Inspection on 30/06/06 for Oxfield Court Nursing Home

This inspection was carried out on 30th June 2006.

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 26 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 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 09/07/2008.

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 30th June 2006 09:40 Oxfield Court Nursing Home DS0000001124.V303057.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.V303057.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.V303057.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 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.V303057.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd February 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 05.05.06 that the standard charge was £449.67 per week with additional charges that vary according to individual service users’ needs. Additional charges are made for hairdressing, toiletries, chiropody 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.V303057.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two regulation inspectors conducted this key site visit on 30.06.06. The visit started at 09.40 and ended at 16:40. At the time of the visit there were 27 service users in residence. 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, quality assurance documents 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. To obtain the views of those who use and have contact with the service, surveys were sent to a sample of ten service users, two of the seven returned had been completed, their relatives, seven were returned, GPs, two were returned and health and social care professionals, three were returned. The inspectors met and spoke with 5 service users, 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 registered manager and the newly appointed deputy manager assisted throughout the inspection. 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: Service users’ needs are assessed before they are offered a place at Oxfield Court and they are welcome to visit the home to help them to decide if they want to live there. Two service users said they were asked if they wanted to live at the home and that they received enough information to help them choose. Some records are well maintained and clear and detailed individual care plans and risks assessments are in place for some service users, which give good guidance to staff about how to meet individuals’ needs. Oxfield Court Nursing Home DS0000001124.V303057.R01.S.doc Version 5.2 Page 6 All those who completed surveys indicated that they were satisfied with the overall care provided at the home. One relative said that the care was “excellent” and a service user said that she liked living there. The home is clean and comfortable and service users’ bedrooms are furnished to a high standard. A good range of equipment and adaptations are also provided to help service users to be as independent as possible and to protect staff when they are supporting service users to mobilise. A varied diet is provided including fresh fruit and vegetables, which service users enjoy. Food is also provided that meets service users’ cultural needs. Service users are supported to maintain contact with their friends and families. Relatives said that they were welcomed when they visited the home and that they could make their visits in private. The home’s recruitment practices ensure that only those who are suitable to work with vulnerable adults are employed to work at the home. What has improved since the last inspection? What they could do better: There is some good practice with regard to care planning and associated documents on some bungalows. However, the approach to care planning and risk assessment across all the bungalows should be improved, so that record keeping is consistent and so that staff have detailed information available to them when providing care and support to service users. New documentation is being introduced which should improve practice in this area. More should be done, as recognised by the registered manager, to improve the quality of life for service users living at the home and so that service users are afforded more opportunities to be involved in ordinary living activities. Also, staffing levels must be reviewed and minimum staffing levels maintained so that service users’ lifestyles are not restricted. The home should also employ sufficient staff so that the use of agency staff can be reduced. The home’s complaints procedure should be more accessible to service users so that they are enabled to raise any concerns or complaints should they have occasion to do so. St Anne’s has a comprehensive training programme, but not all staff have received all the training required to ensure that they have the skills and knowledge necessary when providing care to younger adults with a learning disability, some of whom display challenging behaviour. Oxfield Court Nursing Home DS0000001124.V303057.R01.S.doc Version 5.2 Page 7 Service users’ views must be sought as part of a quality audit so that their views underpin the day-to-day running of the home. The findings of any audit must be published and made available to interested parties to inform their view of the service provided. 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.V303057.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.V303057.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Prospective service users’ needs are assessed before they move into the home. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: There have been no new admissions to the home since August 2005. Therefore the Commission were unable to make a full assessment of the home’s assessment process. However, the registered manager explained that before an admission, she and the manager of the relevant bungalow carry out a pre-admission assessment. A community care assessment is also obtained. Before admission, staff may work with the service user in their own home to get to know them and to gain insight into how to support them. Introductory visits to the home are also arranged. The views of existing service users about prospective admissions are sought through observation during pre-admission visits. The placement is kept under review. Relatives are invited to review meetings and can be involved in the care of their relative should they choose to do so. Two service users said they were asked if they wanted to move into the home and were given enough information to help them to make a decision to live there. Oxfield Court Nursing Home DS0000001124.V303057.