Inspection on 03/10/07 for Oban House (42-46)

This inspection was carried out on 3rd October 2007.

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

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

Other inspections for this house

Oban House (42-46) 24/11/06

Oban House (42-46) 07/12/05

Oban House (42-46) 12/05/05

Oban House (42-46) 08/12/04

Oban House (42-46) 21/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Oban House (42-46) Oban House 42-46 Bramley Hill South Croydon Surrey CR2 6NS Lead Inspector Michael Williams Key Unannounced Inspection 3rd October 2007 9:45am 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 Oban House (42-46) DS0000019035.V347507.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. Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oban House (42-46) Address Oban House 42-46 Bramley Hill South Croydon Surrey CR2 6NS 020 8649 8866 020 8649 8811 oban.house@ashbournesl.co.uk www.southerncrosshealthcare.co.uk Apta Healthcare (UK) Ltd 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) Zelina Zarina Fatima Ramdhan Care Home 61 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (61) of places Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One (1) place for a service with dementia can be accommodated Date of last inspection 24th November 2006 Brief Description of the Service: Oban House was trading as APTA Healthcare UK Limited, a subsidiary of Ashbourne Healthcare Ltd., but is now owned and managed by Southern Cross, a large company with homes across the country. Oban has kept the company name Ashbourne and continues to be called ‘Oban House’. Oban is a modern, purpose built care home. It first opened in 1997 for older people who require nursing care. The home admits residents both privately funded and through placement agreements with the local authorities. The home is arranged over three floors. Each bedroom has an en-suite toilet and shower and there are toilets and bathrooms located on each floor. Each floor also has its own communal living room, kitchenette and dining room. There is a main kitchen in the basement of the building and a laundry service is provided for the residents. Fees were from £524 to £900 in 2007. Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. To monitor all aspects of this service the two inspectors visiting this home in October ‘tracked’ the care provided to a number of residents and cross checked the information by speaking to the residents, and where possible to their visitors, and by examining the documentation supporting care; by observing the meals and catering arrangements; by checking the arrangement for medication, handling money, records of complaints and accidents. Staff providing care were interviewed including nurses, carers and ancillary staff as well as senior managers and a regional manager. Questionnaires were also distributed and feedback noted. The Commission has also attended a number of meetings arranged by the local Social Service Department which, in addition to routine reviews of residents’ care has also been investigating a number of serious concerns about the quality of care provided. In this connection, inspectors have attended a number of ‘strategy meetings’, which are safeguarding meetings conducted by the local authority when investigating concerns that affect the welfare of residents. In compiling this report the Commission has also taken account of other information such as the monthly reports provided on behalf of the owners of Oban and the AQAA [Annual Quality Assurance Assessment] – which is a new self auditing tool each home is required to complete and send to the Commission. What the service does well: What has improved since the last inspection? The home has changed ownership and has a new manager, Mrs Zelina Ramdhan. As part of an on going programme of refurbishment the home is replacing equipment such as kitchen units and hoists used to assist in moving residents; some bedrooms are being redecorated and carpets replaced. To improve the quality of service of meals lunchtime has become a ‘protected’ time when all care staff direct their attention to supporting residents while they eat and not undertake other activities such as administering medication, writing up notes or taking breaks. Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1, 3: Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. Assessments are in place for each resident and these form the basis of the initial care plan and risk assessment. This ensures the care needs, including the health care needs, of prospective residents are made clear from the outset so they will be able to judge whether or not Oban House can meet their needs. EVIDENCE: A sample of case notes of those residents being ‘case-tracked’ to monitor care was checked. The Home’s Manager, the company’s Operational Manager, some staff and relatives were interviewed during the course of this and the previous inspections; the residents themselves advised the inspector of their experiences at the time of admission. Inspectors were advised that an information pack is prepared for each resident and includes the Resident Guide (a copy of which was seen to be located in each bedroom), a summary of the Statement of Purpose and copies of the Contract. Care staff then start compiling the care planning documentation. The pre-admission assessments include general information about each resident, details of their background medical and social history and comprehensive details of specific issues such as Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 9 mobility nutrition, diabetes, continence, medication and diversity needs or choices. Residents, with their representatives, assist in the compilation of these case notes. Areas of strength include the depth and range of pre-admission assessments and the general information provided on admission and as no matters requiring improvement arise this section, about choice upon admission, is assessed as good. Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 10 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): NMS 7 to 11: Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. Individual plans of care plans are in place for all residents but they are complex tick-box systems which do not always provide the level of detail a resident might expect in their care plans. Medication policies, procedures and administration practices ensure the safety of residents. Residents are not always treated with respect and dignity. Staff have not always been able to provide the care, dignity, comfort and pain relief residents expect at the end of their life. EVIDENCE: Residents have access to health care services both within the home and in the local community. Residents are able to choose a General Practitioner from one of the local practices and they attend surgery or receive treatment from doctors, local dentists, opticians and other community services in the home itself. Health needs are monitored and appropriate action and intervention is usually taken. The home is generally able to provide the aids and equipment recommended, more attention could be given to the changing needs of the residents. Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 11 There is evidence in the Care Plan of health care treatment and intervention, and a record of general health care information. There are some gaps in information in so far as the care plans are complex data sheets covering all aspect of care but many requiring no more than a tick as confirmation of a need or an action completed and does not provide a great deal of detail in some instances one such example was in the night care notes which read as ‘all safety checks made’ with no indication of what was checked to reach this conclusion. This volume of form filling also appears to leave residents and visitors feeling that staff are busy filling in paperwork and not free to support them; staff are not often seen sitting with residents in the lounge or in the bedrooms. Whilst it is highly commendable that the care plans cover so many important areas of need and risk staff, need to be more aware of the detailed wishes and the immediate needs of residents; for example it took nearly ten minutes for an extra round of toast to be delivered to a resident at breakfast time; another was clearly in need of drink but staff were not patrolling the bedrooms to see this – nevertheless their paperwork demonstrated that care was being given at the specified intervals. This gave the impression that staff were not using their initiative but merely following lists of prescribed care duties. A visiting care manager identified that these tick-box lists are sometimes marked in advance and therefore cannot represent the actual care provided. The home has a medication policy which is accessible to staff, medication records are up to date for each resident and medicines received, administered and disposed of are recorded. No resident currently administer their own medication but would be supported to do so if they wished to and had the capacity to do so safely. We observed the administration of medicines and checked a sample of medication records to confirm safe practice. In discussion with nurses it was evident that they understand the need to comply with the administration, safekeeping and disposal of controlled drugs. When we interviewed staff and the manager it was clear they were aware of their responsibility to treat residents with respect and dignity but in practice this was not always the experience of residents. Residents indicated that they are happy with the way that “most” staff deliver their care and respect their dignity. However several residents said staff were sometimes “a bit off-hand” and another said “I speak up if they are rude to me” and for another resident a relative has posted notices on the bedroom wall suggesting she is not confident staff will meet her mother’s needs in the manner she would expect. During the course of this visit there was an instance when a member of staff’s comments to a resident were less than polite and respectful. The manager advises us that she is aware that some staff have been disrespectful and has taken action including further training and disciplinary action. The lack of door locks on bedrooms compromises the residents’ right to privacy and security. The home has policies and procedures, which provide guidance for staff on how to support a person and their family when faced with a terminal illness but these have not always been followed. Staff have received some training in terminal care but there have been serious lapses in how care has been Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 12 delivered when residents who are terminally ill even though specialist palliative care nurses have delivered training. Although residents and their family have given advice and instructions about last wishes and preferred arrangements before and after death this information has not always been followed by the nurses. The consequences have been to cause great distress to at least one family who had expected their relative’s last days to be dignified, pain-free, peaceful and with family nearby in comfortable surroundings and this was not the case. The managers of the home concede care practices were poor and that the local authority investigation substantiated the allegation of neglect in this instance. Whilst the local authority has suspended admissions, the home’s management team has responded positively by arranging for further training of staff. During the course of our visit we met specialist nurses who were delivering this training about end of life care. We note this as another example of where complex documentation did not ensure good practice, if anything it appeared undermined common sense and initiative. Areas of strength include the range of documentation used to support care; the layout of the home and the equipment available in the home to ensure the safe moving of residents; access to health care professionals and no problems were identified in respect of the administration of medicines. Matters requiring improvement include bedroom door locks for privacy. ‘Customer care’ needs to improve, staff need to provide care in a respectful manner at all times and need to pay attention to the details of care that concern residents. If it is the case that staff are following check-lists to guide their practice then greater attention needs to be given to using their initiative and staff need to time, training and support to do so. Whilst there have been serious lapses in care practice this does not reflect the experience of most residents who feel safe and well cared for. This section, about health and personal care, is assessed as adequate. Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 13 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): NMS 12 to 15: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents appreciate the comfort and lifestyle provided in this care home. They maintained contact with their families and are given every opportunity to exercise choice and control commensurate with their health and abilities. Most residents praised the meals provided whilst some were less enthusiastic. EVIDENCE: During the examination of a sample of case files the very detailed care plans and multiple assessments were noted with some reservations about their complexity noted in the previous section. Case files were clearly laid out and easy to follow and give scope to make clear the specific care needs of each resident. Residents in this home are very dependent as a result of their age and frailty; their capacity to control their lives and make significant decisions and choices is therefore somewhat constrained. The initial assessment and information provided by family and friends helps staff gauge residents’ wishes and preferences but this vital information must be known to staff who must act upon it if it is to be of any value – this point is also noted in the preceding section. Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 14 Residents are being supported and encouraged to maintain links with family, friends and the wider community as they wish and I met with residents and their visitors to confirm that relatives are always welcomed into the home. On the day of the inspection that there were a wide range of visitors including family and friends, and professional health carers. The visitors’ book, a required record, confirm this social and professional contact with the wider community. The daily routines in this home are reasonably flexible, within the constraints of a large service. Residents are being supported and encouraged to maintain links with family, friends and to exercise choice and control over their lives in so far as they wish and are able to do so. The home employs an activity coordinator who told me that she makes sure all residents, whether they are sitting in the main lounges or spending the day in their bedroom, have an opportunity to met with her and take part in social activity. She also advised me that she has asked residents about what activities they enjoy and she found several activities remain popular and that residents want to stick to them, including for example Bingo. Whilst it is commendable that the home employs a member of staff whose role is to provide ‘social activities’ it was noticeable and commented upon by visitors that the nurses and care staff are rarely seen sitting with residents in the lounge. Staff may need to be directed to spend time in this way as it is often the case that care staff think form-filling, laying tables and tidying is the real work. In discussion with the activity coordinator we identified that at least one resident with visual impairment would enjoy ‘talking’ books and newspapers and she has agreed to reinstate this service. Once again the resident herself thought that staff would be too busy to set this up and had not pursued the idea herself. This disability issue had not been identified and acted upon by staff until I raised the matter; it indicates that if residents have visual or hearing impairment their specialised disability needs must be noted and acted upon. Residents are receiving a wholesome, appealing and a well balanced diet in congenial settings, small dining rooms on each floor. I visited the kitchens, spoke to the new chef and checked the menus to confirm that catering in this home is to an acceptable standard. In general this is in accordance with residents’ recorded requirements and preferences. However a small number of residents had reservations about some meals. One resident for example wanted breakfast at 8 am (as offered in the home’s resident guide) but I was told this never happens because staff arrive on duty at that time. Another felt some meat was a little tougher than she prefers and others said the meals were usually very good. I tested the nurse call system and noted that it took about 10 minutes for extra toast to be delivered – providing some evidence staff are indeed very busy as residents told me. Equally unsatisfactory was the thought of a resident that it was not worth raising issues with the nurses or care staff. Areas of strength include the spacious and well presented home with nice dining areas on each floor. Meals were generally commended as very good and Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 15 residents appreciate the activity coordinator’s work. Matters requiring attention include the need for staff to be alert to and respond to residents’ needs as they become known or change – for example as hearing or sight decreases; staff should have enough the time to spend with residents either engaged in specific social activity or providing comfort and ‘getting to know’ residents. This section about life is assessed as adequate. Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 16 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): NMS 16 and 18: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to deal with complaints but residents and their representatives cannot always be confident that their complaints will be listened too and responded to in a timely manner. Staff training and the home’s policies and procedures for the protection of vulnerable adults is in place to ensure the safety of residents but in practice residents cannot always be assured they are ‘safe in their (staff) hands’. EVIDENCE: The service has a complaints procedure that meets the National Minimum Standards and Regulations. The procedure is up to date and is on display in each bedroom as part of the resident guide. Some individuals say they know how to make a complaint but others do not or do not perceive complaining as something they could or should do. Residents say of staff, “They’re very busy, I won’t bother them”. Staff are aware of the complaints procedure but may not realise the importance of listening to, and then acting on, residents concerns and may give the impression that they are very busy and wouldn’t have time to attend to minor details. Staff need to be aware that giving attention to detail is what will raise the home from an adequate or good one to an excellent one. Having been the subject of several serious complaints this year the home is fully aware and has put into practice the local authority’s ‘procedures for safeguarding’. When interviewed the staff confirmed that they had received training in the protection of vulnerable adults and knew that such matters Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 17 must be reported upwards, to a senior member of staff, the manager or to a suitable agency such as the Social Service Department or the Commission. The outcomes from any referral are managed by the home and its senior, regional managers, but this has not stopped a number of serious welfare and safety issues arising during 2007. Since there is a multiplicity of documentation to support care practices and to direct staff in monitoring residents’ care needs and staff have received a wide range of relevant training this may point to the need for better supervision of all staff (nurses and carers) on each floor and may require a review of staffing levels – a matter that is addressed in the staffing section of this report. Despite some reservations most residents I spoke to told me that they are satisfied with the care in the home and feel safe. Areas of strength include the information available about how to complain and the manager’s positive response to concerns raised with her. Conversely the fact that several incidents reflect poor practice indicates that residents are not always being safeguarded from harm. Several such incidents required referral to care managers under the local authority’s safeguarding procedures. These matters were investigated by care managers and resulted in some allegations of neglect being substantiated. It should be noted that this did not indicate deliberate or malicious neglect, instead it indicated poor care practices that must be addressed by the manager. This section, about complaints and protection, is assessed as adequate. Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 18 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): NMS 19, 22 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, clean, warm and well-maintained and comfortable environment. This is a purpose built care home and is subject to ongoing refurbishment. EVIDENCE: The layout of the home and the manner in which it is being maintained means that this is a safe, comfortable and suitable environment for the residents. The style of décor makes Oban House look homely and well presented. There were however a number of matters requiring attention and they are outlined here; wallpaper is beginning to suffer wear and tear, for example over radiators the walls are blackened, some walls have been damaged by chairs and now look unsightly and this has occurred in various locations around the home including some bedrooms and lounges. Tiles are missing or damaged in a number of locations, particularly in bathrooms, and there are at least two areas of ceiling in bathrooms that have water stains; these points were noted in November 2006 and is a recommendation outstanding despite the manager’s assurance that the home is undergoing a Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 19 cycle of refurbishment. These damaged areas now need more prompt and effective action. Some bedroom doors now have (false) letter boxes fitted and a door knocker and each bedroom door is painted a different colour, this gives the impression of personal front doors. However, not all bedrooms have suitable door locks as advised in the national minimum standards. The call bell system (nurse call) was inadequate in so far as there is no central sounder or panel to indicate who needs assistance. I also noted that on the day of inspection there was only one pager in use on the floor, so when the carer with the pager was occupied she was unable to respond to another call. The premises are being kept clean, hygienic and free from offensive odours and systems are in pace to control the spread of infection. Residents and relatives commented how clean the home is, so domestic staff are to be commended. The laundry-room is in the basement and I noted that the washing machine are not always working properly and so need effective repair or replacement. I met with one of the cooks, who has very recently returned to take up his old position as chef and he reports that all the kitchen equipment is in working order and that having worked in Oban before he is familiar with residents’ preferred style of cooking. Areas of strength include the general quality of the premises and the matters requiring improvement include improvements to the nurse call system, bedroom door-locks and the wear and tear noted throughout the building. This section, about environment, is assessed as good. Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 20 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): NMS 27 to 30: Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. In view of the several complaints made about care in this home residents cannot always be assured they are being cared for by a competent and qualified staff team in sufficient numbers to met their needs. The home does have suitable staff recruitment procedures in place, induction, training, support and a supervision regimes are also in place but this is not always ensuring residents are in safe hands at all times. EVIDENCE: Residents of Oban House are generally satisfied that the care they receive to meet their needs, but they tell me that there are times when they have to wait for staff support and attention. It is not clear to the Commission that there are enough staff on duty for any one shift. Whilst there is a nurse working on each of the three floors of this home this gives an average ratio of 1 to 20 residents per nurse. In addition to the three nurses there were eight care staff to cater for the needs of 47 residents on the day of inspection. In view of the number of allegations of poor care practice in this home and the number of comments made by residents about staff being too busy the Commission will make a requirement that staffing levels be reviewed with a view to increasing support. It will also be required that Nurses who are not qualified first level general nurses [RGN], for example mental health nurses [RMN] and enrolled nurses [EN] work under the direction of suitably competent general nurse and do not provide nursing care in areas where they are not competent to do so. Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 21 Although there have been some serious lapses in care and therefore not all residents have been protected from harm the service has acted positively and assertively to address shortcomings and recognises the importance of training, and tries to delivers a programme that meets any statutory requirements and the National Minimum Standards but the Home’s own audit of staffing qualifications indicates that only 30 of care staff has an NVQ [National Vocational Qualification] when 50 in advised in the NMS. The home has given an undertaking to work towards this level of skill and qualification for its care staff and we make a requirement is made to do so. The service does recognise when additional training is needed, for example in palliative and end of life care. The home has made arrangements to meet training needs and we saw evidence of this on the day of our visit when palliative care nurses were present to observe, train and guide Oban’s staff team. However, the reason for this considerable input by these nurses is because they are specialists in pain management and end of life care and they regard Oban House as one of a small number of care homes that is struggling to meet a suitable standard in this specialist area of work. Some staff were commended for their kindness and thoughtfulness. The work of the activity coordinator was very much appreciated and the new cook was praised for providing a lovely meal on the day of inspection. The inspectors thank staff for their patience and hospitality throughout the visit. The service has a recruitment procedure that meets the regulations and the National Minimum Standards. The procedure is followed in practice and there is accurate recording at all stages of the process. Oban House does use agency staff and the home has not always assured that these staff are providing an acceptable level of nursing care so this can and has adversely affected the quality of the individual care and support of residents. Areas of strength include a good recruitment process and a commitment to training and improving staff skills; residents praised some staff for their kindness. Matters requiring improvement include a need to improve staff skills and qualifications for example in attitude towards residents and protecting residents from harm; to revise staffing numbers. This section, about staffing, is assessed as adequate. Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 22 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): NMS 31, 32, 33, 36, 37 and 38: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The owners of Oban House are Southern Cross, a large national group, and the Manager is Mrs Ramdhan. The owners and manager have been assessed as suitable and fit people to operate Oban House. EVIDENCE: The manager is qualified and experience nurse/manager who has been assessed and registered as person competent to run Oban House. She is supported by regional or ‘operational’ managers who visit the home regularly to support and direct the running of the home. The managers are well informed about the National Minimum Standards and it is evident they work towards achieving good outcome for the residents of this home. Indeed we are told the organisation hope to make Oban House a ‘flagship’ home given high standards of the premises. Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 23 The manager is aware of the need to keep up to date with practice and continuously develop management skills and so she attends various training/conferences courses to keep herself abreast of developments in care and nursing practice. The manager, with the full support of the owners Southern Cross, trains and develops her staff team who are generally competent and knowledgeable to care for the people who use the service. But there have been a number of lapses in the delivery of care. Injuries and very poor care practices have been investigated by care managers from the local Social Service Department. Further training is offered and where appropriate disciplinary procedures have been followed where staff have failed to work to professional standards and safeguard residents. It is the responsibility of the manager to ensure residents are safe and well cared and it is for senior managers, through their monthly unannounced visits and other auditing arrangements, to ensure policies, procedures and practice remain safe and this has not been the case in Oban House in 2007. The manager and operational managers are without doubt intent on providing safe and good quality care service and have been open and straightforward in their dealings with the Commission. The service is planned to be user focused, to take account of equality and diversity issues, and generally works in partnership with families of people who use the service and professionals but despite complex documentation families do not always feel listened to. The home has a Statement of Purpose that sets out the aims and objectives of the service but again residents have said that the service the home advertising in its Guide does not always match their experience. For example, the timing of meals and the