Random inspection report
Care homes for older people
Name: Address: Oldfield Residential Home Derrington Road Ditton Priors Bridgnorth Shropshire WV16 6SQ one star adequate service 02/09/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Becky Harrison Date: 0 9 0 2 2 0 1 0 Information about the care home
Name of care home: Address: Oldfield Residential Home Derrington Road Ditton Priors Bridgnorth Shropshire WV16 6SQ 01746712286 01746712411 oldfield@oldfieldcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Simon James Badland care home 45 Number of places (if applicable): Under 65 Over 65 0 0 29 dementia learning disability old age, not falling within any other category Conditions of registration: 15 1 0 The maximum number of service users who can be accommodated is 45. The registered person may provide the following categories of service only : Care home only Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places 45) Dementia - Code DE (maximum number of places15) Learning Disability - Code LD (maximum number of places 1) Date of last inspection 0 2 0 9 2 0 0 9 Care Homes for Older People Page 2 of 11 Brief description of the care home Oldfield Residential Home is a care home for older people, registered to provide accommodation and personal care for up to 45 people. The home is situated on the edge of the small Shropshire Village of Ditton Priors, which is in is in a rural location therefore there is limited access to it by public transport. The property is a purpose built single storey building, and offers both single and double bedroom accommodation, some rooms provide ensuite facilities. The home has been extended in order to upgrade the living accommodation offered to the people who live there. The grounds are well-maintained with shrubs, mature trees, flower borders, lawns and woodland walks. The home makes its services known to prospective residents in the Statement of Purpose and Service User Guide. People are consulted about the service provided at Oldfield by questionnaires, that are given to people living at the home, families, friends and staff. In addition the manager regularly speaks with people to find out their views. Care Homes for Older People Page 3 of 11 What we found:
The purpose of this unannounced inspection was to check the providers compliance against the requirements and recommendations that we made at the last key inspection undertaken 2nd September 2009 and to review recommendations following recent adult protection meetings. During this inspection we spoke with some residents, a visitor, a health professional, the manager and two members of staff. We observed how residents were supported by staff and sampled the care documentation held for two people. We undertook a brief tour of the home and sampled recruitment records for three new members of staff. Recommendations were made at the previous inspection for the manager to provide information about the home so that prospective residents and their supporters have the relevent information to help them decide if the home is right for them. The manager provided us with an information pack about the home to include a Statement of Purpose, Service User Guide, a post viewing questionnaire and a leaflet explaining about the philosophy of care, facilities and services and life at Oldfield. The manager reported that she is aiming to provide this information for each individual currently accommodated and for prospective residents. We advised the manager to explore further ways of providing people with this information for example in alternative formats such as easy read, large print, pictorial, DVD, videos and alternative languages. We randomly selected the care documentation held for two people who live at Oldfield. At an adult protection meeting held in November 2009 it was identified that care plans and risk assessments had not been reviewed at the required frequency. We made a recommendation following our last inspection that care plans are kept up to date and accurate to reflect care given and that these be developed adopting a more person centred approach to reflect life histories, goals and aspirations. Both care plans sampled had been updated at the required frequency or sooner when individual needs had changed. Information in one of the care plans was far more detailed than the other and this was acknowledged by the management team in addition to a Regulation 26 report that we had recently received from the operational director following her visit to the home in January. It was reported that the importance of reviewing and updating care plans had been discussed in a staff meeting and that staff have been offered support with care plans to bring them up to the required standard. Discussions with managers and review of care documentation evidence that this continues to be work in progress therefore we will further review this at the next inspection of this service scheduled to take place before September 2010. Managers also agreed that further work around personalising care records should be explored so that people who use the service and those close to them are involved in the development of their care plan and review. This will ensure that individuals receive their care in a way that they prefer. Managers reported that the activities organiser is in the process of seeking life histories, goals and aspirations and other important information from residents and their families to help provide a more personalised service. Risk assessments were available on both care files sampled with evidence of regular review as recommended following the last inspection and discussed at an adult protection
Care Homes for Older People Page 4 of 11 meeting. We advised managers to ensure information held in risk assessments is cross referenced and updated in care plans. For example a risk assessment for an individual with pressure areas stated the person required 2 hourly pressure care checks, as recently recommended by a health professional but the care plan had not been updated to reflect this change. Also the manual handling risk assessment had not been updated to reflect that the person is currently on bed rest. Managers fully acknowledged these shortfalls and committed to address these at the earliest opportunity and ensure all records are detailed, regularly reviewed and updated to reflect the current needs of individuals in their care. Three requirements and one recommendation were made following our last inspection in relation to medication. Discussions with managers and a review of procedures evidence that the home have actioned these. The manager has developed and implemented a brief protocol about medications prescribed as and when required but we advised that this needs further development so staff know under what circumstances they can