CARE HOMES FOR OLDER PEOPLE
Oakwood Rest Home 78/82 Kingsbury Road Erdington Birmingham B24 8QJ Lead Inspector
Monica Heaselgrave Unannounced Inspection 5th, 6th & 12th June 2006 08:40 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.V293674.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 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 Vacant Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Category of registration is to provide personal care and accommodation for thirty elderly people. 30 (OP) Ensure that there are a minimum of four care staff on duty at all times one of whom is a senior. Ensure that there are a minimum of two care staff throughout the night, one of whom is a senior. 20th March 2006 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. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Fieldwork at Oakwood took place over three visits, totalling 20 hrs. Each visit was unannounced. Two visits were made in the first week early in the morning in order to establish the morning routines. One visit included the evening routine. There were twenty-one service users in residence; a number of these people were spoken with to obtain their views on the service. As part of the inspection process service users were provided with comment cards offering them the opportunity to share their views about the care received. Five of these were returned and utilised as part of the inspection. The Responsible Person completed a pre-inspection questionnaire prior to the visit, which provided information about the service. Information from this was used as a record in this report. Information taken from the CSCI service history for Oakwood has been used to inform this report. Following the visit to the service the inspector contacted some relatives and ex-service users, by telephone in order to obtain their experiences of the service, this is included in this report. The inspector met with the Responsible Person, the external consultant and the deputy manager. A number of senior and care staff plus the cook were spoken with during the inspection. The acting manager was off sick. A brief tour of the kitchen, communal areas and some bedrooms was undertaken. A number of records were inspected to include those of three service users chosen for case tracking. This enables the inspector to establish the specific needs of service users and explore through a variety of records, staff interviews and observation, how well the needs of someone are met. Records necessary to the recruitment, training, and work patterns of staff were examined. The arrangements for the safe administration of medicines were examined, and a drugs audit carried out. Mealtimes were observed, menus examined and food preparation and storage areas viewed. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 6 The procedures and records for the management of service users finances were explored. Examination of the procedures in place to protect the health and safety of service users was undertaken. This included seeing certificates relating to the maintenance and servicing of equipment, such as gas, electric and water temperatures, fire procedures, and hoist equipment. What the service does well: What has improved since the last inspection?
Oakwood Rest Home changed ownership in the last 2 years. The current owners are committed to working with the commission to ensure deficits identified are addressed and a number of environmental improvements have taken place. The Responsible person has invested heavily in external consultancy to drive new initiatives forward. This has led to an overhaul of most of the working practices in the home, and there are now good systems emerging to monitor and maintain standards of care. There has been a significant improvement in the management of risks. A decrease in the levels of falls and clearer management plans in place to guide staff in this area. There has been a significant decrease in the number of complaints made, none have been received since December 2005. This indicates that service users and their relatives are increasingly satisfied with the improvements being made. Improvements in the assessment of new service users have taken place. This has led to significant improvements in the management of safe working practices, including developing a full assessment of need for each new service user referred to the service. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 7 There have been significant improvements relating to the health and safety of service users. These are now recorded, in enough detail to enable care staff to ensure the health care of service users is met. The Responsible Person has invested significantly in improvements to the home and has complied with requirements within timescales. There have been some noted improvements in the environment. A rolling programme of internal redecoration and refurbishment has been implemented, which has led to benefits to service users, to include, redecorated bedrooms, communal areas and a new bathroom. Service users live in a home that is clean, spacious and hygienic, relatives and service users commented favourably on the improvements made in the last twelve months. Service users are supported and protected by the improved recruitment practices, which ensure the required checks, are carried out prior to staff taking up post with vulnerable people. The daily management of the service was poor twelve months ago. However there has been a substantial improvement relating to most aspects concerning the management and running of the home. Improved record keeping, improved systems, and an acting manager in post for several months, plus the commissioning of a consultant has enabled improvements to be made across most aspects of the service. Oakwood Rest Home is a safer, more comfortable home in which service users in the main, are satisfied. The standard of care has improved, and should continue to do so if the staff team can consolidate their good practices. What they could do better:
This year the service has concentrated on reviewing it’s written policies, procedures, assessments and care plans, which has been a major undertaking. There needs now to be a wider distribution of information to service users and their families. In particular the Statement Of Purpose, Service User Guide, the Complaints Procedures, and informing them of their rights to access the inspection reports. Service users relatives should be involved in the care planning and review process. There has been good development of monitoring practices to ensure they are being conducted properly. These systems are in place, but must be applied consistently to ensure for instance that risks are not overlooked, to ensure medication audits are taking place. The service is attempting to consider the preferences of service users in relation to their preferred care routines and choices, but is really in the early
Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 8 stages of gathering this information. This will enable them to structure this aspect of provision with consistency. The updating of service users care plans will enhance this further. It is envisaged that as all service users care plans are updated issues relating to equality and diversity will be included. For instance referring service users for a wheelchair assessment, which may enable them to access outdoor activities. The development of menus and wholesome balanced meals, based on good practice guidelines, and including service user consultation, needs to take place. The cleaning schedule for food preparation areas must be adhered to ensure hygiene standards. There are several platforms evident where concerns and complaints are now being monitored this is a good achievement in a short period. There have been no formal complaints made to the Commission For Social Care and Inspection since December 2005. This is a significant indicator as to how standards have improved and how the service is managing concerns made before they become formal. Health and safety checks should be carried out regularly to ensure there are no risks to service users. This should include the checking of window restrictors to prevent the risk of falls. Records relating to the employment of staff had some minor shortfalls; all staff must have a contract of employment. The acting manager should establish a system where-by staff supervision records are separated from staff disciplinary action to improve the audit trail. Accurate written records of the interview process should be maintained to reflect how the decision to employ was made. Gaps in employment history or application forms must be explored. This will enhance the protection of service users. Staff members were able to demonstrate a reasonable awareness and understanding of equality and diversity. The service recognises the importance of promoting equality and diversity for service users and staff. Some service users who have mobility needs may benefit from referral for wheelchairs to increase opportunities in the community. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 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.V293674.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. The quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Service users are provided with information prior to moving in, which could help them in deciding if the home is suitable for them. A contract detailing the terms and conditions of residence has been produced. Existing service users need a copy to be fully informed about their rights and responsibilities. Service users are assessed prior to being offered a place in the home, this means they can be confident the home will be able to meet their needs. EVIDENCE: In the last 12 months there have been 8 admissions to the home. Three care files were sampled. Two of these were for people admitted in the last 12 months and one for a person admitted in 1994. Of these three files each had a contract specifying the terms and conditions of residency and the fees to be paid.
Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 11 The Statement of Purpose and Service User Guide has been amended as required at the previous inspection. These now provide good information for Service users. The Responsible Individual stated that they intend to provide the Service User Guide and Complaints Procedure in large font and bold format and on audiocassette to enhance accessibility for service users. Existing service users do not yet have a copy of these formats as they have only just been completed. This was confirmed when the inspector spoke with individual service users and the Responsible Person, who intends to implement these within the next couple of months. The more stable management team including using an external consultant has led to significant improvements in the management of safe working practices, including developing a full assessment of need for each new service user referred to the service. The files of three service users were sampled and each contained an assessment of their needs provided by the referring agent, in one case the hospital. These had been developed into a comprehensive assessment undertaken by the manager and the deputy, who had the required skills to do this. Two service users were asked about their involvement in the admission process. One confirmed he had visited and had been asked about his needs, likes and the level of support he needed. Another could not remember and stated he had not been given any written information about the home, or been involved with a care plan or review. The files of the service users case tracked indicated that they and or their family were consulted on all aspects of their care. It is important that the new initiatives regarding consulting with service users and their families is recorded, so that in the event service users can not recall their involvement, records will evidence that this has taken place. The inspector was satisfied that this had occurred for the new service users, and that existing service users have yet to undergo the new assessment and care plan procedure. Three service users have now a completed assessment and care plan, which when seen, was comprehensive. However there are still eighteen existing service users who have not yet had theirs completed. The Responsible Person must be mindful that targets are set and each service user can benefit from this process over a short period of time in order for the standard to be met in full. Staff has received mandatory and some specific training in the needs of the people accommodated. Further specific training is needed to ensure service users needs are consistently well met and recognised. Oakwood do not provide intermediate care. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, &10. The quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. All service users had a care plan, which would ensure their day-to-day needs are met. Further work has commenced in which service users are being involved. Medication is generally well managed ensuring service users get the required medication at the right time. Service users reported that they are treated with respect and their right to privacy was being upheld. EVIDENCE: Three service users were case tracked specifically because they had been prone to falls, and or required nutritional support. A further two service users were identified as having specific health care needs relating to swallowing, and a hearing impairment. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 13 The files of these service users were examined in order to ascertain how the service plans their care. The care plans varied, two people had a full and proper care plan. The practice of involving residents and or their family in the development and review of the plan is variable. One relative described good levels of involvement whilst another two had not been involved. This appeared to be related to the fact that people recently admitted had a full assessment and care plan, whilst longer- term service users had not yet been involved in this process. Relatives said they were informed as to changes in health care, and were very complimentary about the support offered to their relative, which included escorting to the hospital and staying with the service user throughout. A second relative had not been involved with care planning. They had not received updated information regarding the management of risk, but had said they were informed of falls, and that they were generally satisfied with the standards of care. Relatives consulted with reported being very pleased with the standards of care and that staff were friendly and caring. The plan for those service users who have lived in the home prior to the new care planning procedures being implemented did in most cases include the basic information necessary to plan the individuals care. Care plans for two people, included both a risk assessment and relevant clinical guidelines. For example, both are prone to falling, particularly from their beds. 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 new bed is on order more suited to the service users needs. Interim arrangements to reduce falls were appropriate. Two concerns were noted. The care plan was checked for a service user who when talking with the inspector highlighted a difficulty in swallowing. This was described as a risk of choking. There was no mention in the care plan of how this was to be managed or monitored. The file did not contain a risk assessment, which would guide staff in what to do. At interview however, staff gave verbal accounts that demonstrated they were aware of this difficulty. The lack of supporting documentation could potentially place the service user at risk. An immediate requirement was made for a risk assessment to be drawn up for the service user, with specific guidance to staff on what to do in such an event.
Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 14 A second service user was complimentary of the staff and felt health care needs were addressed well. He confirmed access to G.P district nurse and hospital consultants. However he had recently missed an appointment with the hearing clinic and was concerned. When this file was viewed, it was discovered this had been overlooked. The deputy agreed to action this immediately. These examples demonstrate the importance of records, and the need for senior staff to monitor them. When staff were interviewed they all were able to highlight the specific needs of the two service users, and had seen the risk assessment and used the observation records. There was a much improved, system for recording, highlighting and acting on health care concerns or risks. The inspector also saw that several new initiatives had been implemented in order to improve communication. This included communication books to be used across the staff teams, detailing appointments, professional visits and health care needs. The staff hand over was observed and these records were utilised to communicate effectively the health care needs of service users and how they were being managed. Several staff were interviewed, two seniors, two care staff, and the deputy. The consultant and Responsible Person also participated in the inspection process. From discussions with them there were good examples of the improvements that had taken place. All commented that there is a much clearer structure, role definition and understanding of who is responsible for which task. All commented that health care tasks are monitored much more closely, records are more detailed and staff know the outcome of professional visits and how they are to be followed up. Staff now have access to the care plans and risk assessments which enables them to be up to date on any changes to the care provided, they felt this enabled them to know what to do, they had much improved information, and ultimately standards of care and consistency of care for the service user had improved. The service history for last year highlighted 21 falls. Previous visits to the home resulted in requirements being made to develop risk assessments for those at risk of falls, and to implement a falls register in order to monitor the level of falls and what action could be taken to minimise these. At this inspection the three service users identified as at risk in this area, all had a risk assessment that identified the risk, the action to be taken and included relevant clinical advice and guidance. However the risk assessment Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 15 format differed for each seen, there is a need to decide on the format that best suits and implement this one to replace the existing ones. A falls register had also been introduced. Entries were checked and 7 had occurred. These 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, during a visit to the home. It should also be audited and used as a tool to demonstrate that this area is monitored and what outcomes have occurred. This should be signed and dated. There was a record of professional input in the files of service users case tracked, professional visits were recorded in daily records which identified service users have regular access to other health professionals. The storage of medicines was in a locked facility. A new trolley has been ordered. Medication administration records were signed. An audit of medicines was undertaken on three service users, case tracked. Two of these tallied with the records, one did not. This needs to be rectified via a drug audit so that any mistakes can be rectified ensuring medication is given to service users correctly to ensure their safety. Cream for one service user was dated appropriately at the time of opening. A homely remedies policy is in place as required at the last inspection. Forms have been sent to the G.P for consent to supply homely remedies to service users where required. Copies of these are to be placed in service users files. These arrangements will ensure that service users are not given homely remedies that may react to medications they are already taking. Not all staff that administers medication has received accredited training. The inspector was informed that a date for training was set for June 2006 for all senior staff. Staff had good knowledge of the care routines of service users. During the course of the visit observations of their interactions with service users were very positive. They were sensitive towards individuals who required support to use the toilet, and regular routines were evident. One lady frequently required reassurance and this was given in a caring manner. The personal appearance of service users clearly demonstrated that their dignity is promoted. Their clothes were clean, and general appearance was good, well groomed. Following dinner, one lady needed a change of clothes and staff responded to this. Service users stated that staff is responsive if they need assistance staff are on hand. They described good personal care routines that respect their privacy, Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 16 for instance closing doors, enabling individuals to maintain some aspects of their personal care independently. Service users said that if they see the G.P this is in the privacy of their own room. Relatives spoken to say that the physical care has been good. One lady said in particular continence management was good, and that her relative was always clean and well dressed. Another said that the foot spa had been used and that nail painting and hair dressing was consistent, which she felt demonstrated that staff takes care of service users, particularly those who are very dependent. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 17 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14&15. The quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Opportunities for leisure and activities are provided, it is positive that that this is to be further developed after consultation with service users. Family and friends are supported to maintain contact with people living at Oakwood. Food offered is not always varied, tasty or nutritious, and was not to the satisfaction of all service users accommodated. The service clearly requires the services of a dietician in order to ensure service users receive a wholesome and balanced diet. The cleaning of food preparation areas and food safety practices has not been consistently well managed. This aspect of service delivery will require close monitoring. EVIDENCE: There has been an improvement in terms of providing service users with activities, and the support they require to engage in these. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 18 Staff are aware of the need to plan the routines and activities of the home in a way which meets the choice and wishes of service users. It was pleasing to see that there has been some progress in implementing this. An activities worker has been identified on the staff team. In discussion with staff they confirmed that they are now asking service users for their preferences in activities. Whilst personal preferences were not recorded in all care plans, there is a record maintained of those service users who engage in each activity and this was consistently maintained. This is enabling the staff team to identify specific activities enjoyed, particularly where individuals cannot communicate this, but could demonstrate it through their enjoyment. Service user meetings have also recently commenced, the minutes of these demonstrated that service users are asked about the activities they would like. The monthly visit record for August 2005 demonstrated that individual service users preferences are being sought, one lady requested more bingo as she frequently missed this session through other commitments. The activity list was checked and showed that she was engaging in this. The key worker was requested to make arrangements for her to access activities outside of the home, such as weekly shopping trips and visits to the park. Daily records did not reflect if this had occurred. The home tries to be flexible and attempts to provide a service which is individual, and which consults with service users, and make changes in response to service users’ wishes. One lady had said she did not have enough storage for her clothes, it was positive to see that a second wardrobe had been purchased for this. A gentleman had commented that he enjoyed the new activities available and had requested a card table or mat to play ‘Patience’ the Responsible Person was in the process of purchasing this. One service user goes out daily via ‘ring and ride’ and enjoys playing dominoes. He said he sees staff daily playing ball, bingo, dancing and that he thinks staff ‘spend more time now with service users’. One relative said ‘when mom went to live there we talked about her needs, she’s very confused, so finding activities she will do can be hard, but when I visit I have seen her doing bingo with a staff helping her, she’s had her nails painted, has her hair done weekly, and used the foot spa. She’s done some ‘keep fit’ and loves to walk in the garden. I have been very pleased with the care. Mom has really improved physically, I know she’s happy because she’s never upset when we leave her’. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 19 Questionnaires returned by service users stated they were happy with the activities and routines. There are policies to promote independence and choice. Staff had good knowledge of these and how to relate them to their practice. At interview and in the monthly visit records and staff meeting records it was evident that staff are trying to develop this area further. Records show that generally service users choose the time they get up, go to bed and have some meal choices. One service user stated in the monthly visit record, ‘the staff look after me very well, they help me choose the clothes I want to wear’. In discussion with service users regarding the routines and flexibility, there were varied responses; one said ‘I bath once a week every Thursday, no real choice, would like it more frequent’. Another said ‘I can have a bath when I want, usually have help to shave and staff are very good for that.’ A third service user said ‘I bath once or twice a week or could ask if I wanted one. I see the G.P when I need, and my clothes are kept clean and always put tidy for me. I receive my own mail and my finances are handled by my family, I enjoy politics and have done a postal vote.’ The service is attempting to consider the preferences of the majority of its residents but is really in the early stages of gathering this information to structure this aspect of it’s provision. The updating of service users care plans will enhance this further. It is envisaged that as all service users care plans are updated issues relating to equality and diversity will be included. In relation to accessing community based activities or amenities further work is required. Several service users would require the use of a wheelchair in order to utilise amenities in the community, this has not been fully explored. A requirement was left with the service to refer service users for wheelchair assessments. Observation of practice showed that there is a staff team whose members originate from a wide range of ethnic origin, who would 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. Staff training records indicated that some had the training necessary to meet the diverse needs of service users, this included training in Health and Safety, Manual Handling, some Dementia care, and 70 had NVQ level 2. 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. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 20 A relative said, ’The staff are very pleasant, when we visit they are friendly and offer tea or coffee ‘. Another relative said ‘I can’t fault the care staff they do a good job, always in clean clothes and well groomed, they manage the continence well, but I don’t really know the people in the office, it’s difficult to get to know people and I’ve never been involved in a care plan meeting, and didn’t know there were inspection reports we could read.’ The Responsible Person should consider how the involvement of family and representatives of the service user could be maintained. This should include involvement in care plans and possibly carers meetings where they can be provided with information and contribute feedback to the service. The food is considered by service users to be of variable quality. Several service users were spoken with and their comments were, ’The food is passable but not exciting, would like to see some changes on the menu, although I do have my own preferences which are met.’ ‘Just lately getting a lot of bread pudding, dough and pastry, don’t like that would prefer a choice, do a nice dinner, meaty dinners which I like and is substantial.’ Teatime is not so good it’s usually cake and sandwiches’. Two out of three returned questionnaires stated that service users ‘sometimes’ like the food. The main meal of the day was Turkey or roast lamb, roast potatoes carrots cauliflower peas and gravy; teatime menu was sandwiches, cheese ham or corned beef, and cake. Menus were sampled, a lot of repetition was evident for example fish three times in two days, cottage pie and a further two ‘pie’ meals, beef and onions followed by burgers and onions, and a further three beef meals in four days. Lots of ‘peaches and cream’ puddings. Discussion with staff members and sampling of staff meeting records described the choice and variety of food as poor. Some consultation with services users for alternatives was observed. Suggestions from service users was said to be included on the menu. The deputy and cook were advised to seek support from a dietician in order to ensure menus are nutritionally balanced. On the second day of the visit contact with a dietician had been made, and a selection of menu samples had arrived. A requirement was left with the service to develop new menus to include consultation with service users as well as following professional guidance in this area.
Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 21 There are quality control measures in place in order to monitor food hygiene practices. The cook has worked in the home for four years and has had previous experience. She has undertaken Food Safety training. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 22 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16&18. The quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service Complainants can be confident that their concerns will be listened to and acted upon to their satisfaction. Service users are largely protected from abuse by policies, procedures and staff awareness. EVIDENCE: There is a new complaints procedure, which has been given to new service users with the Statement Of Purpose and Service User Guide. The Responsible Person stated that existing service users do not have the new copy. The complaints procedure must be widely distributed, and have a higher profile within the service. Oakwood are in the process of developing large print /audiotapes in order to improve service user accessibility. The complaints record was viewed. There was one complaint in May 2006. A record of investigation and outcome was faxed to the complainant within 24 hours. It was positive to note that complaints are also audited via the monthly regulation 26 visits. This will further enhance the protection of service users, whilst ensuring that the systems are in place to deal with any complaints as they arise.
Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 23 Three service users were able to describe their experiences in relation to complaints. One stated “I can’t remember if I ever made a complaint, or if I had a complaints leaflet, but I would talk to staff” Another stated ”I did complain once about………his T.V was too loud, he was in the room next to me, I told the staff and they had a word with him, had no trouble since.” A third said, “I’ve got no complaints, things have really improved, I’ve had repairs done to my bedroom and when the toilet seat broke it was fixed straight away.” Staff members spoken with were aware of the complaints procedure and how to report any complaint made. It was positive to note that some had a good understanding of how to advocate on behalf of those service users who may have dementia. One staff member described how this could affect, what the service user is saying, but would not diminish the fact that it would be reported to the senior staff and the service user would be observed. Regular service user meetings are now taking place. The minutes of these confirmed that any complaints or concerns are recorded and followed up. The main complaints raised concerned the food choices, particularly around teatime. This is addressed previously in this report for action. In discussion with the Responsible Person it was advised that the procedure to be taken for the reporting of concerns is to be displayed. Senior staff must be familiar with the steps to take should a concern occur on their shift. There has been progress on producing and implementing an Adult Protection Policy and Procedure; this includes a Whistle Blowing Policy. There is conflicting information on pages five and six regarding the timescale for reporting any allegations or suspicions of abuse. Staff interviews for four members indicated that not all had up to date training in Adult Protection or Abuse. There was generally good awareness of recognising abusive situations and all staff said they would report this to a senior. However not all seniors had this training, and one did not know the procedure for reporting any concerns to the Commission For Social Care and Inspection. One senior had not completed a regulation 37 and did not have a good understanding of this. Senior staff must be aware of their responsibilities in relation to reporting concerns to the Commission For Social Care and Inspection. This will protect service users against any allegation or suspicion of abuse, whilst ensuring the service is clear when incidents need external input and who to refer the incident to. Staff must receive training in Adult Protection. A previously made requirement regarding developing an inventory for items stored in the safe was met. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 24 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19&26. The quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. The premises at Oakwood have improved, and now provide service users with a comfortable, homely environment, in which their needs can be met. EVIDENCE: The Responsible Person has long-term plans to improve facilities throughout the home, a vast amount of work has been undertaken in the last twelve months. Six bedrooms were inspected three of these belonged to the three service users who were case tracked. These were found to be clean, personalised and redecorated to a good standard. New carpets, furniture, curtains and lamps had also been provided. 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.
Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 25 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. Doors to the bedrooms sampled were fitted with different locks, these may not all be suited to service users needs and therefore an audit of all the locks should be undertaken to ensure they are suitable. Window restrictors were in place to prevent the risk of falling, some were faulty and an audit of all restrictors needs to be undertaken to ensure safety in this area. At the time of the visit a variety of improvements were underway, curtain rails were being fitted, radiator covers were being put in place and the patio door had new locks.The communal lounge has been redecorated with new curtains and steam cleaned carpets. A newly refurbished bathroom suited to the needs of those who require assistance was also seen. The exterior of the building has been painted and the rear garden which is very large with level surface suited to service users needs, is well maintained. 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. There is a plan for the renewal of the fabric and redecoration of the premises. The Responsible Person has invested significantly in improvements to the home and has complied with requirements within timescales. There are some areas of the premises that are in particularly poor condition namely the hall stairs and corridors; the Responsible Person has a plan to complete this work in 2007. Service users commented favourably on the improvements, they were happy with their bedrooms, and particularly pleased at the ‘fresher’ lounge since it has been redecorated. Service users and staff commented on the improved cleanliness. Relatives spoken with said the home was always clean and tidy and had a homely feel, with no unpleasant odours. Those parts of the premises viewed were indeed clean, tidy well maintained and comfortable, these standards were evident on each of the three visits, which were unannounced. Staff members are booked to undertake infection control training. Practices in the management of infection control measures were discussed with all staff, they demonstrated good awareness in this area. Observation of the practice for dealing with laundry and the safe disposal of clinical waste was good. Provision of protective clothing was evident and staff described good awareness of how to manage common occurrences such as vomiting, spillages, MRSA, and incontinence. It was positive to note that staff
Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 26 described senior staff as being particularly disciplined and ensuring standards are maintained in this area. Requirements relating to food safety were made at the previous inspection in relation to the dating and labelling foods, expiry dates, cleanliness of the kitchen, and replacing dishwasher. An audit of these areas was undertaken and it was found that all but one had been met. A tour of the kitchen highlighted a need for high level cleaning, as some areas were dusty and greasy. Two utensils were condemned due to rust. A frying pan with ladle and oil in had been left out. A large sack of potatoes was seen in the kitchen, and the methods for moving this contravened health and safety. Staff sandwiches were in the fridge, and a leak had developed in the air conditioning system (although repairs were in hand). These concerns were shared at the time with both the cook and deputy manager. Requirements were made to address these within a two-day period. At the time of writing the report, the Responsible Person had forwarded an action plan, which demonstrated progress in these areas; this will be monitored on future visits to the service. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 27 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The quality in this outcome is adequate. This judgment has been made using available evidence including a visit to the service. There has been a sustained improvement in staffing levels. Staff has some skills to meet service users needs. However, some mandatory training is required both for senior and care staff, to ensure they can recognise and meet the needs of service users. Service users are supported and protected by the improved recruitment practices. EVIDENCE: The Conditions of registration have been met. A recognised management consultant has been employed for the first twelve months following the change of registration. Further consultancy has been retained during the period when the previous care manager resigned. The Responsible Person has complied with the conditions of registration relating to staffing levels. Minimum staffing levels of four care staff on duty at all times, one of whom is a senior, has been consistently maintained. Oakwood is registered for 30 older people. Occupancy numbers have remained at 21 service users for the past 12 months. The Responsible Person is considering an application for a variation in staffing levels, as these deficits are having financial implications.
Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 28 Service users are generally satisfied that the care they receive meets with their needs. The service recognises the importance of training, and has begun to review staff training needs. This was evident on the sampling of staff supervision records. The pre-inspection questionnaire stated that over 70 of staff is trained to NVQ Level 2 or above. The service is able to recognise when additional training is needed, and attempts to plan over time to provide this training. Some staff had completed training in dementia care. Staff are currently doing Infection Control and Safe Handling of Medicines, most have completed Manual Handling, some require First Aid training, and all must complete Adult Protection training. Staff files showed that induction had been undertaken and all staff files contained copies of training. However, it was noted that some training was out of date and some, but not all, had undertaken relevant statutory training in manual handling, first aid, fire safety, infection control and health and safety. The Deputy Manager has not had any recent training in medication management and has not undertaken any training in first aid and adult protection.Training in Safe Handling Of Medicines was seen to be booked. Systems are in place to ensure senior care staff are being inducted into their role and understand their responsibilities. Whilst some have their NVQ level 3 there is still a need for others to obtain this. A training needs analysis to identify training requirements is underway and supervision has been implimented. It was positive to note that the home has offered some training in dementia care. All staff are clear regarding their role and what is expected of them. Residents report that staff working with them, know them well and are generally able to meet their needs. The service 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). Of the staff files looked at all had evidence of an interview, however this was a pre-set questionaire completed by the applicant prior to interview, then informal questions to follow up the responses made. Without clear records of the interview process and answers it is difficult to ascertain how the decision was made to employ or not employ the member of staff.This is an area that should be considered for further development.
Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 29 It was positive to note that the service reviews this aspect of it’s practice via the monthly regualation 26 visits, during which the June 2006 report showed staff files and recruitment information had been audited. Not all staff files had a statement of Terms and Conditions. This was discussed with the Responsible Person who stated that a new contract had been drafted and would be issued to each staff member. This was made a requirement to be addressed within four weeks. The service has developed a comprehensive Induction process, which is in line with legislative requirements. There had been three new staff appointed and one file demonstrated that a staff member was currently going through the new induction process. This was seen to be linked to the Skills For Care training targets which ensures that within six weeks of being in post, new staff receive training in the principles of care, safe working practices, the workers role, the organisations role and the particular requirements of working with service users at Oakwood. The service is investing heavily in comprehensive staff training; to implement imminently, this will address training deficits and ensure that the Skills For Care targets are achieved. Staff meetings are undertaken and these are now regular. At interview all staff commented on the improvements Three visits were made to the home during this inspection period, all unannounced and two early in the morning. It was positive to note that there was a full complement of staff on duty as per rota. A number of staff was spoken to and interviewed during the fieldwork visits and it was positive to note that many have detailed knowledge of individual service users. Staff confirmed they are key workers to individual service users. Staff also commented on the improvement in staffing levels and how this has helped them deliver a better service. Staff were keen to co-operate with the inspection process and seemed committed to improve the quality of care received at Oakwood. Staff spoke positively of the Manager, deputy and the new 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.V293674.R01.S.doc Version 5.1 Page 30 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38. The quality in this outcome area is adequate this judgment has been made using available evidence including a visit to the service. The management of the home has stabilised and improved, which has resulted in better outcomes for service users. Service users’ financial interests are safeguarded by robust management of money and valuables. Health and safety of service users, staff and visitors is mainly ensured by routine testing and servicing of equipment and appliances. EVIDENCE: During the previous twelve months there has been a noticeable limprovement in the management and running of the home, maintaining a stable staff team and staffing numbers on each shift, and generally improving the systems for records and procedures which have led to a good standard of care being consistently maintained.
Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 31 The Responsible Person has invested heavily 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, which when sampled had improved considerably. The registration of the care manager has been set in motion, the appropriate Police check has been returned and the Commission now awaits the application to be processed. The acting manager was off sick at the time of the inspection visit. In her absence the deputy, Responsible Person and Consultant assisted with the inspection process. The acting manager has had the full support of both the Responsible Person and the Consultant in developing a staff appraisal system that will lead to a training programme to develop staff competence in caring for older people. Management meetings have recently been 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. Where mistakes had occurred, these were identified and rectified, for example mistakes on the medication administration records were noted and rectified, ensuring that the safe administration of medicines is maintained for service users. At interview three members of the senior team described a variety of improvements, previously there was confusion as to their role and responsibilities, now they describe clear role definition and have tasks and targets to complete daily, which are monitored. Staff said that they now have access to care plans which has improved the consistency of care for service users. They were able to highlight 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 service users and staff spoke positively about the ethos of the home. Recently many platforms have been introduced in which staff and service users can contribute to the way the service is delivered. Staff meetings and service user meetings have been re established, from these records it was evident that views are sought and acted upon. Service users had the opportunity to make choices regarding redecoration, and the activities they would like to do. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 32 As part of the inspection process some relatives were contacted by telephone, in order to ascertain their experiences of the service. There were varied responses as to how much 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. They had not received any information such as the service user guide or statement of purpose, but felt that the staff had made it clear that they could ask for any information. A second relative had no involvement in the care planning element and had not received information regarding what the home offers or how to make a complaint. Neither had seen an inspection report. It is evident that the Responsible Person has begun the process of consulting with service users and relatives as to the service provided, but this is in the early stages. The systems are evident, but not all service users or their relatives have yet benefitted from these. Further consolidation of these quality assurrance initiatives is now required,in order to establish an effective means of seeking views and acting on them. There are systems in place to safeguard service users finances. An audit of money and records was undertaken and confirmed this. The system in place for the management of service users finances was audited. There was a proper audit trail with records to evidence income, expenditure and balance this tallied with the money held in the home. One service user self manages finances. Discussion with staff highlighted some concerns regarding his capacity in this area. The deputy agreed to address this formally via a review It was positive to note that the service has conducted it’s own audits of service users finances to ensure these are maintained appropriately. A monthly regulation 26 visit was seen which demonstrated a random check had been carried out to audit accounts. Where shortfalls were noted, appropriate action was recorded in order to establish a proper audit trail of bank statements. Discussion took place regarding the capacity of a service user to manage finances. The Responsible Person gave an undertaking to arrange a formal review to establish the financial arrangements for the service user in question. When spoken with, the service user was satisfied with the systems for managing their money. Six staff training records were sampled and six staff interviewed. Most had some training in manual handling. Infection control was booked for the following week, and senior staff, were booked for Safe Handling of Medicines. First aid training was out of date for those who had it. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 33 The inspector was informed that a training needs analysis has commenced, and that a staff training programme, is to be implemented this year, which will meet with training targets. At the point of inspection, 10 staff had received formal supervision, which is the start of this process. In the time since the last inspection, it would appear that the Responsible Person is on target, and working towards meeting previous requirements. The staff team have begun to work to a clear health and safety policy, and some random checks have taken place to ensure staff are working within these guidelines. These records were sampled and demonstrated that checks are carried out on a weekly basis, although those sampled were for the period of February 2006. A recent food safety inspection highlighted minor requirements relating to the supply of paper towels, liquid soap, replacing a toilet seat, securing a door hinge and repairing a floor tile. A brief tour of the facilities confirmed that these deficits had been rectified. Staff demonstrated good awareness of health and safety issues and how these were to be managed. There is a more structured and planned response to meeting the needs of the service users, and ensuring service users are safe and receive a good standard of care. The reporting procedures for accidents and incidents were discussed with staff. All had a good understanding of the procedures to follow. The service history for the home also showed that there is consistency in reporting any concerns to the Commission. Records for the maintenance of fire equipment, gas and electric were seen to be maintained. The certificates