Inspection on 31/07/06 for Oulton Park Care Centre

This inspection was carried out on 31st July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Oulton Park Care Centre 16/07/08

Oulton Park Care Centre 30/07/07

Oulton Park Care Centre 12/01/06

Oulton Park Care Centre 06/09/05

Oulton Park Care Centre 02/03/05

Oulton Park Care Centre 21/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Oulton Park Care Centre Union Lane Oulton Lowestoft Suffolk NR32 3AX Lead Inspector Lead Inspector - Jill Clarke, Second Inspector – Kevin Unannounced Inspections 10:00 31st July & 11th August 2006 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.V306506.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.V306506.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 Post Vacant 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.V306506.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th January 2006 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 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 sixty bedrooms have ensuite bathrooms, electrically adjusted beds and remote controlled televisions with integral radio as standard. The home offers a variety of communal spaces which include an enclosed courtyard atrium, dining rooms, quiet rooms, lounge / dining areas and activities room. There are secure landscaped gardens and courtyards with seating and raised flowerbeds. Fees • • • • start from: Frail older people £680 per week Younger adults with physical disability £800 per week Older people with dementia £680 Younger adults with dementia £750 per week Fees are based on residents requiring 4 hours care a day, therefore fees could vary if assessed as requiring more care. The post of Registered Manager is currently vacant, however interviews have been held, and an appointment will be made shortly. In the meantime, the Matron, Ms Valerie Lawrence, is providing management cover. Oulton Park Care Centre DS0000059115.V306506.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, carried out over 2 days. The first day of the inspection (31/7/06) was undertaken by 2 inspectors, with the lead inspector completing the inspection on their own on the 11/8/06. The report has been written using accumulated evidence gathered prior to, and during the inspection. Commission for Social Care Inspection (CSCI) feedback cards were sent to the home in May. This gave an opportunity for relatives, visitors and staff to give feedback on how they thought the service was run. Comments from the completed residents (36), joint relative/visitor (25), and staff (1) feedback cards have been included in this report. The home is divided into 3 areas ‘Poplar’ (16 beds for younger people with a physical disability), ‘Hawthorn’ (12 beds for frail older people), and ‘Beech’ (32 beds for people with dementia). To give a comprehensive view of the home, time was spent in all 3 areas of the home observing the daily routines, and spending time talking to residents and their visitors. Staff (Matron, Sister, Charge Nurse, Nurse, Care Assistants, Housekeepers, Catering and Administration staff) were helpful and cooperated fully throughout the 2-day inspection. A tour of the building, took in all the communal rooms and a sample of 4 bedrooms, bathroom, laundry and activities room. Records viewed included, care plans, staff recruitment and training records, Fire Risk Assessment, Statement of Purpose, Menus and medication records. 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. What the service does well: People wishing to move into the home will be given a good level of information, including a video, which shows them what questions they should ask, and what they should look for in a care home. Oulton Park Care Centre offers residents a high standard of accommodation. This includes an atrium, where homemade cakes and drinks are available all day, enabling residents to receive visitors and offer refreshments, as they would in their own home. Staff support residents to personalise their bedrooms. All bedrooms have en-suite facilities, and have remote-controlled TV with integral radio and electric, fully adjustable beds with pressure-relieving Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 6 mattresses, as standard. A relative described the home as having “every comfort”. Residents are offered a varied, nutritious diet, which includes a full cooked breakfast each day (if requested) and 3-course lunch. Comments on the food included, “food usually very fresh and nicely cooked”, “There is always a choice of fish or meat at lunch time” and “very good. Visitors are made to feel welcome, can visit at any time, and for small fee (£3.00) join residents for lunch. Relative’s comments on the home included “from care, nursing, food, cleaners, laundry staff, they are all first class. I could not better them”, “I am very pleased with the care, staff are always available for information and are amazing”. The home has it’s own training facilities, and comprehensive training programme. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. The home does not offer intermediate care. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are given information needed to identify if the home will meet their needs. They have their needs assessed and are given a contract which clearly tells them about the service they will receive. EVIDENCE: Information given to prospective residents and their representatives include, Statement of Purpose, ‘Welcome to Barchester Healthcare’ pack which includes a short video (also available with sub-titles), sample menu, and coloured ‘Oulton Park’ booklet showing photographs of the home and gardens. Residents are also given a ‘Welcome to Oulton Park Care Centre’, which gives further useful information on the day-to-day running of the home. Staff confirmed that information could also be provided in other formats, such as using symbols and pictures. A copy of the most recent CSCI inspection report was available in the reception area. Feedback from the CSCI resident survey, confirmed that residents felt that they had been given enough information on the home to help them decide if it was the right place for them. Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 9 Each resident is supplied with a copy of Barchester Healthcare ‘Resident’s Terms and Condition’, 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, and is not covered by the fees. The office held signed copies of the contracts. All residents have their needs assessed prior to admission, by the Manager or the Matron. Four care records looked at showed completed assessments covering the resident’s nursing, physical, mental and social care needs, undertaken prior to their admission. Discussions with 2 residents and a relative during the inspection, confirmed that they and/or their relatives had visited the home prior to their admission. Time spent talking to residents showed that they liked the staff and felt well cared for. Surveys asked relatives if they were satisfied with the overall care. Twenty-two out of 24 had stated ‘Yes’. Two relatives felt it varied, depending if there was enough staff on duty and some residents said they would like to see more activities undertaken, (see Daily Life and Socail Activities and staff section of this report). Residents asked if they received the care and support they needed?, 28 had replied ‘always’ and 8 ‘usually’. One resident had written that ‘care and support is very good’. Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are given clear guidance on residents physical and nursing needs. However, residents can not be assured that their behaviour and social care needs are being fully recorded. The home has safe systems in place for the storage and administration of medications, although staff are not always following these procedures, when recording that medication has been given, which could potentially put residents at risk. Nursing staff have the skills and knowledge to support residents requiring palliative care. EVIDENCE: To ensure a balanced view of the home, resident’s care was tracked on each of the units, which covered all 3 areas of the service. This included looking at 5 residents care plans, discussing their care needs with staff, and where able, spending time with the resident’s to hear their views on the level of service, or using observation. Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 11 Generally care plans held a good level of information on resident’s physical, medical and nursing care needs, which were being monitored, and regularly reviewed. This included resident’s nutrition, pressure areas and wound care. There was evidence of staff liaising with external specialist health professionals, to support individual resident’s care and symptom control (palliative care).. The care plans for 2 resident’s living on the dementia unit, did not give any life histories, or detailed social/daily activities plan linked in with their behaviour needs. This was fed back to staff who showed copies of Barchester Healthcare’s new ‘care profile’ (care plans) which the home is currently in the process of introducing, and which they feel will address the issues raised. On Poplar unit, time was spent looking at a resident’s care plan, which was in the new format. Held in a ring binder it was found to be more comprehensive, and user friendly. The file contained a ‘Life Story’ page, which was still to be completed. Another positive aspect with the move away from nursing style ‘kardex’, staff had more space to write in. Due to the resident being only at the home a few weeks, the staff were still building up the information, therefore some areas were blank. However, the difference in the way the information was written in the old and new style care plans was evident, with the new care plans giving more information on how the resident wanted to be cared for, with their wishes being recorded. On Beech, some staff were observed to act in a caring way towards the provision of residents personal care, they were polite and helpful towards residents. However, some staff were found slow to respond to the needs of some more vulnerable residents, including talking, providing activities or diversional therapy and activities. The information within one care plan checked did not reflect the individuality and dignity of the resident, for example, ‘behaviour remains entirely as one would expect from a dementia patient’. On Poplar and Hawthorn, residents and relatives confirmed that care needs were being met, although sometimes they had to wait, and there was a high use of agency staff (see staffing section of this report). Medication for the home is kept in 2 areas. One area covers people living on Poplar and Hawthorn, the second area covers Beech. The medication and records of 3 residents living on Beech were checked and nursing staff were observed administering the lunchtime medication. Medication Administration Records (MAR) were found dated, signed and appropriately maintained. However, a sample audit of one resident’s medication supply checked against the MAR sheet, revealed that 2 of their medications were in excess of the balance shown, by one tablet. This was discussed with the nurse in charge and an immediate requirement made for the home to investigate to determine how this may have occurred. The home wrote to the CSCI (2/8/06) with an Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 