CARE HOMES FOR OLDER PEOPLE
Oulton Park Care Centre Union Lane Oulton Lowestoft Suffolk NR32 3AX Lead Inspector
Jill Clarke Announced Inspection 6 September 2005 10:00 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.V252864.R01.S.doc Version 5.0 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.V252864.R01.S.doc Version 5.0 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 Mr Simon Atkinson Care Home 60 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (12), of places Physical disability (16) Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd March 2005 Brief Description of the Service: Oulton Park Care Centre is located in the village of Oulton, near Lowestoft. The new purpose built home, owned by Barchester Healthcare Homes Limited, opened in February 2004 and is registered as a care home with Nursing for up to 60 people. The home is divided into 3 main wings, 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). The home is in the process of submitting a variation application to reflect the age group within the dementia unit, which covers both younger adults and older people. All facilities for people living at the home are located within the single-storey building, which has wheelchair access throughout. All of the 60 single bedrooms have en-suite facilities, electrically adjustable beds and remote controlled television with integral radio as standard. The home offers a variety of communal spaces, which include an enclosed courtyard atrium, dining rooms, quiet rooms, lounge/diners and activities room. There are secure landscaped gardens, and courtyards with seating areas and raised flowerbeds. Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a routine announced inspection carried out over 9 ½ hours on a Tuesday in September. Before the inspection, CSCI comment cards were sent out to the home, for residents, relatives/visitors and staff. This gave the chance for people (who did not have to give their name) to give their views on the level of service provided and make any comments. At the time of writing this report 4 resident, 8 relative/visitors, and 7 staff comment cards had been returned. Information gained from comment cards has been included into this report. During the inspection the Lead inspector, was joined by the CSCI Pharmacist Inspector. Their focus was to review the homes medication system, and investigate a complaint concerning medication. Whilst the lead inspector, spent the majority of their time focusing on Beech unit (dementia care), with a shorter time spent on Poplar unit (Physical disabilities). Time was spent in private with 8 residents, to hear their views (where able), on what it was like living at Oulton Park Care Centre. General feedback was also given during conversations with residents throughout the inspection. Time was also spent with 7 relatives and 11 members of staff, which included the Registered Manager, Matron, Nursing Staff, Training Officer, Activity Therapist, Domestic staff and care workers. Records viewed included, care plans, staff records, rotas, medication records, menus and social/activity sheets. A tour was made of the communal accommodation and sample of 9 bedrooms, to check the condition of the décor, furniture and cleanliness. Discussions during the day with people living at the home, and staff, identified that they preferred to be known as residents, rather than service users. This report respects their wishes. What the service does well:
Residents spoken to, said they were comfortable, and raised no concerns over the standard of care they received. Comments written on 2 relatives CSCI comment cards praised the level of care provided, saying ‘this excellent home should be the industry standard – I cannot fault it in any way’, and ‘Oulton Park is the best I have ever seen’. Positive comments from relatives during the inspection included “marvellous staff”, and “can’t fault the place”.
Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 6 Management are committed to working with relatives, to address any concerns or issues. The purpose built home allows space for residents to walk around, and is suitable for wheelchair users throughout. The Atrium, with self-service hot drinks and homemade cakes, allows residents to receive their visitors as they would in their own home. The home is committed to ensuring staff have the knowledge and training to be able to do their job. This was further reflected in a comment made a relative ‘The staff are caring and well trained’. What has improved since the last inspection? What they could do better:
The home needs to continue reviewing their staffing rotas, to ensure that there are enough staff on duty at busy times, such as meal times. Staff needs to ensure that furniture and equipment used by residents is kept clean, and continue taking action to get rid of any unpleasant odours. Concerns were raised by 2 relatives during the inspection, over the level of care provided on the dementia unit. The manager, aware of their concerns, will continue to work with the relatives to try and address any issues. The home was asked to ensure that medication and care records were fully completed by staff, and residents (or their representative) are more involved in checking the information held in care plans is correct. Some staff raised concerns that the home needed extra manual handling aids (hoists, Stand-Aids), to support residents when being transferred. The home was asked to check to see if they had enough equipment, so residents were not left waiting. Concerns should be addressed as the management said they would be purchasing a new hoist.
Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 7 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.V252864.R01.S.doc Version 5.0 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.V252864.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. People wishing to move into the home, can expect their needs to be fully assessed. This ensures that the home only admits residents within their registration category, whose care needs they can meet. Where it is identified (during the assessment period) that the home cannot provide the level of service to meet the expectation of the resident or their advocate, the home will work with the persons concerned, to address the issues. EVIDENCE: Time was spent with a new resident (Poplar unit) and their family, to discuss their experience during the admission process. They said they came to look around the home, and received a visit from the Matron, who undertook a preadmission assessment. The relatives said they were given written information on the home, and arrangements were made for their next-of-kin’s admission to the home. Both the resident and relatives were aware that a review would be held after 6 weeks, to discuss how everything was going. The resident agreed it was a “big change” for them, but they found the home was “alright”.
Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 10 Contact was made with the relative who answered ‘No’. They felt improvements (supporting the resident with their personal hygiene, and monitoring their whereabouts) on Beech unit, had been made leading up to this inspection, but felt it was too early to see if this would be maintained. Care records looked at, and discussions with staff, identified the work being undertaken with the relative to address any care issues. Discussions with a relative, who felt the home could not meet their next-ofkin’s needs, identified work being undertaken with the management through meetings, to try and address the relative’s concerns. Booklets and videos where available from reception, which gave information on the home and the organisation. The Home’s ‘Service users Guide and Statement of Purpose’, gave a good level of information. Which included ‘General Terms and Conditions Applicable to Residents’. Care plans looked at, held completed pre-assessment forms, undertaken by the Manager or Matron, prior to the resident being admitted. Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9. People using the service can expect staff to develop a care plan, which covers their physical, medical, nursing (if applicable) and mental health needs. However, the home needs to regularly consult with residents, or their advocate to ensure information is up to date, and meets their current needs/wishes. EVIDENCE: The home has a set care-planning format, used by Barchester Healthcare Homes. The different sections of the care plan, when completed supports staff in monitoring resident’s physical, medical, nursing and mental health. The monthly monitoring sheets showed any changes in the resident’s mental and physical health. Nursing staff are responsible for identifying any areas of the resident’s physical or mental health, which requires monitoring, or nursing intervention, such as preventing pressures ulcers. Care plans looked at, gave information on any identified problems, if any medical treatment/monitoring was required, and gave staff guidance on how to support the resident. Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 12 Time was spent on Beech (dementia) Unit looking at a resident’s care plan, with their next-of-kin. This was to see if the information written in the care plan, reflected the level of care, which the relative felt the resident (who acts as the resident’s advocate) would need and want. The relative felt that the resident’s hair was in a “bad way”, saying they would normally have their hair washed when they were bathed. In 1 section of the care plan staff were informed that the resident ‘refuses bath – does accept shower’. The next-of-kin said that this was not right, as the resident did not like showers, but could sometimes be persuaded to have a bath. Further review of the care plan, found another entry in a different section, informing staff that the resident ‘does not like shower – prefers bath’. Records showed that the resident had their hair cut at the beginning of July, but no mention of their hair being washed. Monitoring sheets used by staff to record baths, showers, and hair washing, had an entry for hair wash and shower in March. This was fed back to staff, who felt that the resident’s hair was being washed, but staff were not completing the records correctly. The care plan-monitoring sheet showed that the care plan had not been reviewed monthly between March and June 2005. However since July was being reviewed monthly. Other care plans looked at, also had not been reviewed during all, or part of this period. The manual handling assessment did not mention that the resident used a wheelchair for transfers. Monthly weights were not always being recorded, although there were no concerns raised over the person’s weight. Staff said that the ‘daily report’ was not always completed daily, if there had been no relevant occurrences, or changes to the residents care. The relative felt it was informative looking at the care plan, and said that they “were happy” for the resident to be at the home. In addition to the care plan, 1 resident’s daily personal care, and any staff interaction was being recorded in the resident’s own diary, which was kept in their bedroom. This was to support the relative in knowing what care the resident had received. This followed previous concerns, over the level of personal care the resident was receiving. The relative felt this was a good communication tool, which enabled them to monitor the care being given. One care plan, gave staff clear guidance (including risk assessment) on how they should approach and support a resident with their personal care needs. It gave information on any actions (trigger points), which might cause the resident to become agitated or distressed. Time spent with 1 resident, who required support with their physical care, identified that they felt they received a “good” level of care, and their care needs were being met. Another resident, who was unable to verbally
Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 13 communicate, was able to nod ‘yes’, when asked if they felt comfortable and well cared for. A relative (Beech unit) raised concern that staff were not aware of their nextof-kin’s full medical history. Further review of care records, identified that reference had been made in a letter, but had not been previously mentioned by the relative. A relative had written on their CSCI comment card, that they felt Physiotherapy should be offered to support residents with their mobility. This was fed back to the Manager, who said private Physiotherapy could be arranged. The CSCI Pharmacist Inspector reviewed the homes medication system and found ‘in general the management of medicines within the home is of a very good standard’. However shortfalls were identified in the recording of medication on the Medication Administration Records (MAR) sheets. Although the temperature of 1 of the fridges holding medication was checked regularly, there was no evidence that staff had taken action when it was identified that the fridge temperatures were outside the required temperature range. To support the home, a more detailed report was sent following the inspection. The requirements and recommendations made at the end of this report, links into the pharmacist report sent direct to the home following this inspection. Relatives (8) asked if they ‘were satisfied with the overall care provided?’ (CSCI comment card), 6 had ticked ‘yes’, 1 ‘no’ and 1 stated ‘most of the time – not always’. The 4 residents who had completed the comment cards, had all answered ‘yes’ when asked ‘if they felt well cared for?’. Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 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 and 14. People using the service can expect to be consulted over what social activities and interests they would like to join in with, or pursue. EVIDENCE: Feedback on the residents comment cards was mixed, when answering the question ‘Does the home provide suitable activities?’, 2 residents had ticked ‘Yes’ and 2, ‘sometimes’. There was no further information given by the residents to indicate what kind of activities they would like to have at the home. Although relatives were not asked on their comment cards if they thought the activities were suitable, 1 had commented that entertainment came in ‘quite often’, and that there had been an outing to the theatre. Relatives of 1 of the residents, felt they had seen an improvement in them since moving into the home, due to them being able to have “more communication and stimulation”. Prior to the inspection, the home sent copies of their weekly activities programmes for residents. These gave a list of the activities for the whole week, for both morning and afternoons. The programme for Beech unit focused on activities suitable for people with dementia. This included reminiscence, Video afternoon, model making and
Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 15 flower arranging. For Hawthorn and Popular units, there were daily pre-lunch drinks and a chat, handicrafts, Ten-Pin Bowling, card games and crafts. During the inspection 2 Activity Therapists were playing music, which residents on Beech unit were singing a-long-to, dancing, hitting balloons to each other or playing an instrument. A small group of 5 residents were seen to be smiling and joining in. The Activity Therapist showed the hats/bonnets residents had made for ‘Ascot day’. The manager showed completed ‘Residents profiles’ undertaken for each resident. These gave a brief history of the resident, and interests, hobbies. The profile also gave information on any activities or trips they would like to go on, or join in with. Following feedback from the home’s own quality assurance survey, arrangements had been made, to provide activities at weekends. Discussions with the manager identified 1 resident who had been supported to attend the Lowestoft Air Display, and visit people they knew at another home. They had also set ‘goals’ with the resident to support them to increase the quality of their life, by being able to go out more, and join in social activities arranged by the home. Two relatives raised concerns that the residents on the dementia unit (Beech), were not offered the same choice of meals, as they are on the other units. This was also reflected during a discussion with staff, who felt that all residents should all be “treated the same”. The examples given by both relatives and staff were the desserts. It was felt that residents on Beech used to be offered more of a variety, but now it seemed to be all “mousses and jellies”. When they had asked why, they said they had been informed it was because during the hot weather, ‘jellies’ helped increase the resident’s liquid intake. The manager confirmed that this was seen as good practice, following guidelines from the Department of Health, and was offered in addition to the desserts normally offered, and not instead of. Time spent on both units showed that the residents had been offered the same choice of meals and desserts, which included tarts and flans. Due to this inspection being announced and comments made over inconsistency between the units, standard 15 will be assessed at the unannounced inspection. All the relatives (8) asked if they were made to feel welcome when they visited said ‘yes’. Visitors were seen arriving and leaving throughout the inspection, with some taking an active interest in the inspection, which included spending time with the inspector. Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 16 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. People using the service can expect their concerns to be listened to, and staff to take appropriate action. EVIDENCE: The home’s complaints policy is displayed in the reception area and contained in the home’s ‘Service Users Guide and Statement of Purpose’, which is given to all new residents. The staff comment cards showed that 1 person had not been shown the home’s complaint policy, and another was not aware of the policy. This was fed back to the management who showed the inspector a copy of the homes complaint procedure, which was held in the staff’s policy and procedure file, kept in the Nurse’s office on the units. Prior to the announced inspection 2 complaints were made directly to the CSCI. One of which (concerning the administration and recording of a previous resident’s medication) was investigated and addressed on the day. The second will be addressed at a future inspection. The second complaint raised concerns over care practice, recording of information and management of the home. The investigation into the complaint could not be fully completed, and a follow up inspection was arranged with the home. Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 17 Once the complaint investigations have been completed, a complaint report will be written (for each complaint), a summary of which, will be made available to the general public, on request from CSCI Suffolk Area office, Ipswich. Concerns raised by 1 relative over an Agency worker’s care practice, was fed back to the manager who confirmed that no concerns had been made directly to the home, to enable them to investigate. They said that they would monitor the situation. The home tries to use the same Agency staff to ensure consistency in care. If staff raised any concerns they would not be used again. They also said that they had been recruiting to vacant hours, which should reduce the need for Agency staff. Seven staff asked if they had received training in the homes abuse policy answered ‘Yes’ on the CSCI comment card. One person said included watching a video. Staff were aware if they had any concerns over residents welfare, that it was their responsibility to report it straight away. Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 18 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): 21, 22, 23, and 26. People can expect a comfortable, purpose built, homely, environment, which should meet their needs. Not all staff felt that the home has sufficient manual handling transfer aids, which could lead to residents having to wait before being transferred. EVIDENCE: Staff asked (CSCI comment cards) if they felt the home ‘had sufficient mobility aids to support individual residents needs?’, 3 out of the 7 replies had said ‘no’. Comments made included ‘we need 1 more hoist - as some people have to wait a little, before being helped out of bed or up into a chair/wheelchair’. Another carer explained that it was not the homes policy to keep residents in their wheelchair, which increased the use of hoists and stand-aids. Further comments were made by non-care staff who said ‘ I see and hear the frustration of the carers as they are waiting for hoists’, and ‘there is never enough equipment to go around at certain times of the day’. Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 19 Feedback from staff on duty was mixed, with some feeling there was enough equipment, others saying during peak times there was not enough hoists. Whilst spending time with a resident and their family, the resident requested to go to the toilet, but was informed that there would be a short delay as staff did not have a hoist free at the time. This was fed back to the management, who said that staff had not raised their concerns during the team meetings, but confirmed that an Argo hoist, was being purchased for Popular unit. A relative on Beech unit commented that the home “smells sweet today” then went on to say, “the home doesn’t always smell sweet”. This was reflected in another relative’s comments, who felt that Beech Unit did have “an odour at times”. Staff discussed the problems they had keeping the dementia unit free from odours, due to residents “urinating inappropriately”. They said the “cleaners were absolutely excellent – can’t fault them – there straight away”. Residents have a large area to walk around, which can cause problems if they have removed their continence pad, which can cause odours – but staff said they try to deal with it straight away. Although there was a odour of urine in 1 bedroom on Beech, it was noted that the smell came from an article which had been urinated on, once pointed out to staff they took action to remove the article. Relatives spoken to on another unit said that they always found the home clean. One relative asked “who should clean up?”, further discussion