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Inspection on 16/07/08 for Oulton Park Care Centre

Also see our care home review for Oulton Park Care Centre for more information

This inspection was carried out on 16th July 2008.

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

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People who use the service, including those with special needs, are provided with personal care and support that meets their care requirements. People told us, `the high level of care my relative receives is outstanding and communication with the relatives is excellent`, and ``the quality of staff, nursing staff and environment is excellent. The quality of the care at present is however dependent on how many staff are on each shift`. The home provides a purpose built, homely environment, which promotes independence. Staff members are `friendly and polite` to families and friends. The home`s gardens and courtyards are accessible and well maintained to very good standards. The home continues to offer `5-star` catering served in a range of comfortable dining rooms. The home provides opportunities for some younger adults to access activities within the community. One younger adult told us, `I go sailing every week, and also to a club`. The company`s quality assurance processes ensure that residents and relatives are consulted about their views on the quality of the care and service provided for the residents. Care plans would record the care and support agreed. Staff members would be appropriately recruited, trained and supervised to ensure that they could meet the specialised needs of the residents at the home. Residents would be treated with equality and respect, by staff who are committed to improving their quality of life.

What has improved since the last inspection?

Improvements continue to be made around all aspects of dementia care, including a stimulating environment, and supporting residents to maintain `life skills` by support from an appropriately trained staff group. The home has reviewed all sedating medicines in consultation with the local pharmacists and GP`s, and these have been reduced to a minimum where possible. This is to ensure improvements in the quality of life for the residents. The home has tried to involve the younger disabled residents to have more input into any changes to their environment. The home has tried to increase outings and activities for all residents, and include families, where appropriate, into the care planning process.The gardens have again made the semi-finials of the Barchester homes in bloom competition.

What the care home could do better:

The home continues with the provision of a care service that usually meets the needs of the residents. Three key concerns need to be further addressed. There have been some difficulties in maintaining staffing levels however the home is actively recruiting. Additional staffing would enable more attention can be given to the social needs of residents. A medicines audit showed some discrepancies in medicine totals. Management were required to investigate the discrepancies, and shortly after the inspection, provided a detailed response identifying action being taken to remedy these shortfalls. The proposed actions should ensure that residents receive their medicines, as prescribed. The home should consider providing a profile of daily routines, and weekly event schedules for younger adults, to ensure that there is a planned and normalised programme of events/opportunities for them, that meets their social care and leisure needs. Residents current social and leisure activities should be recorded in their activities plan to ensure the home can evidence they have provided appropriate social and leisure opportunities, for these residents.

CARE HOMES FOR OLDER PEOPLE Oulton Park Care Centre Union Lane Oulton Lowestoft Suffolk NR32 3AX Lead Inspector Kevin Dally Unannounced Inspection 16th July 2008 09:30 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.V368505.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. Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oulton Park Care Centre Address Union Lane Oulton Lowestoft Suffolk NR32 3AX 01502 539998 01502 539994 suehill@barchester.com www.barchester.com/oulton Barchester Healthcare Homes 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) Mrs Susan Jean Hill 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.V368505.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may admit one young person aged 17 years to the poplar wing, until 10th September 2007. 30th July 2007 Date of last inspection 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, opened in February 2004 and is owned by Barchester Healthcare Homes Limited and registered as a care home with nursing for up to 60 people. The home is divided in to three service areas, Poplar offers 16 places for younger people who have a physical disability, Hawthorn has 12 places for frail older people, and Beech cares for 32 people with dementia. All facilities for people living in the home are located within the single storey building, which has wheelchair access throughout. All 60 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, dining rooms, quiet rooms, and lounges and activities room. The dementia care unit enables residents to access a secure courtyard, which has seating and raised flowerbeds. Fees start from (as given at the time of the inspection): Frail older people from £850 per week Younger adults with physical disability from £950 per week Younger people with dementia from £850 per week Fees are based on residents requiring 4 hours care a day; therefore fees could vary if assessed as requiring more. Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was a key unannounced inspection undertaken over 10 hours, which focused on the main standards relating to people who use the service including older people, people with dementia, and some younger adults with physical disabilities. The report has been written using all the information gathered before and during the inspection. Mrs Sue Hill, the manager, was on leave at the time of this inspection, so Mrs Valerie Lawrence, head of clinical care, provided us with relevant information about the service. We were shown around the home and were able to spend time with some of the residents (3) and staff (3), and talk with some of the relatives (3) visiting the home. This gave us information about what people thought about the home and the quality of the care provided. Care plans; residents’ and staff records, maintenance records and training records were also checked. To enable us to gain feedback from people, who due to their mental frailty may be unable to complete a CSCI survey, the inspector spent an hour observing 4 residents in Beech unit dining room over the lunchtime period. During this time we were able to look, and record how the residents spent their time, their mood/well being, and how well staff worked with the residents. Observations made, have been included in the relevant parts of the report. The Commission for Social Care Inspection (CSCI) also sent surveys to the home to distribute, prior to the inspection. Comments were received from one person who used the service, two relatives, and a staff member who gave us feedback on how they thought the service was run. A selection of their views about the home is included within this report. Prior to the inspection, the management also completed the CSCI Annual Quality Assurance Assessment form (AQAA). This enables the home to inform us on how well they are meeting the National Minimum Standards, and allows them to say what they do well, what they could do better and any plans to improve the service. Some of the information from these documents has been used in this report. A tour of the building took in the main communal rooms in Beech and Poplar units, including dining rooms, and a sample of several bedrooms. Records checked included, care plans, staff recruitment and training records, complaints policy, safeguarding policy, and medication records. Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Improvements continue to be made around all aspects of dementia care, including a stimulating environment, and supporting residents to maintain ‘life skills’ by support from an appropriately trained staff group. The home has reviewed all sedating medicines in consultation with the local pharmacists and GP’s, and these have been reduced to a minimum where possible. This is to ensure improvements in the quality of life for the residents. The home has tried to involve the younger disabled residents to have more input into any changes to their environment. The home has tried to increase outings and activities for all residents, and include families, where appropriate, into the care planning process. Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 7 The gardens have again made the semi-finials of the Barchester homes in bloom competition. 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. Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4. The home does not offer intermediate care therefore standard 6 was not assessed. Quality in this outcome area is good. People can expect to receive the information they need about the service, and their care needs would be assessed prior to them entering the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections have identified there is a good range of information for prospective residents on the home, including printed material and a video available, which tries to answer some of the questions people may have about moving into a care home. The information provided by the home (AQAA) said that ‘residents have information they need to make an informed choice about their admission to the home’. We checked the home’s statement of purpose, and this provided key information including the aims of the service, the management structure of the home, and how to make a complaint. The last Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 10 CSCI inspection report (30th July 2007) is available for people to read in the reception area. Surveys (CSCI) received from a resident and relatives told us that they had received enough information about the care home to help them make decisions. Care plans checked showed that the home had completed detailed assessments for each person in order to ensure that they could meet these peoples’ care needs. Assessment information included details of the personal care needed, behavioural information, any nursing needs, and peoples’ social interests. The information is included within the resident’s care plan to provide a detailed picture of the care that is required, when they move into the home. Residents would be provided with the Barchester Healthcare ‘resident’s terms and conditions’, which comes as a booklet, and contains a copy of the completed ‘resident’s admission agreement’ contract. The booklet gives detailed information on what is covered in the fees. The information provided by the home (AQAA) said, ‘Residents are provided with a contract of terms and conditions’. Further, they confirmed that 25 privately funded people had received written contracts, and 36 council or healthcare trust funded people had received agreements that specified the arrangements made. The home was able to show us that they provided adequate training for staff, which would ensure they could provide the support, and meet the care needs of the people who lived at the home. For example, staff training included safeguarding training, fire, moving and handling training. Specialised training would be provided around the memory lane programme (dementia care) training to ensure that staff could meet the specific needs of