12 explanation of what had happen, and reassurances that the resident had been given their full dose of medication. Review of the medication procedures for Poplar/Hawthorn, showed as with Beech, that medication is delivered every 28-days in ‘blister’ packs from the pharmacist. Medications that cannot be held in the blister packs are sent in separate boxes/bottles. When staff gives out medication, their policies and procedures state that they must sign or enter the appropriate code on the MAR sheet to confirm the medication has been given. MAR sheets for Hawthorn were looked at which showed out of 11 resident’s records, 4 had missing signatures. An audit check of the blister packs, showed that the medication had been removed from the blister, therefore assumed given, but not signed for. On the second unannounced visit the MAR records were checked again, which identified gaps, including staff not confirming on 1 day that the Warfarin tablet had been given. Due to the variable dose given, linked with the outcome of blood tests, it would be time consuming to undertake an audit of the medication during the inspection. Therefore the home was asked to look into the situation to ensure that the resident had been given the medication. One resident had commented (CSCI survey) that that the home is sometimes ‘very slow in procuring prescriptions’. Discussions with nursing staff, identified at times that they had needed to collect items, such as suction catheters themselves, due to running low on supplies. They felt that they had built up good links with community Health professionals, and the Pharmacist works with residents General Practitioner’s to review their medication. The home has systems in place for recording all medication coming in and out of the home. Systems are also in place for the safe destruction of any medication no longer required. Good practice was seen with residents photographs attached to the MAR charts, as part of the safe systems in place for ensuring the right resident receives their prescribed medication. During the inspection, staff were observed to be polite to residents, and knock on bedroom and toilet doors before entering. Discussions with residents on Poplar and Hawthorn confirmed that they had no concerns over staff not ensuring their privacy and dignity was maintained. Staff were seen to ensure a resident’s dignity was maintained on Beech whilst, dealing with a sensitive situation in a public area, caused through the resident’s incontinence. Staff have built up good links with the local and hospital palliative teams, which includes 2 of their Nurses attending their training sessions, in managing end of life care, linked to the national palliative care ‘Gold Standards Framework’. This will ensure residents, at the end of their life are offered appropriate care and pain control, to meet their individual needs and wishes. Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 13 Oulton Park Care Centre DS0000059115.V306506.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that there are sufficient activities to meet their individual needs. People can expect to be served homemade, nutritious and varied meals. EVIDENCE: The home benefits from having an activities room, and dedicated part-time activity therapists. Craftwork undertaken by the residents was displayed in the room, and on the notice boards in the corridor. Photograph albums, evidence residents enjoying activities, which included courtyard gardens ‘make over’. This included growing flowers, planting, painting flowerpots and making tactile sculptures for the courtyard. These enhanced the garden giving colour and items of interest for residents to look and touch. The home had done well in the ‘Lowestoft in Bloom’ flower competition, winning 3 Gold and 1 Silver award for their gardens. Residents when asked if the home arranged activities that they could take part in? 14 answered ‘always’, 17 ‘usually’, 3 ‘sometimes’ and 1 ‘never’. Comments made included ‘Not enough activities to include more clients, Bingo – skittles – 10 pin bowling almost non-existent – activities are not scaled to clients needs’. One resident felt that the ‘activities on the list’ were ‘rarely carried out’. They Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 15 also went on to say they wanted something to ‘break the tedium at weekends as there are no activities’. The ‘summer activities programme’ was displayed on the notice board, and given in the resident’s information pack, showed that there were no activities at weekends. Previous discussions with staff identified that they were looking to do this, however, the full compliment of staff were not currently available. The activity programme shows that there were planned activities on 2 mornings and 3 afternoons a week (which included an afternoon outing). On other days it stated ‘see carers programme’. It was not clear during the inspection, whether any activities were going on in line with the carers programme. Information in resident’s care plans on social activities was very limited, with gaps indicating that no activities had been undertaken. Activity therapist’s, keep a log of which residents have attended their organised activities. However, activities as part of the carers programme were not reflected in these records, or the care plans seen. It was clear form discussions with residents and staff, and photographs viewed that external and internal activities were arranged, but there was no set work with residents seen in the care plans viewed, of giving a structure to their day, and being able to take part in meaningful activities. Observation on Beech, showed at times staff interaction was limited, and