CARE HOMES FOR OLDER PEOPLE
Oldfield House Oldfield House 15 Hawkshaw Avenue Darwen Lancs BB3 1QY Lead Inspector
Mrs Jennifer M Turner Unannounced Inspection 3rd November 2005 10:00 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 Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 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. Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Oldfield House Address Oldfield House 15 Hawkshaw Avenue Darwen Lancs BB3 1QY 01254 702920 01254 707418 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) Dr Govindon Asoka Kumar Mrs Kathleen Kumar Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (18), Physical disability (1) of places Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. A total of 18 (OP) elderly service users can be accommodated at the home. One named service user who requires personal care and is under the age of 65 (PD) can be accommodated at the home. When this service user leaves the home, the Commission for Social Care Inspection must be contacted to remove this condition. The home shall employ, at all times, a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 23rd May 2005 3. Date of last inspection Brief Description of the Service: Oldfield House is a converted two-storey building set within its own grounds. There is car parking space at the front of the building. The home is situated about 200 metres from the main Blackburn to Darwen road where there are a variety of shops and retail premises. This road is a bus route. Darwen town centre is approximately one mile away. The home is part of a small local group of three homes. Accommodation is provided on two floors. There are 17 single bedrooms and 1 double bedroom. The home has one lounge and a separate dining room. There are bathrooms and toilets upon each floor. Gardens are accessible to residents via a ramp. A passenger lift connects the two floors. Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 3rd November 2005 between 10am and 3.45pm. The Pharmacy Inspector was at the home between 10am and 12.30pm and has produced a separate report. Information was obtained by talking with the acting manager, 3 staff members, 1 visiting professional and 8 residents, by examining a variety of records and walking around the home. Views were obtained from residents and staff on a variety of topics and information was also obtained by case tracking. Two comment cards, which had been completed by relatives, were returned to the CSCI. Views have been recorded collectively where the answers obtained were similar. Any specific or differing comments have been recorded in the main body of the report. The inspector’s notes have been retained as evidence of the inspection. The Commission for Social Care Inspection is awaiting the return of the application form from Tracy Brown in order for her to be registered as the manager. What the service does well:
Pre admission assessments were carried out ensuring that staff at the home could provide the required care. Prospective residents were informed in writing that staff would be able to meet their assessed needs. Residents spoke about staff being kind and looking after them well. They said that their visitors were always made welcome. Residents spoken with enjoyed the meals offered. They said that “meals are good”. Staff continue to attend training courses in respect of the Protection of Vulnerable Adults. Residents said they could talk to the staff or owners about any concerns they may have. The home was clean, safe and in good decorative order. Refurbishment was taking place. Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection?
Upon completion of assessments and reviews, the member of staff and resident concerned are signing the documentation. This indicates that the resident has been involved in any decisions taken about their care. Staff who administer medication have undertaken appropriate medication training. This ensures that residents’ healthcare needs are protected. A record of furniture that residents bring into the home was kept. ensured that their property was properly protected. This Blended meals had each food blended separately in order to provide a meal with varied texture, colour and taste. The majority of residents enjoyed the meals offered and commented “meals are good”. Policies and procedures are retained in the home. This ensures that staff have access to any information required. Staff continue to receive training in respect of the Protection of Vulnerable Adults ensuring that residents live in a safe environment. Maintenance is ongoing and new carpets have been fitted in some area of the home. Documentation was in place stating that the premises complied with the Water Supply (Water Fittings) Regulations 1999. This ensured that residents were living in a safe environment. Staff files containing all the required information were retained in the home. This meant that the acting manager had access to any information she may require relating to staff issues. Staff in induction training meets the standard set be Skills for Care. ensures that staff are trained to meet the care needs of the residents. This Visits are being made to the home under the requirements of Regulation 26. This indicates that the acting manager is receiving appropriate support from her managers. The Fire Risk assessment has been reviewed. This ensures that residents and staff live and work in a safe environment. Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 Page 7 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. Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 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 Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1:2:3 The Statement of Purpose and Service Users Guide needed to be reviewed in order for prospective residents to have full information of what was provided in the home. Pre admission assessments were carried out ensuring that staff at the home could provide the required care. EVIDENCE: Although there was a Statement of Purpose and Service Users Guide available not all the required elements of this standard or Schedule 1 of the Care Homes Regulations 2001 were included or up to date. The Statement of Terms and Conditions made available did not contain all the required elements of this standard. When these forms are being completed both the new resident or their representative and a member of the homes management team should sign them. Three case files were examined. One was for the most recent respite care admission into the home. Pre admission assessments were provided by referring social workers. The manager or Senior Care staff on duty completed
Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 Page 10 an assessment on arrival that covered all areas of this standard. These were signed and dated by both the member of staff and resident. Information was also obtained from family members. All the information gathered was used as the basis for the care plan. Assessments supplied by District Nurses were recorded separately but the information was included within the main assessment. Prospective residents received a letter indicating that staff at the home could provide the care they required. Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Residents were protected by the homes procedures for dealing with medicines. EVIDENCE: The requirement made at the previous inspection for the acting manager to undertake accredited training and familiarise herself more fully with the policies and procedures relating to medication had been met. The Pharmacy Inspector addressed other issues and a separate report has been produced. Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14;15 Residents were able to make choices so that their lifestyle met their preferences. Social contacts were maintained. Meals offered at the home were good and ensured that the individual dietary needs of the residents were met. EVIDENCE: A tour of the home showed that some residents had brought their own personal items with them. Records showed that upon admission, a room audit was completed and signed by the resident concerned. The acting manager said that residents or their families controlled their own finances. Information relating to the East Lancashire Advocacy Service was displayed on the notice board. Records were maintained and stored appropriately. The breakfast and supper menus were displayed on the notice board in the hallway. The daily menu was displayed in the dining room and in the lounge. A hot main meal was served at lunchtime with an alternative available if required. A lighter type, hot meal or sandwiches, was available at teatime. A record of any snacks served to residents during the day was kept. Specialised diets were catered for. Blended meals had each food blended separately in order to provide a meal with varied texture, colour and taste. The inspector joined the residents for lunch and observed that they were encouraged to be independent when eating. Staff offered any assistance needed in a calm and unhurried manner. Residents asked enjoyed the meals offered.
Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16:18 Policies and procedures were available to protect residents from abuse. Some staff had received training in respect of the Protection of Vulnerable Adults ensuring that residents live in a safe environment. EVIDENCE: A copy of the complaints procedure was included in the homes Statement of Purpose. The complaints book was kept in the entrance hall and had no further entries since the inspector last examined it. Residents and staff spoken with were aware of the procedure. A comment made in a relatives comment card was that they were not aware of the homes complaints procedure. Several residents informed the inspector that they knew who to talk to if they were not happy about things. There was a copy of the Blackburn with Darwen adult abuse procedure available. Four staff had been on the Protection of Vulnerable Adult course organised by the Local Authority and more places were booked. Policies and procedures were in place that safeguarded residents from possible financial abuse. Monies for one resident were maintained in the home. Two signatures were obtained for all transactions (resident and staff). The monies were kept securely. Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19;24;25;26 The home was warm, clean and comfortable. A good standard of hygiene was achieved. Residents have their own possessions around them. EVIDENCE: Maintenance and refurbishment throughout the home was noticeable and a record of routine maintenance was seen. The carpet had been replaced in the hallway. The health and safety officer carried out monthly safety checks and written outcomes were seen. The grounds were safe, tidy and accessible to residents. Fire equipment examined was maintained and regularly serviced. Staff spoken with were aware of the fire drill procedure. The Fire risk assessment relating to the home had been reviewed. Some doors were wedged open. Consideration was to be given in respect of the fitting of appropriate self-release mechanisms. Residents spoken with were happy with the furniture provided in their room. In some areas electric socket extensions or adaptors were seen. These should be replaced by installing more double electric sockets.
Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 Page 15 The inspector conducted a tour of the building. A variety of aids were seen in various parts of the home. All windows had restrictors fitted that enabled residents rooms to be ventilated naturally and safely. Bedrooms were centrally heated and residents said that they were able to control the temperature if they wished but “usually asked the staff”. Emergency lighting was provided throughout the home. Residents felt that the lighting was adequate for their needs. Thermostats were fitted onto water outlets. The inspector tested random outlets and temperatures were within the recommended range. Records examined showed that senior staff made daily checks on water outlet temperatures. A plumber had been approached in respect of the testing of stored water for the prevention of Legionella. Laundry facilities were sited away from any areas associated with food. The floor was impervious and the walls were easily washable. The washing machines reached temperatures above 65 degrees centigrade and met disinfection standards. Dryers were available. The home had a current clinical waste certificate and protective clothing was provided for staff. There was no sluice, but a sink was provided in areas where clinical waste was handled. Liquid soap and paper towels were provided in bathing areas and in the laundry. Policies and procedures were available for the control of infection. Documentation was in place stating that the premises complied with the Water Supply (Water Fittings) Regulations 1999. Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29;30 The numbers and skill mix of staff met residents’ needs. Staff were recruited using current guidelines. Staff received training suitable to the residents residing at the home. EVIDENCE: Two staff files were examined. They contained the necessary documentation. There was evidence of CRB’s being applied for and there were responses confirming clear POVA checks. Staff indicated that they had received their own copy of the General Social Care Council Code of Conduct and Terms and Conditions of Employment (Contract). Individual training records were viewed on a number of staff files. They showed that a variety of core training was offered. Staff said that they felt confident to meet the assessed needs of the residents and confirmed that they received the required days of paid leave for training purposes. The acting manager said that the induction training provided in the home met the current requirements. Some staff had attended an accredited medication course. Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31:33;38 EVIDENCE: The acting manager had worked in the capacity of a Senior Carer within the Group for a number of years. She has forwarded her completed application to become registered to the Company office for it to be forwarded to the CSCI. She has commenced training in respect of the NVQ level 4 and the Registered Managers Award. She had received a job description in her role as manager. She was responsible for one home only. Reference to the lines of accountability appeared in the Statement of Purpose. A manager of another home within the group completes Regulation 26 reports. Although the reports indicated that a copy had been forwarded to the CSCI they had not been received.
Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 Page 18 Questionnaires showed feedback from residents in respect of standards within the home. The information was retained on resident’s files. The acting manager said that she intended to start her own information gathering and was to collate the information on an annual basis and insert the results into the Service Users Guide. Residents said that they had meetings with the staff. Minutes showed that these were held every three months. Staff meetings need to be more structured. Records were seen of issues raised by the member of staff responsible for health and safety within the home. There was a copy of the document, “5 steps to Risk Assessment”. Many of the aspects of the health and safety training of staff was covered in the NVQ training. Staff spoken with were aware of their responsibilities. Records were maintained for accidents. Fire extinguishers examined had been serviced. The homes fire risk assessment had been reviewed. Various records were examined in respect of the maintenance of equipment throughout the home. Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 Page 19 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 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X X X X 2 2 3 STAFFING Standard No Score 27 X 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 3 Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation (4)(5)(6) Sch 1 Requirement The registered person must produce an up to date copy of the Statement of Purpose and Service Users Guide. They must contain the elements of NMS 4 and 5 and Schedule 1. These should be kept under review. Following completion, copies must be forwarded to the CSCI. The registered person must provide a terms and conditions/contract for each resident. The acting manager must undertake accredited training in the administration of medication. She must familiarise herself fully with policies and procedures relating to medication. Full and accurate records must be kept of all medicines received, administered and leaving the custody of the home. All medication must only be administered in accordance with the General Practitioners instructions The registered person must ensure that doors are fitted with appropriate self-release
DS0000005831.V255828.R01.S.doc Timescale for action 31/01/06 2 OP2 5(1)(b)(c) 30/11/05 3 OP9 18 (1) (a)(c) 31/03/06 4 OP9 13(2) 17(1) Sch3(i) 13(2) 30/11/05 5 OP9 30/11/05 6 OP19 23 (4)(a)(c) 30/11/05 Oldfield House Version 5.0 Page 21 7 OP25 13 (4) (ac) 8 OP31 18 (1)(a)(c) mechanisms if they are required to be left open. The registered person must ensure that water is stored at a temperature sufficiently high enough to prevent Legionella. Previous timescales pf 31/12/04 and 30/06/05 not met. The registered person must ensure that the acting manager becomes suitably qualified, is competent and has the required experience to manage the home. 31/03/06 30/06/06 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 OP9 OP9 Good Practice Recommendations You should review medication policies and procedures in line with Royal Pharmaceutical Society of Great Britain guidelines to cover all aspects of medicines management. Criteria for the administration of when required and variable dose medication should be clearly defined and recorded for all service users prescribed such items. A second member of staff should witness all hand written annotations on Medication Administration Record charts. A record of temperature should be maintained for all areas where medicines are kept Discontinued medication should be returned to the pharmacy as soon as practicable Photographs of residents should be kept with the Medication Administration Record charts to aid identification Staff authorised to administer medication should have an assessment of their competence to complete this task. There should be a ‘signature’ list for staff authorised to administer medication
Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 Page 22 3 OP9 4 OP9 5 6 7 8 OP16 OP24 OP31 OP33 Written authorisation and instructions should be obtained from the District Nurse prior to performing nursing techniques (including blood glucose tests) for non-nursing service users. In order for all visitors to be aware of the complaints procedure, it is recommended that it is displayed on the notice board in the hallway. A minimum of two double electric sockets should be provided in resident’s bedrooms. Reports written in respect of Regulation 26 should be forwarded to the CSCI as well as being retained in the home. Staff meetings should be more structured and minuted. Oldfield House DS0000005831.V255828.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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