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Individual care plans for some service users are clear, detailed and current. Where physical intervention may be required, strategies are not adequately clear. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: In response to previous recommendations about care planning, new documentation is being introduced which should help staff to improve consistency with record keeping in this area. Support plans and associated documentation such as risk assessments were inspected for five service users. Generally there was a good level of detail within the support plans and evidence of review. For one service user, about whom the Commission has received a number of notifiable incident forms, there was no clear behaviour management plan in place which would provide sufficient, clear guidance to staff about how to manage the service user’s behaviour. There was contradictory information on two risk assessments relating to this service user’s behaviour. This has been identified at previous Oxfield Court Nursing Home DS0000001124.V303057.R01.S.doc Version 5.2 Page 11 inspections and it is of concern that further work remains necessary to address the issue. Recommendations about support planning documentation are carried forward. The registered manager should address these so that service users and staff are not placed at unnecessary risk. Records of physical intervention were not available for inspection although the registered manager reported having had sight of them. All records must be available for inspection and a requirement about this is made within this report. It was evident from surveys reported that relatives are kept informed of important matters concerning their relative and all were satisfied with the overall care provided. One relative commented that the care is “excellent”. A discussion took place with the registered and deputy manager about the use of advocates for service users. It was said that advocates would become involved if there is an issue but that it was difficult to obtain advocacy services for service users on a general basis. The service provider should look into the provision of independent advocacy/peer support for service users to increase their opportunities for involvement in decision–making. A recommendation about this is made within this report. Oxfield Court Nursing Home DS0000001124.V303057.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Service users’ personal and social needs are at risk of not being met because few opportunities are created to ensure that service users are supported to use community facilities, engage within the community and take part in social and educational opportunities. Quality in this outcome area is poor. This judgement is based on evidence gathered both during and before the visit to this service. EVIDENCE: Service users’ needs in respect of their lifestyle are identified as part of a person centred planning approach and this is positive. On the day of this site visit the weather was warm and sunny and it was pleasing to note that most of the service users had gone out for the day with staff from the home or were at day care. However, as noted from previous inspections more attention should be paid to improving the lifestyle experienced by service users. The registered manager said that she was aware that lifestyle was a management issue across the bungalows and that more could be done to improve the quality of life for service users. This is an issue that should be addressed so that service users are afforded greater opportunities to be involved in ordinary living activities. A requirement about this is carried forward in this report. Oxfield Court Nursing Home DS0000001124.V303057.R01.S.doc Version 5.2 Page 13 The home has four vehicles and service users contribute their mobility allowance towards this. The registered manager explained and it’s clear from previous inspections and from discussion with staff during this site visit that the use of the minibus varies according to staffing levels within the bungalows. From examination of the staffing rota and discussion with staff, it’s evident that there have been occasions when staffing levels have dropped below the agreed minimum levels. This tends to happen during the afternoon/evening. It was also noted from service user surveys that there is a lack of flexibility as to what service users can do during this time. Reduced staffing levels has a direct impact on the amount of time staff can spend with individual service users and, also, the choices and activities available to them. Minimum staffing levels must be maintained and a requirement is made in this report. From records, observation and discussion with staff it was evident that a balanced and varied diet including fresh fruit and vegetables is offered to service users. Culturally appropriate food is also available. A service user confirmed that a choice of foods was available and that the food was enjoyable. Staff offered service users a choice of drinks and kept a service user informed of progress while the drinks were being prepared. Meal times are flexible to suit the needs of individual service users. Oxfield Court Nursing Home DS0000001124.V303057.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Service users receive personal support in the way they prefer and require. Service users’ physical and emotional needs are met. Service users are not fully protected by the home’s practices regarding medicines administration. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The arrangements for health and personal care ensure that service user’s privacy and dignity are respected with the staff being heard to speak to people in respectful ways, and with service users themselves saying that the staff are kind, caring and very patient. Comment cards received by the Commission demonstrate that relatives are happy about the way care and support is provided to people. Care staff confirmed that they are involved in maintaining the personal and oral hygiene of people at the home, and that wherever possible, support people’s own capacity for self-care. This was supported by comments from people at the home such as, “the staff help me when I can’t do something myself.” The manager and staff confirmed that they can access professional Oxfield Court Nursing Home DS0000001124.V303057.R01.S.doc Version 5.2 Page 15 advice about the promotion of independence from not just within the organisation, but externally. The records show involvement from external professionals. There was evidence of health checks being carried out and both GPs and two health and social care professionals reported that staff have a clear understanding of service users’ care needs and that specialist advice is incorporated into the service users’ plan. One sample of medication was audited on three of the bungalows. The registered manager explained that she audits medication on at least a weekly basis. It was positive to note and evident of good practice, that a photograph of the service user was available together with information for staff as to how the service user liked to take their medication and the type of drink preferred. Some stock samples were easily reconciled with records held, but record keeping was not always clear and there were some signature omissions on one medication record. Medication records must be fully completed and clear for audit purposes. A requirement about this is carried forward within this report. The registered manager explained that the homely remedy policy needs reviewing. A recommendation to review the policy is made within this report so that it is clear that the service user consents and the GP is consulted about the administration of homely remedies. Oxfield Court Nursing Home DS0000001124.V303057.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The home’s complaints procedure is not fully accessible to service users. Service users are not always adequately protected from harm. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: No complaints have been received at this home since the last inspection. A complaints procedure is in place. It was evident from surveys received that relatives are aware of the home’s complaints procedure. However, this is not the case for all service users. The introduction of a complaints procedure which is more accessible to service users would be a positive step forward and would afford a vehicle to all service users to raise any complaints should they have occasion to do so. The registered manager explained that the service provider is looking into how the format of the complaints procedure could be made more accessible to service users. A recommendation about this is made within this report. Monthly management visits also provide an opportunity for the home’s management to seek service users’ views about the care and support they receive. However, there is no evidence within reports supplied to the Commission that service users’ views are sought during management visits. This should be addressed so that service users have an opportunity to comment on the service they receive. Oxfield Court Nursing Home DS0000001124.V303057.R01.S.doc Version 5.2 Page 17 Robust procedures are in place for the protection of vulnerable adults. It was evident from discussion with staff that adult protection training is provided and that appropriate action would be taken was any abuse seen or suspected. However, it was not evident from training records seen that all staff have received this training. A requirement about this is made within this report. A physical intervention policy and procedure is available that is in line with Department of Health guidance. However, a number of serious incidents of aggression have taken place in one of the houses whereby staff have been forced to physically intervene with a service user on a number of occasions. As noted under the section on Individual Needs and Choices above, there was contradictory information on the service users’ risk assessment regarding physical intervention. Risk assessments must be clear and a clear and detailed behaviour management plan must be available to staff. This is particularly important given the number of agency staff used by the home to cover staff vacancies. Although staff have received some training on physical intervention, the training was not accredited. The registered manager was aware of this. The service manager informed the Commission that accredited training is being provided for staff from September 2006 onwards. Until all relevant staff have received accredited physical intervention training, a requirement is carried forward within this report. It is positive to note, however, that a healthcare professional who is involved with the service user concerned has provided staff with monitoring charts so that the service user’s behaviour can be recorded. Oxfield Court Nursing Home DS0000001124.V303057.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Service users live in a homely and comfortable environment, but a lack of maintenance in some areas of the home has the potential to place service users at risk. The home is clean and hygienic. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: A limited tour was made of each bungalow including some service users’ bedrooms. The communal and private areas seen were clean, tidy and odour free. Whilst some maintenance work has been completed, there are a number of maintenance issues that are still outstanding. For example, a sample of water temperatures was below the recommended limit of 43 degrees Celsius. A shower gave a reading of 36 degrees Celsius and a bath gave a reading of 39 degrees Celsius. This is too low and must be rectified. Staff explained that there are still problems with the water system and that a water temperature recording system has been introduced but that they were awaiting instruction on how to use this. Oxfield Court Nursing Home DS0000001124.V303057.R01.S.doc Version 5.2 Page 19 On one of the bungalows a toilet seat, which was loose, poses a potential risk to anyone using it and it must be made safe. Also, a hand rail to a toilet in one of the bathrooms had a piece missing and was not sufficiently stable and there is a problem with water drainage to one of the showers. A sink in one shower room is still out of order. One of the toilet fans was excessively noisy. These and other maintenance issues have been outstanding for some time now and remedial action must be taken. A requirement about maintenance issues is made within this report. Hoisting equipment, adapted baths and specialist beds and seating are provided where necessary. Service users who need to use the hoist have their own, labelled slings so that they are not used communally. This is good practice. Oxfield Court Nursing Home DS0000001124.V303057.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Although training is provided, not all staff have received all required training to equip them with the skills and knowledge necessary when providing care to younger adults with a learning disability, some of whom present challenging behaviour. Service users are supported and protected by the home’s recruitment practices. There is not always enough staff on duty to meet service users’ needs in all areas. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The registered manager for Oxfield Court has responsibility for the five bungalows and also manages the on site day service. Each of the bungalows has a home manager with a nursing qualification and a team of support staff. As noted under the Lifestyle section above, there have been occasions when staffing levels have dropped below the agreed minimum levels. This has an impact on service users and on staff’s ability to support service users to meet their lifestyle objectives. Minimum staffing levels must be maintained and a Oxfield Court Nursing Home DS0000001124.V303057.R01.S.doc Version 5.2 Page 21 requirement is made in this report. From the pre-inspection information supplied by the registered manager, there has been high usage of agency staff to cover vacant shifts. Whilst the use of agency staff is sometimes unavoidable, this should not be maintained in the long term as it inevitably impacts on the home’s ability to provide continuity of support to service users. The registered manager also expressed reservations about the use of agency staff to support service users in achieving their goals. Recommendations have been made in previous reports about the need for the service to review staffing levels. A requirement is now made within this report for the service provider to supply the Commission with a staffing calculation that identifies the number of staff necessary to meet the needs of current service users, taking into account service users’ dependency levels. Training records for three members of staff were inspected. The level of recorded information differed across the bungalows. Some documents had not been fully completed and did not, therefore, provide sufficient information about the training received. Mandatory movement and handling training for one member of staff was out of date and refresher training must be provided. Also, one member of staff had not received fire safety training. There was some evidence on two of the files seen of staff having received training in challenging behaviour, although as previously noted the training is not accredited. Documentary evidence of training received by staff must be available. A previous requirement regarding staff training is, therefore, carried forward in this report. The registered provider must ensure that all staff receive all mandatory and recommended training to ensure that they have the skills and knowledge necessary when providing care to younger adults, some of whom may present challenging behaviour. Whilst it is positive to note that National Vocational Qualification (NVQ) training is ongoing at the home, and that twelve members of staff were reported to have completed the training, the minimum of 50 of staff to be qualified to NVQ level 2 or equivalent has not yet been achieved. A previous recommendation regarding this is, therefore, carried forward in this report. During the site visit staff were observed to interact appropriately with service users, explaining what was happening and talking to a service user who was being assisted with transfers. Two service users who commented said that staff ‘usually’ and ‘sometimes’ listened and acted on what they said. Both also commented they were ‘always’ treated well by staff. An agreement is in place between the Commission and St Anne’s Community Services for staff recruitment records to be inspected by one of the Commission’s Provider Relationship Managers. An audit of staff recruitment records was carried out on 12.04.06. Although some recommendations were made around record keeping and guidance documentation, good practice was noted around the recruitment of staff. Oxfield Court Nursing Home DS0000001124.V303057.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Service users live in a home that is managed by an experienced, qualified, registered manager. At present, service users’ views are not obtained as part of a formal quality audit system. Generally, the health, safety and welfare of service users are promoted and protected. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. 