staff appeared to be task orientated. On Poplar, a resident was seen to be receiving one-to-one care, as part of their care management. Time spent with 3 other residents showed that they preferred to spend time in their bedrooms, watching their television, Videos, or looking at books/magazines. Residents from Hawthorn, were using the atrium, 1 reading their newspaper, another talking to their visitors. General discussions showed that they liked the activities when they were on, but would like to see more. Time spent sitting on Beech (mid morning) during the second day of the inspection, was found to have a relaxed atmosphere, with residents getting up in their own time. Discussions with 3 residents from Hawthorn and Poplar, confirmed that they choose to get up and go to bed when they wanted to, and did not feel restricted at all. One resident said they “liked to get ready for bed – then settle down and watch TV”. Information on religious services was displayed around the home. The daily menu was displayed in the entrance hall. Breakfast menu for the 31st July 2006, included a choice of cereal, porridge, toast and preserves, yoghurt, fresh fruit with a selection of fruit juices, tea or fresh coffee. A full cooked breakfast is also available on request. The 3-course lunch included a choice of Braised Beef in a Red Wine Sauce or Roasted Salmon with a Parsley & Prawn Sauce – all served with Seasonal Vegetable and New Potatoes. There is also a ‘Chef’s Vegetarian Special’ available. Residents are able to choose their homemade dessert from the sweet trolley. Tea and homemade cakes are Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 16 served during the afternoon (as well as being available 24-hours a day in the atrium). Generally the comments from residents and relatives on the standard of food was positive with ‘there is always a choice of fish or meat at lunch time’, ‘the waitress is very kind and tries to find things I like to eat’. A relative also stated that their next of kin’s ‘tastes has changed since becoming ill, but the Chef here always cooks whatever (resident’s name) fancies - which they appreciate’. Resident’s were asked (surveys) whether they liked the meals at the home, 18 replied ‘always’ and 17 ‘usually’. One resident, felt the teas in the evening were ‘very boring’. On the first day of the inspection the evening meal menu consisted of ‘Soup of the Day’ or fruit juice, Tagliatele with Ham & Cream Sauce, assorted sandwiches followed by a choice from the sweet trolley, which included fresh fruit. Menus seen for the 31 July to the 6 August 2006 showed resident’s choices included assorted sandwiches each day, and a cooked snack. For example, Bubble & Squeak, Homemade Pizzas, Savoury Potato Cake, and Scrambled Egg and Beans. The main dining room for Hawthorn and Poplar is furnished to a high standard and gave residents and their visitors space to enjoy a positive dining experience. Tables were laid up with coordinating tablecloths, napkins, crockery and glassware. The day’s menu was displayed on a stand. Time spent with a resident showed that they had enjoyed their meal, and they liked the catering staff. On Beech (dementia care), parts of the lunchtime routines in the 2lounge/dining rooms were observed on both days of the visits. It was noted that where residents tables were set up with glasses in the main dining room, on Beech, residents were observed to be given cold drinks in thin plastic cups, normally associated with vending machines. The inspector raised concerns over their suitability for older people, and was informed that it due to was Health and Safety. Staff advised that some individual residents where know to have ‘bitten through’ the plastic beakers. Barchester Healthcare as an organisation are currently commissioning specialist crockery to use in their dementia care units. No date could be given as to when this would be implemented. There were no menus, using a suitable format seen in the dining room. The inspector was shown a ‘dining implementing interventions activity sheet’, which gave information on a planned activity to be undertaken with residents which was designed to encourage participation in choosing their own food, laying the table and ‘creating a social atmosphere using table decorations, music and a careful selection of dining companions’. This had not yet been implemented. Residents were observed receiving assistance with their meals from care staff during the lunchtime period. Staff were found to be attentive and patient with more vulnerable residents and took time to ensure they were appropriately nourished. One worker was observed to entirely mix the meal Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 17 (by mashing it with a fork), which did not look appetising for the resident. A relative dined with their next of kin at the table. The atmosphere was not relaxed, as a resident could be heard shouting out from their bedroom, and the eating habits of another resident made them a point of criticism from other people eating in the dining room. One resident (Poplar) felt that ‘it was a very long time from tea (which is over in 15 minutes) till breakfast’. The residents ‘Welcome’ booklet showed that the evening meal (High Tea) is served from 5 pm, breakfast from 8 pm. There is no mention of snacks being available after this time. The daily menu confirmed that milky drinks are served during the evening. Previous discussions with staff confirmed that residents are able to access snacks 24 hours a day on request, and sandwiches and biscuits were always offered with the milky drink around 8 pm. Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents using the service can expect staff to listen to their concerns and take appropriate action. EVIDENCE: The home’s complaint procedure is displayed in the reception area, and a copy contained within the Statement of Purpose and Residents ‘Welcome To Oulton Park Care Centre’ handbook. The home informs the reader that if dissatisfied, they can also complain at any time to the Commission for Social Care Inspection. The home needs to update their policy to reflect, that the Care Commission is not a complaints agency. However, concerns can be raised with the Commission, which can then be re-directed to the home to investigate, or advise given on the appropriate agency that should be contacted, in respect of their complaint/concern. The home keeps a record of their complaints and action taken. Prior to the inspection the CSCI was informed that relatives had made a complaint to the home, regarding actions taken following a fall. However discussions with staff identified that no formal complaint had been directed to them, only a telephone call to discuss another matter. Residents were asked (CSCI surveys) ‘if staff listen and act on what you say’. Thirty-five had answered ‘Yes’. Feedback also confirmed that the majority of residents knew how to make a complaint if they felt unhappy about their care. One relative stated that ‘there are certain staff members who they found it Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 19 more easier to communicate with than others, but on the whole everyone takes an interest if you have a problem’. Time spent talking with residents and relatives, confirmed that they felt happy to raise any issues with staff direct, and gave examples of minor concerns, which staff had dealt with. All staff receive training in the home’s complaint procedures as part of their induction. One complaint was made direct to the CSCI in March 2006, from a relative concerned over the individual care given to a resident, whilst living at the home. An external, senior member of Barchester Healthcare staff investigated the complaint, and comprehensive report of their findings, was sent to the complainant and CSCI. The home has their own abuse policy, and staff receive yearly refresher training, to support them in identify any abuse, and what actions to take. Records showed staff who had undertaken the training and when their next training sessions was due. Staff were aware of the local protocols for reporting abuse, and had a copy of the Vulnerable Adult Protection Committee’s operational and staff guidance file for reference. Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23 ,24, 25, and 26. The quality in this outcome area is good. 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, homely and comfortable environment, which encourages independence. Residents safety in the garden cannot be fully assured. EVIDENCE: The home has an on-going maintenance programme to ensure the fabric and decoration of the building is maintained at a good standard. The CSCI was made aware by the home, that a resident with dementia had fallen and sustained an injury in May 2006, when they had ? tripped/fell/slipped on the grass banks in the dementia garden. The home had acted appropriately by assessing the risk and informing the Commission that they would be erecting a fence to stop a recurrence of the situation. However, on the first day of the inspection, it was noted that no work had been undertaken. Although quotations for the work had been received, no date had been given for the work to start. The inspector raised concerns both verbally and in writing. On the second day of the unannounced inspection, the fence, in keeping with the Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 21 environment was just being completed. Some areas of the paving in this area looked slightly uneven, discussions with staff also confirmed that this had been looked into by the organisation, but they had received no feedback as to any action being undertaken. All bedrooms are single occupancy and have en-suite facilities, remotecontrolled TV with integral radio and electric, telephone points and fully adjustable beds with pressure-relieving mattresses, as standard. Time spent talking to residents in their bedrooms, showed that they had been personalised to reflect their individual character. Furnishing throughout was of a good quality and domestic in nature. The atrium gave a light airy space for residents to be able to receive their visitors. An automatic ventilation system ensured that the area did not become too hot, and when it started to rain, the sensors ensured that the windows closed. Residents spoken with, felt the temperature was comfortable, and no concerns raised over the lighting or heating of the home. Residents on Beech have a continuous walkway around the unit, and can access the courtyards, which have raised flowerbeds and seating areas, which residents were making full use of. The corridors, although light and airy, lacked points of interest, where residents can interact with tactile pictures/objects. On both days of the unannounced inspection the home was found to be clean, and when an unpleasant odours were detected, staff took action to eliminate it. Residents surveys and conversations held during the visits, confirmed that they always/usually found the home fresh and clean. A resident also said that the “place is kept clean – staff good like that”. One relative did ask if the beakers used for cleaning teeth ‘could be washed out on a regular basis – as at the present time they are not’. A visit to the laundry confirmed that the home has infection control procedures in place for the safe handling of soiled clothing and bedding. Residents said that they had no problems with the laundry service which they described as “good”. Oulton Park Care Centre DS0000059115.V306506.