accessibility to staff when they need assistance. Checks were made regarding the home’s arrangements for assisting residents with their personal allowances (‘pocket money’) and the system appears sound. Residents can access their funds and auditable accounts are kept. Systems are in place to ensure that the property and money of residents (held by the home) can be held securely and is safeguarded. Provision is also made for residents to control their own money if they wish to do so. The service provider takes responsibility for the home’s accounts and business development. The home has insurance cover in place. Checks show that records are generally well maintained, up to date and accurate. Also a range of records were reviewed during this visit include the visitors’ book, accidents, incidents, complaints, care plans, staff files, kitchen records, and so forth. However, a visiting care manager advised that he has noticed that the documentation to support residents’, the care plans and checklists, have been on at least one occasion completed in advance. If this is the case then it is at worst fraudulent and at least unprofessional and could lead to serious problems - for example if an aspect of care is not provided based upon the records suggesting it has been given, for example a bath, medication or a routine check. It is for the management team to monitor the use of their complex documentation to ensure staff know how to use the forms, why they are being used and have the time to do complete them Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 24 correctly. Staff time is a recurring theme and suggests the need to increase staffing levels and a requirement to this effect will be made. A number of safety issues arose - in addition to those incidents that caused harm to residents and referred to in preceding sections of this report. Some fire doors did not close fully to the frame. Magnetic door holders were faulty – although I note that the maintenance person addressed this issue at the time of my inspection visit. The nurse call system is inadequate, one pager per floor and with no central sounder if the carer was occupied then other residents had to wait for assistance – this a matter of inconvenience for some residents but could be a safety issue if assistance is needed urgently. This section about management is assessed as adequate. Oban House (42-46) DS0000019035.V347507.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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X 2 X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X 3 3 2 Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 12(1)b Requirement Health care: In order to ensure that residents receive optimum health care their care plans must be must competed accurately and in detail and staff must know the contents of each care plan and adhere to it so residents will know their needs are known to staff and will be acted upon. Privacy: Bedroom door locks must be provided for each resident’s bedroom so residents can be afforded privacy. End of life care: For residents who are terminally ill staff must have suitable skills and training to meet the needs of residents who are terminally so that residents and their families will know the last days will be well managed including control of pain and their last wishes complied with. Aids and adaptations: Equipment must be provided for residents with hearing and visual impairments so they may engage is social and recreational DS0000019035.V347507.R01.S.doc Timescale for action 30/12/07 2 OP10 12(4)a 13(2)e 12(3) 30/03/08 3 OP11 30/12/07 4 OP12 23(2)n 30/12/07 Oban House (42-46) Version 5.2 Page 27 5 OP14 6 OP18 7 OP19 OP22 8 OP19 9 OP19 10 OP19 11 OP27 activities as they may choose. Choice: Residents must be supported in making choices such as when and where they take their meals and how they spend their day. These choices must be made clear in their care plans and staff must act upon those choices. 13(4)a b c Protection and complaints: Residents must be protected from harm in so far as it is practical to do so. Residents must be adequately supported and supervised to reduce risk of falls, of bruising and injury and of accidents with hot liquids. 16(2)c Call bell system: improvements must be made to the nurse call system so that staff can respond within a reasonable time and so residents know they will get help if they need it in a timely manner. 23(2)b Damage to bathrooms: Wall tiles and ceiling in bathrooms must be kept in a good state of repair and appearance for the benefit of residents who use these communal facilities. This is an outstanding recommendation from the previous report is now made a requirement. 23(2)b Damage to décor: Walls must be kept in a good state of repair and appearance for the benefit of residents. Damage and discolouration must be dealt with in a timely manner. 23(2)c Washing machines: equipment used by residents or staff must be maintained in good working order including washing machines. 18(1)a Staffing numbers: The home must employ care and nursing staff in such numbers as will meet the needs of residents at 12(3) DS0000019035.V347507.R01.S.doc 30/12/07 30/12/07 30/12/07 30/12/07 30/03/08 30/03/08 30/12/07 Oban House (42-46) Version 5.2 Page 28 12 OP30 12(5)b 12 OP30 18(1) c i 13 OP38 23(4) and 23(4A) all times. The home must submit proposals to the Commission that will demonstrate how this requirement will be met. Staff attitude: staff must receive training, support and supervision so as to ensure they maintain good relationships with residents and so residents do not have cause to complain about poor staff attitudes. Staff training: Staff must receive training support and supervision to ensure they can protect residents from harm, including reduction in falls and accidents and deliberate harm. Fire doors: the home must ensure that all fire doors close fully to the door frame so as to protect residents from fire and smoke in the event of a fire. 30/12/07 30/03/08 30/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Oban House (42-46) DS0000019035.V347507.R01.S.doc Version 5.2 Page 30 - 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!