CARE HOMES FOR OLDER PEOPLE
Oxendon House 33 Main Road Oxendon Maket Harborough Leicestershire, LE16 8NE
Lead Inspector Sarah Jenkins Unannounced Thursday 07 April 2005 10.30 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 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. Oxendon House Version 1.10 Page 3 SERVICE INFORMATION
Name of service Oxendon House Address 33 Main Road Oxendon Market Harborough Leicestershire LE16 8NE 01858 464151 01858 461646 Htaqi@btopenworld.com Integra Management Services Ltd Mr Hamid Taqi Ms Gwendolyn Johnson Care Home Only 27 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of Physical disability over 65 years of age registration, with number (PD(E)) 7 of places Old age, not falling within any other category (OP) 27 Oxendon House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No one falling within the category of PD(E) may be admitted to the home where there are 7 persons of category (PD(E)) already cared for within the home. 2. One named service user in the home with a diagnosis indicative of the DE(E) category was admitted by agreement with the registration authority in September 2003. No other service users in this category may currently be admitted to the home. Date of last inspection 17.08.04 Brief Description of the Service: Oxendon House is a care home providing personal care for 27 older people, including up to 7 people who may have additional physical disabilities. It is owned by Integra Management Services Ltd, represented by Mr Hamid Taqi. The Registered Managers post has been filled by Mrs Johnson since the last inspection.The home is located in the rural village of Great Oxendon, which is between Northampton and Market Harborough, the latter being 3 miles away. The home was opened under the new ownership in early 2003 and consists of a 2-storey older traditional building with a modern, in character, extension on the ground floor.The homes bedrooms consist of 21 single rooms (11 of which have en-suite facilities) and 3 double rooms. There is a passenger lift. The home has extensive and well-maintained gardens that are easily accessible for services users. Oxendon House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Inspectors visited the home for 6.25 hours during which they reviewed a sample of service users records and spoke with service users, staff, a visiting relative and the District Nurse who currently visits service users at the home. The Registered Manager and the Responsible Individual were also present at the time of the Inspection, and were able to meet with the Inspectors for full feedback on the outcomes of the Inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting 3 service users and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. What the service does well:
The staff at the home are committed to responding to service users individual needs and wishes. This was evident from the Registered Managers detailed knowledge of service users individual needs; and from the feedback that the home has received from relatives; service users; and professionals visiting the home. Inspectors received compliments about the home and its staff during the inspection process, for example service users informed the Inspector that they felt the homes staff were generally very good and worked hard to help them with all their needs. The health and personal care needs of service users are kept under review and relevant professionals are consulted and involved in maintaining service users health, and in resolving as far as possible service users individual difficulties or problems. The visiting District Nurse told the inspectors that she found the health care at the home had become much better since the arrival of the new Registered Manager Service users who spoke with Inspectors were all very complimentary about the provision of food at the home, and the inspectors observed that the midday meal was appetizing, nutritious and well presented. Oxendon House Version 1.10 Page 6 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Oxendon House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Oxendon House Version 1.10 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 standard(s) 3 The admission process is generally sound, and information is usually gathered on prospective service users, which is conducive to the delivery of care during the first few weeks of a service users stay. However shortfalls, which may have resulted from a period of staff shortage, compromising the delivery of consistent quality care, were identified on the files of recently admitted service users. EVIDENCE: The Registered Manager has a detailed knowledge of service users needs from her admission process and from discussions with prospective service users and their carers. Some of the information available to staff at the point of admission was fully detailed, for example a service users who preferred to use a magnifying glass for reading, but access to such detailed information was inconsistent and it was sometimes hard to find all the necessary relevant information. There may be inconsistencies in the manner of care delivery, as one staff interviewed was not all able to detail where she would find the information Oxendon House Version 1.10 Page 9 relating to care practices and said that she relied on the guidance of other staff for the detail. The assessment process failed in one instance. Retrospectively, a service user was identified as having considerable mental health needs which had not been fully explored at the time of admission as focus had been on the other care needs. The