Inspection on 14/05/07 for Oakwood Rest Home

This inspection was carried out on 14th May 2007.

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 Rest Home 05/06/06

Oakwood Rest Home 20/03/06

Oakwood Rest Home 19/09/05

Oakwood Rest Home 17/02/05

Oakwood Rest Home 16/09/04

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

CARE HOMES FOR OLDER PEOPLE Oakwood Rest Home 78/82 Kingsbury Road Erdington Birmingham B24 8QJ Lead Inspector Monica Heaselgrave Key Announced Inspection 10:00 14th May 2007 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 Rest Home DS0000056587.V336735.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 Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakwood Rest Home Address 78/82 Kingsbury Road Erdington Birmingham B24 8QJ 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) 0121 373 8476 0121 382 9167 Unity One Ltd Miss Samera Iqbal Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP 30) The maximum number of service users to be accommodated is 30. 5th June 2006 2. Date of last inspection Brief Description of the Service: Oakwood Rest Home is a Residential Care Home providing residential care for up to thirty older persons. The home is situated on the Kingsbury Road, close to bus routes to Sutton Coldfield and Birmingham. It is a short bus journey from the shopping centre of Erdington, where there is a range of local facilities. Oakwood Rest Home was originally three adjoining properties, and provides accommodation on 3 floors, accessible by a shaft lift. The accommodation comprises of twenty single bedrooms, fourteen with en suite facilities and five double rooms, all with en suite. There are 2 lounges, and a dining room that is situated off the large main lounge. Bathing and toilet facilities are situated on all floors of the home. There is a car park at the front of the building, and at the rear, there is a large enclosed garden. Access to the garden is gained via the large lounge. The fees at the home are single room £332. Single en suite £346.00. Double £314.00 per week. A Top-up fee of £20.00 per week applies to some residents. Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection was carried out over one day in May 2007. During the course of the inspection a partial tour of the home was made, three staff files and seven care files for the people living in the home were sampled as well as other care and health and safety documentation. The inspector observed lunch, the medication round and spoke with the manager, deputy, owner and three staff members. Prior to the inspection a completed pre inspection questionnaire had been returned to the Commission that gave additional information about the home. Information taken from the CSCI service history for Oakwood has been used to inform this report. There were twenty-seven residents being cared for; a number of these people were spoken with to obtain their views on the service. Visiting families and friends were spoken to on the day of the visit, as well as a visiting district nurse. Following the visit to the service the inspector contacted some relatives by telephone in order to obtain their experiences of the service. The comments received were very positive. The procedures in place to protect the health and safety of service users was looked at, this included seeing recruitment information, staff rotas, training plans and certificates relating to the maintenance and servicing of equipment. What the service does well: People are actively encouraged to visit the home and experience the facilities before they make a decision to move in. New residents said that this helped them to make up their mind because they liked what they saw. There is a good system for involving residents and their relatives in assessment and care planning, which is comprehensive and thorough. This ensures that the preferences of residents in relation to their preferred care routines, choices and the way they like to be cared for is recorded and staff know how to deliver this care. For instance ensuring people have authentic cultural meal choices and access to religious services and contacts of their choice. There are positive approaches to promoting health care. There is good followup with doctors and other professionals to ensure any health care needs are acted on without delay. There are good practices in place to manage the risk of falling. This has led to a significant decrease in the level of falls and clear management plans are in place to guide staff in this area. Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 6 Routines are flexible enough to enable the people living in the home to make some choices. People are provided with a variety of activities according to their preferences and wishes. An activities worker is available and has developed an activities list. Oakwood have introduced ‘pub lunches’ and had two successful parties, for Halloween & Christmas. All enjoyed these events. Meals are varied and nutritious. The menu was compiled with the help of a dietician. Specific cultural food preferences were included which suggests the home considers residents religious, and cultural needs. Residents particularly like the afternoon fruitcakes such as; apple and cinnamon cake, banana tea bread, date and raisin tea bread, sultana cake and fruit cake. This is a very positive approach to increasing fruit intake for older people. Oakwood provide staffing levels above the required standard, which means residents’ needs can be met in a safe and flexible manner. There is a stable staff team who know the needs of the residents, and provide good continuity of care. The people living in the home made positive comments about the staff team and friendly relationships were evident. Staff was well trained and worked well as a team. The staff spoken with was very knowledgeable about the individual needs of the people living in the home. The manager ensured the smooth running of the home in a competent manner. The health and safety of the people living in the home and the staff were well managed. Residents are supported and protected by recruitment practices, which ensure the required checks are carried out prior to staff taking up post with vulnerable people. Oakwood Rest Home is a safe, comfortable home in which residents say they are happy. What has improved since the last inspection? People are provided with good information about the home, which would help them to make a decision as to whether the home can meet their needs. This is in easy read formats such as large print and bold type there is also an audiotape for those who would require it. The owner has extensively refurbished the entire environment including new equipment and furniture. Residents enjoy a home that is clean, homely, and newly redecorated. Relatives and residents