Inspection on 11/11/05 for Oxfield Court Nursing Home

This inspection was carried out on 11th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Oxfield Court Nursing Home 16/04/08

Oxfield Court Nursing Home 31/10/07

Oxfield Court Nursing Home 22/03/07

Oxfield Court Nursing Home 30/06/06

Oxfield Court Nursing Home 22/02/06

Oxfield Court Nursing Home 01/03/05

Oxfield Court Nursing Home 14/07/04

Oxfield Court Nursing Home 13/02/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

CARE HOME ADULTS 18-65 Oxfield Court Nursing Home Oxfield Court Albany Road Dalton Huddersfield West Yorkshire HD5 9UZ Lead Inspector Alison McCabe Unannounced Inspection 22nd November 2005 10:20 Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 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 Oxfield Court Nursing Home DS0000001124.V264353.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 Adults 18-65. 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. Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Oxfield Court Nursing Home Address 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) Oxfield Court Albany Road Dalton Huddersfield West Yorkshire HD5 9UZ 01484 424232 01484 428967 St Anne`s Community Services Mrs Judith Bermingham Care Home 28 Category(ies) of Learning disability (28) registration, with number of places Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st March 2005 Brief Description of the Service: Oxfield Court is operated by St Anne’s Shelter and Housing Action and it is registered to provide nursing care and accommodation for up to twenty-eight adults with a learning disability. Oxfield Court is a complex of five purpose built brick bungalows situated in a quiet cul-de-sac, all the local amenities are within a couple of minutes walk, Service users have access to the garden areas and there is ample parking. A day centre is also situated on the same site. Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by two inspectors between 10.20am and 5.00pm. The inspectors spent time in each of the bungalows and had the opportunity to meet with staff and service users. The registered manager was not on duty at the time of inspection. As part of this inspection, health and safety records, individual care plans and risk assessments, and medication stock and records were sampled. A tour of the premises was also conducted in each bungalow, although not every bedroom was seen. What the service does well: What has improved since the last inspection? What they could do better: Recording systems regarding service users should be the same throughout the service to make it easier for staff to easily identify and meet service users needs. Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 6 Where physical intervention is required with service users, clear guidance must be available to staff to make sure that everybody is kept safe from harm. The provider needs to review staffing levels and increase staffing levels where necessary to ensure that service users identified needs are met in all areas. Guidelines specific to a service user should be removed from a communal area. The heating and hot water system needs to be repaired so that there is sufficient hot water at all times and the home is maintained at a comfortable temperature. Routine health care checks need to be arranged for those service users who have not received these as intended. Damaged equipment needs to be repaired or replaced. Medicine management needs to improve in some areas. 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. Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not assessed on this occasion. Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 There are some good systems in place for planning and risk management but systems should be standardised throughout the service. Where physical intervention may be required clear strategies need to be identified. EVIDENCE: Inspectors found that there were wide variations between the personal plans found in the houses on site. In some houses there were good plans seen, which gave a good indication of the goals and choices offered to individuals. For some there was evidence that individuals had been involved in person centred planning meetings and that these have identified goals which are important to service users. For other individuals there seemed to be a lack of clarity about their plans, and the format of files made it difficult to access up to date information because of the presence of historical information. For those individuals who had clear plans, there was also a clear indication of monitoring of the goals, which inspectors found to be a very positive aspect of the recording system. This allows key workers and manager to see clearly if goals are being met on a weekly basis and to take action promptly if they are not. It would be helpful if this system was in place throughout the service as it would be a positive benefit in planning for all service users. Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 10 For some service users, empowerment and induction assessments had been carried out. These clearly identify ways in which service users can be supported by staff, and what the limits are to their involvement in their own decision-making and how staff can support them to make a contribution to decision-making. These were again very positive, but were not found on every file examined. Staff on duty indicated that the qualified staff are working towards standardising the recording systems throughout the service. Risk assessments were found for all service users whose files were examined. In the main these were found to be useful and of a good standard. However where significant risks were found which might require physical intervention from staff to prevent injury to service users or staff, inspectors found that there was insufficient guidance available for staff. In these cases it is recommended that more detailed management plans be drawn up to address these needs. Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 The staffing levels within the home unacceptably limit the lifestyles of service users. EVIDENCE: The service has adopted a person centred planning approach to help ensure that service users have the opportunities to follow their aspirations and chosen lifestyles. While this is commendable, the reality in terms of what people can realistically achieve given the staffing levels within the home gave some cause for concern. Some service users have identified modest goals, such as for example in one case to go out once a week. The monitoring sheets showed in this case that even this was not achieved for a period of three weeks. In discussions with staff and service users it appears that the staffing levels mean that it is difficult for people to get opportunities to go out. For most people their activities outside the home are limited to day care services with the occasional trip out in the minibus. Some of these trips appeared to be simply a ride out in the bus rather than a trip to do something more meaningful. In addition, inspectors observed little meaningful activity within the houses. Staff Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 12 in some houses seemed unable to generate activity and engage service users, even in conversation. Some service users have had the opportunity to have short break holidays away from the service. This is positive and staff reported that where this has happened service users appear to have really benefited from the opportunity. Contacts with family appear to be encouraged where service users have relatives who want to be in touch. This was found to be facilitated by offering transport support for one individual to go home once a week. A service user said that she has regular contact with her family who visit her at Oxfield Court. Inspectors noted that in some houses there were restrictions on movement around the home, for example through the locking of bathrooms. This was reported to be for the safety of specific service users but inevitably impacts on all service users in that house. Because of staffing levels, it appears that the problem is difficult to manage in a different way. The inspectors did not assess whether restrictions placed upon service users were recorded and agreed, as part of their individual plans, and this will be looked at during the next inspection. Menus and records of food were examined in three houses and were found to demonstrate that a nutritionally balanced diet is offered in two of the three. Food records in one of the houses did not include details of fruit or vegetables that were offered, and it is recommended that this be included. No fresh fruit was available in one of the houses and staff explained that the delivery would arrive in two days time. Mealtime guidelines developed for a service user provided clear guidance to staff, however these were displayed on the front of the kitchen cupboard. These should be removed to protect the privacy of the service user. A service user said that she liked the food provided at the home. Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Health care and personal support is generally good but needs to be monitored to check all service users’ needs are being met. The management of medication stocks needs to be tightened up. EVIDENCE: There was evidence on some files that service users had been consulted about their wishes in terms of personal support. In terms of healthcare needs, on some files there was evidence of a proactive approach to managing these needs and there were good records showing that regular appointments were kept. For some service users, there were gaps between recording of health appointments some years ago and more recently when recording has started again. Some service users need to ‘catch up’ on some routine health checks such as optician appointments. It is recommended that all service users files be reviewed to ensure that routine health screening is up to date. For some service users a health action plan has been developed and is reviewed annually. This is good practice. In several houses, medication records and storage was examined. There appeared to be some confusion around recording of stock levels for ‘as Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 14 required’ medication. In one case two systems were in use, showing different balances, neither of which tallied with the number in the cabinet. The system needs to be simplified and the MAR sheet should be the record for all balances. Also medication should be balanced on the day it is received, rather than the day it is started, as was the case in at least one house. Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not assessed on this occasion. Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,29,30 Service users live in a generally clean and comfortable home, although the unpleasant odour identified in one of the bungalows needs to be addressed. A good range of equipment if provided to maximise independence and safely move and handle service users, however there needs to be improved auditing of this equipment to ensure that as it becomes worn or damaged it is repaired or replaced promptly. The heating and hot water systems at this home need to be improved. EVIDENCE: A tour of the premises was conducted in each bungalow including all communal areas, laundry, kitchens and a sample of bedrooms. Staff have worked hard to decorate service users’ bedrooms in a style of their choice. Bedrooms were personalised to reflect individuals’ tastes and most were decorated and furnished to a high standard. A lot of the furniture in service users’ bedrooms had been purchased with their own money. Staff explained that this would only happen if the individual service user had sufficient funds. Staff reported that some bedrooms are still to be decorated, and keyworkers are in the process of planning and arranging this with service users. Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 17 The heating and hot water system is problematic throughout the houses to varying degrees. Staff reported that there had been ongoing problems with the system and that engineers had been to the premises in an attempt to fix the problem. Some areas of the building were excessively cold whilst other areas were too hot. Staff reported that they were unable to control the temperature. There was no hot water or water was not hot enough in a number of areas, whilst in other areas the hot water was excessively hot. For example in bungalow four, there was no hot water in the sink in the bathroom or a service user’s bedroom, and the water temperature from the shower was excessively hot. In bungalow two, there was no hot water in the shower room sink, in the toilet the water from the sink was measured at twenty degrees centigrade, and the water from the bathroom sink was measured at sixty degrees centigrade. The recommended temperature is close to forty-three degrees centigrade. It is a requirement of the inspection that the heating and hot water systems be repaired. Most parts of the houses were clean, comfortable and free from odour, with the exception of bungalow eight where there was an offensive odour in both the