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Inspection on 30/07/07 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 30th July 2007.

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

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

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

Residents are provided with a purpose built, homely environment, which promotes independence. Their families and visitors are "made to feel welcome" and are `often invited to join in with celebrations or entertainment`. Gardens and courtyards can be easily accessed, and has points of interests. The home offers `5-star` catering, served in a range of comfortable, dining rooms. Staff receive training from the home`s dedicated trainer, and nurses are being supported to keep their clinical knowledge updated. Residents are treated with equality and respect, by staff who are committed to improving their quality of life. People completing the CSCI surveys were asked what they felt the home did well, their comments included: `the nursing and personal physical care are excellent` `staff are extremely kind and supporting` `care plans are straight forward and easy to read` `in most aspects the care home is good` `each resident`s needs are cared for to a very high standard`. This reflected observations and discussions with residents and relatives during the inspection, who liked the staff and felt people were being well cared for.

What has improved since the last inspection?

Mrs Sue Hill, whose skills, knowledge and experience will complement the clinical care at the home, has been recruited as General manager. Improvements have been made on all aspects of dementia care, including a more stimulating environment, and supporting residents to maintain `life skills` through installing a specialist kitchen. Residents on Poplar unit have been involved in the designing their lounge/dinning room to meet their needs and preferences. The introduction of Barchester`s 5-star dining experience, making meal times a enjoyable focus of the resident`s day. Relatives meetings have been started, to aid communication and give people a closer insight into the work, and changes happening at the home. The gardens have made the semi-finials of the Barchester homes in bloom competition. The new care plan formats, which are more individualised, have been introduced, and are still being developed to ensure the residents are fully consulted and the information reflects how they wish to be looked after.

What the care home could do better:

The home has gone through a difficult period, when they have not always been able to maintain their staffing levels. This should be addressed by the recruitment of new staff, however if it continues to be a long term problem, they will need to review their occupancy/dependency levels, to ensure they are able to meet needs, and does not affect the quality of care. They also need to ensure staff morale is maintained, as staff feedback indicated that some staff`s morale was being affected by having to cover the shifts.

CARE HOMES FOR OLDER PEOPLE Oulton Park Care Centre Union Lane Oulton Lowestoft Suffolk NR32 3AX Lead Inspector Jill Clarke Unannounced Inspection 30th July 2007 10:10 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.V347845.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.V347845.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 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) www.barchester.com/oulton Barchester Healthcare Homes Limited 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.V347845.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. 31st July 2006 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, lounges and activities room. The dementia care unit enables residents to access secure courtyard with has seating and raised flowerbeds. Fees start from (as given at the time of the inspection): Frail older people from £720 per week Younger adults with physical disability from £850 per week Younger people with Dementia from £795 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.V347845.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, undertaken over 8 hours, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to, and during the inspection. Commission for Social Care Inspection (CSCI) feedback surveys were sent to the home to distribute, prior to the inspection. This gave an opportunity for residents, relatives, visitors, and staff, to give feedback on how they thought the service was run. Following the inspection surveys were also sent to the Team of Social workers who have contact with the home. Information obtained from the service user (1), relatives/advocates (4) staff (9) and care managers (1) surveys has been included in this report. To enable the inspector to gain feedback from people, who due to their mental frailty may be unable to complete a CSCI survey, the inspector completed a Short Observational Framework for Inspection (SOFI) record sheet. Developed in conjunction with the University of Bradford, this enabled the inspector over a period of 1½ hours, to watch 4 residents sitting in Beech unit dining room. During this time the inspector was able to look, and record how the residents spent their time, their mood/well being, and how well staff engaged (interacted) with the residents. Observations made, have been included in this report, within the relevant sections. Prior to the inspection the home was required to complete their Annual Quality Assurance Assessment (AQAA). This enables the home to inform the CSCI on how well they are meeting the National Minimum Standards. The home is also asked to state what they feel they do well (and where able to provide evidence to back this up), and what areas they feel they could do better in. Information obtained from the AQAA, has also been included in this report. Both the Registered Manager and the Matron were available throughout the inspection, and were very helpful in providing any required paperwork, and giving feedback on the service. A tour of the building took in the main communal rooms, and a sample of 2 bedrooms, a bathroom, easy access toilet, Atrium and dining rooms. Records viewed included, care plans, staff recruitment and training records, complaints policy, and medication records. This and previous visits to the home identified that people living at Oulton Park Care Centre preferred to be known as residents, this report respects their wishes. Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Mrs Sue Hill, whose skills, knowledge and experience will complement the clinical care at the home, has been recruited as General manager. Improvements have been made on all aspects of dementia care, including a more stimulating environment, and supporting residents to maintain ‘life skills’ through installing a specialist kitchen. Residents on Poplar unit have been involved in the designing their lounge/dinning room to meet their needs and preferences. The introduction of Barchester’s 5-star dining experience, making meal times a enjoyable focus of the resident’s day. Relatives meetings have been started, to aid communication and give people a closer insight into the work, and changes happening at the home. The gardens have made the semi-finials of the Barchester homes in bloom competition. The new care plan formats, which are more individualised, have been introduced, and are still being developed to ensure the residents are fully consulted and the information reflects how they wish to be looked after. Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oulton Park Care Centre DS0000059115.V347845.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.V347845.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 and 5. The home does not offer intermediate care therefore standard 6 was not assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have their needs fully assessed, and are given a range of information, in a suitable format to support them in identifying if the home will meet their needs. EVIDENCE: As identified during previous inspections, there is a good range of information for prospective residents on the home, and the organisation that runs it. A video is also available (with sub-titles) which tries to answer some of the questions people may have about moving into a care home, and the level of service they should expect. The last CSCI inspection report (31 July/11 August 2006) is available for people to read in the reception area. Relatives surveyed, felt they had received enough information about the care home to help them make decisions. Part of this information is given verbally, when experience staff visits prospective residents at home, or in their care Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 10 setting. Duirng this visit staff will complete a pre-assessment, to support them in identifying what level of care the person is looking for, and if the home is able to meet this need. This was confirmed by a social worker who said the home sends their ‘own trained staff to assess clients for placements’, to ‘compliment the Social Workers Assessment’. Each resident is supplied with a copy of 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. A resident surveyed said that they were ‘initially’ admitted as ‘respite’ care and had not received a contract, or enough information on the home. No further information was given as to whether this had been an emergency admission, and they had been the information at a later date. Staff encourage people to visit the home and look around. All places are offered on an initial 4-week trial period, or residents can get to know the home through short respite breaks (subject to availability). The home states in their AQAA that they are looking to invite support groups such as the Alzheimer’s society, to hold coffee mornings at the home, which will help people build links. Relatives asked (CSCI survey) if they felt the home met the needs of the residents, 2 replied ‘always’ and 2 ‘usually’. Comments included ‘physical care needs are always well cared for. The need for mental stimulation is understood and met by some carers, not others’, and ‘lack of carers (see staffing section of this report). Oulton Park Care Centre DS0000059115.V347845.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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans gives staff guidance on how residents physical, nursing, mental and social care needs will be met. EVIDENCE: Since the last inspection the home has finished introducing the new Barchester care plan formats throughout the home. The old care plan system gave limited space for staff to write in, which resulted in a more task orientated care plan, which did not fully reflect people’s choices and preferences. The new formats look at each area of care (physical, mental, nursing, behavioural, social). Staff are required to work jointly with residents, or (if unable) their advocate, to ensure the information is personalised, and reflects the level of care they would wish for. Sections included ‘life story’, ‘nutrition’ and pressure area care. The 2 care plans looked at, both gave guidance on the resident’s nursing, mental health, social and physical care needs. However, the level of information in 1 of the care plans for a younger adult, was more informative, showing that the person had been fully involved, and was consulted on aspects Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 12 of their care. It showed that staff were aware of the diverse needs of the person, and with the resident were looking to see how they could meet them. The inconsistency in the quality of recording information was highlighted in a relative’s comments who said ‘what is agreed with one carer is not always known to others’. Information held, also showed where nursing staff liaise with other health and social professionals, and specialist nurses, for example speech therapists and tracheostomy care. A social worker confirmed that at joint reviews staff ‘often presents their own write up detailing developments since the client was placed with them’. They also describe the care plans as ‘clear, straight forward and easy to follow’. Residents and relatives spoken with during the inspection confirmed that they were happy with the level of care and support given. The resident completing the survey said that they ‘usually’ received the care and support they needed. Relatives completing the surveys when asked if the home gave the level of support that they expected, 1 replied ‘always’ and 3 ‘usually’. 