for the servicing of the shaft lift and bath hoist were also evident. A previous requirement to develop manual handling risk assessments for the use of the hoist, had been addressed. New service users who require this assistance had a risk assessment on file. All existing service users who may require this assistance are having their risk assessment updated. The inspector spoke with several service users, one of whom described the assistance he required. He was happy with the arrangements for his personal care, which included the use of a hoist and staff using manual handling techniques, he said he felt safe with the arrangements in place. His needs were accurately reflected in his care file. Accident records were viewed and these showed that there had been a significant decrease in the number of falls. There are now mechanisms in place that enable staff to manage risks more carefully, and service users have the Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 34 risk assessments in place that will protect them by giving staff clear guidance on how to manage the risk. The Responsible Person has acknowledged a number of deficits over the past twelve months and has taken steps to address these. The majority of requirements made at the time of the last inspection, have been met within the timescales set. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 35 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 36 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 4(2) 5(2) 22(5) Requirement The Responsible Person must ensure that the Statement of Purpose, Service Users Guide, and complaints procedure are distributed to service users and their family. The Responsible Person must ensure that existing service users are reviewed and that a care plan is drawn up with each service user and their family or representative. Previous requirement. A risk assessment for service user at risk of choking must be drawn up. This must clearly specify what action should be taken to prevent the risk and what action to be taken in the event of choking. This must include any relevant clinical guidance from the health care consultant. An immediate requirement was left with the service to action this in 1 day, i.e. 13/06/06. Timescale for action 01/09/06 2. OP7 14(2)15(1 ) 01/09/06 3. OP7 13(4) (c) 13/06/06 Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 37 4. OP8 13(1)(b) 5. OP9 13(2) 6. OP12 12(4)(b) 7. OP15 16(2)(i) 8 OP18 13(6) The hearing appointment for one service user must be rearranged. An immediate requirement was left with the service to action this in 2 days, i.e. 14/06/06. The Responsible Person must ensure that staff adheres to medication procedures to include regular auditing of medication to identify any deficits. The Responsible Person shall make arrangements to ensure that the needs of service users who have a disability are specific in their care plan, and that referrals are made for any equipment necessary to increase their equality of opportunity. Service users must be referred for wheelchair assessments. Menus must reflect nutritiously balanced and wholesome meals are offered to service users. Service users must be consulted in this process. The Responsible Person must make arrangements for staff to receive training in adult protection. 14/06/06 08/06/06 06/10/06 01/08/06 10/10/06 9 OP18 15(2)(b) 10 OP19 16(2)(c) Senior staff must be familiar with the reporting procedures for responding to suspicion or evidence of abuse. The Responsible Person will 12/09/06 arrange for a review of the service user with regard to the concerns around finances. The Responsible Person must 01/09/06 audit the bedroom door locks to ensure they are suited to the needs of service users. Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 38 11 OP19 23(2)(d) 12 OP26 16(2)(j) 13 OP26 18(1)(c) (i) 14 OP29 17(2) Schedule 4 6. (e) 15 OP29 13(4)(c) The Responsible Person must ensure that the rolling programme of redecoration continues, specifically redecoration of remaining bedrooms, halls, stairs and landings. Progress in these areas should be forwarded to the Commission on a three monthly basis. The Responsible Person must make suitable arrangements for maintaining satisfactory standards of hygiene. Hygiene standards in the food preparation areas must be maintained. An immediate requirement was left with the service to action this in 2 days. The Responsible Person must ensure that a risk assessment is carried out for the movement of heavy objects, and that significant findings are recorded. e.g. sack of potatoes. Staff must receive instruction as to carry out safe working practices in this area. An immediate requirement was left with the service to action this in 2 days. All staff must receive a statement of Terms and Conditions of Employment. An immediate requirement record was left with the home to action this within 4 weeks. Eg.12/07/06. The Responsible Person must ensure that service users are supported and protected by the homes recruitment practices. Interview notes, must be an accurate account of the interview process, and include exploring any employment gaps, or gaps in the application form.
DS0000056587.V293674.R01.S.doc 01/10/06 08/06/06 08/06/06 12/07/06 01/10/06 Oakwood Rest Home Version 5.1 Page 39 16 OP30 18(1)(a) 17 OP31 38(2)(c) 18 OP33 24(1)(ab) The Responsible Individual must 01/10/06 complete a training review and provide the staff training required which meets the National Training Organisation (NTO) workforce training targets. On completion a proposed plan of training should be submitted to the Commission. The Responsible Person must 01/10/06 ensure that an application is submitted to the Commission, for the appointment of the Acting Manager. The quality assurance system 01/10/06 needs to be formalised. The views of service users and their representatives must be consistently sought. Systems should be in place to ensure the results of consultations are made known to current and prospective service users, their representatives and other interested parties. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 40 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk Oakwood Rest Home DS0000056587.V293674.R01.S.doc Version 5.1 Page 41 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!