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents cannot be assured that the staffing levels will meet their individual care needs. The home is committed to ensuring staff have their own training programmes, to ensure they have the skills and knowledge to undertake their work. EVIDENCE: The commission had raised concerns previously that the staffing levels on Beech (dementia care) were not sufficient to ensure residents individual personal, physical, mental and social care needs are being met. From the 24 relatives/visitors surveyed, 16 felt there was enough staff. This left 33 feeling that there was not enough staff on duty. Resident’s surveys asked if they felt staff were available when they needed them. Eighteen replied ‘always’, 13 ‘usually’ and 3 had stated ‘sometimes’. One resident wrote ‘obviously sometimes staff are not available when we need them – because we are not the only residents requiring attention. Early evening seems to be the worse time in my experience’. Another felt that ‘Younger people need more support to keep normal’. Discussions with residents and relatives during the inspection, reflected the comments made. Prior to the inspection concerns were raised with the CSCI, via a Social Health Care professional, that they felt the staffing levels on the dementia unit were inadequate to ensure residents are properly supervised. A good majority of residents living on Hawthorn and Poplar, had been able to complete the CSCI surveys, or verbally give feedback on staffing during the inspection, therefore Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 23 the inspectors focused their attention on the dementia care unit, where residents were unable to give feedback in this way. To enable a balanced view, each inspector separately spent time observing the units daily routines and how staff interacted/worked with residents, at different times of the day. One looked at the hour leading up to lunchtime, whilst the other observed practice during the morning on the second day of the inspection. Observations identified good practices, and areas of the service that need to be developed to ensure residents physical and mental health needs are being fully met. The first inspector’s feedback included ‘quality of life and signs of well being for residents with special needs was lacking and in need of urgent attention. Residents were observed in Beech unit during the hour before lunch, and were observed to lack sufficient stimulation and lifestyle opportunities from staff. For example a support worker spoke positively with 2 residents, but 7 further very vulnerable residents within the lounge, were not interacted with for considerable periods of time. This included a period of time when several support workers arrived at the lounge and who generally spoke amongst themselves or to some of the more alert residents. One of the inspectors identified good interaction at times between staff and residents, however, due to their busy work loads, residents were also seen to be left wandering the corridors or sitting in their bedrooms and lounges for long periods without interaction (see daily life and social activities). Comments on surveys and discussions with relatives identified a high use of Agency staff. This was fed back to the management who confirmed that this was due to covering maternity leave, and overseas staff who had been working as carers, but were now away on their adaptation training, to enable them to practice as nurses in this country. A staffing action plan showed in the long term, how the staff were looking to cover the 306 vacant care hours a week,. This included dates when staff would be returning from training and maternity leave, and the start dates of new staff recruited to fill the permanent and temporary vacancies. Rotas seen for week commencing 22 may 2006, showed that staffing levels were being maintained at 2 nurses and 7 care staff in the mornings and 1 nurse and 6 care staff in the afternoon. Although the home stated that they were working to the National Forum Guidance for staffing levels, this is only used as a guidance. The staff rotas looked at did not show flexibility, with staff working set early or late shifts. There was no extra cover provided for staff working double shifts (long days) to cover their breaks, or during known busy times. From information supplied by the home, it was identified that with 13 of the 41 care staff having achieved a National Vocational Qualification 2 or equivalent, with 2 further staff currently undertaking their training, they currently did not have 50 of their staff qualified to NVQ2 (or equivalent). The training Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 24 coordinator is currently undertaking their NVQ Assessors training, which will support more staff to obtain the qualification. Previous reports have commended the home on having a full-time dedicated trainer and training facilities. Although the post has been reduced to 8 hours a week, time spent discussing and looking at training records, showed a positive training ethos. This started from the induction stage, through to reviewing annual training and ensuring Nurses professional knowledge is maintained and updated. New staff go straight on to the Barchester Healthcare induction programme, which includes working shadow shifts, completing an induction training record book, and undertaking manual handling training. Staff are supported throughout the induction, and given written feedback on their performance. A new member of staff was receiving their induction training, working alongside the training