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Inspection on 22/03/07 for Oxfield Court Nursing Home

Also see our care home review for Oxfield Court Nursing Home for more information

This inspection was carried out on 22nd March 2007.

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 no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Before someone is admitted to the home, pre-admission assessment takes place and individuals are welcome to visit and stay overnight at the home, if they wish, before making a decision to live there. Staff working at the home reflect the cultural mix of the service user group. And service users` cultural needs are met through the provision of foods, delivery of personal care in accordance with cultural needs and the celebration of important events. It was evident that staff are committed and have positive relationships with service users. Service users appeared content and did not display any signs of negative well-being during this visit. A relative`s survey noted that her relative is "Treated with skill, efficiency, but also fun and warmth that only good carers can give". And a GP survey noted that "The carers seem to respect, know and love the residents". One relative`s survey noted that "I could not be happier to find Oxfield Court and the excellent management and staff".

What has improved since the last inspection?

Since the last key inspection of the home, there has been an increase in staffing levels. Staff also spoke positively about this as it means they have increased opportunities to support service users within the home and the wider community. There has been a good level of staff mandatory training so that staff have upto-date knowledge and skills when providing care and support to service users. Maintenance issues have been addressed and arrangements are in place for outstanding works to be completed so that a safe and comfortable environment is provided for service users. Owing to the nature of their disability, some service users are unable to communicate verbally. But there is evidence that the service provider is now seeking the views of service users during monthly management visits to the home.

What the care home could do better:

Although some care plans and risk assessments contain a good level of detail, further work is required to ensure that detailed care plans and risk assessments are in place for all service users so that staff have full information and so that risks can be managed safely.Medication is generally well managed and where there have been errors with the administration of medication this was addressed with the staff concerned. But there is no formal audit of medication to ensure that good practice prevails and this should be addressed. The service provider needs to ensure that sufficient funds are made available for day-to-day expenditure because, at present, monies are borrowed from service users. This is not acceptable and suitable arrangements must be made for the home to be adequately financed. Although minimum staffing levels are being maintained, there is a high use of agency staff. And although, where possible, the same agency staff are used to provide consistency to people living at the home, the service provider should recruit sufficient staff of their own so that the use of agency staff can be reduced. The use of agency staff was also commented upon by one GP who felt the service could improve "by having regular staff to ensure continuity of care and so that staff are experienced in supporting service users` complex needs".

CARE HOME ADULTS 18-65 Oxfield Court Nursing Home Oxfield Court Albany Road Dalton Huddersfield West Yorkshire HD5 9UZ Lead Inspector Jacinta Lockwood Unannounced Inspection 22nd March 2007 09:45 Oxfield Court Nursing Home DS0000001124.V334273.R01.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.V334273.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V334273.R01.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 jenkinlodge@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.V334273.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th December 2006 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 in close proximity 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 Ms Judith Bermingham who is registered with the Commission manages the overall site. A day centre, which is also managed by the home’s registered manager, is situated on the same site. The Commission was informed on 05.03.07 that the standard charge ranged from £249.40 to £531.67 per week. Additional charges are made for hairdressing, toiletries, chiropody. Aromatherapy, hydrotherapy and outings. Information about the home, including the latest Commission for Social Care Inspection report, is available from the home. Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of this inspection, two regulation inspectors made an unannounced visit to the home on 22.03.07. The visit started at 09.45 and ended at 16:45. The inspectors spent time in each of the bungalows and had the opportunity to meet with staff and service users. A tour of the premises was also conducted in each of the bungalows, although not every bedroom was seen. A sample of records were inspected, including service user support plans and associated documentation, service users’ medication, staffing rotas, staff training records, maintenance documentation and some policies and procedures. The inspection findings are also based on a range of accumulated evidence received by the Commission (CSCI) since the last inspection, for example, notifiable incident reports when service users are involved in an accident or incident and management reports from the service provider. Random inspection visits have also been carried out. One on 10.11.06 