2 staff in their surveys (see staffing section of this report) raised concerns that low staffing levels affected the level of care they could give, saying that it led to ‘short cuts’, and ‘having to refuse basic needs’. These comments were fed back to senior nursing staff that this should not be happening, as staff are informed/reminded that they provide a 24-hour service. When they are running short staffed, physical care takes priority, and tasks such as making beds – can be handed over for the next shift to do. Another member of staff, when asked what the home does well, had replied ‘provides up to date individualised, quality and high standards of care’. Residents met during the inspection, looked well cared for, which was a view shared by the Charge Nurses. Following the inspection, due to previous concerns raised by Social Care, on behalf of their clients, CSCI ‘care manager’s surveys were sent to the social care team. At the time of writing this report, 1 had been returned. In response to the question were their client’s health care needs being properly monitored and attended to by the care service, they had replied ‘usually’. They went on to say that the ‘service does ensure clients care needs are monitored’. They also felt the home ‘has an understanding of diversity judging by the respect accorded clients and professionals across the divide of race, colour religion and abilities’. During the SOFI observation, staff were seen to address residents by their preferred name, and respect their dignity. For example at lunchtime staff did not automatically go around putting protective clothing on residents, but would offer residents an apron if they wanted to keep their “clothes clean”. Residents, who took up the offer, were seen choosing the design they wanted. Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 13 Walking around the home, staff could be heard talking politely to residents, and closing doors when personal care was being undertaken. Whilst undertaking the SOFI in the dementia care dining room, 2 trained nurses were giving, 1 by 1 residents their medication, which was undertaken in a relaxed manner. They took time to talk and assist each resident. Although giving out the medication whilst the residents were eating, taking into account this was being given in-between the 3 courses; it did not seem to interrupt the residents dining experience. Staff were seen to follow safe practice in the checking of residents medication Administration Records (MAR) charts, and locking the medication trolley before going to find the resident. However, it was noted, that a resident who was waiting to be given their lunch, was given a food supplement before – instead of following the meal. The homes AQAA confirmed that they are still undertaking weekly audit checks of medication, undertaken by the Matron. Good practice was seen with resident’s photograph attached to their medication record,. The records also gave useful information on individual residents, which staff needed to be aware of. For example ‘takes medicines well, place in XXXXX hand and offer drink’, and ‘at times refuse medicines and needs to be left alone to calm down – and then try again’. The sample of MAR charts looked at, had been fully completed to confirm that medication had been given to the residents, or as otherwise indicated by the ‘code’ letter given. Where 1 resident was prescribed 1 to 2 tablets, except for the last 4 days – staff had not always been writing in the number given. When fed back to the Matron, they said that this had been picked up during an audit, and staff reminded to do this. Although the temperature of the medication fridge was being checked, the readings showed that at times, the temperature did not fall in to the correct range. This reflected concerns raised by a member of staff that the ‘treatment room only has an electric fan working’ instead of having ‘air conditioning’. This was fed back to the manager who confirmed that an air conditioner was being fitted. Oulton Park Care Centre DS0000059115.V347845.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 excellent. This judgement has been made using available evidence including a visit to this service. Residents are able to make choices about their life style, supported to develop/maintain life skills and able to enjoy a range of nutritious, well presented meals. EVIDENCE: Since the last inspection the home has continued to work to ensure that a range of suitable activities is available, which meets the diverse needs of the residents. Beside ‘group’ activities, the focus is changing to make days more meaningful for residents, which includes being able to take part in daily tasks, and pursue their interests/hobbies. A social worker felt that this was an area the home could still improve on by ‘the introduction of more person centred approaches and arrangements for outings’. Relatives surveyed commented that ‘staff make a great effort to give a bit of normality to the lives’ of the young people living at the