commented favourably on the improvements made in the last twelve months. The owner has implemented various feedback mechanisms so that he can Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 7 seek the views of the people who live in the home, on the service provided. This has included holding parties where people can come together and enjoy themselves whilst also getting to know the owner, manager and staff team. A suggestion box has also been placed near the entrance so that people have the means to put their comments forward. In the last twelve months the owner has been consistent in ensuring that monthly audits of the care practice take place and that a copy of this is forwarded to the Commission. This further enhances the protection of service users. A training program, with particular emphasis on mandatory training as a priority has been implemented. New staff undertakes induction training in line with the specifications laid down by Skills for Care to ensure they are equipped with all the necessary skills and knowledge to care for the people living in the home. The manager had completed the Registered Manager’s Award giving her a recognised qualification for managing the home. The manager has started to create a folder with details of local centres and contacts for people from different cultures. This will further enhance the opportunities available to people who live at Oakwood. What they could do better: Some minor improvements to the details in the manual handling risk assessments and the continence management plans, is needed. These should say exactly what type of support is needed so that residents are supported in a safe manner and that staff have good instructions, to help them provide the care. To further develop the range of activities and outings for residents so that they have opportunities that are stimulating and enjoyable. Implement a formal Quality Assurance System. This has actually now been purchased and expected to be implemented within the next three months. The owner has stated that they wish to further develop the care plans based on the concept of Person Centred Care, and that key staff will be trained in this so that the care plans can be specifically tailored to the individuals needs. There have been some successful social gatherings for residents and their families this is a good initiative for including people. The owner intends to hold more of these to further to promote the community ethos of Oakwood. To continue the refurbishment program and complete the replacement of Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 8 carpets/flooring to the the entire premises. 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. The summary of this inspection report can be made available in other formats on request. Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 9 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 Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 10 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): 1,2,3,4,5 & 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 are provided with good information to assist them in deciding if the home is suitable for their needs. There is a comprehensive assessment and care planning procedure which means people can test drive the service and be confident they are in the right care environment where their needs can be met. EVIDENCE: The care files of seven residents were viewed, each had a contract specifying the terms and conditions of residency and the fees to be paid. Contracts are important to inform residents or their representatives of the terms and conditions of the resident’s stay and the cost of that stay. All service User contracts were signed and in place. A Statement of Purpose and Service User Guide including complaint procedures has been provided to service users and their relatives. Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 11 A copy of the latest inspection report is normally on display, a new encased notice board has been purchased, and the manager said that when the decorating had finished, the reports and other information would be displayed here, she showed the inspector photographs of each member of staff which were waiting to be displayed, this is a really nice way to keep people in the home informed as to who their carers are. The Statement of Purpose and Service User Guide provide good information for residents. These documents are available in different formats suited to the needs of people who may have impaired vision. This included; audio format and large print and bold font which makes it easier to see. It was positive to see that residents had all been provided with a copy of these. A full assessment of need is undertaken for each new resident referred to the service. Each care file contained an assessment of their needs provided by the referring agent, usually the social worker. These had been developed into a comprehensive assessment undertaken by the manager and the deputy. The inspector spoke to residents including those who had recently moved into Oakwood. They confirmed that they were able to spend time at the home to assess the facilities and suitability of the home. This also enables staff to see the person in the care environment and assess whether they can meet the needs of the person. The most recent person to the home said that she and her son had preferences for the room and assistance to bring in personal possessions and furniture. She said, ‘They have been really wonderful, my own furniture makes it more like my own room, and it’s nicely decorated and comfortable, my son likes it too.’ The inspector spoke with a district nurse and relatives all confirmed that in their opinion Oakwood offered a caring, and professional service with good standards. The files of the service users case tracked showed that they and or their family were consulted on all aspects of their care. This normally takes place at a ‘family meeting’, when relatives and staff come together shortly after admission to explore the needs of the resident. It was positive to see that consultation with service users and their families is recorded. This has been particularly important as some people in the home have dementia, and or memory loss and are unable to recall their preferences. One family spoken with said ‘it was nice to be able to tell the staff how mom likes things done, and what’s she’s used to, she has little routines like a jug of juice by her side because she likes a drink but can’t see.’ Residents’ religion was recorded on all care files looked at and the inspector noted that representatives of the local church attended the home. There are Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 12 currently 13 men and 14 women being cared for, the majority being white British, with a few people from Irish, and Jamaican ethnicity. The staff team reflect the ethnic diversity of the residents and the Care Needs Assessment prior to admission further highlights any particular preferences that need to be catered for. It was positive to see that care plans identify if a resident prefers to be assisted by a male or female. Male staff are employed which enables people to have a choice as to assists them. Specific cultural food preferences were also recorded, and Akkee. Plantin, mackerel, sweet potato, herbs and spices were available in the kitchen. This suggests the home considers residents religious, and cultural needs. A number of residents have some memory loss and or dementia although this is not part of the home’s conditions of registration. The manager has ensured that all staff has had training in the management of care and activities for residents with dementia. This means that residents’ needs are met well in this area. Oakwood does not provide intermediate care. Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 13 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,and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has demonstrated that it meets the needs and manages the risks of the people who live there. There are positive approaches to meeting the health care needs of people. Some minor improvements are needed in relation to the manual handling risk assessments and the continence management plans, this will ensure that residents are supported in a safe manner. EVIDENCE: It was evident that a lot of work had been undertaken to develop comprehensive care plans. All the files included a detailed assessment of daily living needs that identified the individuals’ needs and where they required help, what they were able to do for themselves and their likes dislikes and preferences. Information can be retrieved easily and this assists staff to know what care was to be given. Family and or other professionals as far as possible have been involved in this process. Care files for seven residents were looked at. These included both a risk assessment and relevant clinical guidelines. For example, one person had a full hospital assessment relating to mental health. There are many health care Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 14 problems such as diabetes, hypertension, and high cholesterol. There are periods of self-neglect and verbal and physical aggression. The appropriate mental health team input is evident and clinical advice followed. This has meant that staff were recently able to recognise the signs of deterioration and seek support without delay. One person was described as doubly incontinent and having advanced dementia, her care plan described the interventions to be used and the triggers to her mental health. There was good information to show how staff should approach her and reassure. Incontinence advice from the continence team had been sought but not specifically detailed in the care plan. Discussions with staff demonstrated a good understanding of these needs, they were able to describe the incontinence programme in place so the outcome for the resident was good, but must ensure that this detail is in the care plan, to include the frequency of changing, and the size of the pad used. Assessments were undertaken for risks such as moving and handling, nutrition and risks of skin getting pressure sores and these were reviewed. The residents’ bedroom was viewed and pressure reducing cushions and mattresses were in use to minimise the risk of pressure sores developing. Moving and handling assessments did not give enough detail. Plans looked at stated ‘ use hoist provided’. The specific details for using the hoist to support people need to be described, such as which hoist, what sling size is to be used, to safely transfer from one place to another. The inspector spoke with staff and was satisfied that they did have this knowledge and consistently described the level of support to be given, however the care plan lacked the specific detail and this is needed to ensure that residents receive care that is personal to their needs, and keeps them safe. Residents were found to have aids available that were described in the care plans such as hearing aids, glasses, dentures and walking frames, pressure reducing cushions and mattresses were in use to minimise the risk of pressure sores developing. Referrals to the dietician to manage weight and high cholesterol were evident. The support required was detailed in the care plan and a tour of the kitchen showed that a list of suggested replacement foods was evident to include, skimmed milk, reduced sugar desserts, sugar free juice, and fresh fruit. A Diabetic menu was also seen for breakfast to include a variety of cereals and fruits. Weight records for all seven residents were consistent in their recording and all showed a weight gain, some residents had been quite frail and now have a healthy weight. All seven files had a good section relating to health care treatments and their outcome, this demonstrated that any health concerns are recorded and reported to the G.P for follow up and that the outcome of the consultation is recorded, this ensures that the changing needs of residents are well managed and records updated, for instance one person had seen the Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 15 chiropodist, dentist and optician. He had also visited the hospital for an eye problem. A falls register was seen. Records relating to this were seen to be comprehensive in their detail and included the advice of the district nurse on how to minimise the risks. The risk assessment was specific, stating that no bedsides should be utilised, rather soft mattresses provided on each side of the bed to soften any fall. Evidence of updating information and changing actions appeared on care plans, as and when the district nurse visited these actions were reviewed and recorded, this included regular nightly checks being implemented for both service users to ensure their safety. The district nurse record was seen and corresponded with the risk assessment drawn up for two service users at risk of falling. A discussion with the visiting district nurse also confirmed good practice, staff were described as ‘responsive to needs and able to follow guidance given’. Staff were said to be ‘helpful and professional ensuring consultations were held in the privacy of the residents’ own room.’ A falls register is kept entries were checked and were cross-referenced with regulation 37 and accident reports seen in the home. The recording and reporting of these was good. There has been a significant improvement in the actions taken for the prevention of falls. The provider had audited the falls register, on a monthly basis copies of which are regularly sent to the Commission. These reports were viewed by the inspector and show that feedback from District Nurses, residents and Social workers is sought, all of which speak highly of the care planning and health care arrangements at Oakwood Rest Home. The relatives advised that the staff always inform them about any changes to health and arrange medical care such as arranging a doctor to visit. Residents were seen to dress differently and have different hairstyles. Their clothes were clean and general appearance is good and well groomed. Oakwood have explored service provision to ensure that issues of diversity are promoted in their practices. The AQAA completed by the provider provided many positive examples of how diversity is addressed within the service. This information was sampled during the visit and the inspector confirmed that gender care is assessed and where the resident prefers to be assisted by a male this is specified and in some instances addressed. Recruitment practices reflect equal opportunities. An employee who has a disability has made a successful and positive contribution to the staff team. Information has been provided in formats for those that may have sight or reading difficulties. Religion & Belief is assessed. An example of this is an Asian couple that were practising Hindus. Meals appropriate to the religious belief were provided throughout their stay, and they were also to carry out their prayers including the use of incense sticks (with appropriate Risk Assessments being carried out). Currently the service meets the needs of a West Indian Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 16 resident, and recently a Chinese resident, for whom they organised a Chinese newspaper and native dishes were prepared for his individual requirements. The inspector met a resident who is of Irish origin. Unfortunately his needs had not been identified as potentially being any different from other white European residents. For instance he did not have access to local contacts or centres for Irish activities, or access to reading material which he may choose to read such as ‘The Irish Post’ ‘The Craig’ or ‘The Harp’, and the menu did not reflect any authentic Irish dishes such as bacon and cabbage or white pudding or soda bread. The care plan could be developed further, by exploring these areas with him to identify his preferences and wishes. His bedroom was viewed, the bedding and pictures were pleasant, and gender appropriate but his surroundings could perhaps have included pictures from surroundings he was familiar with, for example Irish landscapes. The provider was keen to explore these areas and has decided to set up a folder, which will be used as a database for any future placements that may require different cultural contacts or activities. The inspector spoke to some of the people living in the home they did not raise any issues in relation to their rights to privacy. Shared bedrooms had screening to protect privacy and some had en-suite toilet and washing facilities, which further enhanced privacy. All residents could have keys to their rooms if they wished. There were several areas in the home where individuals could meet their visitors in private if they wished. There was a telephone for the use of the people living in the home. Relatives said that when residents need assistance staff are on hand. They described good personal care routines that respect their privacy for instance closing doors, enabling individuals to maintain some aspects of their personal care independently. Residents said they see the GP in the privacy of their own room. Relatives spoken to say that the physical care has been good. Although one said at times more care could be taken with regard to ensuring her mothers’ hearing aid is switched on, and that her trousers are the right way round as she likes to have tissues in her pocket and can’t find the pocket. This was discussed with the manager. The inspector also noted that there is a prompt sheet in the ladies bedroom. The manager said that the lady often fiddles with the hearing aid, which could result in her switching it off. The manager has decided that a named staff member will be delegated as responsible to ensure these points are checked. This should ensure that the dignity of the resident is promoted. One service user was observed to have difficulty in maintaining his dignity. This was discussed with staff that said that throughout the morning he had been prompted several times. Whilst this is a difficult issue, staff need to be more vigilant when he is coming to the table in order to protect his dignity. A discussion regarding clothes that might be more suitable took place staff said they would explore this further. Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 17 The home uses a monitored dosage system. Medicines are dispensed in blister packs. The medicines for the seven residents being case tracked were assessed. All residents had a medication administration record (MAR). No gaps in signing noted. One resident self-administers, insulin, and appropriate guidance had been sought from the district nurse, to support him to do this independently. Medicines are safely stored in locked cupboards within the homes’ treatment room. An audit of the seven residents received drugs, administered drugs and remaining drugs was undertaken and showed that these were in order. The deputy manager carries out medication audits and provides a brief report on findings. It was good to see no errors are being identified during the audits. All staff that administers medication had up to date training. The dates of opening of creams was evident and their shelf life known. This means residents are having treatments within the appropriate shelf life of the cream. All Staff administering medication have received accredited training. Oakwood Rest Home DS0000056587.V336735.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines are flexible enough to enable the people living in the home to make some choices. Social activities take into account the individual choices, abilities and backgrounds of the people living in the home. Varied and nutritious meals were provided that take into account the different cultures of the people living in the home. EVIDENCE: Oakwood provides residents with a variety of activities according to their preferences and wishes. An activities worker was identified at the last inspection and has drawn up an activities list. This was seen and showed that a vicar comes to the home every 2 weeks to conduct mass, an entertainer visits the home every fortnight for a sing and dance session, pub lunches, outings, the hairdresser, bingo, board games are all engaged in. One of the people living in the home was seen walking around the extensive gardens and others stated they liked sitting out in the garden, or playing cards or dominoes. As at the last inspection, staff was documenting some of the activities that individuals were taking part in, and for those people who had memory loss staff tried them with an activity to see how they responded, and if this was successful it was added to their ‘choice list’. This is important where people cannot articulate choices or preferences it is a positive way to explore them on their behalf. These preferences are recorded in the care plans. Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 19 Residents meetings identify the activities that people particularly enjoy. Feedback from residents was that pub lunches, and parties have been the favourite this year. The monthly visit records for 2006 demonstrated that individual service users preferences are being sought, activities outside of the home, such as weekly shopping trips, pub lunches, and visits to the park, plus two parties one for Christmas and one for Halloween had taken place. It was positive to see that the service is auditing this aspect and striving to improve the range of activities offered to residents. They have improved on this area since the last visit. Daily records are now also beginning to reflect the activities people engage in and this is good because it means staff can track if the activities fit the persons care plan. Some residents said that they use ‘ring and ride’ to go to pub lunches, and enjoy playing dominoes, playing ball, bingo, and dancing. Residents said that staff spends time with them to chat or help them to join in an activity. One relative said ‘mom is very confused, but sometimes staff sit with her and do bingo, marking her numbers off for her, I think they are very kind and I see them helping the residents who need help.’ Staff had good knowledge of promoting independence such as residents choosing the time they get up, go to bed, managing their medication and their finances. Residents said the routines were flexible; they opened their own mail and were supported to vote in elections. Comments made earlier in this report regarding religion, culture and authentic meals also show that the service has been flexible and strives to meet individual needs. There is a staff team whose members originate from a wide range of ethnic origin, who have the knowledge necessary to meet the needs of people from differing ethnic origin. English is not the first language of some staff, however they were consistent in their interactions ensuring that they spoke clearly and repeated if necessary in order to help service users understand them. The completed AQAA shows that over 50 of care staff has achieved NVQ level 2 and above. This exceeds the standard. Training records showed training in Health and Safety, Manual Handling, and some Dementia care, this ensures staff can meet the diverse needs of the residents. The home has open visiting arrangements and service users confirmed they entertain their family and friends in their own room, or use the communal lounge. Records show the contact arrangements in place. The owner has considered how the involvement of family and representatives of the service user could be maintained. This has been successfully promoted via the use of family meetings and social gatherings such as the two parties recently enjoyed. Oakwood hope to build on these initiatives to seek relatives’ Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 20 views and contributions for developing the service. This is a good initiative. Meals have improved considerably since the last visit. Oakwood have responded to comments made then and have significantly improved the food offered, the choices and the balance of diet. This has been achieved through the use of 4 weekly menu which was compiled with the help of a dietician. Specific cultural food preferences were included such as Akkee. Plantin, mackerel, sweet potato, and herbs and spices were available in the kitchen. This suggests the home considers residents religious, and cultural needs. The teas are now more varied and include soups, sandwiches and salads, afternoon tea cakes are provided such as apple and cinnamon cake, banana tea bread, date and raisin tea bread, sultana cake and fruit cake. This is a very positive approach to increasing fruit intake for older people. The residents said that the food is good and they have plenty off it and that choices have improved. The cook has recently been trained in Safer food Better Business, following a requirement from an Environmental Health visit. This means that residents can be sure their meals are prepared stored and served properly. The AQAA stated that the service intends to broaden the scope of activities further and include some outings. This will further enhance opportunities for residents. Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 21 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. Current arrangements show that people living in the home can be confident that their complaints will be acted upon. People living in the home are protected from abuse. EVIDENCE: There is a complaints procedure, which has been given to all residents. The procedure is well documented and is contained in the Service User Guide, and Statement Of Purpose. The procedure is also on display in the hallway of the home. Formats suited to the needs of the people living in the home are available to include large print, and bold font, an audio format is also available this ensures that the procedure has a high profile and that attempts to make it accessible to residents have clearly been made. The record of complaints was viewed. A record of the investigation is maintained, as is a response to the complainant. Complaints are responded to within agreed timescales. There has only been one complaint and the outcome of this was faxed to the complainant within 24 hours. It was positive to note that complaints are also audited via the monthly regulation 26 visits, copies of which are sent to the Commission. This further enhances the protection of service users, whilst ensuring that the systems are in place to deal with any complaints as they arise. There have been further initiatives such as introducing a suggestion box, where all visitors can provide feedback or suggestions anonymously. This was fixed to the wall in the doorway and is visible to all who enter. Social events to encourage relative participation have taken place this year with two parties. The owner hopes to Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 22 use this opportunity to gain more feedback from relatives, which is a positive way of encouraging inclusion and confidence. The inspector saw a folder that contained a significant amount of ‘compliments’ sent to the staff