identified that there had been sticky marks on the table, which went over the bed, for at least “3 days” . They said that was “bearing in mind that it has been cleaned today – there was a lot more on it”. The footplates and seat of the resident’s wheelchair was also dirty. The manager showed a check list, which night staff had signed to say wheelchairs, had been cleaned on the unit the previous night. Bedrooms viewed were personalised, reflecting residents individual characters, interests and furnished by the home to a high standard. Residents spoken to in their bedrooms said they were comfortable and the room met their needs. Bedrooms had a range of adaptations to support individual residents physical needs, to make them more independent. Staff said to support 1 resident to be able to monitor the bird life, they had set up a CCTV camera, directed at a feeding table, to enable them to watch the birds feeding. Communal areas looked at included dining rooms, atrium, and 4 lounges, all of which were furnished and decorated to a high standard. Time spent in the atrium, showed that is was used as a meeting area for residents and their guests. In this area residents and their visitors can help themselves to free refreshments and homemade cakes. Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30. The home is committed to ensuring staff are well supported, and trained to undertake their role. Although rotas showed that the home should have sufficient staffing hours, not all relatives felt there were. EVIDENCE: All the staff who had completed the CSCI comment cards felt that the home had a good training and development programme in place for staff. They felt that they had received sufficient training to be able to undertake their role. The home has their own training room and dedicated trainer. Training records looked at showed, that all staff’s training needs were monitored, and the home has a on-going training and development programme. One new member of staff said that it was “the best place they had worked at for training”. Other comments from staff included “training here excellent” and “training 100 ”. Relatives completing the CSCI comment cards were asked if they felt the home always had ‘sufficient numbers of staff on duty?’. Out of the 8, 5 had ticked ‘Yes’, and 3 ‘No’. One relative added ‘never’ after the no, and had written a letter to accompany the comment card. They said that they felt there ‘is always a shortage of staff – weekends are particularly bad’. Another relative had written, ‘although I am told that staffing is above the required minimum number, a great reliance is placed on Agency staff who do not know the resident’s needs’. They went on to say that there was ‘no management presence at weekends, when exceptional shortages of staff has occurred’.
Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 21 During the inspection 3 relatives spoken to, raised concerns over the staffing levels on Beech unit. Comments included “sometimes can ring and ring for ages”, “sometimes can’t find staff at all”, only “3 on duty – when 2 are in a bedroom – only leaves 1 walking around”, “so short staffed”, and “people leave - are not being replaced”. Discussions with the Manager, and records looked at, identified that the home were was actively recruiting and inducting new staff The home’s quality assurance survey, did not ask residents (or their advocate) directly if they felt there were sufficient staff on duty. Instead it mentions availability and do staff come when you need them?. Comments made on staffing included ‘carers need more staff to enable them to do their job better’. On the staff comment cards, 1 member of staff had written ‘there are not enough staff to care for the residents based on their abilities. A large number of residents now require more 1 to 1 care’. They went on to say that the staffing had ‘not been increased to reflect this’. Discussions with 1 member of staff identified that they felt at times staff were “definitely over worked”, but not all the time. An example they gave was meal times, when they felt there was not enough staff, to help residents who required assistance. Staff were asked what the normal staffing levels were for the Beech unit, which, when full, cares for 32 residents with dementia. They said that the staffing level is normally 7 carer and 1 to 2 nurses in the morning, and 6 carers in the afternoon. Rotas looked at (Beech Unit 27 June – 3 July 2005) showed where shortfalls had been identified, but then gave the names of staff who had come into cover. Staff said that they do have problems covering last minute sickness, where Agencies are not always able to cover. The Manager showed the new system that they had in place to monitor shifts, which needed covering. This included a daily staff signing in sheet and duty list. The Sister on Beech said that by writing up the duty list the day before, acts as a double check to ensure they have the right staffing levels, and chase up any Agency cover, which would have previously been requested. They found the new system much better. Time spent on Popular and Beech unit, identified that call bells were answered quickly, and staff were seen sitting, talking with residents. On the residents comment cards returned (4), all had ticked ‘yes’ when asked if they felt well cared for. Residents raised no concerns during the inspection, over staffing levels. Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 22 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): 32, 33, 36 and 37. People using the service can expect to be cared for by approachable staff, who will actively seek feedback, to ensure the home is run in the residents best interest. EVIDENCE: Time spent with residents and relatives during the inspection identified that they felt comfortable to raise any issues, and found staff approachable. The home had recently (July 2005) undertaken a quality assurance survey, which was sent out to residents, relatives and staff. From the 54 sent out – 25 had been retuned. Comments made included:
Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 23 • • • • ‘Thank you for making **** (residents name) so happy’ ‘possible for more activities at weekends’ ‘no problems what so ever – very happy with every aspect of care’ ‘ I am as happy at Oulton Park as I could be anywhere, and like all the carers and nurses lots’ Discussions with Senior Management identified that any comments or suggestions made on the returned surveys, would be looked at and used to develop the service. An example given was providing activities at weekend. Discussions with staff and the Manager, also identified the different meetings that occur regularly in the home, to enable all staff to feedback any concerns or make suggestions. All but 1 of the 7 staff comment cards returned had ticked ‘yes’ when asked if they felt ‘the home was well run’. The 1 person who felt that the home was not well run had written ‘management are rarely seen on the units’, they felt that management ‘shirk’ their responsibilities and blame carers. No examples were given why they felt this. Discussions with staff during the day confirmed that they felt the home was well run, and they were able to “have their say”. When asked how often they saw the manager around the home, one said “not a lot – but shows confidence” in the staff. Another felt that they would like to see more of the manager. Carers felt they had the “full support of the Nurses” on the unit, another carer said that they “liked “ working at the home. Records showed that care staff received regular supervision, which was also reflected during conversations with staff, records viewed and feedback given on the CSCI staff comment cards. Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 24 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 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X 3 3 3 X X 2 STAFFING Standard No Score 27 3 28 X 29 X 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X X 3 2 X Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? 02/03/05 Yes – Pharmacist visit 17/08/04 No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7OP37 Regulation 17 (3) 15 (2) Requirement The home must ensure that information held in care plans is regularly reviewed, completed, and accurate. Records of the administration of medicines must be made accurately and consistently, including a record of the number of doses given when medicines are prescribed in variable doses. (This is a repeat requirement from Pharmacist inspection 17/08/04) Records of the administration, receipt and disposal of medicines controlled under the Misuse of Drugs Act 1971 must be made accurately and consistently and include the full name and address of the supplier and disposer. (This is a repeat requirement from Pharmacist inspection 17/08/04 ) Ensure a procedure is in place
DS0000059115.V252864.R01.S.doc Timescale for action 07/12/05 2 OP9 13 (2) 30/09/05 3 OP9 13,2 17,1,a S3,3,i 30/09/05 4 OP9 13 (2) 30/09/05
Page 26 Oulton Park Care Centre Version 5.0 for the use of maximum/minimum thermometers for the recording of the refrigerator temperatures. 5 OP9 13 (2) Cease the use of duplicate dispensing labels fixed to medication record forms. The home must ensure that they have system in place to ensure furniture and equipment used by the residents is kept clean and hygienic. 30/09/05 6 OP26 16 (2) (j) 07/12/05 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 OP4 Good Practice Recommendations The home should continue liaising with the 2 relatives (as discussed with the management), who feel that their nextof-kin’s care needs cannot be fully met, to ensure the situation is resolved. Although the home consults with the resident and, or their advocate when drawing up their care plan on admission, staff should continue at regular intervals, to liaise with the resident or their advocate, to ensure that the information contained is correct and meets residents current needs/wishes. Ensure written medication policies and procedures are available in all operational areas of the home. Hand-written changes or additions to instructions should be signed and dated by the person making the change. Clear justification for such changes must be made in care progress notes or care plans. Information obtained form Activity Therapist, should be used to try and identify why, not all residents felt the home offered suitable activities. The home should investigate the reason why some staff feels that there is not sufficient manual handling
DS0000059115.V252864.R01.S.doc Version 5.0 Page 27 2 OP7 3 4 OP9 OP9 5 6 OP12 OP22 Oulton Park Care Centre 7 OP26 equipment to transfer residents, without keeping the resident waiting. The home should continue monitor the environment on Beech unit, to try and reduce/eliminate the incidences of unpleasant odours occurring. The home should review their staffing rotas, working practices and routines, to ensure that the home has sufficient staffing hours to meet all residents care needs over a 24-hour period. 8 OP27 Oulton Park Care Centre DS0000059115.V252864.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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