home is not registered to offer care to service users with Mental Health problems but at the time of admission it was assumed that the service users physical disability was the primary focus of the care needs. Additional effort is now being made in consultation with the relevant authorities to fully review this service users needs and the required package of care. Oxendon House Version 1.10 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 standard(s) 7,8, 10 Details in service users records should be fuller, and information should be better organized to enable easy access to the current care plan for staff. EVIDENCE: Service users were confident in the delivery of healthcare and felt that all their health needs were fully met. The District Nurse visiting the home also confirmed her confidence in the staffs’ ability to support her in her duties through following her instructions appropriately. Care plans do not always support consistent care according to the individual needs of service users in that when new staff are appointed there can be inconsistencies in the way in which care is delivered. For example staff describe differing personal care routines. From records and an interview with a staff member it was evident that staff are not always properly supported in their duties by ease of access to relevant information and that newer staff were not sufficiently aware of the use or
Oxendon House Version 1.10 Page 11 purpose of the care plan information, relying heavily on their observations of the practice of other staff, or their own care practices. Some of the essential information on care plans, for example Moving and Handling information is difficult to establish, as there are contradictory instructions on different sheets that are sometimes undated. It was evident from staff interviews that staff are aware of the expectation that they preserve service users rights, privacy and dignity, and evidence from interviews with service users confirmed that this was occurring. A service user said that sometimes the new staff don’t seem to be as professional in delivering personal care as those who have been at the home for a longer time, for example chatting to each other whilst attending her. Oxendon House Version 1.10 Page 12 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 standard(s) 12, 13, 14, 15 The quality of service users lives at Oxendon House matches their expectations in most respects although there have been limited opportunities for regular stimulating recreational activities lately. EVIDENCE: The Inspector found that those service users who were able to occupy themselves, for example in interaction with other service users, reading etc, were satisfied with the activities programme, and the regular community or communal events. However there has been little time for staff to implement “in house activities” for the less able residents, and whilst staff are keen to involve service users, in practice there has been little time available to do so. Several service users identified to the inspector that there were some significant delays in receiving attention from staff when it was required, and two service users observed that it was because staff were “very busy”. Service users felt that they were offered reasonable choice regarding their routines and activities, and there was evidence from records of flexibility according to service users preferences. Service users spoke positively about the provision of food at the home and told the Inspector that the cook was responsive to their requests and comments.
Oxendon House Version 1.10 Page 13 The Inspector observed that the midday meal at the time of the Inspection was appetizing, nutritious and well presented. There was evidence from correspondence that the home had received that visitors are welcomed at all reasonable times, and offered support, assistance and hospitality. Oxendon House Version 1.10 Page 14 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 standard(s) 18 The good communication that the Registered Manager maintains with service users and relatives, and her sensitive responses to issues arising, appear to pre-empt complaints. There were no indicators of any shortfalls in these areas. EVIDENCE: The Inspector reviewed the complaints record and found that no formal complaints had been made to the home. There was evidence from observations of the Registered Managers practice that the good communication maintained with service users and their relatives would be likely to pre-empt complaints. Staff interviewed were properly aware of abuse issues and all confirmed their confidence in other staff. Staff interviewed in the course of this Inspection all demonstrated sensitive and caring attitudes. Oxendon House Version 1.10 Page 15 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 standard(s) 19,26 The environment is homely with a choice of communal areas where service users may spend their time or entertain visitors. The environment, as sampled is safe and well maintained. EVIDENCE: From the sample of areas seen, the home was found to be of a high standard of cleanliness, and reasonable, often good, decoration. The programme of decoration submitted after the last Inspection is being followed and maintained. Service users spoke positively about the environment. The home was seen to be very clean and hygienic on the day of the Inspection. The office area is very small and there are limitations on its use due to its size and the lack of ventilation. Staff therefore frequently wedge the door open thereby potentially compromising confidentiality.