administer such medication to individuals who may require this. Records evidence that staff are now recording the reasons for administering such medication and procedures for checking and recording all incoming drugs to the home has improved with double signatures being obtained and a clear audit record in place. It was reported that there have been no medication errors since the last inspection and that staff responsible for administering medication have previously attended training in the safe handling of medicines and are due to receive training in the monitored dosage system from the supplying pharmacy very shortly. We advised the manager to undertake regular competency assessments on staff responsible for administering medicines to ensure ongoing staff competency in relation to safe practices. This will ensure their current practice is safe minimising the risk of harm to people receiving support with the managing medication. We made a recommendation following the last inspection that arrangements for managing laundry be reviewed to ensure that everyone has access to their own clothes at all times and to prevent clothes from going missing following concerns raised by relatives regarding this matter. The manager reported that since our last visit two laundry assistants have been employed and that arrangements are much improved. Individual baskets have been introduced to ensure soiled clothing is washed separately and efforts are made to ensure residents clothes are laundered and returned to their rooms as soon as possible. However it was reported that an item of clothing belonging to one person has recently gone missing but is being addressed as similar issues have previously been raised concerning the same individual. At the previous inspection we made a judgment that people had limited opportunities to be stimulated mentally or physically meaning that their expectations, preferences and recreational interests and needs were not being met and therefore made a requirement in relation to daily living and activities. The last inspection identified that due to staff shortages the designated activities coordinator was unable to fulfill her role. She has since returned to her designated role following the recruitment of more care staff. It was reported that she has started to collate information about peoples life history, hobbies and interests. Information about a range of activities was seen displayed around the home and during our visit several people participated in a music workshop provided by an external provider. Discussions with residents and staff evidence that activities have improved. It was reported that the activity organiser has also met with other organisers within the group to share ideas and is very passionate about her role and improving lifestyles for individual living at Oldfield. A tactile reminiscence wall display has also been
Care Homes for Older People Page 5 of 11 started in addition to a display of photographs of farming in the past, which has proved popular given the homes location and occupational backgrounds of many of the residents. Following the last inspection we made a recommendation that the home provides real alternatives to main meals to ensure that people have a choice. A new cook has been employed and new menus have been developed providing a greater choice of food. During our visit we observed that people were provided with a choice of food, which was well presented and people who required assistance with eating were supported in a sensitive manner. People told us that they enjoy their meals. We advised the manager and the cook to further develop menus as it was noted that on a Friday people are offered either fish and chips or fish pie on another day the choice was chicken chasseur or chicken curry. This still restricts people from being offered real choices and although the staff are aware of individual preferences and specific dietary needs, more needs to be done to involve people who use the service with menu planning. Since we last visited the home three referrals have been made under local safeguarding procedures. A number of recommendations have been made following meetings held to include staff being provided with training in dementia care, engaging people in activities, reviewing care plans and risk assessments at the required frequency and the need for staff to report and record events. A recent referral raised concerns regarding the family of a resident not being informed of a health issue and an incident that resulted in injury. We spoke with the Operational Director and raised our concerns about this incident and the influx of referrals and requested a detailed account of the incident. The report received indicates that the manager has taken action and spoke with staff regarding the seriousness of not documenting or contacting relatives. As a result of recent incidents the provider is looking to increase night staffing levels and the review the deployment of staff to ensure residents are supervised in all areas of the home. A requirement was made following the last inspection that the bathroom must be safe to use by people and floorings in bathrooms and toilets must be hygienic. A tour of these areas evidenced that the required work has been undertaken to ensure people are able to use these facilities safely. We also recommended that the home review the environment to make sure it is fit for purpose in relation to supporting people with dementia so they are able to maintain their independence as far as possible. Photographs and names were seen on most bedroom doors and improved signage displayed around the home. Redecoration of the original building has commenced, new lighting provided and one double room with ensuite has been refurbished. The manager reported when bedrooms become vacant she wants these to be redecorated. The home has a fulltime handy man and he confirmed that he has sourced suitable handrails for corridors and these are to be fitted very shortly to assist people when moving between areas. Maintenance tasks are now being carried out promptly as we previously recommended and this was confirmed in discussions held and records seen. The manager reported that new curtains and blinds for the sun lounge are on order and that the provider meets with the handyman to prioritise work. We made a requirement as a result of our last inspection that care and ancillary staff must be provided in sufficient numbers to ensure that the care needs of people who use the service are met. The manager stated that since our last visit she has recruited three care staff, a cook and a laundry assistant. As previously stated waking night staffing levels have been reviewed and these are due to increase shortly to provide greater staff supervision to residents throughout the night.
