Inspection on 15/04/08 for Oasis House

This inspection was carried out on 15th April 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Oasis House 17/09/08

Oasis House 23/10/07

Oasis House 07/07/06

Oasis House 06/12/05

Oasis House 20/04/05

Oasis House 06/01/05

Oasis House 08/07/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Oasis House 19, Arundel Drive West Saltdean Brighton East Sussex BN2 8SJ Lead Inspector Elizabeth Dudley Unannounced Inspection 10:00 15th April 2008 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 Oasis House DS0000014218.V361064.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. Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oasis House Address 19, Arundel Drive West Saltdean Brighton East Sussex BN2 8SJ 01273 279683 01273 299083 oasishome@ntlworld.com 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) Sunrise Apartments Limited Mr John Mark Ghazal Care Home 5 Category(ies) of Old age, not falling within any other category registration, with number (5) of places Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users must not exceed 5 The service users will be aged 65 or over on admission That the home is registered to accommodate a named service user under the age of sixty- (60) years on admission with a sensory impairment. Only older people who have been assessed as requiring residential care are to be accommodated 23rd October 2007 Date of last inspection Brief Description of the Service: Oasis House is a small, family-run care home that provides personal care and accommodation for up to five older people. The home is a detached residence, situated in Saltdean, East Sussex. It is opposite a park that has a bowling green, pitch and putt and tennis courts. Oasis House is a short distance from the local community centre, library and shops, with a bus route to Brighton and other coastal towns nearby. Accommodation is provided in five single rooms on the ground floor. There are two communal bathrooms, one with a walk in shower. The joint proprietors are resident at the home and provide the bulk of the overall staffing. They also employ a small group of staff. There is a garden area at the front and rear of the property that is accessible to service users. The home has a communal lounge, with recliner style chairs for each resident, and a dining area. The cost of rooms is £380 and £450 per week. Charges for extra services such as hairdressing and chiropody are not included in the fees. Details of these can be obtained from the home. Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This unannounced key inspection took place on the 15th April 2008 over a period of five and a half hours and was facilitated by a member of the care staff. Methodology used to inform the judgements made at this inspection, included a tour of the home, discussion with residents and staff and examination of documentation kept in the home. Documentation examined included care plans, medication records, catering records, personnel files and training records. Some health and safety documentation was seen. Prior to the inspection 6 relatives and five resident surveys were sent to the home. Two relative surveys and five residents surveys were received. Comments received by survey were positive about the home: ‘Staff are very cooperative with relatives and residents”. “I am happy and satisfied with my care”. Residents spoken with said ‘Its alright here, the food is alright, there is some variety but breakfast is always the same’. ‘ The staff are lovely, really nice people.’ ‘ Fair here, alright as it goes’. What the service does well: The service provides a pleasant small home for five older people and gives the people living there the benefit of being in a family environment. Three residents spoken with during the inspection said that the staff were kind and polite and that the manager was around to answer any queries they may have. Residents said that they were well looked after and that they were treated with kindness and dignity. Weekly fire drills are carried out to ensure that staff are familiar with this routine in the event of a fire. Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The Service user guide should reflect the current practices in the home and include up to date contact details on the regulatory bodies. Prospective residents should be informed in writing about whether the home is able to meet their needs. Care plans must be reviewed on a monthly basis, be formed in consultation with the resident or their representative and where changes are made to care plans when reviews take place, then these should be recorded and signed by the resident and or their relative/representative. Care planning must be in place for all the current and changing needs of the residents. Any information relating to the care of the resident, including daily records should be kept in the care plan in a confidential manner. The keys to the drug cupboard were accessible to residents and visitors to the home. The senior person on duty should ensure that these are in a secure place. There were some areas of concern around drug administration, the return of unwanted medication and the provision of medication that was neither prescribed nor on the ‘homily remedy list’. Not all staff have the required documentation in their personnel files. Personal and general risk assessments are required to ensure residents safety. Documentation required by the CSCI had not been returned in a timely manner and the improvement plan did not accurately reflect the current status of the requirements made at the last inspection. One of the seven requirements made at the last inspection has been complied with. The CSCI will be taking enforcement action to ensure that requirements are met. Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 7 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. Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 8 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 Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 9 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. People who use the service experience adequate quality outcomes in this area Whilst information provided to residents is comprehensive and written in a manner to promote ease of use, some information included in this is not accurate, and does not reflect the current practice in the home in some areas. The preadmission assessment that was available contained sufficient information to enable staff to be aware of the prospective resident’s care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 10 The Statement of Purpose was not available on this inspection. All residents have a copy of the Service User Guide, which was written in plain English and provided the resident with clear information about the home. Some amendments are required, the address of the CSCI was out of date, the regulating authority was referred to as the NCSC and this should be amended. The times of breakfast advised in the Service User Guide did not correlate with what the residents were saying, these are shown in the service user guide as being available from 8-10 whilst the residents were saying that breakfast had to be taken at 8 am. All residents have received a contract. Prospective residents are assessed prior to admission and one preadmission assessment was available. The preadmission assessment seen was quite comprehensive, but some personal details such as resident’s religion were not transferred to the care plan. There was evidence that the proprietor/manager also gains pre-admission assessments from care managers when residents are placed into the home by a local authority. There are four residents in the home at present. It was not possible to ascertain as to whether prospective residents were informed in writing as to whether the home can meet their needs, and a requirement will be made around this. The home accepts residents for respite care but not for intermediate care. Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. People who use the service experience poor quality outcomes in this area The standard of care planning does not reflect the current care required by the residents. Daily records are not kept in the care plans and this could impact on confidentiality of the residents. The standard of medication does not safeguard the residents This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four (100 ) of the care plans were examined. Much of the information in the care plans had not been updated to reflect the needs of the residents, there was no evidence of regular or annual review and there was no evidence of the care plan having been formed in consultation with the resident. One care plan had been reviewed regularly since February 2008 but prior to this, not since Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 12 2007. There was no evidence to show that other care plans had been reviewed since 2007. One resident does not go to bed due to continence problems and this was not identified in the care plan. There was no evidence of any care planning relating to the prevention of skin or pressure damage or advice gained about continence needs. The call bell was not near the bed or the chair, and therefore assistance was not readily available. Two residents have nutritional problems, nutritional needs were not addressed in a thorough manner in the care plans and there was no evidence of monthly weights. Residents had been weighed three monthly or less frequently and there was no indication of comparison of weight or what action had been taken to address any losses or inappropriate gains. Supplement feeds are given to one resident, these did not form part of a satisfactory nutritional care plan and whilst records were seen in the home’s diary of when a resident had refused a meal, there was no follow up in the care plan and no evidence that appropriate health care professionals had been contacted. There was no evidence recorded of the general deterioration in this resident’s health and abilities. A satisfactory nutritional plan was not in place for a resident with both medical and weight problems and there was no evidence of dietician consultation. Continence care plans were not satisfactory, no details of catheter care were recorded and there were no specific instructions to care staff. The mental health needs of a resident had not been satisfactorily addressed in the care planning process, neither was their any evidence of visits by relevant health care professionals regarding this. Staff said that visits from health care professionals were recorded in the visitor’s book only; there was no evidence in the care plans about health care professional’s visits and the results of these visits. There were no risk assessments in the care plans and moving and handling plans had not been reviewed regularly. The care plan for a resident who has a sight deprivation did not fully address her needs, and was out of date regarding the social opportunities afforded to this resident. Care staff have no specific training to provide the specialised care required for this resident. Daily records of the care given to residents are kept in a general diary in the kitchen. This does not allow residents confidentiality and this could be further compromised if these records were required out of the home, makes it difficult to refer the care given to the care plan, and were generally not informative. This was a requirement at the last inspection. Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 13 The majority of call bells are not sited near the beds or the chairs, there are two pendant call bells in the home and these are given to those at risk of falling. The home provides sleeping night staff and therefore if a resident was ill in the night they could not summon help. Staff said that one resident fell in the night but managed to get up again, but staff were not aware of this until the following morning when the bruising was seen. One resident spoken with said ‘ I look after myself at night’. Residents spoken with identified the care given as ‘reasonable’ or ‘fair’, with two residents saying the home was not meeting all their expectations. Residents looked clean and comfortable and said that staff were ‘very good’, ‘very helpful’, ‘always willing to help’. Requirements made at the last inspection around care planning and recording of care have not been complied with and the CSCI will take enforcement action. New medication policies have been written but these were not examined at this inspection. No residents currently in the home administer their own medication. The keys for the medicine cupboard are kept hanging on a hook outside the office door in the corridor, this puts residents at risk and is not in line with the ‘Pharmaceutical Guidelines for the Administration and Control of Medications in care homes’. Quantities of loose cards of tablets, without the name of the resident for whom they were prescribed, were found in the drug cupboard. A bottle of prescription lotion was found with the label torn off and no resident was prescribed this at this time. A medicine which was neither prescribed for a resident or identified as a ‘ homely remedy’ (able to be given by staff if required for a limited period without prescription) had been purchased and was being given to a resident, although some of the side effects of this may have affected her medical condition and should have been discussed with her General Practitioner and prescribed if the General Practitioner felt appropriate. A liquid medication prescribed in April 2007 had no date of opening recorded and was still being used. Staff are continuing to give pills prescribed in 2007 although fresh stocks have been delivered. Receipt of medication was not always dated and signed and administered medication was not being signed with the full initials of the carer and there was no list of names of administering staff with corresponding initials which would help with identifying care staff administering medication. Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 14 The correct document for recording return of medication has only recently been supplied, although a requirement relating to disposal of medication was made at the last inspection. Staff had not previously been adhering to the guidelines when returning drugs to the dispensing pharmacist. A requirement was made at the last inspection relating to ensuring that practices around administration of medication were in line with Pharmaceutical guidelines. This has not been complied with. Some members of staff have medication training and training has been booked for other staff. Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. People who use the service experience adequate quality outcomes in this area Opportunities to participate in leisure activities are limited. Lack of choice of menu and variety of food available may affect resident’s nutritional status. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Activities provided by the home include an art therapist visiting once a fortnight, some outings, and staff providing board games and reading to residents. Staff said that there was not much time to do activities with the residents and they can only take them out when the manager is in the home due to having only one member of staff on duty. A day trip to France, which was available to those who could afford to go, took place last year. Residents spoke of how much they enjoyed this. Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 16 Birthday parties take place with relatives providing a cake and being invited to join the residents. Visiting can take place at any time. There is a strong ethos of Catholicism throughout the home with weekly catholic service held in the home. Residents said they do not have to attend this and they think other ministers of religion could visit the home if required. There is no evidence in the home of religious diversity being catered for. The service user guide states that breakfast is available from 8-10, but both staff and residents said that it was at 8am and there isn’t a choice of time. Residents have a light breakfast in their room. One resident said that they try to go back to bed afterwards, “but not for long as the staff come and do the personal care”, others said “ I know the staff come in with breakfast at 8 – if you don’t want it then I suppose you do without – don’t know”. “. Have to get up at 8 for breakfast- there is certain time which you have to keep to, to get up”. There was no evidence in the care plans to show what time residents would prefer to get up in the morning. All residents said that they could choose when they went to bed at night. There is no rolling menu and the one menu printed out for guidelines for the evening meal, showed that this offers the same options every week. Staff and residents said that they always have roast chicken on a Sunday, cooked breakfast for lunch on a Saturday and that the menus were generally the same every week. Residents said that the main meal was served in the evening and they had a light lunch such as sandwiches or soup and could choose the type of sandwiches they had. Desserts mainly consist of yoghourt or ice cream, with occasionally pies or puddings being brought in. The menu did not show what was available for dessert. However there was plenty of fresh fruit, both in the lounge and the kitchen. Residents can choose whether to have their meals in their rooms or in the dining room. Not all staff have the food hygiene course but the manager has recently arranged training in this for staff in the next few months. Daily records of resident’s meals and whether they have eaten the meals are maintained. Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 17 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. People who use the service experience poor quality outcomes in this area Residents are not confident about making a complaint. Arrangements for protecting the residents are not satisfactory and may place them at a risk of possible abuse. Recruitment procedures do not safeguard the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is included in the Service User Guide, but not displayed in the home. This requires review to include the correct address of the regulatory body. There was no evidence in the home of any complaints or concerns having been received in the past year. Two of the three residents spoken with were unclear as to how to make a formal complaint and said that they would probably not make a complaint to the manager. A third resident said that although they were aware that they could take complaints to their social worker, they would not like to pursue a complaint because they would not like to ‘upset the manager, as he does his best’. One member of staff had Adult safeguarding training in a previous employment in 2006. Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 18 Other staff have not yet undertaken this although the manager and one carer have this training booked in the next two months. The carer in charge over the manager’s absence had read the ‘Multi Agency Guidelines for Safeguarding Adults’ but was unsure about the reporting protocols. The recruitment systems in the home do not ensure that residents are safeguarded. Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 19 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): 19,20,21,22,24,25.26 People who use the service experience adequate quality outcomes in this area Whilst the environment is comfortable and clean, residents are at risk from cross infection. Lack of suitable risk assessments, and call bells being out of reach, could endanger residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is clean and provides a homely and well-maintained environment for the people that live there. The small garden to the rear is largely taken up by the swimming pool for the use of the provider/ manager’s family. No risk assessment for this is in place Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 20 although residents could access it, and a requirement will be made regarding this. There is a paved area that residents can use. Communal areas consist of a lounge/dining, which looks out across Saltdean and to the sea. This is furnished in a comfortable and domestic manner. Residents can bring their own possessions into their rooms and these are pleasantly decorated and furnished. No lockable drawers or lockable doors are provided for residents privacy, any resident in the future that self medicates will require a lockable facility and residents should have the option of being able to lock their doors if they go out. Door locks should be provided within the auspices of a risk assessment. Not all radiators have guards to protect residents and staff said that the radiators get quite hot. The owner is required to contact the health and safety executive regarding this and should take into account the rapid changes in both physical and mental ability that can occur in residents of this age group. There was no risk assessment seen for the portable heater in the lounge. A requirement will be made relating to this. Water temperatures to resident’s washbasins and bathrooms have been monitored regularly and records showed that these were within recommended parameters. Call bells in residents rooms were situated some distance from the beds, if a resident required urgent assistance during the night they may have difficulty in reaching these. Two neck pendant call bells are available for those residents at risk of falling. The home provides two assisted bathrooms for residents, which include both a bath and a shower. A hoist is available for any resident that requires this; at present the residents in the home are mobile. There were no soap dispensers or paper towels in the home, cloth towels were left in bathrooms, as were personal toiletries and block soap. Leaving towels in the bathroom and block soap can impact on the control of infection and leaving personal toiletries in the bathrooms can impede choice and can put residents at risk. Commode pots were in one bath having been left to soak. Staff said that this is the usual way that they are cleaned. The manager should be aware of the implications on resident’s health by this practice and will be required to ensure that all the members of staff in the home receive sufficient training in infection control. Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 21 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. People who use the service experience poor quality outcomes in this area. Staffing levels in the home are not always satisfactory and could put residents at risk. Lack of training in care skills could put residents at risk Recruitment systems are not robust and do not safeguard the residents in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing provided in the home is 1 member of care staff from 8am to 8 pm and night cover is provided on a sleeping basis by the manager / owner who lives upstairs. The call bell system goes through to the flat. There are no ancillary staff and care staff do the cleaning, cooking, care and activities. On the day of the key inspection the registered proprietor/manager was on holiday and not expected back till the 17th April 2008. The inspector has concerns in that the member of staff with sole responsibility for the home on a twenty four hour basis, had not attained her National Vocational Qualification level 2 in care, usually only works in the home one day Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 