people with dementia. Feedback received from staff informed us they had received physical disabilities and challenging behaviour training, which they described as ‘helpful’. Staff told us that this training had enabled them to deal with more challenging situations in a calm and safe way. The home recorded that around 46 of their care staff (21 of 46) had achieved a national vocational care qualification (NVQ) level 2 or above, with a further 11 currently undertaking this course. This informed us that around half of the staff group had achieved a formal care qualification, and of the home’s ongoing commitment to ensuring a competent and qualified workforce. Surveys (CSCI) received from relatives (2) said that the care home ‘always or usually’ meets the needs of the residents, that staff have the right skills and experience to look after people properly, and that they give their relative the support and care that they expected. One resident said, ‘I think they do most things well’. Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The quality in this outcome area is good. People living at the home can expect that they will have a plan of care, which aims to meet their needs and reflect their choices. Peoples’ health care needs would usually be met although some shortfalls in medicine practices may put people at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans follow the Barchester care profile format, and were introduced throughout the home last year. The care plan looks at each area of care need including residents’ physical, mental, nursing or social care needs, and any challenging behaviour problems. Staff work with residents or their advocate, to ensure the information provided reflects the level of care they would wish for. Care plans checked showed 15 areas of assessed need, which included personal care information, a life story background, nutritional issues, mobility and risks, and pressure area care. Care plans are reviewed monthly to ensure that they remain current. Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 12 Two care plans were checked, one for a resident with physical disabilities, and one with dementia. Both residents were also later tracked to see if the care recorded matched with the care provided. Care plans provided detailed guidance for staff around each resident’s particular nursing, mental health, social, and physical cares needs. Very positively, the resident’s life history profile showed important key information about their past and present background, and important relationships, which included family and friends. For example, one memory lane profile detailed information about their family, extended family, preferred former holidays, their occupation, social and religious preferences. This information gave the reader a good understanding of the person’s individual background, their preferences and past choices, and which could be considered when providing their current care. Records checked showed us that nursing staff liaise with other healthcare professionals, for example, the chiropodist, the doctor or dentist. Accident records checked for the previous 4 months showed that there had been 39 accidents during this period, with 26 recorded in the month of March 2008. Due to further close monitoring by the deputy manager and nursing staff, these had been reduced; month on month, to now only 4 falls total in June 2008. One resident who experienced 11 falls in March 2008, these had now been reduced by monitoring, to 2 falls in June 2008. Residents and relatives spoken with during the inspection confirmed that they were happy with the quality of care and support given, although they did raise concerns about the level of staff numbers (Please refer to staffing outcome group). During the inspection we observed that all residents looked well care for, were well groomed, and constantly attended to by staff. Staff worked hard throughout the morning, assisting and supporting the residents with their care needs. Staff were observed to be polite and caring towards the residents. The resident completing the survey said that they ‘usually’ received the care and support they needed, and that staff were ‘usually’ available when they needed them. Further, they said that they ‘always’ received the medical support they needed. Relatives completing the surveys said staff ‘always’ or ‘usually’ met the needs of their relatives, and that they provided the support and care that they expected or had agreed. One staff member in their survey (please refer to staffing outcome section) raised concerns that lower staffing levels affected the level of care they could give. They said, ‘Sometimes, the quality of care is limited due to lack of time because we had to do the second absent member of staff’s work. During observation of people in the dementia unit, staff were seen to positively interact with vulnerable residents, and this included periods of conversation, fun and laughter with many individuals. Residents were able to freely move around the unit, including walking outside in the secure central garden/ courtyard. During the lunchtime period, residents gathered in the dining room, at various tables, so were able to participate and enjoy the ‘dining experience’. Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 13 Residents, who required higher levels of assistance, were positively supported by staff located at each table. Staff were calm and unhurried and asked residents about their preferences and choices. For example, if they wished to have a protective apron on. There were always staff present in the dining room at all times to provide appropriate support. One resident became agitated during the lunchtime period, so a staff member took time to find out what the problem was, and after reassuring them, the person managed to have lunch independently, without the need for any further support. The medicine round was observed during the teatime period in Beech unit. The nurse in charge administered medicines from the portable trolley, which was designed for use with the monitored dosage system and blister packs. Medicines were administered to residents without disruption to them, while they were eating. The nurse was seen to follow safe practice in the checking of residents’ medication administration records (MAR) charts, and locking the medication trolley, if they had to leave it for a short period. Three residents’ medicines were audited (7 medicines in total) to check that the records balanced with the medicines left in the containers. Five of the 7 medicines checked balanced with the records, but 2 did not quite balance, with each medicine box containing slightly more medication, than the records showed. As no immediate reason could be found to explain the discrepancies, the home was immediately requested to investigate these shortfalls. The company provided us with a full report shortly after the inspection, and in one case, the medicines had been accidentally placed in another resident’s container, who used the same type of medication. In the second case the home was unable to identify how the error had occurred. However, as a result of these errors, the home has put in place a number of additional monitoring processes including increased audits by the nursing in charge of Beech unit, and the company’s regulation manager. Further, the regional development manager states that they will remind nursing staff during training sessions of their responsibilities, and a new 24-hour auditing tool will be implemented, to ensure that residents receive their medicines, as prescribed. An immediate requirement notice was issued at the time of the inspection, in response to these shortfalls, as follows. The home must investigate two medicine shortfalls to determine why the medicines recorded did not balance with the medicines stored. This is to ensure that people receive their medicines as prescribed, so keep them safe. As evidenced above, these shortfalls have been addressed by the home. The control drug cabinet and medicines were checked, and these were appropriately stored, and maintained with appropriate records. Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. Residents can expect to be offered a range of daily lifestyle activities and would be supported to maintain contacts with family and friends. They are offered a choice of nutritious well-presented meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Time was spent in the morning in Poplar unit speaking with the residents and assessing the routines and activities provided for them. One person was spoken with in their room, and they showed us a jigsaw they were completing. The resident also had access to additional games and puzzles, which they told us, they really enjoyed. We also met other residents (4) in Poplar dayroom, and during the time spent there, (around 30 minutes) there was no obvious programme of events for that morning, with only the television for people to view. However, one resident told us that they accessed a number of hobbies in the community. For example, sailing at Alton Broad, or attendance at a local support club. The resident told us that they attended these activities on a weekly basis, and which they very much enjoyed. Their care plan and social interest information Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 15 was checked, and although this was not up to date, it did show that they had previously accessed a variety of interests in the past. These included boxing and football interests, football memorabilia, and visits out with their family, bowling, TV cartoons, and the latest videos. Daily care notes recorded some of these events. For example, ‘went sailing’. However there was no daily or weekly plan of events available, to show how the home was currently meeting these peoples’ particular social and leisure needs. Feedback from staff told us that there were 2 activity coordinators at the home, who actively promoted positive lifestyle opportunities for the residents in Beech and Hawthorne. However staff said that they did not often see them in Poplar, but were unaware if there was an ongoing programme specifically for the younger adults here. Staff feedback confirmed that the home does provide ‘very good key events’ for the residents. For example, Irish singers, a Valentines meal, country and western music event, a 40’s disco and a Zulu event. We spoke with one resident’s relatives from Poplar, who confirmed that their relative did have access to some activities, including within the community, but they thought less than there used to be. They described for us the ‘fun things’ that used to be more readily available like bowling in the corridor, and social activities that were run within the home. The relative said that the residents needed more events like this. Resident’s views about the activities were as follows. ‘We need more activities’, and, ‘Activities vary on where/what activities are on, and sometimes what I can do. Some things I am not able to take part in’. In spite of these concerns it was evident that the home did provide other quality opportunities for residents to participate in. Beech unit had a fulltime activities coordinator, with a full knowledge of dementia. Residents were able to access secure, sensory gardens with raised flower beds, in an accessible central location. One of the corridor wings had clothing and other memorabilia, which people with dementia could access, and touch and which was designed to remind them of items from their past. The kitchen in Beech lounge has been replaced with a ‘skills for life’ kitchen, a specialist kitchen, designed for people with dementia to be able to use safely. Special crockery, finger foods and soft drinks are provided for the resident’s