Inspection on 23/06/08 for Oakwood Nursing Home

This inspection was carried out on 23rd June 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Nursing Home 08/08/07

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Oakwood Nursing Home 8 The Drive Northampton Northamptonshire NN1 4SA Lead Inspector Stephanie Vaughan Unannounced Inspection 23rd June 2008 09:10 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 Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 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 Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakwood Nursing Home Address 8 The Drive Northampton Northamptonshire NN1 4SA 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) 01604 713098 01604 792762 oakwoodnursinghome@hotmail.co.uk Sanpas Ltd Mrs Patricia Blackburn Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No persons falling within the category of OP can be admitted to Oakwood Nursing Home when there are 29 persons within this category already accommodated within the home. The maximum number of persons that can be accommodated within Oakwood Nursing Home is 29. 8th August 2007 Date of last inspection Brief Description of the Service: Oakwood Nursing Home is a care home providing nursing, personal care and accommodation for 29 older people. The home has been owned by Sanpas since may 2007. Mrs Patricia Blackburn has been the manager for many years. The home is situated on the outskirts of Northampton in a residential area and is easily reached by private and public transport. There is parking available in the road outside the home. The accommodation is a converted two -storey house with the addition of an extension. There is a main lounge and small dining room on the ground floor. There is a mixture of single and shared bedrooms on both floors and some of them have en-suite facilities. The first floor can be accessed by stairs or by a passenger lift. There is a patio area with seating, which is accessible for the residents and wheelchair users. The current registration certificate from the Commission for Social Care Inspection is displayed in the reception area. The latest Commission for Social Care Inspection report is available in the manager’s office. The home can be contacted by telephone, fax or email. The fees range from £427.00 to £560.00 per week. There are extra charges for hairdressing, chiropody, newspapers and personal items such as clothing and toiletries. Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 5 Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is a 1 star. This means the people who use this service experience adequate, quality outcomes. Prior to this statutory inspection, a period of three hours was spent in preparation. This comprised reviewing the previous inspection reports and associated requirements, the service history and other documentation. Due to circumstances beyond the control of the provider the Annual Quality Assurance Assessment and associated Comment Cards were not available for use in the preparation of this inspection. However a small number of Comment card were handed out to residents, relatives and staff during the inspection and some completed ones were returned by the end of the inspection and the comments have been used to inform the inspection process. These indicated a good level of satisfaction with the service provided at Oakwood Nursing Home. The Commission have received one concern regarding the number of deaths occurring within the home during the winter months. The Commission have been monitoring the notification about deaths in the home and this was also followed up during the inspection. There is no evidence to support these concerns given that the home specialises in providing care to people with significant health problems and that the majority of deaths were anticipated. There has been one Safeguarding Adults allegation about this service; this has been referred for independent investigation under the Local Authority Guidelines for the Safeguarding of Adults and as yet the outcome is unknown. The Commission have a focus on Equality and Diversity and issues relating to this are also included in the main body of the report. This site visit to the home was conducted over a period of seven hours and 40 minutes during which the inspector made observations and spoke to residents and staff. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. Case tracking is the method used during inspection where of a sample of three residents were selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. Some of the residents’ case tracked had limited ability to recall their experiences and also Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 7 to communicate their views. In these circumstances observations are used to inform the inspection activity. The Registered Manager was not present during this inspection, however a provider representative was present during most of this visit. What the service does well: Arrangements are in place to ensure that people who might need to use the service have access to the right information so that they can decide if they would like to live there and that the service is able to meet their needs. Residents have access to the right health care services and professional specialists. Arrangements are in place to make sure that the residents’ health and well being is promoted. Residents were able to confirm that they felt well cared for and that the staff were responsive to their needs. Resident’s routines and preferences are known to staff and are generally well documented. Visiting is flexible and residents are supported to access the local community. Meals and meal times appear to be managed well. Residents are able to make choices regarding their meals and should be encouraged to be more involved with the menu planning. The food that is served appears to be well presented and of adequate proportion. Residents confirmed satisfaction with the food and also said that the staff knew their dietary needs and preferences. Residents say that the staff are nice to them and that they feel safe living at Oakwood Nursing Home. Resident’s rooms are well presented and are fitted with appropriate fixtures and fittings including call bells, radiator covers and other safety devices. Residents are able to personalise their rooms with small items of furniture and personal memorabilia. The home is clean and hygienic throughout. Staffing levels are generally good and recruitment practices ensure that residents are protected from abuse. Staff have access to mandatory training, and training specific to the individual needs of residents. The Registered Manager is registered and competent to run the service and the new providers maintain an active interest in the running of the home. Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: All written information needs to be reviewed to make sure that it is in the right formats so that people with differing needs can access it. Individual plans of care need to be further developed to ensure that they are specific to the individual and cater for all of their health, personal and social care needs. Daily records need to be more detailed to show how residents are cared for on a daily basis and are supported to make choices within their daily lives. Staff need to make sure that residents have all the right checks to make sure that they are cared for safely and protected from harm. Residents or their nominated relative should be enabled to be more involved in the development and review of the individual plans of care. Medication systems need to be reviewed to make sure that medication is stored appropriately at all times and that stock control systems are effective. Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 9 Arrangements need to be in place to make sure that residents are able to manage their own medication if they wish to do so and to demonstrate that they are able. Where medication is to be given by staff consent needs to be obtained from either the residents or their representative. Staff need to make sure that residents privacy and dignity is respected at all times and in particular when Movement and Handling practices are conducted within the communal areas. The management need to make sure that working practices comply with the Mental capacity Act 2005 and British Medical Association and Royal College of Nursing guidelines on ‘Decisions Relating to Cardiopulmonary Resuscitation’ Dated October 2007. Arrangements should be made so that residents can be involved in activities relating to the running of the home such as menu planning and planning the activities programme. Activities could be further developed according to the residents’ individual and collective preferences, one resident stated ‘ I would like to help out with a bit of washing up but I am not allowed in the kitchen because of health and safety’. Arrangements should also be made to avoid the last minute cancellation of scheduled activities. The complaints policy needs to be further reviewed to make sure that it has all the right information and that it is up to date. The staffing mix needs to be reviewed to ensure that residents are able to be cared for by members of the same gender. Staff training should be reviewed to enable staff to access more external accredited training for the full range of mandatory subjects and this should be evidenced within staff files. Staff supervision has been commenced however this should be further developed, in addition to the provision of training and updating to also include processes to monitor staff performance and development. The management of resident’s money needs to be reviewed to make sure that the appropriate records are maintained. The management need to make sure that dangerous chemicals such as cleaning products and dental cleansing agents are stored appropriately at all times. Please contact the provider for advice of actions taken in response to this Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 10 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 11 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 Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service receive clear information to enable them to make a judgement about whether or not they might wish to live in the home. EVIDENCE: Following a Requirement made at the last inspection the Statement of Purpose has been reviewed and contains information about the age range of the residents to whom it provides a service. The service provides access to the Statement of Purpose, Service Users Guide and a brochure and these are available within the home. The information is Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 13 provided in the English language and as such is appropriate for the existing residents. The management are mindful of the need to keep this under review and ensure that information is accessible to residents who may have other first languages or require information in other formats such as large print and pictorial easy read versions. The Statement of Purpose is available on request within the home and staff were able to confirm that the contents of our reports are made available and discussed at team meetings. Residents were able to confirm that they had information about the home before deciding whether they would like to live there. The service specialises in palliative care and admits many residents from the hospital setting as such they are often unable to visit the service themselves before deciding whether they would like to live there. However they were able to confirm that their relatives had been able to visit the home on their behalf to meet the staff and view the facilities. This was also evident through observations made during the inspection. A management representative was able to confirm that following changes to the ownership of the home that all residents have new individual contracts in place. Individual plans of care evidenced that prospective residents are assessed before they are admitted to the home to ensure that the service is able to meet the individual’s needs. In addition there is also evidence that the service obtains assessments conducted by the funding authorities. Both these assessments form the basis for the individual plans of care. Residents were able to confirm satisfaction with the homes admission processes and say that they were supported to settle in by the staff who were welcoming and friendly. The service does not provide intermediate care. Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 &11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls in the management of health, personal care and social care mean that the resident’s needs and wishes are not consistently met and have the potential to put residents at risk. EVIDENCE: Individual plans of care contain instruction to staff about how the resident needs and wishes to be cared for. In general these address the resident’s health, personal and social care needs and include some information about residents preferences such as their preferred name. Additional information about the resident’s preferences regarding personal care and preferred routines such as times of rising and retiring to bed are included in a separate file within the resident’s individual accommodation. Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 15 Individual plans of care are of a standardised format these need to be further developed to ensure that they are person centred and include specific information about the individuals needs. For example one of the resident case tracked was of a different ethnic and cultural background, there was no information in the individual plan of care about how the resident was to be supported in the maintenance of their ethnicity and culture. The daily records are in general basic and include statements such as ‘care given’ and ‘all care given as per care plan’. Both individual plans of care and daily records need to be further developed to ensure that they demonstrate how people are supported to make choices within their daily lives and to ensure compliance with the Mental Capacity Act 2005. Individual plans of care evidenced that residents have basic risk assessments in place for falls, however although these identify whether the risk is high, medium or low they fail to demonstrate how these risks are to be reduced or managed. In addition there is also a very basic tick box system that shows whether a resident requires the use of bedrails, these require further development to ensure that the rationale for the use of bedrails is specific to the individual and shows how the associated risks such as entrapment and potential restraint are to be reduced or managed. Also some of the residents in the lounge are cared for in reclining chairs and there are no risk assessments in place to reduce or manage the risk of choking or potential restraint. There is some evidence that residents representatives are involved in the care planning process in that their written consent is obtained for the use of bedrails and that they are asked to provide information about the extended family, previous lifestyles and interests. However there is no evidence that arrangements are in place to involve the individual residents if they are able and wish to be involved. There is evidence that individual plans of care are reviewed by the staff on a regular basis. Individual plans of care evidenced that residents are supported to access health care services such as hospitals, General Practitioners, Continence Services, Community Psychiatric Nursing Services, Speech and Language Therapists, Opticians, Dentists and Podiatrists. Individual plans of care contained information to staff about the residents oral heath needs and there was evidence that this is carried out well. Residents are also assessed for the risks associated with pressure and nutrition. Both of these risk factors appear to be managed well, residents have access to appropriate pressure relieving equipments and nutritional supplements to support their well-being. Residents were able to confirm that they felt well cared for and that the staff were responsive to their needs. Relatives were also able to confirm satisfaction with the care that is provided by the service. Residents appeared well cared for and were well presented. Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 16 Medication systems were reviewed; in general the storage of medication is satisfactory with appropriate and dedicated storage for controlled drugs however none of the residents require the use of these drugs at the present time. General stock appears to be in appropriate quantities and is stored within a locked cupboard. Other medications are stored in an appropriate trolley, which is kept locked and chained to the wall when not in use. However there were two large bottles of pain reliving liquid medication, which had been left on the bottom of the trolley in between medication rounds. This was brought to the attention of the nurse in charge who ensured that they were stored securely and she also brought it to the attention of other nursing staff. Medication Administration Records were reviewed and seen to be in good order indicating that residents receive their medication as prescribed. However the medication is supplied to the service in boxed containers rather than a monitored dose system. Although in some instances the dates of opening are recorded on the boxes or bottles this is not consistent. Staff need to ensure that there is an appropriate stock control system in place to ensure that medication can be accounted for in relation to the amount dispensed, the amount administered and to demonstrate an accurate balance. There is some evidence within the individual plans of care that residents are assessed for their ability and wishes to self medicate, currently this tends to show when they are considered to be unable to do so. However there is no evidence of any documented rationale to show how this judgement is reached and at present there do not appear to be any procedures or facilities in place to enable residents that might be able and wish to manage their own medication. There is no evidence that consent is sought from either the resident or their representative for the staff to administer medication on their behalf if the resident is unable or does not wish to manage their own medication. Privacy and dignity is generally managed well, staff were seen to relate well to residents and to address them by their preferred name, to knock on their bedroom doors before entering. One resident was able to confirm that they received their mail unopened and that staff were respectful of their privacy and dignity. Screening is provided to protect resident’s privacy in the main lounge for Movement and Handling purposes, however there were occasions during the inspection when this was not used. This was discussed with senior staff and management who agreed to ensure that this was addressed with staff. The service specialises in palliative care and the staff are trained in the use of systems designed to support residents through terminal illness. Resident’s needs are monitored on a regular basis and interventions are documented. Some of the files contained evidence of decisions made in hospital regarding the resuscitation of residents in the event of collapse. The service needs to ensure that the management of these instructions are reviewed and Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 17 maintained in accordance with the British Medical Association and Royal College of Nursing guidelines on ‘Decisions Relating to Cardiopulmonary Resuscitation’ Dated October 2007. Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have their social, spiritual and nutritional needs met. Their views are taken into consideration and acted on. EVIDENCE: There is evidence that routines are flexible within the home and that residents preferences are recorded and are known to staff. Residents are supported to maintain their faith should they wish to do so. The Individual plans of care contain life histories about the resident’s previous lifestyles and interests, these help to inform staff about the types of activities that residents might wish to have in the home. A calendar of activities is displayed in the main sitting room and shows a varied programme, activities in which residents participate are also recorded in the individual plans of care. Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 19 Feed back from staff and residents is that the activities programme could be further developed to ensure that residents receive more opportunities for stimulation and entertainment. One resident stated ‘ I would like to help out with a bit of washing up but I am not allowed in the kitchen because of health and safety’. During the inspection the scheduled activity was not provided due to a staff member being off sick, another on leave and other demands on the staff time. However residents are able to receive their chosen visitors, have access to appropriate music in the morning, television for short periods in the afternoon and access to newspapers and magazines. One resident stated that ‘there are often activities going on but I choose not to take part. Sometimes staff take me out to the shops or activities at the local church, we are having a summer fete soon so we are getting ready for that’. Residents spoken to could not recall whether there were regular residents meetings in the home to enable them to make decisions about the activities programme and the menus. However discussion with staff indicated that consultation with residents tends to be through individual contact on a one to one basis and the views of residents are known to staff. The residents’ are not currently involved in activities relating to the running of the home such as menu planning, however the preferences of individuals are known to staff and are used when planning the menus. Lunchtime service and teatime service were viewed. Residents are able to select from two choices and the meals appeared to be of adequate proportion and to offer a varied and balanced diet. Residents requiring assistance were supported by staff with patience and sensitivity. The service accommodates residents who require special diets. Residents spoken to were able to confirm satisfaction with the food provided and also to say that their individual preferences were catered for. Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are systems in place to enure that people are able to voice their concerns and that residents are protected from abuse. EVIDENCE: Residents spoken to were able to confirm that they knew how to complain and felt confident that their views would be listened to and acted upon. The service has a complaints procedure a summary of which is displayed it the main entrance of the home and is also included in the Service Users Guide and Statement of Purpose. Although this information has been amended since the last inspection some of the contact details are either missing or out of date. This was discussed with management who have agreed to ensure that the information is updated and that it complies with the criteria set out in the National Minimum Standards. The existing residents are English speaking however the management are mindful of the need to ensure that information is made available to people who may require the information to be produced in different formats such other languages, large print, easy read and other formats for the visually impaired. Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 21 Residents spoken to were able to confirm that they felt safe living at Oakwood Nursing Home and that the staff were nice to them. Staff spoken to had a good understanding of their responsibilities in the Safeguarding Adults and were also able to confirm recent training in the Safeguarding Adults. There has been one Safeguarding Adults allegation since the last inspection, this has been referred for independent investigation under the Safeguarding Adults Guidelines and as yet the outcome is unknown. Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite improvements to the environment the limitations of the communal areas continue to impact on the lifestyle of the people who use the service. EVIDENCE: Residents spoken to confirmed that they felt comfortable living at Oakwood Nursing Home, however the home is an extended period property, which at present has some limitations of which the new management are aware. Since the change of ownership some refurbishment has been undertaken, including the replacement of carpets throughout the home, new curtains in the Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 23 lounge and decoration of some of the bedrooms. In addition a new wet room has been fitted to ensure that people who require the use of wheelchairs are able to access appropriate shower facilities. The management are currently reviewing other opportunities for improvement including arrangements to the lay out of the communal areas and possible relocation of the office to increase the space. At present there is one