Inspection on 16/04/08 for Oxfield Court Nursing Home

This inspection was carried out on 16th April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 11/11/05

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 28/09/2008.

CARE HOME ADULTS 18-65 Oxfield Court Nursing Home Oxfield Court Albany Road Dalton Huddersfield West Yorkshire HD5 9UZ Lead Inspector Cathy Howarth Key Unannounced Inspection 16th April 2008 09:00 Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 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.V362415.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V362415.R02.S.doc Version 5.2 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 www.st-annes.org.uk 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.V362415.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st October 2007 Brief Description of the Service: Oxfield Court, which is operated by St Anne’s Community Services, is registered to provide nursing and personal care and accommodation for up to twenty-eight, male and female, adults with a learning disability. Oxfield Court is a complex of five purpose-built, brick bungalows situated in a quiet cul-de-sac. Bedrooms are for single occupation and have a wash-hand basin with toilet facilities near to bedrooms and communal areas. Each bungalow has a communal lounge/dining area and a kitchen. There are enclosed outdoor areas accessible from each bungalow and well-maintained, mature garden areas to the front of the properties. All the local amenities are within a couple of minutes’ walk. There is ample parking to the front of the properties. Each bungalow has a manager and there is an acting site co-ordinator who manages the overall site including a day centre. The Commission was informed by the manager that the standard charge to individuals on the 16/4/08 was in the range of £431 to £469 per week. Additional charges are made for hairdressing, toiletries, and chiropody aromatherapy, hydrotherapy and transport. Information about the home, including the latest Commission for Social Care Inspection report, is available from the home. Inspection reports are also available on the Internet at www.csci.org.uk Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate, quality outcomes. This inspection was conducted over the period of one day by two inspectors. In addition to visiting the home, inspectors also used information supplied by the home in their Annual Quality Assurance Assessment (AQAA), information from notifications received over the last six months and feedback from people using the service, their relatives and from staff who work at the home. During the site visit, the inspectors visited 4 of the 5 bungalows, met with people using the service and staff; observed interactions between staff and people living there; and examined documents relating to the operation of the service. Overall it was found that the service has improved in several areas over the last six months since the last inspection. There is still a substantial amount of work to be done to enhance the quality of life for some people living at Oxfield Court but if this momentum is sustained then the outlook is generally positive. The inspectors would like to thank all involved for the co operation with this visit. What the service does well: What has improved since the last inspection? We saw more evidence of good practice in personal care and support for people. Moving and handling plans for people have improved. Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 6 Some locks have been fitted to people’s bedroom doors where there was a problem with people going into others’ rooms. There have been some improvements in how people’s views are listened to at the home with regular meetings for people living there. We noted that not so many bank or agency staff were being used which means that people are being supported more often by people they know and who know them. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 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.V362415.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. New procedures may have improved this area of practice at the home. EVIDENCE: There have been no new admissions into Oxfield Court since the last key inspection. However following recommendations made t that inspection the acting manager has brought in new procedures. The practical implementation of these will be assessed at a future inspection once a new admission has taken place. Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. Individuals are involved in decisions about their lives in a limited way. More could be done to improve the plans for individuals to make sure their goals enhance their lives. EVIDENCE: Inspectors visited four of the five bungalows and observed staff supporting individuals. The service aims to offer people opportunities to plan their lives and to develop as individuals. There is some evidence that this is achieved with some individuals, whose plans we looked at, but it was variable across the service as a whole, with some bungalows achieving this better than others. In all bungalows there was still little evidence of how people have been involved in the process of planning. Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 10 One person had a goal to have a communication book to help stop him feeling frustrated about lack of communication skills. This book had been prepared with pictures of everyday items such as hot drinks, bedroom, etc, but was very bulky so couldn’t easily be carried around and used as a communication tool. Staff were recording that they were sitting down with the person to look at the book of pictures on Saturdays and Sundays. Unsurprisingly the person was reluctant to do this after a few weeks and then it was recorded that ‘he ran away.’ Staff have clearly not understood the purpose of a communication book nor how to use this effectively to support someone with communication difficulties. Despite their good intentions, the outcome was poor for this person. Care plans showed that people are having meetings and plans are made to meet people’s needs. There was some evidence of staff making an effort to improve the appearance of some of the plans to make them more accessible to individuals, by using pictures. The plans were not always updated however, following the meetings, so some people were carrying on with the same goals for a long period of time with no change. One person’s goals were originally set in October 2006. Also as mentioned in the last report sometimes these goals are very limited and yet still not achieved. For example one person had a goal to buy a full-length mirror, which took seven months for it to be bought and put up in his bedroom. People’s plans include support to take risks where this is important to them. For example one person likes to smoke but dislikes having staff observing at close quarters. A risk assessment was done and measures put in place keep her from burning herself as she is likely to do. This means she can enjoy her cigarette without the need for staff to be present. The plans seen did not evidence that people had been involved in their development. It was previously recommended that people have access to advocates. There was no evidence of this on the files seen and people did not report this. Relatives of people who use the service and the people living there responded to our surveys. The response from them was overwhelmingly positive about the service with comments such as: “I make choices and decisions about what, when and if I want to do things.” “I enjoy being with my staff, they know me well I enjoy having 1:1 time with staff at least 3 times a week.” “Everything to do with my brothers care at Oxfield Court is excellent, the staff are wonderful, and the home is first class, Im always well informed about anything to do with my brother’s care, the home is always well run and the place is always spotlessly clean” Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 11 “I have every confidence that X is being very well looked after and have no hesitation in filling in this form.” “X is treated as an individual and her wishes and feelings are always respected.” “I have every confidence that my sister has all her needs met & is looked after/supported very well.” “They always make sure that X’s needs are met, medically and physically and always try to make her life as enjoyable as they can given X’s difficult needs.” There were few negative comments made: “Communication was always a bit lax, but is getting better - though not perfect.” “I am unable to make decisions on any specific changes which might lead to a major life change.” At the last inspection it was identified that one person , who is a Muslim was not receiving a diet to suit their cultural needs. Again it was noted that little had improved in this area when the menu was seen, with the majority of meals being vegetarian or fish rather than halal meat. As mentioned above, there was a lot of variability between the bungalows. On No 10 there was no manager in place, and it was noted that here the lack of someone to co-ordinate individual plans had a detrimental effect on this aspect of care. x Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. People’s lifestyles are improving but they need better support to do the things they say they want to do. EVIDENCE: People living at Oxfield Court have some opportunities to enjoy their chosen lifestyles. From observing on this visit and from records and responses from people and their relatives, it is again clear that the picture is mixed. People clearly value their opportunities to be active and to go out and enjoy leisure activities, holidays and to meet people. One person said: “I enjoy going out for picnics in the country and I like going out into restaurants for my lunch/evening meals which I do quite regularly.” Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 13 One area the home seems to be good at is in keeping people in touch with their families. The following comments are typical of those received in our surveys: Sometimes they support my sister to ring & send letters or postcards from holiday. Also Xmas cards & gifts. “Our mum passed away 2 years ago I was asked to do a memory book of family pictures of family i.e mum, dad, sister, cousin, nice, husband. I live a long way away. I know that the staff would look through the book with X and give her the support she would need. This was very good of them to care so much.” There was also evidence of families visiting the home and people being supported to visit home regularly. “I enjoy visitors coming into my home - my family are always welcomed.” One of the main areas of difficulty for people is in transport and staff time to do activities. People said: “Sometimes there are transport issues or no drivers working so I cant get out as much as I would like.” Staff surveys confirmed this: “Sometimes we don’t have enough staff on for individuals to go out.” A detailed breakdown of transport usage showed there is marked variation in people’s opportunities to go out. There is more detail about this in the section of this report on Concerns Complaints and Protection. On most people‘s plans we noted that goals for activities and meeting people were often central to what people said they wanted to do to enhance their lives. Again the achievement of this was mixed. Some people were being supported to do activities on a regular basis, others were not going out much or only for very short periods. For some people who do not have any regular day care, this lack of occupation is of particular concern and can exacerbate behaviour problems. One person had a goal to visit a family grave, which was identified in September 07, this has not yet been achieved. Another person had a visit to the GP recorded as an outing, which, does not seem to be appropriate. Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. People’s health and personal care needs are well met. Some improvements are needed in the disposal arrangements for medicines. EVIDENCE: On the whole it was seen that people were treated with respect and dignity by staff. Some good practice was seen in how staff discreetly offered personal care to individuals. This was an improvement from the last visit where some poor practice had been observed. The home offers good support for people with their health needs. Regular health appointments were seen on files and where there are specific health issues these are generally managed well. One relative reported for example: “X was recently been in hospital for 22 days and the carers were with him 24 hrs a day. They were excellent.” Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 15 Staff identified this as an areas where they feel they do well too. When asked what does the service do well one person said: “Provides excellent health care needs.. Listens to people’s concerns. Liaises with other services GP, Physio, families day centres.” In recent times the home has had to support several people who have been very ill and two that have died. This has been done with sensitivity and staff have advocated on behalf of people for example, to allow them to die at home. Another person was having trouble feeding and the decision was made to stop feeding orally. This decision was made in conjunction with his parents and other professionals in his best interests and recorded appropriately. The management of medicines was examined in two bungalows as part of this inspection. Medication administration records (MAR) sheets were completed appropriately; with no gaps noted and regular stock checks take place to ensure that medicines are not going missing. Qualified nurses give out medicines. When medicines are no longer required each house has a bucket where these are to be placed and the number disposed of is written on a log and two people sign this. The log did not indicate whose tablets they were and strips of tablets were not taken out of their packaging but placed in the bucket unopened. This meant that the tablets could be retrieved and used if someone wanted to do this. One nurse demonstrated how this could be done when there was a problem in reconciling stock on one of the sheets. This could put people at risk as extra medicines could be given to people and this would not be noticed. Also medicines could be taken off the premises and used for other purposes. Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The service is beginning to listen more to people living there, but there are still some improvements to be made in the way that their financial welfare is protected. EVIDENCE: People who responded to our survey generally indicated that they knew how to raise issues of concern and some said that staff knew them well and would help them. One person was not sure: “I feel there are too many people here so I don’t know who to go to.” Relatives were likewise confident that they would be listened to on the whole: “I once complained directly to Sharon Allen (the responsible individual) -matter was sorted out straight away.” Staff responses were also positive: “I would discuss their concerns and if I could help them solve the problem I would, if not I would discuss this with the home manager & site manager.” At the last inspection it was recommended that information about complaints was presented to people in a more user friendly format – this has not yet been taken up. However the site coordinator has set up meetings for people who Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 17 live at the home to offer them opportunities to raise issues and influence developments within Oxfield Court. No complaints have been received since the last inspection. The home has policies and procedures in place to keep people safe and training for staff is provided. The manager explained that a programme of refresher training is booked for June to December 2008. One newly employed person gave a good account of what they would do if they suspected someone of being harmed or at risk. This person also told the inspector that they had received training in managing difficult behaviour. There have been no safeguarding (Adult protection) referrals since the last inspection. At the last inspection a requirement was made for people’s use of transport should be monitored as it appeared that people were being charged for transport they were not using. Records have been kept of every occasion when individuals have used the transport but no indication was found of the length or type of journey. The acting manager had not done a detailed analysis of the data but did provide copies of the records. . On looking at these records in detail it showed there is a huge variation in usage by individuals. Eight people’s usage was looked at over the period January to 24 April 08, which is approximately 16 weeks. One person had used the transport 55 times, which works out at £5.50 per trip. This was the highest usage. The lowest user had only 11 occasions where they used the transport, costing them £27.60 per trip. The average usage by people was 26 occasions which is £11.69 per trip. Without details of destinations it is not possible to give a clear picture of whether or not this is value for money. However the person that used the vehicles the most, does this as part of a weekly routine where he accompanies a driver to deliver mail to other St. Anne’s properties. This was seen on the day of this inspection visit and involved the person being out of the bungalow for less than an hour. These details raise questions for some individuals as to whether they would be better off opting out of this arrangement. The previous requirement remains and needs to be addressed. Finance records for some individuals were looked at as part of this visit. These were found to be accurately completed and receipts obtained for purchases. Staff go with some people who have bank accounts, and help them withdraw cash using a card and PIN. Receipts are obtained for these withdrawals but there was no evidence that these were cross checked with the bank statements when these arrived. This would help to safeguard people from unauthorised withdrawals being made. All staff responding to the surveys confirmed that they had been through a thorough recruitment process and felt they were kept up to date with current policies and practice to keep people safe. Staff records seen confirmed this. Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 18 Risk assessments that were of concern at the last inspection have been improved for those individuals identified. Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The living accommodation meets people’s needs overall. EVIDENCE: Since the last inspection at Oxfield Court there have been some improvements in the environment on most of the bungalows. Areas have been redecorated, such as corridors, and exposed plasterwork has been covered up. There are further plans for work but in general the living spaces for individuals in their bedrooms and lounge areas are much improved. Locks have now been put on people’s bedroom doors on No 6 where one person had been in the habit of entering other people’s rooms. There are still some outstanding issues to be addressed. The bathing temperatures for people are still too low, generally around 39°C on No 8 the Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 20 bath and shower temperature were recorded as low as 34°C. The manager explained that a new heating system is planned for and will be put in within the next few months. Most areas were found to be generally clean and tidy and laundry facilities were good. Where it is needed, equipment needed to help people move is provided, such as ceiling tracking in lounges and bedrooms. The toilet in no 8 was seen to be very cluttered with 2 fans, a wheelchair and a convection heater making it difficult to move around and to reach the washbasin and towel. Staff on duty explained that storage space was very limited in the bungalow. For some individuals who have significant physical needs, space in their rooms is likewise limited when all the required equipment is in place. People’s bedrooms were seen to be individually decorated, and some people have said they were involved in choosing colours and furniture. On No6, where there is someone who dislikes having doors closed, a half door has been fitted to the toilet doorway so that he can have privacy to use the toilet without being distressed about the door being closed. This is good practice. Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 35 and 36 People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. Staff recruitment induction and training is improving. Staffing levels are also are improving so that people may benefit from more staff to help them live fulfilling lives. EVIDENCE: The biggest concern expressed by staff and backed up by survey responses from relatives and people who live there was about the staffing Staff comments were typically as below: “Due to budget restraints on staffing levels there are not always enough staff on to meet service user needs.” “Sometimes we don’t have enough staff on for individuals to go out. As a staff nurse I can hold keys to other bungalows and if the staffing levels are low on my own it can cause friction in the staff team as they feel overworked and service users don’t get to do activities outlined for them.” Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 22 “I have a regular supervisions with my manager where we discuss how I am working, I feel supported in my workplace but sometimes feel I need more support with my role as a staff nurse as some people expect too much from me in 1 days work and the manager will not support me when I confront the issue.” One relative said: “Appears to be a high turnover of staff - which is unsettling for clients not enough qualified staff.” The rota for qualified staff confirmed that there are times when each bungalow is without qualified staff on duty. Cover in these circumstances is provided by nurses from other bungalows. On the day of our visit three bungalows had no qualified staff working. However one bungalow had two qualified staff on duty. The home has a vacancy for a qualified nurse. Rotas showed that there is more consistency in cover for the bungalows. Staff reported that they are generally only working on one bungalow most of the time and the use of agency cover has diminished now that new staff have been recruited. The manager informed us that further increases in staffing are due to be implemented following reassessments of individuals. Most relatives commented that they felt staff had the skills to care for people: “They have the most important skill of all. They care for each client and their needs very well.” Staff commented generally that training is good, they are kept up to date and that St Anne’s is good at providing training they need to do the job. Comments included: “Yes training covers my duties as a care assistant, all mandatory training courses are kept up to date and training goals are covered at supervision. St Anne’s is very thorough when it comes induction/training.” “My induction was carried out at the head office with other new recruits. It was one of the best courses I have been on.” NVQ2 training is being provided for care staff. In the course of this inspection one inspector met with two new members of staff who explained that they have had good support in settling in from the manager and other staff, have had a good induction and initial training. Both confirmed that they had extensive checks done before they started work. Staff surveys confirmed that detailed checks on staff before they begin work are something that is consistently achieved at Oxfield Court by St Anne’s. Staff supervision and meetings provides support for staff working in the bungalows. Supervision frequency does not always meet the minimum Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 23 standards. However since the last inspection, meetings have been held for care staff as well as qualified staff to air their views and concerns to the site coordinator. Staff said they felt that they were listened to more and felt this was supportive. Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The management of the home lacks stability and a clear plan to make the necessary improvements to improve people’s quality of life throughout the service. EVIDENCE: The home has been managed by an acting site coordinator on secondment for the last six months. Responses by staff indicate that they are pleased with the developments that have taken place and about the support they have received. Several staff made comments: Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 25 “There have been vast improvements with new site co-ordinator and I feel valued & supported. We now have regular manager meetings, staff nurse meetings, support worker meetings service user meetings. He listens he is fair and he is very supportive to all staff.” “Since having new site co-ordinator things have improved vastly on site improving staff morale and I feel I have more support than before. We now have regular meetings and feel valued and things are discussed as a team and agreed on.” Staff also expressed some anxiety about the future however, as the management arrangements are not clear as the secondment period for the acting manager are due to end soon. Some improvements in the service have been noted earlier in this report. However there is still a large degree of variability between the quality between bungalows. Management oversight for example of the individual plans and the quality of these is poor. For example managers should pick up when people’s goals are not being met or goals are either inappropriate or poorly implemented such as the communication book cited earlier. Monthly visits by the provider have similarly not picked up these issues. The acting manager has been working on a team development plan for the site but this was not available at the time of this visit. This was received later and shows some ambition for the service. However the plan lacks detail, no timescales are identified and monitoring and review is unclear. The service has recently sent out questionnaires to relatives asking for feedback. Overall this was good but people are concerned about planned changes, as the service is planning to change one bungalow’s use into a respite service. People are concerned about disruption to others. These anxieties need to be managed sensitively. The meetings being held for people living at Oxfield Court help to give them a voice in addressing issues relating to improving the service. These showed that the site coordinator has made an effort to open up a dialogue with individuals. As a group they need a lot of support. It may be helpful to introduce an independent advocate to assist with these meetings to help people find their own voice. Health and safety issues are addressed through routine checks. We noted that equipment such as hoists and electrical tests had been carried out as required. One staff member indicated on a water temperature chart that they had sought to improve the temperature of the water by topping up with a kettle full of hot water. While it is commendable that staff want to improve people’s enjoyment of their bath, this presents risks to individuals if staff are carrying hot kettles around. The hot water problem needs to be addressed as a matter of priority to avoid this. Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 26 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000001124.V362415.R02.S.doc 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 2 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Oxfield Court Nursing Home Score 3 3 1 3 2 X 2 X X 2 X Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA7 Regulation 12(2) Requirement People living at Oxfield Court should be supported to make decisions about their lives and to have ownership of those decisions. (From inspection 31/10/07 original timescale 31/12/07) The registered person must set up a system to ensure that the usage of transport is equitable and monitored so that some people are not at risk of being financially abused by the current system. (From inspection 31/10/07 original timescale 30/11/07) Arrangements for the disposal of unwanted medicines must be improved so that medicines that have been discarded can no longer be used as this puts people at the home at risk. Timescale for action 31/05/08 2 YA23 13(6) 31/05/08 3 YA20 13(2) 30/04/08 Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 28 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 YA8 Good Practice Recommendations Individual plans for people should be kept up to date and monitored by the manager to make sure that what people have planned for is implemented. The service provider should look into the provision of independent advocacy/peer support for service users to increase their opportunities for involvement in decisionmaking. This recommendation is carried forward. The format of the home’s complaints procedure should be made more accessible to service users so they can use it should they have occasion to do so. This recommendation is carried forward. 4 YA23 Withdrawals from people’s bank accounts should be cross checked with bank statements to monitor withdrawals and so safeguard people’s money. Hot water temperatures should be maintained close to 43 degrees Celsius. This will ensure that showers and baths are taken at a safe and pleasant temperature. This recommendation is carried forward. 6 YA32 The registered person should continue working towards 50 of all care staff achieving NVQ level 2 or above so that service users are in safe hands. This recommendation is carried forward. 7 YA13 Some people living at Oxfield Court should have more opportunities to participate in local community life. This recommendation is carried forward. 3. YA22 5 YA24 Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 29 8 YA14 There should be more opportunities for leisure activities for people living at Oxfield Court particularly within the bungalows. This recommendation is carried forward. The home should have a consistent manager to lead improvements in the service. This recommendation is carried forward. The organisation should seek to improve its quality monitoring systems within the home. This recommendation is carried forward. 9 YA37 10 YA39 Oxfield Court Nursing Home DS0000001124.V362415.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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