for the care people had received. The management of complaints has significantly improved, and is a positive feature of the service. Regular service user meetings take place. The minutes of these confirmed that residents are asked if they have concerns or complaints. No complaints were evident, but where repairs were raised these had been responded to promptly. Several residents described their experiences in relation to complaints. One stated “I have had a complaints leaflet, but I would talk to staff anyway because they are very good’. Another said ‘I’ve got no complaints, things have really improved, the food is lovely and my room has been decorated, and I must say we always seem to have enough staff now’. The AQAA states an Adult Protection Policy and Procedure; to include a Whistle Blowing Policy, is available. This was viewed on the previous inspection and amendments have since been made, this meets with the required standard. Staff training records show that most of the staff had training in Adult protection and Abuse. Staff had a good understanding of what abuse is, and how it can happen. They recognise behaviour that may indicate abuse is occurring and know the procedure for reporting these concerns. Staff said they would report this to a senior. Discussion with senior staff demonstrated that they know what to do if there is an allegation of abuse and they are aware of how to protect people living in the home from harm. The procedure for reporting concerns to the Commission For Social Care and Inspection is understood. Competence in this area further safeguards residents from potential abuse. Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 23 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): 19,20,21,22,23, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at Oakwood are provided with a very good standard of comfortable accommodation, and a homely environment, in which their needs can be met. EVIDENCE: A partial tour of the home was carried out during which the communal areas, toilets and bathrooms and some bedrooms were sampled. There had been one change to the layout of the home since the last inspection – a wet room, has been created which provides shower facilities for residents in addition to the bathing and shower facilities already available. This gives residents more choice and flexibility as to the facilities they may wish to use. Extractor fans have been installed in communal toilets, and the ground floor bathroom improving the ventilation. Toilet areas were clean, odour free and had sufficient grab rails to support people who have difficulties with mobility. The toilet seats had all been replaced with new ones. Bathrooms and toilets Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 24 provide the people living in the home with a variety of facilities many of which allowed for full staff assistance. There are a range of bedrooms at Oakwood, the majority are single size but some double bedrooms are utilised as single occupancy. Some bedrooms have en-suite facilities. All are spacious and have hand grab rails in prominent positions to aid mobility. Bedrooms are fitted with call alarm buttons to enable staff to respond to service users needs. Water outlets have been fitted with restrictor valves to minimise the risk of scolding. Window restrictors are in place to prevent the risk of falling. There is a large level rear garden which has recently had some trees removed which has substantially improved the light and the view to the rear garden and front drive. Residents said they made choices about their room colour and furnishings, and since the last inspection all bedrooms have been painted, new furniture provided in 25 bedrooms, and new flooring lay in 20 bedrooms. Curtains and bedding has been replaced in all the bedrooms, these are now more contempary and and better quality. The maintenance log book was viewed and demonstrated that a variety of house hold jobs and general maintenece is being undertaken consistently, along side major redecoration and refurbishment. The plan for the renewal of the fabric and redecoration of the premises is well underway. The owner has invested significantly in improvements to the home and has complied with requirements within timescales. There were some areas of the premises that were in particularly poor condition namely the hall stairs and corridors; the owner has now completed work on these to provide an enviroment that is safe, comfortable and of a good standard for residents to enjoy. The whole exterior has been repainted, including repairs to the drainage systems. Emergency lighting on exteriors of home has been installed to assist the safe evacuation of residents in the event of a fire. The kitchen has been fully refurbished including new tiles, floor and equipment such as a fridge, freezer, and dishwasher. New air conditioning has also been installed in the kitchen and office providing a more pleasant working enviroment. The dining area has benefitted from new tables which provide more suitable support for the residents. Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 25 The aids and adaptations throughout the home appeared to meet the needs of the people living in the home and these included, a shaft lift, level entrances and exits, grab and hand rails, assisted bathing and toilet facilities, emergency call system and there were mobile hoists on site for use as necessary. All the people living in the home were very happy with their rooms and were very comfortable. The office and medication room have been refurbished and both now provide a spacious, tidy and well-equipted working enviroment for staff. There were appropriate systems in place for the disposal of clinical waste. Comments from residents and relatives were received regarding the improvements made, residents now are very pleased with their enviroment. The AQAA states that the next major project in terms of the environment is the carpeting of all the communal areas within the home and to continue to sustain the level of maintenance. Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 26 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): 27,28,29, & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of the people who live at Oakwood are met by staffing levels above the required standard. Staff are competent in meeting the needs of residents and robust recruitment practices ensure people are safe and protected. EVIDENCE: In response to a previous condition of registration, Oakwood were required to have four care staff during the waking day as well as a manager who is off the rota during business hours. This condition no longer applies. Whilst there is no formal obligation to maintain this level of staffing, rotas viewed show they continue to maintain staffing levels above the required standard, and this means people have a good degree of flexibility because there are staff that can attend to their needs. The completed AQAA shows that over 50 of care staff has achieved NVQ level 2 and above. This exceeds the standard that at least 50 of staff has achieved NVQ level 2 training. This has positively impacted on the quality of care that people receive; staffing levels and competences ensure that the skills necessary for meeting the needs of older people, some whom have memory loss, dementia and or difficulty with mobility, are evident and that they are cared for in a manner that keeps them safe. Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 27 Oakwood has a recruitment procedure that safeguards service users and meets the regulations and the national minimum standards. Three staff files were sampled, all had evidence of identification, a completed application form, two written references and a Criminal Records Bureau check, to include a POVA 1st check( Protection Of Vulnerable Adults Check). The recruitment procedures have been tightened since the last inspection, and now include written notes of the applicants interview. The importance of clear records of the interview process and answers helps to ascertain how the decision was made to employ or not employ the member of staff. This is a further enhancement in safeguarding the residents. It was positive to note that the service reviews this aspect of it’s practice via the monthly regualation 26 visits. These showed which staff files and recruitment information had been audited, and the outcome of this. The inspector found that all the required information and documentation was available. This demonstrates that the recruitment procedures are robust and protect vulnerable people. There have been developments in purchasing a training package. Training records and the completed AQAA show most staff had received Mandatory training. The training package is comprehensive and provides for more than mandatory training. This will ensure that staff is equipped with the specific skills necessary for meeting specialist needs such as dementia, mobility, behaviour, and continence. Eight staff had completed training in dementia care, this is particularly important as some people have memory loss and or dementia and this helps staff to understand these needs more fully, and deliver the care in a manner that the is more appropriate to the persons needs. Staff have attended training in Safe Handling of Medicines, Manual Handling, First Aid training, Fire safety, Risk Assessment, Health and Safety, Food Hygiene and Adult Protection training. The training matrix showed that training in Infection Control, COSHH, and Record Keeping is planned for the coming year. Person Centred Planning is also on the agenda for the manager and assistant manager and this means that staff will know how to support each person who has different needs. Staff files showed that induction had been undertaken. This means that staff have a good understanding of the principles of care and what standards are expected from them, ensuring that the care delivered to people in the home is of a good standard. Systems are in place to ensure senior care staff are being inducted into their role and understand their responsibilities. The manager is to complete her Registered Managers Award in December 2007, and the assistant manager has been enrolled onto this. It was positive to note that this service places a high value on training and supporting its’ staff team to provide good quality of care. Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 28 Staff meetings are undertaken and these are now regular and provide a forum to improve communication and promote teamwork. Staff commented on the improvements and how nice the facilities are now for the people who live there, and the improvement in staffing levels and how this has helped them deliver a better service Staff spoke positively of the manager, deputy and the owner and felt they were approachable and listened to their concerns. They also described many improvements that have taken place, which have had significant outcomes for the service users. This included consistent staff levels, a more structured senior team who have good communication systems and clear targets. Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 29 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): 31,32,33,35,36 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in a way that benefits the people living there and promotes their best interests. Staff has good direction and appropriate supervision, which means they meet the needs of the people. There have been sustained better outcomes for the people who live at Oakwood. There are good arrangements to ensure that the health, safety and welfare of people living in the home is promoted and protected. EVIDENCE: The management of the home has continually improved over the three years under the present owners, and this has resulted in dramatic improvements for the people who live there. A stable staff team has been maintained with above Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 30 the required staffing numbers. Rotas showed that four care staff are on shift as well as the manager who is off the rota during business hours. This ensures that the needs of the people who live there can be catered for in a more positive manner. The owner regularly spends time in the home to oversee the care practice. The Care Manager has now been registered with the Commission. She has completed her RMA (Registered Managers Award), and is experienced in caring for older persons. It is evident that staff has a clearer role definition which enables them to understand what their responsibilities are. The establishment of daily records and reports ensures that the care practice can be monitored more effectively and any shortfalls rectified. On the day of the fieldwork there was a wealth of unexpected activity; there had been a leak through the lounge ceiling during the night, plasterers were on sight repairing this, the manager and owner had a day of interviews planned to recruit care staff, and the inspector arrived unannounced to carry out an inspection. Alongside this the kitchen was not in use because new flooring was being laid. Despite all the activity the inspector found that the needs of the people were being met in a positive and caring way; dancing and singing was enjoyed followed by a ‘fish and chip’, lunch. Management meetings are well established and the minutes of these show that there is good direction to senior staff of expectations, targets and conduct. There is an improved stance in terms of setting standards and monitoring them. The owner previously invested in external consultancy in an endevour