CARE HOMES FOR OLDER PEOPLE
Oulton Park Care Centre Union Lane Oulton Lowestoft Suffolk NR32 3AX Lead Inspector
Alan Clare Unannounced Inspection 12th January 2006 2.15 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 Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Oulton Park Care Centre Address Union Lane Oulton Lowestoft Suffolk NR32 3AX 01502 539998 01502 539994 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) Barchester Healthcare Homes Limited Mr Simon Atkinson Care Home 60 Category(ies) of Dementia (16), Dementia - over 65 years of age registration, with number (32), Old age, not falling within any other of places category (12), Physical disability (16) Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6 September 2005 Brief Description of the Service: Oulton Park Care Centre is situated in the village of Oulton, on the outskirts of Lowestoft, The purpose built premises are owned by Barchester Healthcare Homes Limited opened in February 2004 and is registered as a care home with nursing for up to 60 people. The home is divided in to three service areas of care, Poplar has 16 bedrooms and offers care to younger people who have a physical disability, Hawthorn offers 12 bedrooms and cares for frail older people, and Beech which has 32 bedroom offers care to people with dementia. All facilities for people living in the home are located within the single storey building, which has wheelchair access throughout. All sixty bedrooms have ensuite bathrooms, electrically adjusted beds and remote controlled televisions with integral radio as standard. The home offers a variety of communal spaces which include an enclosed courtyard atrium, dinning rooms, quiet rooms, lounge / dinning areas and an activities room. There are secure landscaped gardens and courtyards with seating and raised flowerbeds. Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report refers to the inspector’s findings during an unannounced inspection, which took place over 5 hours on a weekday afternoon. The inspector received a warm and hospitable welcome from administrative staff and Matron who was available to assist with the visit. Whilst the inspection focused on the home’s progress on meeting the requirements and recommendations of the report of the home’s previous announced inspection, attention was given to a sample of the home’s records which included those relating to resident’s care, staff records, menus and utility certificates. A tour of the building was undertaken and the inspector took time to speak with residents and visitors to the home separately. Two members of staff were spoken to and the inspector took particular note of the way in which staff interacted with residents as they went about their work. What the service does well: What has improved since the last inspection?
The home is expecting to take delivery of a new lifting hoist, which allow for people who are unable to sit to be weighed whilst lying. The home now updates and reviews residents care plans regularly. Medicine Administration Records (M.A.R.) now record the actual dosage given when medicines are prescribed for variable doses. Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 Page 6 The administration of the disposal of controlled drugs is now recorded accurately and a record is kept of fridge temperatures. The practice of using duplicate medicine labels has ceased. A schedule for the cleaning of resident’s equipment is now operational. The home now meets regularly with a next of kin who has in the past raised concerns over arrangements of care for their relative. Copies of operational policies are now available in each of the operational offices of the home. The home is now developing its focus on activities in the home. The home has reviewed staffing rotas and each unit has clear instruction as to minimum staffing levels permitted. 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. Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 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 Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Residents and their relatives can expect that prior to them making a decision to move in to the home, a comprehensive assessment of their need will be undertaken by the home in order to ascertain that the home is able to meet their needs. EVIDENCE: A selection of care plans seen by the inspector contained detailed assessments of resident’s needs, which the home had undertaken prior to the resident deciding to move in to the home. Additionally, in relation to people with special needs, details of the involvement of health and social care professionals were recorded. Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 ,9 and 10. Residents can expect that the home will provide an individual care plan for each resident which sets out their health and social care needs. Residents can expect that they are protected by the home’s policies and practices for Management and Administration of Medicines. Residents can be assured that they will be treated with respect and that the home will uphold their right to privacy. EVIDENCE: Resident’s individual health and social care needs were clearly identified in the sample of care plans seen in each unit of the home. Each plan gave staff clear instructions on how the resident’s needs should be met and their likes and preferences. Two care plans relating to residents who occasionally present with behaviours which are perceived to be challenging, include clear instructions to staff to allow the resident “ space” and avoid situations, which may exacerbate confrontation. Detailed recording in care plans confirms the homes stated commitment to ensuring that residents have access to specialist medical and mental health
Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 Page 10 care when necessary. Matron informed the inspector that on a number of occasions the home has acted as “advocate” on resident’s behalf when practitioners have shown reluctance to requesting specialist opinion for residents who have a dementia diagnosis. During the visit, Matron informed the inspector that the home continues to care for a resident whose behaviour on occasions requires particular skill and expertise as it is the expressed wish of his next of kin that they should continue to receive their care in their current placement. Samples of six Medication Administration Records (M.A.R.), were seen to be in order having been completed correctly. The home has acquired a new chemical method of disposing of controlled drugs, which has been approved by their pharmacist. During the afternoon the inspector saw that residents in all units moved around the home freely and unhindered or chose to retire to the privacy of their own rooms. Four residents were seen to be receiving guests in their own rooms, one visitor to Beech unit commented, “ I’m here every day, they (the staff) always have a kind word to offer” and “ willingly bring us a cuppa”. Staff spoke to residents courteously and warmly. On one occasion, a resident was offered assistance by a member of staff, to visit their own room where they may feel “more comfortable”, rather than using the lavatory in the communal bathroom. Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The home aims to match the resident’s expectations and preferences in the lifestyle it offers. However, residents of Beech unit cannot always be assured that the home will provide information and activities in formats, which meet their specific orientation and communication needs. Relatives and visitors are welcomed to the home. The home provides residents with an appealing and balanced diet, which is well presented and served in a pleasant surrounding. However, residents cannot be assured that staff administering medicines, at the same time as the resident’s meal is served will not interrupt with their dining experience. Greater interaction between staff and residents on Beech unit, whilst afternoon cakes and tea is served, would offer a more social atmosphere. EVIDENCE: The home employs two activity coordinators who prepare and provide a weekly activity programme. On the afternoon of the visit, whilst residents of Poplar unit were being assisted by staff to join in a game of carpet bowls, most of the residents of Beech unit were sat unstimulated in the lounge area with both the television
Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 Page 12 and radio playing. A member of care staff who was present in the lounge area was stood apart from the residents, watching television. Staff were not seen to interact with the residents until later when serving afternoon tea when the opportunity for afternoon tea and cakes being a social event for residents and staff is missed as preparations were seen to be conducted away from residents and cups of prepared tea ‘given out’. Two residents were assisted to take tea and cake by a member of staff who although behaving in a sympathetic manner, was standing over them. Copies of menu’s and information for residents are available throughout the home. However, information, which may assist residents to exercise choice, was not available in formats appropriate to the special needs of the residents of Beech unit. Providing menus and other items of information in pictorial formats would assist residents understanding of these matters. The inspector noted that the administration of evening medicines was taking place at the same time as the meal was being served. The manner in which this activity was conducted was seen to distract residents from the social ambience of their dining experience. A sample of menus was shown to the inspector who noted that there were ample stocks of food in the home to meet the menu requirements. Homemade cakes were extremely well turned out. Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 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. Residents and relatives can be assured that their complaints will be listened to, taken seriously and acted upon by the home. EVIDENCE: Relatives of two residents of Beech unit who were spoken to separately informed the inspector that “ staff here are the best”, “ they anticipate what residents need”. “ They are always willing to put things right”. Another relative who arrived, as the inspector was about to leave said “ you do sometimes have to mention small things a few times but Valerie is good and will listen” Matron informed the inspector that the home now meets regularly with relatives who previously raised concerns about their next of kin’s care. Since the previous announced inspection on 6 September 2005, two anonymous complaints made directly to CSCI have been investigated. This was undertaken by the Lead inspector, during unannounced visits to the home on 8th and 22nd September. A copy of the inspector’s findings can be obtained from CSCI Suffolk Area Office. Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 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 and 26. Residents can expect that the home provide a safe and well-maintained environment, which is clean and hygienic. EVIDENCE: The home maintains a maintenance programme. Risk assessments are in place for all residents and staff are trained in lifting and handling and medication policies. Residents moved around the home freely, fire doors are alarmed and staff were alerted during the afternoon when doors were opened. Areas of the home were seen to be clean and hygienic with one exception within Beech unit, where there is a risk of slight odour worsening if the cause is not further investigated and managed. Cleaning was seen to go on throughout the afternoon. Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29. Residents living in Poplar and Hawthorn can be assured that the numbers of staff and their skill mix will meet their needs. However, whilst residents who reside in Beech unit can be assured that sufficient staffing levels will be maintained, they cannot be assured that staff will fully interact and communicate with residents with dementia. Staff in Beech unit maintains a constant presence around the areas where residents are sitting. Residents can expect to be protected by the home’s recruitment practices. EVIDENCE: Staffing levels were seen to meet with the home’s agreed ratios. Call bells and fire exit alarms, which rang frequently, were answered without delay. The files of two recently recruited staff were seen to be correct and contained details of all necessary checks having been undertaken prior to the staff being employed. Whilst the agreed numbers of staff were on duty in Beech unit, most of the residents were seen to be sitting in the lounge area whilst staff stood apart from them and did not interact with the group or initiate any activity. The television and radio were switched on. Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 Page 16 Generally throughout the home staff were seen to interact with residents in a courteous and familiar manner. Care plans looked at described how staff should go about caring for residents and the inspector noted that detailed diary sheets recorded that those instructions were being carried out. Both charge nurses told the inspector of their related professional knowledge and care plans reviewed by them demonstrated how they direct staff in caring for residents. Staff were seen using equipment and assisting residents throughout the afternoon. One relative visiting Beech unit informed the inspector “ I know about care homes, and the staff here are the best I have ever come across”. “ All homes should operate like this one”. Another relative who stated they were “ very satisfied with the care the home provides” did raise a concern that on occasions staff from overseas presented as having difficulties in speaking English and being understood by residents. Individual staff records seen by the inspector recorded in detail the training in Health and Safety undertaken by staff. Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 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, 32, 36, 37 and 38. Residents and their relatives can expect that staff of the home are approachable and responsive to their needs. They can also be assured that the registered manager and his deputy take steps to ensure that the home is run in the interests of residents. Staff are trained in moving and handling people; the home has 4 hoists and another on order. Residents can be assured that staff receive training in order to protect resident’s Health and Safety. EVIDENCE: Throughout the visit the inspector noted that residents and staff experienced no hesitation in approaching Matron and engaging in conversation. Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 Page 18 Matron informed the inspector of the various meetings, such as Heads of Department meetings, care staff meetings and the Residents group meeting at which the home encourages feedback and suggestions from those involved. The inspector was informed that although “ by nature of the role” the registered manager was required to spend time in his office, “ his office door was always open”. Comments from residents and visitors as referred to in the appropriate sections of this report were positive one relative stated “ this home should be the standard that all others are judged on”. Staff records show that they received regular supervision. Senior staff at the home are about to commence the individual annual appraisal of staff. One member of staff informed the inspector “ I have worked in three other homes which were very nice and none of them match this place in atmosphere, team work and nice people to get on with”. Records relating to Health and safety checks, servicing of equipment and utility services were seen to be in order as were the records of staff training in Health and Safety. Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 3 3 X Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 Page 20 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 OP12 Regulation 12 (b) Requirement Timescale for action 30/04/06 2. OP14 16 (n) A programme of activities, which take account of the specialist needs of people experiencing dementia, must be made available. Information must be made 30/04/06 available in alternative formats, which take account of the specialist communication needs of people experiencing dementia. 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. Refer to Standard OP15 Good Practice Recommendations Administration of medicines should be organised in away so not to interrupt the social ambience of the resident’s dinning experience. That the serving of afternoon tea in Beech is organised as a social occasion for residents, visitors and staff. Specialist advice should be sought in how to manage resident’s behaviours, which result in them urinating in communal areas.
DS0000059115.V277025.R01.S.doc Version 5.1 Page 21 2. OP26 Oulton Park Care Centre 3. 4. 5. OP33 OP27 OP27 In order to develop further ‘Good Practice’, the home would benefit from developing links and contacts with other with other dementia specialist services. The home should identify the ways in which when required, staff from overseas are supported to improve their ability in speaking English. Staff on Beech unit should be monitored to ensure that they have the confidence, and skills, to interact and communicate with residents who have dementia. Oulton Park Care Centre DS0000059115.V277025.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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