Care Homes for Older People Page 6 of 11 Staffing levels were found adequate to meet the needs of the 40 residents accommodated at the time of our visit. Agency staff continue to be used but not as much following the recent recruitment process. The manager reported only one agency is used in order to provide residents with continuity of care. A visiting relative told us that staff are brilliant and a visiting health professional reported good working relationships with the home. We randomly sampled the personnel files of three staff recruited since our last inspection. This was to determine compliance with two requirements we previously made to ensure the safety of people who use the service. With the exception of staff photographs information required by Law was available. The manager confirmed that she had explored gaps in employment history and a disclosure stated on an application form but had not documented this. Records sampled evidenced that the new staff had commenced employment following an Independent Safeguarding Authority (ISA) Adult First Check, whilst waiting for a CRB certificate. We advised the manager that this is only permissible where it is necessary to take such action because of a real danger that staffing levels will fall below statutory obligations and that such staff must be supervised at all times until the CRB check is returned. CRB checks help providers make informed decisions when recruiting people to work with vulnerable adults and are a requirement by Law. The manager committed to reviewing recruitment procedures which should provide greater safeguards for people living at the home. We have made a recommendation in relation to recruitment practices and will therefore keep this under review. Staff spoken with reported improved training opportunities and the manager confirmed that a number of training courses have been sourced and booked to include food hygiene, adult protection, mental capacity act, deprivation of liberty safeguards, health and safety, moving and handling and dementia care. This should equip staff with the skills and knowledge to meet the individual needs of the people in their care. The manager has been in post for just five months and the findings of this inspection evidence that she has begun to implement change and address the requirements that we made at our previous inspection. She stated that she has commenced the process of applying for registration with us and fully assisted us throughout this inspection and acknowledged areas for continued improvement in the best interests of people living and working at Oldfield. Staff, residents and visitors spoken with were complimentary about the management team. What the care home does well:
The manager has implemented a number of changes in the best interests of people who use the service. Training opportunities for staff have improved to equip them with the skills and knowledge to meet the individual needs of the people living at Oldfield. More staff have been employed which has enabled the activities co-ordinator to return to her role and provide residents with a greater choice of activities so that their expectations, preferences and recreational interests and needs are met. Improvements to the home are underway with the redecoration of corridors, refurbishment of a bedroom and bathroom and toilets to ensure residents safety. Photographs and names are available on most bedroom doors and improved signage displayed around the home to help people recognise rooms. Handrails are due to be fitted shortly to assist people when moving between areas.
Care Homes for Older People Page 7 of 11 People appeared happy and comfortable and told us that they enjoy living at Oldfield and spoke positively about staff and managers. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 11 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 7 Risk assessments should be cross referenced to care plans and reviewed to ensure that they remain current and reflect peoples needs. Care plans should be developed adopting an individualised approach to meeting people is care needs. This is to ensure people receive their care in the way that they prefer. Assessments should be undertaken for staff responsible for administering medicines to ensure ongoing staff competency. Residents should be involved in menu planning to ensure that they are consulted with over their personal preferences and are provided with a greater choice of meals. Recruitment practices should be further reviewed to ensure the safety and protection of people who use the service. 2 7 3 9 4 15 5 29 Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - 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!