to developed systems that monitor practice and compliance with the homes plans, policies and procedures. This has led to a complete revamp of almost all the procedures, policies, and records maintained. Staff spoken with had good understanding of the care practice and procedures, which help them to carry out their care, work in the way that the people who live there, prefer. Staff said that they now have access to care plans which has improved the consistency of care because these are more deatiled and give specific guidance. Staff demonstrated a good awareness of risk factors and could identify those service users at risk of falling and describe the actions to be taken to minimise the risk. Staff said there are now planned activities for service users, and staff are actively encouraged to spend time with service users. Activity plans were viewed and each activity had a risk management framework to ensure all activities engaged in, are safe for individuals. Both residents and staff spoke positively about the ethos of the home. Staff Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 31 meetings and residents meetings are well established, from these records it was evident that views are sought and acted upon. Residents said they are very happy that the care they receive meets with their needs. They have described lots of improvements that have had positive outcomes for them, these have included more staff on duty, staff spending time with them, there are more activities and outings to get involved in. The facilities have greatly improved with total redecoration, new bedroom furniture and communal furniture, and a big improvement in the choice and quality of meals provided. Residents report that staff working with them, know them well and are generally able to meet their needs. A good level of communication and transparency is provided to the commission via regular monthly Regulation 26 audits that are sent by the providers. These are fairly comprehensive and informative, and include the views of both the staff and the people who live at the home, which demonstrates that good efforts are being made to include the views of people and to make changes to the service in line with their views. The AQAA completed by the owner was returned within the stated timescale. This stated how improvements are being made to improve life for the people who live there and said that they have now purchased a Quality Assurance System. This will be implemented within the next 3 months. This will further enhance the existing audits undertaken to monitor practices. Staff supervision records showed that staff had regular formal, supervision sessions to ensure that they are performing their job role, their training and development needs are identified and they are able to meet the needs of the people living in the home. This ensures that the quality of life for the people who live there is kept under review. A staff appraisal system has also been implemented, which will inform the staff-training programme. This means that staff competence in caring for older people will be further developed. Discussions with relatives demonstrated that they are involved in contributing to the way the service is delivered. For example one said that they had been involved in the care planning and had a very good introduction to the home when they did their pre-visit. One commented that they had good relations with the home and felt they could ask for any information they might need. There had also been two successful home events, a Christmas party and Halloween party was said by the people who live there, to be very successful. Relatives and residents said they had a great time, staff were also very positive saying that these activities had not been previously arranged until the new owners came. They said the owners had the best interests of service users at heart. Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 32 The health and safety of service users, staff and visitors is ensured by routine testing and servicing of equipment and appliances. Staff demonstrated a good awareness of health and safety issues and how these are managed. An example of this was evident on the day of the fieldwork. There had been a leak through the lounge ceiling during the night following torrential rain, evacuation procedures had been followed, the fire service called to ensure the electrics were safe and plasterers were on sight repairing this first thing in the morning. This shows a good speedy response to ensuring the safety of people, and maintaining the upkeep of the building and facilities. The reporting procedures for accidents and incidents to the commission have remained consistency good. The owners have invested heavily in the business. They said that they would like to continue to improve resources. They have received comments from people who live at the home and social workers who expressed a high level of satisfaction with progress and improvements for people placed in Oakwood. Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 33 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 3 3 3 3 3 3 X 3 3 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X X Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 34 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(5) Requirement Where the use of a hoist is indicated on a manual handling risk assessment the type of hoist and sling size must be detailed. This will ensure that staff uses the correct equipment, when moving the people in the home. Continence management plans need to include the size of the pad to be used, and the frequency of changing. This will ensure that people are wearing appropriately fitted pads. Timescale for action 30/06/07 2. OP8 12(1)(a) 30/06/07 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 OP12 Good Practice Recommendations To further develop the range of activities and outings for residents so that they have opportunities that are DS0000056587.V336735.R01.S.doc Version 5.2 Page 35 Oakwood Rest Home stimulating and enjoyable. 2 OP32 To continue to build on the successful social gatherings for residents and their families. This is a good initiative for including people, and will further to promote the community ethos of Oakwood. The formal quality assurance system should be implemented. This will ensure there is a consistent and thorough approach to measuring the success of the home in meeting aims. 3 OP33 Oakwood Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection 1st Floor Ladywood House 45-46 Stephenson Street Birmingham West Midlands B2 4UZ 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 Rest Home DS0000056587.V336735.R01.S.doc Version 5.2 Page 37 - 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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