22 a week (although previously had worked for two years in the home) and had no contact person to call who could give advice or guidance on care matters. Although in sole charge of the home, she was helped by other care staff that came in for the morning and afternoon shifts but was alone for the night shifts. The members of staff coming in on duty did not have National Vocational Qualification level 2 in care and had only worked in the home for a few months. The manager also employs another carer who comes into sit with the residents if the manager goes out during the day or at night and no other staff are available. There was no evidence that this member of staff has any experience in care. The manager is the only person in the home with a National Vocational Qualification in Care although one member of staff has nearly completed level 2 and the deputy manager is in the process of gaining level 3. Two members of staff have completed the nationally recognised induction course, one member of staff has completed the home’s own induction course, whilst it was not clear whether the part time member of staff had completed the course as only the summary was in place. Not all members of staff have completed their mandatory training, which included moving and handling and only one member of staff has completed Protection of Vulnerable Adults training in a previous post, this should be updated to include latest protocols. One member of staff had received training in care matters including dementia at a previous post, but there was no evidence of any training in care taking place in the home. Personnel files of all four members of employed staff were seen: Three of these contained two written references. A recent staff member was employed prior to the Protection of Vulnerable Adults check being completed and there was no evidence of the Criminal Records Bureau check for three members of staff including the person in charge of the home on this day. One personnel file identified that the Criminal Records Bureau check had been seen by the manager but there was no evidence to inform the inspector over whether this related to this home. There was no evidence to suggest that the manager had fully investigated all matters in the recruitment process. Staff spoken with said they had not received the General Social Care Code of Conduct. Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 23 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): 31,32,33,35,36,37,38. People who use the service experience adequate quality outcomes in this area. Management systems in the home do not always safeguard the residents. Residents say the manager is usually available to answer any queries that they may have This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a registered nurse and has completed the Registered Managers Award and National Vocational Qualification level 4 in care Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 24 Residents in the home said that the ethos in the home was good and the manager and staff were kind. The Annual Quality Assurance Assessment required by the CSCI was not received and an improvement plan required was not received until a month following the due date. The manager stated that improvements had been made in line with the requirements from the last inspection, this was found not to be accurate at this inspection. This will result in a requirement being made. The past inspection report shows that quality monitoring is carried out by surveys being given to residents and relatives, but there was no evidence of recent quality monitoring in the home. One of the seven requirements made at the last inspection had been met. Surveys sent by CSCI to residents and relatives in the home had been returned but the comments made in these surveys were not fully reflected during conversation with them. Staff said that they are having supervision intermittently, and records confirmed that this was not being done at intervals directed by the standard. Records in the home were difficult to locate and not always up to date, with resident’s records and information relating to them being kept with other unrelated documents. The manager does not act as appointee for residents but keeps some money for residents to access. No records of these were available in the home at this time. The CSCI has no records of any Regulation 37 reports (reports of deaths, accidents or incidents involving residents required by the CSCI) being received over the past two years. No accident report had been completed for the resident who had a recent fall. Some certificates for the servicing of utilities were seen, these were identified at the last inspection as being due 09/07 and generally servicing has taken place within this timescale. Lack of mandatory training such as moving and handling could put residents at risk. Fire drills take place weekly although no formal fire training takes place. Unavailability of risk assessments, both individually and around the home, could put residents at risk, as is leaving the home without suitably qualified and experienced person in charge. Requirements will be made around these issues. Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 25 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 3 2 1 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 1 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 3 3 3 2 x 2 2 1 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 1 x 2 2 2 2 Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 26 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 Reg 4 (2) Reg 5(1) Requirement Timescale for action 14/06/08 2 OP4 3 OP7 That the registered provider/ manager ensures that the Statement of Purpose is available to service users and interested parties. That the Service User Guide is amended to include the correct address of the regulatory body and contains accurate and up to date information. Reg That prospective service users 14(1)(d) receive written confirmation of whether the home can meet their needs. 