use. Residents in Beech unit were observed receiving their main lunchtime meal which was 3-courses with excellent choices available. Residents were able to choose from a starter including the soup of the day or hot ‘n’ spicy baby corn with sweet chilli mayo. The main course was a choice of steak and kidney pie, smoked haddock fillet or cheese and vegetable pasta bake, all served with potatoes and seasonal vegetables. Sweets were syrup sponge pudding and custard, assorted ice cream or a selection of sweets from the trolley. During the lunchtime period, a staff member was located at each table to assist any Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 16 resident with higher support needs, and this would ensure that all residents could enjoy and participate in the ‘dining experience’. Menus checked for the previous two-week period showed the home had provided an excellent range of quality cuisine with choices and variety, which should meet most people’s nutritional needs. Staff spoken with said the ‘dining experience’ was always ‘excellent, with options of soft and liquidised diets also available’. Further, they said, ‘the home provides a 3 course meal with wine or larger, and any specialised diets. For example, diabetic diets. The meals provided were well presented, and each of the dining rooms visited had their own character, with the more formal hotel style Hawthorn, homely Beech unit and ‘cosy’ Poplar. Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. People can expect the service will listen to their concerns, and take appropriate action to safeguard residents’ welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure was provided within the statement of purpose and resident’s, ‘Welcome to Oulton Park Care Centre’ handbook, should a resident or relative wish to raise any concerns with the management. The home had received 3 complaints and 20 compliments within the last year. The complaints received were around changes to staff, a personal medical concern, and incorrect fees charged. All complaints were investigated of which 2 of 3 were resolved. One complaint outcome was inconclusive. A selection of the compliments received by the home included the following views. ‘Thank you for being here for me. It was great to have someone to talk to’. ‘Thank you for all you do. It is much appreciated’. ‘Thank you for making us feel so welcome, and for treating us so very well’. ‘Thank you for your kindness to our relative’. Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 18 There was company policy for the safeguarding and protection of vulnerable adults (POVA), with information and instructions on what to do. The home was aware of their responsibilities in reporting any allegations of abuse to the Social Services team for further investigation. One safeguarding alert had been made by the home within the last year, around the actions of a member of staff, and who was also referred to the POVA list. Staff records checked included criminal record bureau (CRB) and protection of vulnerable adult (POVA) checks, reference checking and identity checks, which would ensure that staff were suitably checked and cleared to work with vulnerable adults. Records checked and feedback from staff members (4) said they had received adult safeguarding training, which would ensure that staff knew what to do in the event of any allegations of abuse by a resident. Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, 25 and 26. Quality in this outcome area is excellent. Residents will benefit from a comfortable, well-maintained and high quality environment that will meet their accommodation needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Oulton Park Care Centre is situated in the village of Oulton, on the outskirts of Lowestoft. The purpose built premises can accommodate up to 60 people, and is divided into three areas. Poplar, offers 16 places for younger people with physical disabilities, Hawthorn has 12 places for frail older people, and Beech cares for 32 people with dementia. The facilities for people living in the home are located within a single storey building, which has wheelchair access throughout. All 60 bedrooms have en-suite bathrooms, electrically adjusted beds, and remote controlled televisions with integral radio as standard. Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 20 The home offers a variety of communal spaces, which include an enclosed courtyard, atrium, dining rooms, quiet rooms, and lounges and activities room. The dementia care unit enables residents to access secure courtyard with has seating and raised flowerbeds. The home is well maintained to ensure the decoration of the building is maintained at a good standard, and the fixtures, fittings and furnishings are all decorated to a high standard. Bedrooms checked were personalised, and furnished with specialist equipment, and good quality furnishings. During the inspection, a tour of the dementia unit was completed, and all areas of the corridors had something for residents to see and do. This included ‘tactile areas’ such as a board made up of doorknobs, handles and bells, which people can touch, and which helps with mental stimulation. Fish tanks are at wheelchair height, and a mixture of new and old pictures, tapestries, and small seating areas are available. To help residents identify their bedrooms; memory boxes have been fitted to the door, which the resident and their family have filled with mementos, which gives ‘a snap shot of their lives’. The layout of the unit included one large lounge and a separate dining room, with a large outdoor area, and Beech unit has an internal courtyard, which residents can access from the corridor or day rooms. The high flowerbeds enable wheelchair users to enjoy the gardening experience, or just touch and smell the “edible plants” and objects in the “sensory” garden. All areas of the purpose built home, and gardens are suitable for wheelchair users. Residents on Poplar and Hawthorn have access to landscaped gardens, which are wheelchair friendly, and have plenty of areas for residents and their visitors to sit out. The home was clean and bright, and generally odour free. Feedback from a resident said that they found the home to be ‘always’ clean and fresh. The central atrium was in constant use by being well used by residents and their visitors. This gives a light airy space, where people can enjoy refreshments and home made cakes. One relative said, ‘The quality of the environment is excellent’. Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. Overall people benefit from staff who are well trained and supervised and would have their basic healthcare needs met. They cannot always be assured that there are adequate numbers of staff on duty to meet their social needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The deputy manager told us that the staffing levels for the morning period was intended as 1 registered nurse (RN) and 7 carers on each side of the home. The rota checked for a 2-week period indicated levels slightly lower than this at 1 RN and 6 carers on average, for each side, and some weekends, there were only 1 RN and 5 or 6 carers, each side. The afternoon period was 1 RN and five carers per side. The deputy manager said the aim was to recruit to 1 RN and 8 carers in the morning, on Beech (for 32 residents) and 1 RN and 7 carers between Hawthorne and Poplar, (for 28 residents) during the morning. Further, a recent recruitment drive had successfully secured 4 more staff members who would be starting very shortly, and that this would improve staffing levels. However, she did acknowledge that staffing levels was an on going challenge for the home. The plan was to recruit staff to the maximum levels, so there would be Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 22 more flexibility, to meet people’s needs, when staff was on sick or annual leave. The rotas checked showed that the home did use agency staff 2 or 3 times in some weeks but preferred to use their own staff, when this was possible. However, while it was noted that the maximum number of hours worked by staff was no more than 45.5 hours per week, some staff did work 3 long days in a week (7.30am to 8.30pm), which may be very tiring for them. At the last inspection the report said, ‘Rotas showed that the home has been running short on some shifts, and some staff were working long days (double shift). The manager said they are looking to try and stop these’. While it was of concern that double shifts continued for most staff, this was compensated for by more days off over a seven-day period. Feedback received from some residents, relatives and staff members, indicated that while staffing levels are usually adequate for meeting peoples’ healthcare needs, shortfalls may be impacting on the time staff need to support people, for example, with their social care needs. One resident told us, ‘I find the staff very nice and helpful. However, I think there are far too few staff. I used to have 2-3 baths a week. This is now not always possible. Staff are employed to take us to town, but this is now left’. One relative told us, ‘The home tell us that there are good activities. I think though there should be more fun things to do, but staff are limited with their time’. Another relative said, ‘The quality of the staff is excellent. However, the care is dependent on how many staff turn up on a particular day’. Variations in staffing levels were impacting on the time that could be spent with the residents. However, it is recognised that the home is actively trying to address these concerns, by recruiting additional staff. This includes higher levels of staff, as discussed with the deputy manager. The home must therefore ensure that is has sufficient numbers of staff to meet the continuous needs of the residents. Feedback received from one staff member, made the following comment. ‘Sometimes the quality of care is limited due to lack of time because we had to cover for an absent member of staff’. Feedback from a staff member said their recruitment had been done fairly and thoroughly. Staff records checked showed that the home had undertaken suitable criminal bureau records (CRB) checks, reference and identity checks to ensure that staff were suitably checked and cleared, prior to joining the home. Recruitment records also contained completed application forms; health questionnaires, and employment histories to show they were suitable for the position. One nurses records checked showed that the home had checked their professional identification number (PIN) number to evidence that they were Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 23 currently registered with the nursing and midwifery council (NMC), UK, which evidenced their professional right to practice as a nurse. Records of staff annual appraisals and supervisions with their manager were maintained on their files. The home uses their own part-time training coordinator, and training room for staff, but the trainer was away on the day of the inspection. The home has its own in house training, which also provides induction for new staff members in line with the common induction standards based on the skills for care standards. This provides a programme of assisted and self-directed learning for staff around 6 key core care subjects that are completed within the first 12 weeks of employment. The induction records we checked showed that the core training provided included moving and handling, emergency first aid, fire training, health and safety, safeguarding adults, and communication training. Information provided by the home showed us that staff received specialist training which included information on strokes, multiple sclerosis training, Parkinson’s, Peg