shower room and bathroom. Handrails in a number of the bathrooms and toilets were unsafe as they were not stable and the shower chair in bungalow eight was broken. These were discussed during the inspection and a requirement has been made that they be repaired or replaced. It was noted that the lounge carpet in bungalow eight was in a poor state and this needs to be replaced. Staff reported that attempts to clean the carpet have not improved the appearance. Hoisting equipment, adapted baths and specialist beds and seating are provided where necessary. Service users that need to use the hoist have their own slings that are labelled to ensure that they are not used communally. This is good practice. It was noted that there was no soap or paper towels in some of the laundry areas. These must be provided to reduce the risk of cross infection when staff have been handling dirty laundry. A number of bars of soap were also found in bathrooms, toilets and shower rooms. In order to reduce the risk of cross infection, liquid soap must be provided in communal areas. Sluice cycles are available on the washing machines, and the red bag system is used for laundering soiled items. A locked COSHH cupboard is in each of the laundry areas. Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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 There is not always enough staff on duty to support service users to participate in community based activities or have access to all areas of the home. EVIDENCE: The inspectors did not assess this standard in full, however concerns regarding the limited opportunities offered to service users to go out because there is not always sufficient numbers of staff available were discussed during the inspection. At times, areas of some of the houses are locked in order to maintain the safety of individuals for whom it would be unsafe to have unsupervised access to all areas of the home. Staffing levels do not seem to allow for alternative, less restrictive ways of managing the safety of all service users. It is recommended that the staffing levels be reviewed and necessary adjustments made to ensure that service users needs are met in this area. Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 41, 42 In general, the health and safety of service users and staff are safeguarded. Reporting of incidents/accidents to the commission and some records need to be better. EVIDENCE: Maintenance and fire safety records were examined in bungalows six, eight and ten. All were found to be up to date and in good order. There was evidence that fire safety checks and servicing of movement and handling equipment are conducted at the required intervals. General risk assessments are in place covering a range of health and safety matters. As discussed previously in this report, some of the grab rails and a shower chair need to be repaired or replaced due to them being unstable and potentially a hazard to service users. Through examination of records it was noted that a number of accidents/incidents reportable under regulation 37 of the Care Homes Regulations 2001 had not been notified to the CSCI. A requirement has been made in respect of this. The organisation has a comprehensive form that is Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 20 completed in the event of physical intervention being used with a service user, however not all of these had been completed fully as required. Many of the records examined were up to date and in good order, however as previously mentioned in the report, some records require further development and clarity. Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 1 X 3 X X 1 1 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score X X 2 X X X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Oxfield Court Nursing Home Score 3 2 1 X Standard No 37 38 39 40 41 42 43 Score X X X X 1 1 X DS0000001124.V264353.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? 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 2 Standard YA20 YA24 YA42 Regulation 13(2) 13(4)a 23(2)b c Requirement An accurate stock balance of medication must be kept within the home. The heating and hot water system must be repaired to provide sufficient and suitable heat and hot water delivered close to 43 degrees centigrade. Grab rails identified as being unstable must be repaired or replaced. The broken shower chair must be repaired or replaced. Liquid soap and paper towels must be provided in all laundry areas. Liquid soap must also be provided in communal bathrooms and toilets. The registered person must notify the CSCI of any events as described under Regulation 37 of the Care Homes Regulations 2001. Staff details must be kept on the premises as outlined in Schedule 2 timescale of 30/6/05 unmet The service provider and CSCI are still in discussion Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 23 Timescale for action 31/12/05 07/01/06 3 YA29 YA42 13(4)(a) 23(2)(c) 31/12/05 4 YA30 YA42 13(3) 31/12/05 5 YA41YA42 37 31/12/05 6 YA34YA34 7,9,19 31/01/05 regarding this matter. 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 2 Refer to Standard YA6 YA41 YA9 YA41 Good Practice Recommendations The planning tools used should be standardised across the service and detailed plans should be available for each individual service user. Specific behaviour management strategies should be in place where there is an identified need for physical intervention by staff. Records of physical intervention should be completed in full. The registered person should ensure that all service users are offered opportunities to participate in valued and fulfilling occupation both at home and in the community, in line with their assessed needs and individual care plan. A review of staffing levels should be conducted and necessary adjustments made to enable service users to access community based activities more frequently and enable service users to access all areas of their home wherever possible. Menus should include fruit and vegetables. All service users’ healthcare needs should be reviewed to ensure they are receiving routine health screening checks. The practice of displaying service user guidelines in respect of dietary requirements on the front of the kitchen cupboard should be reviewed. 3 YA12 YA13 YA14 YA16YA33 4 5 6 7 YA17 YA19 YA41 Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB 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 Oxfield Court Nursing Home DS0000001124.V264353.R01.S.doc Version 5.0 Page 25 - 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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