lounge with the office located at the far end this in effect renders the narrow sitting room as a corridor with residents seated on either side. The lack of space does impinge on the resident’s personal space and presents staff with some challenges regarding the protection of resident’s privacy for example the use of screens when conducting Movement and Handling techniques. There is a separate dining room however this is generally not used by the existing residents as it also has doors on either side and is used a thoroughfare and for temporary storage. Management have confirmed that they are also reviewing the use of this space with the possibility of using it as a quiet area. Despite being in a period building with steps up to the front door of the main entrance, portable wheel chair ramps are available to ensure that wheelchair users are able to access the building and external courtyard area should they wish to do so. All other areas of the home are accessible to wheel chair users. A sample of residents rooms were viewed and these evidenced individual furnishings and fittings and also personalisation. All radiators are fitted with appropriate covers and door guards have been fitted to enable residents to have their bedroom doors open should they wish to do so. Individual plans of care evidenced that residents are assessed for their ability to have a key to their rooms. Staff confirmed that all equipment was well maintained and that there were adequate supplies of hot water. The home was clean and hygienic throughout. Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment procedures are robust and staff have access to training, which ensures that residents are in safe hands. EVIDENCE: Residents spoken to confirmed that the home was generally well staffed and ensured that their needs were met. One resident commented ‘ the staff are very nice and they treat me like I was one of the family’. The Staffing levels are calculated according to the assessed dependency levels of residents. The Management ensure that there is at least one registered nurse on duty at all times and the current staffing levels are two nurses and five care during the morning. One nurse and four carers during the afternoon and evening and one nurse and two carers at night. The staff group in general are representative of the culture and ethnicity of the existing residents. However the staff group are currently female which means that male residents do not at present have access to carers of the same gender. Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 25 Staff spoken to were able to confirm appropriate recruitment practices and this was confirmed by a review of staff files. Each file contained evidence that the appropriate clearances are obtained before staff commence employment within the home. Files also evidenced that appropriate references are obtained undertaken before staff commence employment. Staff files evidenced that staff receive a comprehensive induction training and also access to mandatory training such as Fire Safety, Basic Food Hygiene, Health and Safety, Safeguarding of Adults and Movement and Handling. However the records indicates that in the main this training is conducted ‘in house’ using videos and a questionnaire to demonstrate acquired knowledge and competence. However nursing staff were able to confirm that they had had recent access to training in the Safe Administration of Medication and one staff member indicated that they had had first aid training and infection control training during at a previous place of employment. Staff files need to be reviewed to ensure that staff receive all of the required mandatory training in a timely way and preferably from external accredited sources. Staff files evidenced that staff have access to training specific to the needs of the individuals including topics such as palliative care, catheterisation and wound care. Discussion with management identified that the management are in the process of arranging training of the staff in the care of residents with dementia. Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate leadership, guidance and direction means that the service is managed in the best interests of the residents. EVIDENCE: The existing Registered Manager is appropriately qualified and has many years experience of managing Oakwood Nursing Home. The home changed ownership in 2007 and the new management team have made some improvements to the way in which the home is run. Both residents and staff confirmed that the management is approachable and are responsive to the needs of the people who use the service. One relative stated that they had Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 27 been very happy with the way that their relative had been cared for at Oakwood Nursing Home. The new owners have developed quality assurance processes, residents and their relatives have been surveyed to establish their views of how the service is run and to identify areas for improvement in the service delivery however the surveys have not yet been returned. Regular audits are conducted regarding the standard of the environment, significant improvements have been made and further improvements are being explored. There was evidence that health and safety checks are conducted such as the temperatures of the hot water supply and routine fire checks. The Registered Manager is responsible for ensuring that medication systems are safe and effective and that care plans are regularly reviewed. Through discussion with management it was established that some residents manage their own money if they are able. Otherwise the service obtains services on their behalf and the bill is sent to their representative. The service does not routinely hold money for safe keeping on behalf of residents and this is specified in the Statement of Purpose. However a small amount of money was found to be stored in the controlled drug cupboard for two residents. Although these were in individual containers there was no record of the money having been received or any record of expenditure and receipts. Management confirmed that they would review the arrangements to ensure that if money is held for safe keeping that the appropriate records are maintained and monitored. Staff files evidenced that regular staff supervision was being conducted, however this appears to focus on specific training rather than monitoring how staff are fulfilling their roles in compliance with the job descriptions for which they are employed. The environment appeared in general to be safe, however two potential hazards were identified. One of the residents had a dental cleansing agent, which was not appropriately secured nor was there any risk assessment in place to ensure that this was managed appropriately. However it was identified that these were not required by the resident at the present time and were removed during the inspection to ensure safekeeping. In addition a cleaning product was left unattended in the main entrance during the inspection. This was discussed with staff and the appropriate action was taken to ensure that the product was removed. Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 28 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 2 3 X 2 Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 29 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 13.4 Requirement Risk assessments for falls must be further developed to ensure that they comply with the current best practice and the guidance issued by the Health and Safety Executive. To ensure that the risk of residents falls is reduced and managed. Detailed risk assessments based on the guidance issued by the Health and Safety Executive, for falls from the bed must be conducted to ensure the health and safety of residents. Residents who are assessed as requiring the use of bedrails must also be assessed for the risks of entrapment and potential restraint. To ensure the health and safety of residents. Detailed risk assessments must be developed for the risks of choking and potential restraint for residents who are cared for in reclining chairs Medication systems must be reviewed to ensure the safe storage of medication at all times. To ensure the safe DS0000069630.V366969.R01.S.doc Timescale for action 01/08/08 2. OP7 13.4 01/08/08 3. OP7 13.4 01/08/08 4. OP7 13.4 01/08/08 5. OP9 13.2 01/08/08 Oakwood Nursing Home Version 5.2 Page 30 6. OP9 13.2 7. OP10 12.4 8. OP16 22 9. OP30 18 10. OP35 13.6 11. OP38 13.4 12. OP38 13.4 administration of medication. Medication systems must be reviewed to ensure that there is a clear audit trail of medicines received into the home, the amount administered and the remaining balance. To ensure the safe administration of medication. Resident’s privacy and dignity must be respected at all times, including during Movement and Handling techniques conducted within the communal areas. To ensure the privacy and dignity of residents. The complaints policy must be reviewed to ensure that it has all of the right information and has up to date contact information included. To ensure that residents and their representatives have access to accurate information. Staff files must evidence that all staff received timely mandatory training. To ensure the health and safety of residents. Accurate records must be maintained by the service when resident’s money is held for safe storage. To ensure that residents are protected from financial abuse. Risk assessments must be conducted for residents who choose to use dental cleaning agents. To ensure the Health and Safety of residents. Arrangements must be made to ensure the safe storage of cleaning products at all times. To ensure the Health and Safety of residents. 01/08/08 01/08/08 01/08/08 01/08/08 01/08/08 01/08/08 01/08/08 Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 31 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 OP1 Good Practice Recommendations Written information, such as the Statement of Purpose and Service Users Guide should be reviewed to make sure that it is in the right formats so that people with differing needs can access it. Individual plans of care should be further developed to ensure that they are person centred and provide detailed instruction to staff about all of the individual’s health, personal and social care needs. Daily records should be more detailed to show how residents are cared for on a daily basis and are supported to make choices within their daily lives. Arrangements should be in place to ensure that residents or their nominated representative are enabled to be involved in the care planning and review process. Arrangements should be made to ensure that residents are able to self medicate should they wish to do so. Including appropriate risk assessments and the provision of lockable storage facilities. Where a residents is either assessed as being unable to self medicate or chooses not to do so written consent should be obtained from the resident or their nominated representative. Individual plans of care should be reviewed to ensure that they comply with the Mental capacity Act 2005 and British Medical Association and Royal College of Nursing guidelines on ‘Decisions Relating to Cardiopulmonary Resuscitation’ Dated October 2007 Arrangements should be made to enable residents to be involved in activities relating to the running of the home such as menu planning and activities planning. The activities programme should be further developed to reflect the individual and collective interests of the residents. Arrangements should also be made to ensure that scheduled activities are not cancelled because of the other staff commitments. Recruitment practices should be reviewed to ensure that residents are able to receive care from staff of the same DS0000069630.V366969.R01.S.doc Version 5.2 Page 32 2. OP7 3. 4. 5. OP7 OP7 OP9 6. OP9 7. OP11 8. 9. 10. 11. OP12 OP12 OP12 OP27 Oakwood Nursing Home 12. OP30 13. OP36 gender. Staff training should be reviewed to enable staff to access more external accredited training for the full range of mandatory subjects and this should be evidenced within staff files. Staff supervision should be further developed to include processes to monitor staff performance and development. Oakwood Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: 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 © 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 Nursing Home DS0000069630.V366969.R01.S.doc Version 5.2 Page 34 - 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. 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