coordinator. Since the last inspection the home has introduced, a computerised training programme, which also enables staff to undergo refresher training at their own speed at a time suitable to them. The training comprises of work sheets split into 4 sections, which includes Fire, Health & Safety roles and responsibilities. Each of the sections had questions that staff must answer, and get 100 right before being able to move onto the next section. Once completed, the computer generates a certificate. Where staff on nights require training, and are unable to attend during the day, arrangements are made for the trainer to go onto nights, to offer training, or cover in a ‘hands on’ role whilst staff complete the computer work sheets. Nurses training records showed that their professional knowledge and skills were being maintained through internal and external training. This included copies of certificates showing the range of courses undertaken, which include, ‘PEG feeds’, ‘Airway management’, and ‘Wound care’. Records also showed catering and domestic staff received induction training, and relevant Health and Safety training for their post. Good practice was seen with Barchester Healthcare ‘Visiting Mum’ training, which is undertaken on the computer using a case study of someone using the ‘respite’ (short break) service. The case study asked staff to at how the resident felt about choosing a home, first impressions, care received, thoughts on their stay and during their discharge. This was seen as positive, as contact had been made by a Social Care Professional, that they felt the welcome their client had received was good, but felt the discharge was less positive, with staff not taking time to say goodbye, or pass important information on about the resident’s stay. To ensure staff are following safe recruitment procedures, 3 recently recruited staff records were looked at. This showed that references and checks to validate their identify were being obtained prior to them starting work at the home. However, 2 application forms did not give a complete employment Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 25 history, and dates given on 1 application form did not correspond with the employment dates given in 1 of their references. There was no record of action being taken to validate the reason why the new employee had left their previous employment. When pointed out to the Matron, they took action straight away to contact the people concerned to obtain the required information. Oulton Park Care Centre DS0000059115.V306506.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 37 and 38. The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are committed to providing a safe environment and have robust policies and procedures to ensure the safety of residents. Residents cannot be assured that staff are always following safe manual handling procedures, which could potentially place residents at risk. EVIDENCE: Mr Atkinson informed the CSCI that they were resigning their post as Registered Manager as from the 31 May 2006, a new registration certificate was issued to reflect this. Since this time, the Matron has been covering, both theirs and the manager’s post, with the support of visiting senior management. The first day of the inspection coincided with interviews for the manager’s position. The CSCI will await formal notification that the post has been filled, and receipt of the person’s application to be registered. Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 27 Barchester Healthcare, as an organisation has set, care auditing programmes for their homes to follow, to be able to monitor different areas of their service delivery. The audit programme for 2006, showed 11, (none undertaken in December) monthly internal audits for staff to undertake. By completing the audit sheets, they are able to assess which areas they are performing well in, and which areas required further development. For example areas reviewed during April, were medication administration and in July Activities. The outcome of July’s audit showed that external activities could be developed further, which linked with comments from residents and relatives during the inspection. The home also receives monthly unannounced (regulation 26 ) visits by a senior member of staff, whose reports show that they sample and review practices at the home, and gain feedback from residents and staff. The current quality assurance systems enable residents who are mentally able to give feedback and air their views, however does not allow for residents who due to their dementia are unable to give feedback using these formats (surveys, verbal feedback). Regulation 26 reports do not show that time has been spent observing practice and interaction on the dementia unit, to be able to gain feedback. The current quality assurance systems did not evidence feedback from stakeholders, such as social workers, and health professionals. The home does not hold monies in safekeeping for residents, feedback from the administrator confirmed that either the resident or their representative hold any monies. Facilities are available for the safekeeping of small valuable items, such as jewellery, until a family member or representative can collect them. Records looked at showed that an item currently held for safekeeping had been checked in and recorded, using safe systems to protect the property. As discussed in the ‘Health & Personal Care’ section of this report, although generally medication records were found to be in good order, shortfalls were identified in staff signing to confirm medication had been given. Care plans were seen to be held securely in lockable filing cabinets, within lockable