‘enjoyed a fish ‘n chip supper in the lounge’, another resident ‘watched Kismet from start to finish’. Minutes of staff and unit meetings record discussions about activities and social outings. A relatives’ questionnaire sent out in the last year recorded a high level of satisfaction with the opportunities for activities and hobbies offered in the home. Oakwood House Residential And Nursing Home DS0000024464.V282972.R01.S.doc Version 5.1 Page 12 A sample of the menus was seen and showed a wide range of dishes with a choice of cooked meals at lunch each day. On the day of inspection the main meal choice was pork and apple casserole or lamb tagine. One resident, when asked, said ‘on the whole the food is good but you occasionally get something daft like chicken with apricots!’. Another resident said they had had four slices of toast and some porridge for their breakfast that day. Staff were observed helping residents with their meal in a sensitive way. Oakwood House Residential And Nursing Home DS0000024464.V282972.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 People who use this service can expect that any complaint will be taken seriously and that they will be protected from abuse. EVIDENCE: The complaints log was seen and there were no complaints recorded since May 2005. CSCI has not received any complaints about the service since the last inspection. Last year twenty-three relatives questionnaires were sent out and eleven were returned completed. In response to the question ‘Do you know who to contact to make a complaint?’ nine out of the eleven replied ‘Yes’. Training records show that staff have undertaken POVA training since the last inspection. One recently appointed carer was very clear about their duty of care to the residents and how they would manage any suspicions of abuse. They said they knew what was right and wrong and would not tolerate anyone hurting a resident. Domestic staff spoken with were able to discuss potentially abusive situations and what action they would take but they have not undergone POVA training although they spend a lot of their time around residents and in their rooms. Oakwood House Residential And Nursing Home DS0000024464.V282972.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): 21, 22, 24, 26 People who use this service can expect to live in a clean environment with rooms that are personalised and specialised equipment available to help maintain their independence. EVIDENCE: Oakwood House is a purpose built home. There are three units within the home each caring for eight residents. All the residents’ rooms are single occupancy and have ensuite toilet and shower facilities. Each unit has an assisted communal bathroom. The units have a lounge and dining area and a small kitchenette to make hot drinks and snacks without going to the main kitchen. There is a large communal lounge off the main entrance to the home that was being used for training on the day of inspection. There are small seating areas throughout the home. The gardens are accessible from several doors and are secure. Oakwood House Residential And Nursing Home DS0000024464.V282972.R01.S.doc Version 5.1 Page 15 Two domestic staff spoken with during the inspection explained the system they used to prevent cross infection when doing their daily cleaning. The cloths that are used for different tasks are colour coded as are the mops and buckets used in different areas of the home. Protective clothing is available to them for ‘dirty’ tasks. The trolleys with their equipment and cleaning agents are securely locked away when they finish their work and the area was seen. There was a secure cupboard for storing surplus cleaning agents and the Control of Substances Hazardous to Health (COSHH) guidelines were in evidence. The domestic staff said that there are normally two or three domestic staff rostered each weekday and one domestic at weekends. They have a rolling programme of spring-cleaning residents’ rooms. They had done one that day that involved washing walls, furniture, linen and curtains. The maintenance person generally shampoos the carpet. All the residents’ rooms seen were clean and tidy. The décor was fresh and the rooms were personalised with individuals’ possessions and photographs. Some rooms had specialised pressure relieving mattresses on the beds and special cushions on the chairs. The level of satisfaction about the environment from the returned eleven relatives’ questionnaires was very high. The laundry was visited and was clean and tidy. A member of staff explained the process for managing soiled laundry to reduce the risk of infection. The washing machines have a sluice wash and there is an automatic cleaning agent delivery system so staff do not have to handle chemicals. Hand washing facilities seen throughout the home all had supplies of liquid soap and paper towels available. Oakwood House Residential And Nursing Home DS0000024464.V282972.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, 29, 30 People who use this service can expect to be cared for by adequate numbers of well-trained and correctly recruited staff. EVIDENCE: The duty rotas were seen and showed that there were two trained nurses on an early and a late shift with six carers. One trained nurse and three carers cover night shifts. The senior nurse on duty confirmed these numbers and other staff members said there were enough staff to meet the needs of the residents at present. Staff training records had evidence of a comprehensive induction covering moving and handling, fire awareness, health and safety, first aid and infection control. A newly appointed member of staff confirmed they had done all those subjects and that they were due to do POVA training the following week. After induction training covers other areas such as food hygiene, care of a person with dementia, COSHH, bereavement