15(2)(b)(c The registered provider/manager ) must ensure that care staff in the home review residents’ care plans at least once a month and updated to reflect changing needs and current objectives for health and personal care. (This was a previous requirement with a compliance due date of the 21/12/07) Daily records must be informative, relate to the care given in accordance with the plan of care and be kept in confidential manner. DS0000014218.V361064.R01.S.doc 14/06/08 14/06/08 Oasis House Version 5.2 Page 27 4 OP8 12(1)(a)( b)17(1)(a )(b) The registered person must ensure that a daily record, monthly weight chart and up to date professional health care visit records are kept within the residents’ care plans. (This was a previous requirement with a compliance due date of the 21/12/07) 14/06/08 5. OP9 Reg13(2) (4) 17(1)(a) Sched. 3 (3)(i) 12(2)(3)( 4) The registered 31/05/08 proprietor/manager must ensure and that the practices in the home relating to the receipt, recording, storage, handling and administration of medication, are in line with the policies and procedures in the home and relate to the guidance given by the Royal Pharmaceutical Society in ‘ The administration and control of Medicines in Care Homes’. (This was a previous requirement 21/12/2007) 6. OP12 Reg 12(2)(4)( b) Reg 16(m) (n) 7. OP14 Reg 15(1)(2)( a) The registered person shall as far as possible allow service users to make decisions in respect to the care they are to receive, the daily life in the home. The registered person shall ensure that adequate facilities and opportunities for leisure activities are provided to service users. The registered proprietor/manager must ensure that all information relating to a resident must be kept individually and not collectively to avoid contravening the Data Protection Act 1998 (This was a previous requirement due 21/12/07) 14/06/08 14/06/08 Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 28 8 OP16 Reg 22 (8) Reg 13(6) 9 OP18 10 OP27 Reg 18(1)(a) That records of complaints and 14/06/08 concerns received and the method of addressing these is kept in the home. That all staff receive training in 14/06/08 safeguarding adults and that staff do not commence work at the home until the Protection of Vulnerable Adults and Criminal Records Bureau checks are in place. The registered provider/manager 14/06/08 must ensure that there are suitably qualified staff on duty at all times to meet with the assessed needs of the residents in the home. (This was a previous requirement compliance due date of the 21/12/07) 11 OP28 Reg 18(1)(c) The registered manager must ensure that staff receive suitable and recognised training in the care of the service users in order to ensure their personal and health care needs can be identified and met. 14/06/08 12 OP26 Reg 13(3) 13 OP29 Reg 19 That issues within the home as 14/06/08 stated in the main body of the report, that may have implications on the spread of infection are addressed and that all staff received training in infection control by a suitably qualified person. No staff to commence 14/06/08 employment at the home prior to the employer being in receipt of all documents as directed in the regulation and in Schedule 2 . This must include a Criminal Records Bureau check and Protection of Vulnerable Adults relevant to this specific care home. Staff currently working DS0000014218.V361064.R01.S.doc Version 5.2 Page 29 Oasis House 14 OP29 Reg 18(4) 15 OP33 Reg 24 (1)(2)(3)( 4) (5) 24(A) (1)(2)(3) 16 OP38 Reg 13 (4) without this documentation should work under supervision until received. All staff must be issued with copies of the General Social Care Code of Conduct on employment at the home The registered provider will maintain a system for evaluating the quality of the services provided at the care home and shall at the request of the commission will supply a copy of the report within one month of the receipt of the request referred to in (2) and in the form and manner requested by the commission. If requested to do so by the commission the registered person shall provide an improvement plan setting out the methods and timetable to which the provider intends to improve the services. The registered person shall provide the written copy of the improvement plan within one month of the receipt of request. The improvement plan should accurately reflect improvements in the home. That personal and environmental risk assessments are put in place regarding the swimming pool, portable radiator and other issues identified in the report. Ensure that the risks to service users from all exposed radiators are fully assessed and identified and that appropriate radiator guards or low surface temperature radiators are fitted where required to protect the service users from the risk of harm and injury. Ensure that all service users are provided with a means to DS0000014218.V361064.R01.S.doc 14/06/08 14/06/08 14/06/08 Oasis House Version 5.2 Page 30 17 OP38 Reg 37 summon help in an emergency and that call bells appropriate to the needs of the service users are sited where they can be reached at all times. The provider must notify the commission of any deaths, incidents, accidents or other events affecting the well being of service users. 14/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP28 OP24 Good Practice Recommendations That at least 50 of care staff are trained to NVQ level 2 in care. That service users are provided with a lockable drawer or facility in which to keep personal possessions and are offered within the auspices of a risk assessment, a lock on their door. Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Oasis House DS0000014218.V361064.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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