feeding training, and dementia care (memory lane) training. The Barchester’s ‘memory’ lane programme aims to give staff an insight into supporting residents with dementia. Feedback received from staff informed us they had received physical disabilities and challenging behaviour training, which they described as ‘helpful’. Staff told us that this training had enabled them to deal with more challenging situations in a calm and safe way. The home recorded that around 46 of their care staff (21 of 46) had achieved a national vocational care qualification (NVQ) level 2 or above, with a further 11 currently undertaking this course. This showed us that around half of the staff group had achieved a formal care qualification, and of the home’s ongoing commitment to ensuring a competent and qualified workforce. Surveys (CSCI) received from relatives (2) said that the care home ‘always or usually’ meets the needs of the residents, that staff have the right skills and experience to look after people properly, and that they give their relative the support and care that they expected. Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38. Quality in this outcome area is good. People benefit from an appropriately run service that meets their needs, which includes robust quality assurance checking. This judgement has been made using all the available evidence including a visit to this service. EVIDENCE: Mrs Sue Hill, the manager, has been in this post since November 2006. Mrs Hill has had previous management experience working for a local Authority residential home. Her qualifications include a diploma in dementia care, advanced dementia care mapping, and a diploma in management of care services, NVQ level 4. Mrs Valerie Lawrence, the deputy manager and also a registered nurse, provides clinical support and advice for nursing staff. Feedback received from a relative said, ‘There have been vast improvements with the arrival of the new manager. The home is now on an excellent basis’. One staff member said, ‘I have worked at a lot of homes and I find the carers Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 25 here are more dedicated than anywhere else. There is no cutting corners, and most are committed to the residents’ well being’. The home uses a variety of quality assurance measures to determine if it is meeting peoples’ expectations of the service, and to consider how it can improve the service provision. These include monthly audits by the director of quality care, regulation 26 reports, and the organisation’s compliance officer, who can also undertake audits of the service. The Barchester Company undertakes a satisfaction survey for all homes, of which Oulton Park was completed in December 2007. The survey compares residents’ views within the home with all other Barchester homes, both within the region and in the country, so is a robust quality assurance tool. The report identified that Oulton Park overall, 74 of people thought the service was favourable, with 18 satisfactory, and 8 thought improvements were needed. Some areas where residents rated the home very favourably included the home’s atmosphere, the physical environment, and the catering service, the latter of which surpassed both the regional and national averages for Barchester homes. Some areas identified where improvements were indicated included some aspects of staffs’ care and attention with residents’ care, some aspects of the housekeeping service and medical information provided, and the social activities programme within the home. Although these results are positive, residents’ overall opinion of Oulton Park was slightly lower than the average residents’ satisfaction, in comparison to other Barchester homes in the region. These results were discussed with the deputy manager who acknowledged that there was room for improvement, but that the home was working hard to try to resolve these issues. She attributed some residents’ concerns to a difficult period the home went through last year. The quality assurance information was seen as a detailed picture of what residents thought about the provision of their care. Further, that residents and relatives had been included in the quality assurance process, and that the company, and home were aware of what improvements were needed. The information provided by the service (AQAA) confirmed that the home has a range of policies and procedures for staff, which includes health and safety, and financial procedures, which are regularly reviewed. Staff records show that they have received health and safety training including moving and handling, fire procedures, infection control and food hygiene training. This was confirmed by feedback received from staff. The tour of the premises showed that the building was well maintained. Further, the home has a maintenance person who is responsible for all aspects of health and safety, and that the company employs an external body to carry out health and safety inspections of the home. Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 4 x x x 4 4 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action 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 OP12 Good Practice Recommendations The home should consider providing a profile of daily routines, and weekly event schedules for younger adults, to ensure that there is a planned and normalised programme of events/opportunities for them, that meets their social care and leisure needs. Residents current social and leisure activities should be recorded in their activities plan to ensure the home can evidence they have received appropriate social and leisure opportunities. 2. OP12 Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Oulton Park Care Centre DS0000059115.V368505.R01.S.doc Version 5.2 Page 29 - 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. 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