and Dining with Dignity. Trained nurses do medication administration and there was a list of recognised signatures and the relevant Personal Identification Number (PIN) for each nurse. The personal files of three members of staff were seen. Two contained evidence of enhanced Criminal Records Bureau (CRB) checks and POVA first check being done before the staff member commenced work. The third file contained a CRB check done for a different company two years earlier. Oakwood House Residential And Nursing Home DS0000024464.V282972.R01.S.doc Version 5.1 Page 17 This was raised with the senior nurse and the administrator. Before the inspection finished they were able to produce evidence that the correct checks had been made on that staff member prior to their commencement date. Other checks for identification were in order and each file contained three references. There was written evidence that employment history had been checked and each staff member had a contract for the hours they worked. Oakwood House Residential And Nursing Home DS0000024464.V282972.R01.S.doc Version 5.1 Page 18 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, 38 People who use this service can expect to be cared for by staff that are managed by a responsible person, however they cannot be assured that the present system for managing their personal money is secure or that practices in the kitchen follow food hygiene standards. EVIDENCE: The registered manager has a registered mental nurse (RMN) qualification and has managed this service for a number of years. Although they were not present at this inspection previous discussion with them demonstrated that they have a wide experience in the field of mental health and dementia care. Staff spoken with expressed confidence in the management of the home and said they felt able to approach the manager with any concerns. The record of maintenance checks was seen. It showed that hot water checks in all the bathrooms are done monthly and were all within safe limits. Oakwood House Residential And Nursing Home DS0000024464.V282972.R01.S.doc Version 5.1 Page 19 A health and safety check on the electrical intake room, the boiler room and the lift motor room was done in January 2006. There was evidence that all doors and the home’s security system, floors/carpets, windows and outdoor access were also checked for faults and function. All electrical appliances such as televisions, table lamps, radios and fans were all checked in November 2005. There was a contract for external window cleaning and one for safe disposal of clinical waste. In the kitchen the record of temperatures for refrigerators, freezers and food probes were seen and showed all to be within safe range. Some left over food stored in one of the refrigerators was not labelled to identify it or with a date to indicate when it was stored. The chef was observed to taste some mashed potato from between their finger and thumb and then continue work without washing their hands. The administrator explained the system in use for managing residents’ personal money. They explained that a new system is being trialled alongside the present one. Money kept on the premises is kept in a safe and the keys are secure and available to the manager and the administrator only. There are individual records for residents of transactions and receipts are kept and numbered. Two staff signatures are needed for each transaction. There is also a computer record that gives a total of the money that should be in the safe. The money was checked and did not tally. The administrator then realised that there were some further transactions that needed to be recorded but that would not have made the total tally. The computer recorded two other times since the beginning of the year when the total and money have not tallied. The policy of the home is only to retain a limited amount of money for each resident. Surplus money is banked in an account that keeps individual balances but pays no interest. Oakwood House Residential And Nursing Home DS0000024464.V282972.R01.S.doc Version 5.1 Page 20 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 1 Oakwood House Residential And Nursing Home DS0000024464.V282972.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? None STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP9 OP9 Regulation 13 (2) 13 (2) Requirement The signature boxes on MAR sheets must be correctly completed with initials or a code. Any prescription that is ambiguous must be checked and correctly written before administration of the medication. A method of ensuring that prescribed creams and gels are applied and signed for must be introduced. The system for managing residents’ personal money must be improved to reduce the risk of error of recording and allow an audit trail. The use of a central bank account that does not pay interest must be reviewed to allow the residents’ money to work for them while saved. Left over food stored in refrigerators must be correctly labelled and dated. Food hygiene standards must be observed at all times to prevent the possibility of infection. Timescale for action 08/02/06 08/02/06 3 OP9 13 (2) 28/02/06 4 OP35 16 (2) (l) 31/03/06 5 OP35 20 (1) (a) 30/04/06 6 7 OP38 OP38 16 (2) (g)(i) 13 (3) (4) (c) 08/02/06 08/02/06 Oakwood House Residential And Nursing Home DS0000024464.V282972.R01.S.doc Version 5.1 Page 22 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 Refer to Standard OP18 Good Practice Recommendations All ancillary staff should be included in POVA training. Oakwood House Residential And Nursing Home DS0000024464.V282972.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oakwood House Residential And Nursing Home DS0000024464.V282972.R01.S.doc Version 5.1 Page 24 - 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. 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