was in response to an anonymous complaint about staffing levels and on 11.12.06 a visit was made to check that staffing levels were being maintained and staff training was being delivered. To obtain the views of those who use and have contact with the service, surveys were sent to a sample of six service users, no completed surveys were received. Five next of kin, two completed surveys were received; five GP’s, two were returned and two social care professionals, none were received. The inspectors met service users on each of the bungalows, some of whom owing to the nature of their disability were unable to express their views verbally during the site visit. Inspectors took the opportunity to observe the interaction between service users and staff members. The inspectors were assisted by one of the home’s managers and at the latter end of the inspection by the acting site manager. The inspectors would like to thank all those who contributed to the key inspection and to service users and staff for their time and hospitality during the site visit. What the service does well: Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 6 Before someone is admitted to the home, pre-admission assessment takes place and individuals are welcome to visit and stay overnight at the home, if they wish, before making a decision to live there. Staff working at the home reflect the cultural mix of the service user group. And service users’ cultural needs are met through the provision of foods, delivery of personal care in accordance with cultural needs and the celebration of important events. It was evident that staff are committed and have positive relationships with service users. Service users appeared content and did not display any signs of negative well-being during this visit. A relative’s survey noted that her relative is “Treated with skill, efficiency, but also fun and warmth that only good carers can give”. And a GP survey noted that “The carers seem to respect, know and love the residents”. One relative’s survey noted that “I could not be happier to find Oxfield Court and the excellent management and staff”. What has improved since the last inspection? What they could do better: Although some care plans and risk assessments contain a good level of detail, further work is required to ensure that detailed care plans and risk assessments are in place for all service users so that staff have full information and so that risks can be managed safely. Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 7 Medication is generally well managed and where there have been errors with the administration of medication this was addressed with the staff concerned. But there is no formal audit of medication to ensure that good practice prevails and this should be addressed. The service provider needs to ensure that sufficient funds are made available for day-to-day expenditure because, at present, monies are borrowed from service users. This is not acceptable and suitable arrangements must be made for the home to be adequately financed. Although minimum staffing levels are being maintained, there is a high use of agency staff. And although, where possible, the same agency staff are used to provide consistency to people living at the home, the service provider should recruit sufficient staff of their own so that the use of agency staff can be reduced. The use of agency staff was also commented upon by one GP who felt the service could improve “by having regular staff to ensure continuity of care and so that staff are experienced in supporting service users’ complex needs”. 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.V334273.R01.S.doc Version 5.2 Page 8 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.V334273.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Before a service user is admitted to the home an assessment of needs is undertaken to ensure that the home can meet the person’s needs. EVIDENCE: There has been one admission to the service since the last key inspection on 30.06.06. Telephone conversations with the registered manager and healthcare professionals prior to this visit, indicated that a detailed preadmission assessment was carried out before the service user moved to the home. This was confirmed from records during this visit. The inspectors were informed that prospective service users are welcome to visit the home before moving there. These take the form of tea visits and maybe an overnight stay. Multi-disciplinary team meetings may be held depending on the complexity of the person’s needs. A care plan is produced based on the assessment information and developed as the service user settles into the home. Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 10 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, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally, service users’ care plans identify their needs and goals. And they are supported to make decisions about their lives. Service users are supported to take risks as part of an independent lifestyle EVIDENCE: A care plan and associated records for one service user on each of the bungalows was inspected. Care records included behaviour management and support plans as well as risk assessments. Generally, there was a good level of information within the documents relating to the individual’s personal and cultural needs and risks and how these were to be met by staff. But some were more detailed than others. There were some entries that noted the person ‘needs full assistance’, with no explanation as to the form the assistance should take. Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 11 A behaviour management plan was available for one service user but this was very basic. Records showed that the service user’s behaviour was quite settled at present. However, care planning documents must be detailed and include the actions that staff need to take to support the service user and to manage any behaviours. This will ensure that care and support is delivered in a consistent manner and will help to avoid any misunderstanding as to what staff need to do to deliver care to service users in a way that meets their individual and diverse needs. A requirement about this is carried forward. Also, it was evident from a service user’s risk assessment that two staff were to be present in the home when the service user was having a bath but the associated care plan did not include this level of detail. It was clear a permanent member of staff knew this information, but agency staff also work at the home and it is important that full and detailed written information is available to them within a service user’s plan. Service users’ plans and risk assessments are kept under review, but some were overdue and should be reviewed again to ensure the information is still current. A requirement for care plans to be detailed and for documents related to care planning to be reviewed more frequently is made within this report. Although records show that relatives and social workers are involved in reviewing service user’s needs, one relative commented in a survey that she was only ‘sometimes’ kept up-to-date with important issues affecting her relative. Staff should ensure that relatives are kept informed as appropriate. Daily records and action plans showed that service users’ goals were being met and arrangements made for the achievement of future goals. A record of when physical restraint was used on a service user was seen. A multi-disciplinary panel had agreed the use of restraint to promote the service user’s safety and well-being. A member of nursing staff explained that this had been used on one occasion but not since. A relative returning a survey made positive comments about the care and support provided to her relative by staff at the home who she thought were “Very aware of (service user’s) needs” which are “Always attended to with skill and understanding”. Oxfield Court Nursing Home DS0000001124.V334273.R01.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, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to engage in community based and in-house activities and to maintain contact with family and friends. Service users are offered a healthy diet, which meets their cultural and individual needs. EVIDENCE: At the random inspection on 11.12.06 and from this inspection it was positive to note that good progress has been made regarding activities and community contact for service users. This was also evident from monthly management visit reports carried out by the service provider and the pre-inspection questionnaire. Activities, which were linked to service users’ objectives in their support plans, reflected their social and cultural needs and included family and community contact. A relative returning a survey confirmed this. Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 13 During the inspection, service users accessed community based facilities with staff, such as meals out and day care. And it was evident from observation and discussion with service users and staff that service users enjoyed the activities. A photographic record was seen on one service user’s file of friends, events and relatives which the service user can look through with staff support as a positive reminder. Service user records noted the choices they could make, for example, regarding food and clothing. And a service user was observed being given a choice and accepting a drive out in the minibus. Service users and staff were observed listening to music together and enjoying meal times. Service users appeared to be happy and displayed positive wellbeing by smiling and interacting with staff. A balanced and varied diet including fresh fruit and vegetables is offered to service users, which takes account of their individual and cultural needs. Meal times are flexible to suit service users’ needs and where support is needed this is provided by staff on a one-to-one basis. However, staff should ensure that mealtimes are protected so that staff who are assisting a service user to eat do not leave them mid-meal to support another service user, as was observed on one of the bungalows. A recommendation about this is made within this report. Oxfield Court Nursing Home DS0000001124.V334273.R01.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, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ personal care needs are met and staff generally meet service users’ healthcare needs. Community based healthcare professionals also attend service users. Generally, medication is managed appropriately. EVIDENCE: As noted in the section on Individual Needs and Choices, care plans need to be more detailed to ensure that service users receive support in a way they prefer and require in a consistent manner. There was evidence that service users have health checks and these were generally up-to-date. But there were some gaps in recording in a service user’s healthcare diary and weight chart. A recommendation about this is made. Also, a service user had not had a dental check up for some time. Following discussion with the nurse in charge, arrangements were made at the time of the inspection for the service user to have a dental check-up. Staff explained nursing staff were aware of and were monitoring a service user who had a chesty cough. Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 15 There was no detailed care plan for a service user with epilepsy, which would inform staff how to support the service user during or after a seizure. A requirement is made about this. Bathing risk assessments were also not available for service users with epilepsy. Although bathing risk assessments were put in place at the time of the inspection, it is important that all risks associated with service users’ health and personal care needs are identified and relevant documentation put in place. GPs returning surveys reported that staff ‘usually’ or ‘always’ have the right skills and experience to support individual’s social and health care needs and that they ‘usually’ or ‘always’ respond appropriately if concerns are raised. It was evident from observation and discussion with staff that they were aware of service users’ health and support needs. Medication samples on each of the bungalows were checked and, generally, record keeping was good and stock reconciled. But one medicine had been signed as being given but was still in the blister pack. Failure to administer medication as prescribed without clear and recorded reasons could impact on service users’ wellbeing. Where medication errors have occurred, appropriate action has been taken and the errors addressed with the staff concerned through the staff disciplinary procedure and supervision. Nursing staff are responsible for medicines administration and reported that they have received training in operating the monitored dosage system. A recommendation is made for the staff signatory sheet to be updated, as some staff have left the service. Also, although a running stock balance is maintained, there is no formal audit of the system and this is recommended within this report. Records note any allergies service users may have and how they prefer to receive their medication. Records show that service user’s medication is periodically reviewed. Two GPs returning a survey reported that staff manage medication appropriately. Oxfield Court Nursing Home DS0000001124.V334273.R01.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, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints are dealt with appropriately. Generally, service users are protected from abuse. EVIDENCE: The home has a complaints procedure, which needs updating with the current contact details of the Commission for Social Care Inspection. A previous recommendation for the procedure to be available in a range of formats to suit service users’ needs has not yet been addressed. A recommendation about these areas is made within the report. Staff explained that relatives would raise concerns on behalf of the service user. A complaints record is maintained and shows that appropriate action has been taken, within a 28-day timescale, where concerns have been raised. An up-to-date multi-agency adult protection policy and procedure was available. Staff have received adult protection training and were aware of the action to take were they to see or suspect abuse. A previous requirement was made for staff at the home to receive accredited training in managing challenging behaviours. It’s positive to note that the service now has Positive Behaviour Support Instructors and that accreditation is being sought. A physical intervention policy and procedure is available that is in line with Department of Health guidance. And a number of staff have received training in managing work related violence. However, the previous Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 17 requirement stands for relevant staff to receive accredited managing challenging behaviour training. A sample of service users’ monies was checked and reconciled with records held. However, where there are shared costs, for example, group hydrotherapy, individual receipts should be on service users’ finance records. A recommendation is made about this. Also, it was evident from records and discussion that monies are borrowed from service users to fund the home’s housekeeping. Although records showed that this money is reimbursed to service users, the home must ensure that it has sufficient funds of its own and the borrowing of service users’ monies must stop. A requirement is made about this. Service users have joint use of minibuses and contribute their mobility allowance to this. Agreements were in place, but it was evident that these needed bringing up-to-date to reflect the current contribution. A recommendation about this is made Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 18 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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a homely, comfortable and safe environment, which is clean and hygienic. EVIDENCE: A limited tour of each bungalow was made. The bungalows were generally well maintained and provided a comfortable and homely environment for service users. Bedrooms reflected service users’ lifestyles. And on one bungalow a service user’s framed artwork was displayed. However, some maintenance work is required and records and discussion show that this is in hand. A good range of equipment is provided to maximise service users’ independence and for the safe movement and handling of service users. Staff were observed to use good movement and handling techniques and to explain to a service user what was happening. The service user remained calm and looked comfortable throughout the transfer. Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 19 The bungalows were clean, tidy and odour free on the day of the visit. However, a shower room floor was grubby and needed a good clean to ensure hygiene standards are maintained and to present a more pleasant environment for service users. A recommendation is made about this. A new boiler has been fitted. Water temperature monitoring records were available and water temperature sampled during this visit. Water temperatures fluctuate and records show that low water temperatures had been reported and were waiting to be addressed. A recommendation is made about this. One bungalow did not have a thermometer available to test water temperatures and a recommendation is made for these to be available to staff throughout the site. Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by competent and qualified staff who are employed in sufficient numbers to meet service users’ individual and collective needs. EVIDENCE: A representative of the Commission carried out an audit of St Anne’s staff recruitment records on 12.04.06. Although recommendations were made, the audit found good practice for the recruitment of staff. Through discussion with a member of staff and a check of staff records, it was evident that training and supervision forms part of the induction process. However, induction records for two recently employed staff were not accessible at the time of the visit owing to the absence of the registered manager. A recommendation is made for suitable arrangements to be in place, in the absence of the registered manager, for all staff induction records to be available for inspection. Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 21 A random visit was made to the service on 10.11.06 in response to an anonymous complaint about staffing levels. An immediate requirement letter was sent to the provider for minimum staffing levels to be maintained. The provider responded positively by ensuring minimum staffing levels. A further visit was made on 11.12.06 to check compliance with regulations regarding staffing levels and staff training. It is positive to note that minimum staffing levels had been and continue to be maintained. Also, where a service user requires one-to-one supervision arrangements are in place. From observation, discussion and records it’s clear that a lot of training has been provided. The majority of staff have received up-to-date mandatory training and remaining staff have been booked on training courses. Survey information indicates that generally staff have the necessary skills and experience to meet service users’ needs. And although further training is necessary, for example, accredited managing challenging behaviour training, it is positive to note that action is being taken to address this. A requirement about this is carried forward. Twenty-four percent of staff have achieved an NVQ (National Vocational Qualification) and training in this area should continue so that a minimum of 50 of staff have a relevant NVQ qualification. A recommendation about this is carried forward. Staff demonstrated good movement and handling techniques when hoisting service users into wheelchairs. This was done in a very dignified way explaining what they were doing and why. This was done at an easy pace, showing respect for the service users. Agency staff cover staff vacancies at the home. Where possible, the same agency staff are used to provide continuity for service users. The inspectors were informed that recruitment had taken place and clearance checks were awaited, but that agency staff would still be needed. There is a high usage of agency staff at Oxfield Court and the service provider should take steps to recruit sufficient numbers of its own staff so that the use of agency staff can be reduced. A recommendation about this is made within this report. The home employs drivers for the minibus and they support service users to access community based facilities. The drivers are not included on the home’s staffing roster and this must be addressed so that all those employed to work at the home are included on the roster as required by legislation. A requirement about this is made. Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 22 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 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a home that is managed by an experienced, qualified, registered manager. Quality assurance mechanisms are in place, and service users appear happy at the home, but recent survey findings were not available for inspection. The health, safety and welfare of service users are promoted and protected. EVIDENCE: The registered manager, Mrs Judith Bermingham, is a first level registered nurse (learning disabilities). She has achieved the Registered Managers’ Award and has many years’ experience of working at a management level in nursing care homes. Mrs Bermingham is absent from the service at present Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 23 and arrangements have been made for management of the service in the meantime. The inspector was informed that quality assurance surveys had been sent out and those returned contained mostly positive comments. The registered manager was reported to have these but she was not present. Any report on the findings of the quality surveys must be supplied to the Commission and made available to service users as required by legislation. The quality assurance system should also take into account the views of other interested parties in the community such as health and social care professionals. A requirement about this is carried forward within this report. And a recommendation is made for wider consultation to take place. Monthly management visits also provide an opportunity for the registered provider to monitor the quality of the service and to seek service users’ views about the care and support they receive. Management visit reports supplied to the Commission note that maintenance issues are actioned and health and safety checks are carried out. The reports also note that service users take part in community-based activities and appear content and happy at the home. It was evident from information supplied by the service and records seen during this visit that health and safety checks and records are made to ensure the health, safety and welfare of service users and staff. Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 24 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 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 x 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 3 X 3 X X 3 x Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 25 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. Standard YA6 Regulation 15(1)(2)(b)(c)(d) 12(1)(b) Requirement All people using the service must have an up to date, detailed care plan. This must include behaviour management support plans, where appropriate. This will ensure service users receive person centred support that meets their needs. (Timescales of 15.04.06 and 10.11.06 not fully met). Detailed risk assessments must be in place for all service users. These must be reviewed on a regular basis or when required. This will ensure that action is taken to manage the risk and information is up-to-date. (Timescale of 15.04.06 and 10.11.06 not fully met). Accurate medication records must be kept in the home. Medication must be administered as prescribed. (Timescale of 31.03.06 and 10.11.06 not met). This will ensure that service users’ healthcare needs are fully met and provide a clear audit trail. Version 5.2 Timescale for action 24/05/07 2. YA9 YA19 13(4) 24/05/07 3. YA20 13(2) 27/04/07 Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Page 26 4. YA23 13(6), 18(1)(c)(i) All staff expected to physically intervene with service users must have undertaken a recognised and accredited course. This must be kept up to date, follow best practice guidelines and be specific to the needs of the individual service user. (Timescales of 30.04.06 and 10.11.06 not met). This will ensure that service users and staff are protected. The borrowing of service users’ monies to fund the home’s housekeeping must stop. The service provider must ensure that adequate monies are made available to staff for the day-to-day running of the home. This will ensure that all of the service users’ monies is available for their own use. Minibus drivers employed to work at the home must be included on the staffing roster as required by legislation. Service users’ views must be sought as part of any quality audit. The findings of any quality audit must be published and a copy supplied to the Commission and made available to service users. (Timescale of 10.11.06 not met). This will provide information to interested parties about the quality of service at the home. 09/06/07 5. YA23 25(1) 27/04/07 6. YA35 17(2) Schedule 4 24/05/07 7. YA39 24(3) 09/06/07 Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 27 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 YA6 Good Practice Recommendations The planning tools used should be standardised across the service and detailed plans should be available for each individual service user. This will ensure consistency in care provision. This recommendation is carried forward. 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 service provider should ensure that meal times at the home are protected so that staff assisting service users to eat do not leave the service user mid-meal to support another service user. Service users’ healthcare records including weight monitoring charts should be complete and up-to-date, so that service users’ healthcare needs can be clearly identified and met. The medicines staff signatory sheet should be updated, as some staff have left the service and agency nursing staff work at the home. This will assist in identifying persons administering medication. A formal audit of medication stock should be introduced so that practice can be monitored and any shortfalls identified. The home’s homely remedy policy should be reviewed so that it is clear that the service user consents and the GP is consulted about the administration of homely remedies. This was not assessed on this occasion. The up-to-date contact details of the Commission for Social Care Inspection should be included within the home’s complaints procedure so that people can contact the Commission should they have occasion to do so. 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. Agreements in place for the joint use by service users of the minibuses should be brought up-to-date to reflect their current contributions. Where service users share the cost of an activity, for example, group hydrotherapy, individual receipts should DS0000001124.V334273.R01.S.doc Version 5.2 Page 28 2. YA8 3. YA17 4. YA19 5. YA20 6. 7. YA20 YA20 8. YA22 9. 10. 11. YA22 YA23 YA23 Oxfield Court Nursing Home 12. 13. 14. 15. 16. 17. YA24 YA24 YA30 YA32 YA33 YA35 be kept on each service users’ individual financial record. This will ensure a clear audit trail. 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. Thermometers to test water temperatures should be available to staff on each of the bungalows so that water temperatures can be tested. The shower room floor should be cleaned to ensure hygiene standards are maintained and to present a more pleasant environment for service users. 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. The service provider should take steps to recruit sufficient numbers of its own staff so that the use of agency staff can be reduced. In the absence of the registered manager, suitable arrangements should be made for staff induction records to be available for inspection. Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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. Extracts may not be used or reproduced without the express permission of CSCI Oxfield Court Nursing Home DS0000001124.V334273.R01.S.doc Version 5.2 Page 30 - 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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