home, ‘by taking them to the cinema etc’. Beech unit now has a ‘full time activities coordinator’ with specialist knowledge of dementia, which leaves the other co-ordinator to concentrate on, Hawthorn Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 15 and Poplar units. Time spent talking to residents on Poplar, showed ways they were being supported to access the community, such as attending an air show, concerts, and having broad band installed on their computers. Staff also mentioned the special “Birthday Surprise”, arranged by a Hawthorn residents family (further information may identify the person)– which they very much enjoyed. Previous inspections had identified the lack of activities at the weekend; the inspector was informed staff undertook this at weekends. However, this may be affected by the staffing levels (see staffing section of this report) as, staff said they needed to prioritise work. The notice board displayed a list of ‘forthcoming outings’ during May to August, which included outings to Gt Yarmouth Seal Life Centre, Banham Zoo and Bure Valley railway. However, the list also showed at least 6 had been cancelled due to bad weather – but staff were looking to re-arrange these. The satellite 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. The Sister on the unit said they had watched the “positive reaction” from residents who had not lost all their life skills – as they offer to make a cup of tea”, if they “drop anything they will clear it up with the dust pan and brush – left out for people to use”. 1 member of staff raised concerns on money spent on ‘buying stuff’ that ‘in their opinion was not needed by residents’, as it was a ‘nursing home and not a hotel’. These comments showed that perhaps not all staff have fully developed their knowledge of dementia care. Minutes from ‘Beech Unit’ first relative meeting (26/7/07) showed that relatives were also coming to terms with the changes, and gave explanations from staff on how these changes were benefiting residents. 1 relative said they had observed, with the new lounge and dining room set up (see environment section of this report) people ‘are being brought together – who would never have met each other’. Staff also commented that the “interaction was much better”, which was also observed during the inspection. Previous concerns had been raised that residents were seen to sit in the armchairs, for a large part of the day – having their meal, and only moving when requiring personal care. Now residents can divide their day up, with moving to the dining room for lunch. Nursing staff spoken too, said this worked well, that residents “looked forward to going to the dining room”. Good practice was seen during lunch on Beech unit with residents being shown, each of the 3 courses and the choices available, to support them in identifying what they would like. During previous inspections, concerns had been raised by staff and relatives that residents on Beech unit were not offered the same choice of desserts, as the rest of the home. The manager said that this had been addressed, to ensure equality of choice for all residents. This Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 16 was evidenced when the dessert trolley was taken around the tables for residents to choose. Residents were able to choose from a range, which included Carrot cake, Chocolate Gateaux, Cheese & Biscuits, Cream Caramel and fresh Fruit Salad. Residents were looking as it passed – some requesting seconds. Residents were also offered a choice of wine, beer or fruit juices – many taking up the offer of red or white wine. Nursing staff on Poplar/Hawthorn praised the “5 Star dining experience”, and how it gave a “focus” to the resident’s day. Meals were well presented, and from feedback given “lovely”. Each of the dining rooms visited had their own character, with the more formal hotel style Hawthorn, homely Beech unit and ‘cosy’ Poplar. The atmosphere in all 3 areas was positive, with residents interacting well. On sale in the reception was the second in the range of ‘Cooking with Care’ cookbooks. This has been put together by Barchester staff (across their homes) from recipes that have been sent to them and enjoyed by residents – or have been specially developed by Barchester Chefs to meet individual dietary needs. Oulton Park Care Centre DS0000059115.V347845.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. This judgement has been made using available evidence including a visit to this service. People using the service know that staff will listen to their concerns, and take appropriate action to safeguard residents welfare. EVIDENCE: The home’s complaint procedure is displayed in the reception area, and a copy contained within the Statement of Purpose and resident’s ‘Welcome to Oulton Park Care Centre’ handbook. Relatives surveyed confirmed that they knew how to make a complaint, which were responded to appropriately. Staff surveyed were asked if they knew what to do if resident or relative has concerns about the service, 2 out of the 9 had said ‘no’. During a previous inspection, a copy of the complaints policy was held in the unit’s offices, and was being discussed during staff’s induction. The AQAA confirmed that all staff received training in the protection of vulnerable adults, and that staff are made aware of the companies ‘whistle blowing’ policy. A social worker asked if the home responded appropriately, if you, or a person using the service have raised any concerns, replied that this was ‘always’ undertaken, and in all their ‘dealing with the service any issues raised have been responded to and addressed quite appropriately’. This also reflected a conversation with another social worker, who felt the new manager had built up good communications with the team, which was beneficial to their clients. The homes AQAA stated that this was one area that they had improved by Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 18 working to ‘avoid complaints’ by implementing a more transparent approach involving all team members residents and visitors’. Minutes of relatives meetings, confirmed that this had been discussed, and people encouraged to raise any issues, so they could be dealt with quickly, and not allowed to grow into a more formal complaint. Oulton Park Care Centre DS0000059115.V347845.