Oxendon House Version 1.10 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 There have been some difficulties regarding the recruitment and induction of staff since the last inspection, which appeared to result in a period when service users care needs were not fully met. There have since been some improvements with the recruitment of more staff. There are some shortfalls in the levels of experience of staff. EVIDENCE: 4 National Vocational Qualifications trained staff have left since the last inspection. The Responsible Individual informed Inspectors that he has since reviewed and improved rates of pay for trained staff. New staff have been recruited, but there have been considerable training and supervision time implications for the Registered Manager during this period. There is only one staff member, in addition to the Registered Manager, at the home who is employed in a senior role at present. Ongoing training for staff continues, some “in house” by the Manager and also by the District Nurse, and some external courses. However the Inspectors found that there were shortfalls with regard to First Aid training, due to the recent turnover of trained staff. Oxendon House Version 1.10 Page 17 Service users were complimentary about the fact that staff were very caring but the shortfalls in the maintenance of a fully trained and experienced staff team had been noticed and comments were made by 2 service users about the training of some new staff members. Staff interviews demonstrated the commitment of staff to caring compassionately for their elders, and interviews and observations supported this. Confidentiality relating to the office area was raised as a concern. In one instance a staff member recruited from abroad was interviewed and described the process. The interview was over the telephone but was said to be a professional discussion of some length with the Responsible Individual, exploring her experience and attitudes. Inspectors were surprised that the Registered Manager had not been involved in this recruitment and recommended that the homes practice should enable a Registered Manager input to decisions made about the employment of staff. Oxendon House Version 1.10 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,36,38 The management of the home has suffered some setbacks due to staffing issues. Inspectors found that there were insufficient experienced staff currently employed to properly support the Registered Manager, and to free her up to fully undertake her managerial duties. The ratio of senior staff needs to be improved. Poor Care plan records could compromise the Health and Safety of service users (see example re Moving and Handling). EVIDENCE: The Inspectors observed that the Registered Manager was undertaking a good deal of the routine care work, and kept herself closely informed of the needs of
Oxendon House Version 1.10 Page 19 service users and the staff responses to these during the Inspection. She agreed that she had insufficient Senior staff to whom to delegate matters. The inspection process showed that the shortfalls in trained staff. i.e. the lack of experienced staff to take on senior roles; had put pressure on the Registered Manager in terms of proper induction and training for the new staff. There was also evidence that the Registered Manager had not been properly involved in recruitment. There had been a long gap (December- April) during which most staff had not received any formal supervision. There was evidence that the Registered Manager had been working “on the floor” during this period to a degree that was detrimental to her management duties. The improvements in records that the Registered Manager had previously intended and discussed with the Inspector had not been implemented. Oxendon House Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x 2 x x 2 x 1 Oxendon House Version 1.10 Page 21 Are there any outstanding requirements from the last inspection? A previous requirement (1) was met, but has since lapsed again 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 30 Regulation 18 Requirement There must be a member who has current first aid training on duty on each shift.( Previous requirement in August 2004) There must be sufficient experienced staff at the home to enable the Registered Manager to fully undertake her management duties. Moving and Handling assessments for Service Users must be accurate and up to date. Timescale for action By May 1st 2005 By May 31st 2005 2. 29 18 3. 8,38 13 By May 31st 2005 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 3 Good Practice Recommendations Documentation should demonstrate that assessments on prospective service users are undertaken with sufficient time to fully explore all aspects of a prospective service users care needs and relevant history, and thereby guard against inappropriate admissions. The Registered Manger is reminded that the information on Service users Care plans should be in sufficient detail to ensure that staff are enabled to deliver care consistently according to the individual needs.
Version 1.10 Page 22 2. 7,33 Oxendon House 3. 4. 12 36 The Registered Manager should review the provision of daily activities to enhance Service users involvement. The Registered Manager is reminded that formal staff supervision and induction training should be undertaken consistently.(See above requirement relating to management duties) Oxendon House Version 1.10 Page 23 Commission for Social Care Inspection Northamptonshire Office Newland House, First Floor Campbell Square Northampton, NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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