offices. It is the home’s responsibility to ensure as is reasonably practicable, the health and welfare of residents and staff. The home has set policies and procedures in place to ensure equipment is regularly serviced and required safety checks are undertaken. To ensure compliance a sample check of records were looked at which showed that regular checks and servicing are undertaken on the Gas installation, hoists, Fire systems and hot water supplies. Records are kept of any incidents relating to residents, and information on action taken. This included in one instance, staff applying for further funding to enable 1 to 1 cover to be provided, where it had been identified that the resident was most likely to fall/put themselves on the ground. Good practice was seen with the incidents reports seen, having an area, which allowed any previous incidents to be recorded, supporting staff to track multiple incidents Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 28 over a period of time. However staff stated that a new form had just been introduced, which did not have this section on it. Training records showed that staff received yearly mandatory training in Health & Safety, which included Fire, Food Hygiene, and Infection Control procedures. Seventeen staff had been trained in First Aid. Whilst observing on Beech, a member of staff was seen to move a resident using an underarm lift, which is no longer used. This was fed back to the management to investigate, and take any appropriate action to ensure the correct moves were used. Training records confirmed that care staff had received manual handling training, which was updated yearly. The training coordinator showed records of staff being observed performing different techniques and using transfer aids, which gave feedback on their performance. This was seen as good practice. Oulton Park Care Centre DS0000059115.V306506.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 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 X 2 3 4 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score N/A X 2 X 3 X 2 2 Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 OP10 Regulation 15 Requirement On the dementia unit, care plans must ensure that they contain detailed information, which outlines positive strategies used for managing and improving individual resident’s mental health and well-being. Staff must ensure medication is given as prescribed, by their General Practitioner. Staff must complete medication records accurately. Timescale for action 08/10/06 2 OP9 13 (2) 31/07/06 3 4 OP9 OP37 OP12 13 (2) 16 (2) (m) 12/08/06 30/10/06 The home must consult with service users to ensure that they are able to take part in a range of daily meaningful activities, (including weekends) which is fully recorded in their care plan. Where residents are unable to communicate or express their wishes, choices must be undertaken taking into account life histories and discussions with their representatives. Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 31 5 OP14 16 (n) Information must be made 08/10/06 available in alternative formats, which take account of the specialist communication needs of people experiencing dementia. Repeat requirement from the 30/4/06 The home must ensure that residents on Beech are provided with suitable drinking vessels, which meets their individual needs, whilst promoting independence. The home must review their staffing levels on Beech, to ensure that they can flexibly meet the social, physical and mental health needs of residents over a 24-hour period. The home must have suitable quality assurances procedures in place to enable them to gain feedback from residents with dementia. The home must ensure they have fully complied with schedule 2, prior to staff commencing work at the home. To ensure the safety of residents, the home must ensure that all staff undertake approved manual handling techniques. The home must take action to make the outside area safe, in line with the home’s risk assessment. 25/09/06 6 OP10 OP22 16 (2) (g) 7 OP27 18 (1) (a) 09/10/06 8 OP33 24 01/11/06 9 OP29 19 (1) Schedule 2 13 (5) 12/08/06 10 OP38 12/08/06 11 OP38 OP19 13 (4) 15/09/06 Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 32 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 OP7 OP12 Good Practice Recommendations The home should look to implementing their interventions activity sheets, and recording any findings/outcomes in the residents care plan. To ensure all residents are aware that food can be accessed 24 hours a day, this should be included in the residents information books and menus. Where residents require a soft/pureed diet, this should be presented in an attractive and appealing form, and not ‘mashed’ at the table. The home should review the current dining arrangements on Beech, to ensure that residents are able to enjoy their meals in a relaxed, dignified atmosphere. It is recommended that the home reviews their corridors on Beech, to offer more points of interest, to support residents with sensory and cognitive impairments. Training plans should include information on how they aim to ensure the home meets their target of having at least 50 of their staff trained to NVQ 2 or equivalent. It is recommended that the home use trained people in dementia mapping to support them in gaining feedback on Beech unit. The home should also look at how they can gain feedback from stakeholders. 2 OP15 3 OP15 4 OP15 5 OP22 6 OP28 7 OP33 Oulton Park Care Centre DS0000059115.V306506.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V306506.R01.S.doc Version 5.2 Page 34 - 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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