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, 22, 23, 24, 25 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, homely, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The home has an on-going maintenance programme to ensure the fabric and decoration of the building is maintained at a good standard. It is furnished and decorated to a high standard. Bedrooms seen were personalised, and where required, furnished with specialist equipment to support resident’s physical disabilities. Time spent on Poplar unit speaking with a resident identified that they had been involved with a Barchester interior designer, to redesign their lounge/dining room. The new design will include a coffee bar, wooden flooring, bold colours (red was mentioned), computer with broadband, and large flat screen TV. Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 20 Other positive work undertaken since the last inspection are the changes on the dementia care unit. The last inspection raised concerns that the ‘corridors, although light and airy lacked points of interest, where residents can interact with tactile pictures/objects’. This has now been rectified, with every area of the corridors having “something to see and do”. This includes ‘tactile areas’ such as a board made up of doorknobs, handles and bells, “which a lot of people, like to touch and fiddle with the items”, which helps with mental stimulation. Fish tanks are at wheelchair height, there is a mixture of new and old pictures, tapestries, and small seating areas. 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 manager said that some families, of residents who have passed away, have asked if they could keep them. The layout of the 2 lounge/diners on the unit has also been transformed into 1 lounge and 1 dining room. The ‘satellite’ kitchens, previously used by staff have been removed in the lounge, “taking the square ness off”. The lounge has also been divided into 4 separate areas as the manager was aware not “everyone wants to do the same thing at the same time”. A small flat screen was in 1 of the areas, which residents were watching; in another there was a piano. The room looked much more ‘homely’. Observation (SOFI) undertaken during the lunchtime showed how well the dining room was working, although it appeared a little cramped, however nursing staff said this was “work still in progress”. They were aware that they were still “needing to make adjustments” , and “once we get there it will be brilliant”. After lunch 3 residents walked over to the settee, where they sat, and chatted with each other and joked with staff. Where concerns were raised at the last inspection that residents were drinking on Beech from ‘vending machine’ cups, this time residents were using specialist crockery, and drinking from wine /beer glasses. The 2 handled soup bowls were very good, as it enabled residents who had problems using a spoon, to hold the handles and use it like a cup. Dinner plates also had a ridge, which stopped food being pushed off. 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. A relative pointed out the ‘cricket charters’ set out on the grass which were “lovely to look at”. The manager said that the home had reached the “semi finals of the Barchester in Bloom competition”, which Charlie Dimmock was involved in. 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 Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 21 objects in the “sensory” garden. There are seating areas for residents and their visitors, 1 resident was walking around with their watering can. The home was generally found to be clean and bright, although a slight unpleasant odour was noticed in the corridor on Beech towards the end of the afternoon, which staff said they would deal with. This reflected the findings of 1 visitor to the home - who under the ‘How could the home improve’ question had written ‘keeping cleanliness levels to the maximum’, as occasionally, they had ‘detected an odour of urine in the home’. Feedback from a resident said that they found the home to be ‘always’ clean and fresh. As with every visit to the home, the atrium was being well used by residents and their visitors. This gives a light airy space, where people can enjoy refreshments and home made cakes. Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 22 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. This judgement has been made using available evidence including a visit to this service. Staff are trained, however residents cannot be assured that there are adequate staff on duty all the times. EVIDENCE: A relative wrote on their survey ‘carers vary from those who can always make time to attend to details, to those who never have time to do more than basic care’, they went on to say ‘the management and nursing staff aim at giving the highest standard of support, but in the end it is the care on duty who counts’. The resident completing the survey said that staff are ‘usually’ available when they needed them. Staff surveyed voiced their concerns that staffing was a ‘big issue’. They went on to say at the moment ‘we do not have enough staff and unfortunately we are having to refuse basic needs – such as a bath due to the time factor’. They said it was not helped by the manager’s ‘no agency’ policy. These comments were fed back to a Senior Nurse, who confirmed that they had been going through a difficult time due to staff sickness and holidays. They said they were allowed to use agency staff, however, they had also been let down by the agency’s, leaving them short staffed. They felt it was sometimes better to have less staff, who know the residents well, than use a agency person who did not know the home. The manager confirmed, and showed evidence that agency staff were being used, and to ensure consistency they tried to use the same staff. Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 23 The nurse said staff must not “use being short staffed as an excuse for bad practice”, that they would rather that “staff took longer and do it right”. Staff are told “anything not done – handover to the next shift”. This was also reflected in the minutes of a staff meeting (5/7/07), which said that they were having problems ‘on both units regarding shortage of staff, and how difficult it is to cover shifts’. This included kitchen staff, housekeepers and care staff. The AQAA showed that the home only had ‘1’ bank care staff’, which did not give a lot of flexibility. The manager said that they had taken on more staff, and once recruitment checks have been completed they will be starting. Minutes of Beech unit’s staff meeting, showed that they had been told to ‘look at their own work practice, and prioritise residents needs’ that is ‘feeding, washing and dressing’. Staff were informed that they must ‘give the best care they can whilst on shift, then pass over what isn’t done, onto the next shift at handover’. The staffing levels given for the morning is 7 carers and 2 trained staff – in each half of the home. The set number of staff on shifts does not give flexibility to vary according to residents dependency needs. However, discussions with senior nurses identified that the current staffing levels are sufficient (when there are no absences) but acknowledged they were very busy at meal times. This had been helped on Beech by re-organising the lunchtime routines, to ensure those residents eating in their bedrooms, were served, and given assistance first. This would then enable staff to concentrate on residents eating in the dining room, to ensure they get the required assistance. When undertaking SOFI during the lunchtime period, 1 of the resident’s being observed, who required full assistance, watched for over 1 ¼ hours whilst over residents were served their meal, and given drinks. Although some staff were aware the resident had not eaten, they still sat and gave assistance to residents arriving later in the dining room – rather then assist the resident who had been waiting some time. When they were given assistance, it was with a meal supplement - and not the meal (see Health and Personal care section of this report). The manager acknowledged the high level of needs at meal times and was addressing this by recruiting another carer to give support over the lunchtime period. The AQAA showed that at the time it was completed, they employed 49 care/nursing staff and 22 ancilliary staff. Unfortunately, only a small amount (9), took the opportunity of completing a CSCI survey. Information given in staff surveys also referred to staff feeling ‘run down, over tired and unfortunately this is affecting staff performance and morale which was at an all time low’. This they accredited to ‘having to work extra shifts, long shifts and changing their shift patterns’. 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, however they are Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 24 aware of staff who prefer to work longer shifts and extra hours. Previous requirements have been made to the home, that although it is not within the CSCI remit to tell providers how rotas are managed, however they must ensure that staff, as part of their safeguarding policies, are both physically and mentally fit to undertake the shift. A comment was also made that the home ‘should encourage staff to stop and drink’. The manager said that staff are able to do this, however they did find that staff were making themselves a drink, and not offering the residents a drink – which they have now been asked to do. Some catering staff felt that they ‘struggled to continue’ the ‘5–star dining experience’ when ‘catering assistants or chefs were off sick’. Discussions with the manager identified that when the kitchen domestic was off; they were not covered, resulting in more work for the catering staff. Staff who had replied (5 had left this blank) on their surveys if they felt their recruitment had been done fairly and thoroughly had replied ‘yes’. Barchester has set policies and procedures for their homes to follow when recruiting staff, which includes ensuring the required paperwork is obtained to validate their identify, and an enhance Criminal Bureau Record (CRB) check is undertaken. To ensure they are complying with this, a sample of 2 staff’s (1 recently recruited) personnel files were looked at. They contained completed application forms, Health Questionnaires, employment histories and paperwork to validate their identities, Prevention of Vulnerable Adults (POVA) first checks had been undertaken before they commenced employment. The new files, used by all the Barchester homes, also held 2 written references, job descriptions, and for the Nurse confirmation of their registration ‘Pin’ number. Information in the files were clearly set out, which enable information to be quickly accessed. For the person who had been employed longer, their file also contained a copy of their yearly appraisal, which looked at their ‘key objectives’ development needs’ an ‘overall assessment ‘ of their work and comments on their performance. The home has their own part-time training coordinator, and training room for staff. As they were covering a care shift, time was not spent looking at training records during this visit. Nurses’ training was discussed with the manager, and information given to access training from the local hospitals, and other training undertaken at the home. The Matron, Charge Nurses and a visiting Barchester clinical support nurse who arrived during the inspection provide clinical support for nurses. Time spent with the training co-coordinator during previous inspections demonstrated the comprehensive training given to staff, which includes Barchester’s ‘memory’ lane programme to give staff an insight into supporting residents with dementia. Due to a lot of staff changes, information supplied in the AQAA shows that currently only 8 of their staff hold a National Vocational Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 25 Qualification (NVQ) level 2, however they currently have 50 of their care staff working towards this qualification. Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 26 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, 32, 33, 35, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are committed to working in the best interests of the residents within a safe environment. EVIDENCE: As identified in the last inspection report, the home was in the process of recruiting a new manager. Mrs Sue Hill took up the post in November 2006, and was registered with the CSCI in April 2007. Mrs Hill was previously registered as a manager for a local Authority residential home. Her qualifications include (at the time of her fit persons interview) Diploma in Dementia Care, Advanced Dementia Care Mapping, and Diploma in Management of Care Services NVQ level 4. Prior to the appointment being made the CSCI was consulted over having a manager who was not a registered nurse. This was not deemed as a problem, as the organisational Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 27 structure of Registered manager (overseeing the day to day operations), Matron (head of clinical care), and charge nurses would give the required clinical support to nurses and monitoring of nursing activities. Discussions with nursing staff during the inspection raised no concerns that they were not being listened to over clinical issues, and that they felt supported. They were positive saying “on-going change” was “a good thing”, however it was acknowledged the difficultly some staff were having with the changes. Talking with staff, and information gained from CSCI surveys identified that the changes were benefiting the residents, but some staff were not so happy about the changes and felt it was affecting staff morale. 1 member of staff contacted the CSCI following the inspection, concerned that the home had been given prior information on the date of their inspection, however this was not the case. The appointment of a manager, with a focus on dementia care was seen by the CSCI as a positive move forward. This was due to previous concerns made by staff, relatives and observations during inspections, that the quality of the dementia care, did not match the rest of the home, which affected their overall rating. Mrs Hill is experienced in dementia care, and trained dementia ‘mapper’, a process which is used to monitor residents over a 6-hour period, to look at their quality of life, and how it can impact on their mood and well being. In a short period of time, benefits have been seen, evidenced in this report. Having worked her ‘apprenticeship’ as a carer, Team Leader and Manager, Mrs Hill feels it has given her a good insight on the “hands on” role, as well as the administration side. This was reflected in conversations, with nurses who said that the manager regularly attends handovers, and spends a lot of time on the units – observing practice and gaining feedback from the residents. They said it was normal for the manager to turn up at different times of the day, evenings and weekends . From discussions with staff, minutes of meetings and surveys, it was clear that some staff were having difficulty in Mrs Hill’s style of management, which they felt focused on identifying shortfalls, and not praising staff on the positive work undertaken. The home is introducing new systems of gaining feedback on the service to ensure that all residents, regardless of their physical or mental abilities are able to give feedback. This is includes dementia mapping, by an external person, which will be undertaken on Beech unit. Once completed a report will be written, and used by staff to acknowledge good practice and any areas for development to enhance the residents well-being. Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 28 Information in the AQAA confirmed that the home has a comprehensive range of Policies and Procedures for staff, which includes Health and Safety, and financial procedures, which are regularly reviewed. Staff records show that are trained to follow safe practice, and safety checks of the environment, including fire safety. Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 29 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 3 N/A 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 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 4 X 3 4 4 4 3 STAFFING Standard No Score 27 2 28 2 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 3 3 Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 30 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 OP33 Good Practice Recommendations To be able to assess staff morale and deal with any problems before it affects the home’s atmosphere, the home should look at how they can obtain constructive feedback from staff, to enable them to address any issues. Oulton Park Care Centre DS0000059115.V347845.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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.V347845.R01.S.doc Version 5.2 Page 32 - 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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