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. It was evident from observation that service users were comfortable in Mrs Bermingham’s company. Oxfield Court Nursing Home DS0000001124.V303057.R01.S.doc Version 5.2 Page 23 Mrs Bermingham explained that the home does not have a formal quality assurance system at present but that service users’ views about the service were obtained through person centred planning reviews and that the home’s complaints procedure was also available and any suggestions were welcomed. As noted under the Concerns, Complaints and Protection section above, monthly management visits provide an opportunity for the home’s management to seek service users’ views about the care and support they receive, but there is no evidence within reports supplied to the Commission that service users’ views are sought during such visits. A requirement is made within this report for the views of service users to be sought as part of a quality audit. The findings of any such audit must be published and a copy supplied to the Commission and made available to service users. A requirement is also made, within this report, for copies of monthly reports by the registered provider, required under Regulation 26 of The Care Homes Regulations 2001, to be supplied to the Commission. Evidence was available that accidents and incidents are recorded. The registered manager explained that senior management also monitor the level of accidents at the home. It was of concern to note that one entry in the accident book involved hot water in the shower. As noted under the section on the Environment above, there have been ongoing problems with water temperatures at the home. Where a service user is to be immersed in hot water, whether this is in the bath or the shower, a temperature reading should be taken to ensure it is at a safe level and the reading recorded before the person is immersed in the water. A recommendation about this is made within this report. Records showed that the fire alarm and emergency lighting are checked on a weekly basis. Evidence was also available that equipment is serviced although one item of lifting equipment had not been serviced as required. A requirement is made for an audit to be carried out on all items of lifting equipment to identify those that require servicing and for appropriate action to be taken so that service users are not placed at unnecessary risk. It was evident from records and discussion with staff that fire safety training, including fire drills, takes place so that staff know what to do in the event of a fire. However, records show that not all staff have received fire training or been involved in a fire drill twice each year as required. A requirement about fire safety training is made within this report. Oxfield Court Nursing Home DS0000001124.V303057.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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 2 X Oxfield Court Nursing Home DS0000001124.V303057.R01.S.doc Version 5.2 Page 25 Yes 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 YA18 YA23 YA41 Regulation 15(1)(2)(b)(c)(d) 12(1)(b) Requirement A current individual care plan that includes personal support plans, behaviour management plans and physical intervention plans (where appropriate) must be in place for service users accommodated at the home. This must be kept under review and must be implemented as agreed. (Timescale of 15.04.06 not met). Detailed risk assessments must be in place for all service users. Risk assessments currently in place must be reviewed to ensure they contain sufficient detail. (Timescale of 15.04.06 not met). Risk assessments must be detailed and must not contain contradictory information. The registered person must make arrangements for all service users living at the home to have Timescale for action 25/08/06 2 YA9 YA41 13(4) 25/08/06 3 YA12 YA13 YA14 16(2)(m)(n) 12(1)(b) 31/08/06 Oxfield Court Nursing Home DS0000001124.V303057.R01.S.doc Version 5.2 Page 26 4. YA12 YA13 YA14 18(1)(a) 5. YA20 13(2) 6. YA23 YA32 YA35 13(6), 18(1)(c)(i) 7. YA23 17(1)(a)(b) 8. YA24 YA42 13(4)a 23(2)b c regular access to community activities and recreational and daytime occupation/education opportunities consistent with their interests and wishes. (Timescale of 15.04.06 not met). Sufficient numbers of staff must be employed at the home. At a minimum the staffing notice agreed with the previous regulatory authority must be met. Accurate medication records must be kept in the home. Medication must be administered as prescribed. (Timescale of 31.03.06 not met). All staff must be provided with appropriate training including fire safety, movement and handling, adult protection, health and safety and training specific to challenging behaviour, by an appropriately qualified trainer. 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. (Timescale of 30.04.06 not met). Records of physical intervention must be kept at the care home and be available for inspection when required. The heating and hot water system must be repaired 30/07/06 30/07/06 30/09/06 30/07/06 25/08/06 Oxfield Court Nursing Home DS0000001124.V303057.R01.S.doc Version 5.2 Page 27 9. YA24 to provide sufficient and suitable heat and hot water delivered close to 43 degrees centigrade. (Timescales of 07.01.06 and 15.04.06 not met). 16(2)(c)23(3)(b)(c) The registered person must ensure that the care home is kept in a good state of repair therefore, outstanding maintenance issues must be addressed. (Timescale of 15.04.06 not met). 25/08/06 10. YA29 YA42 13(4)(a)23(2)(c) 11. YA33 18(1)(a) Adequate furniture and other furnishings as detailed in regulation 16(2)(c) must be provided. Therefore: unsafe furniture in a service user’s bedroom must be repaired or replaced. (This element was not assessed on this occasion but will be followed up at a future visit). Grab rails identified as 15/08/06 being unstable must be repaired or replaced. (Timescales of 31.12.05 and 31.03.06 unmet). The registered person shall 30/07/06 having regard to the size of the care home, the statement of purpose and the number and needs of service users (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users, therefore, a staffing calculation must be Version 5.2 Page 28 Oxfield Court Nursing Home DS0000001124.V303057.R01.S.doc 12. YA39 24(3) 13. YA41 26(2) 14. YA42 13(5) provided to the Commission that identifies the number of staff necessary to meet the needs of current service users, taking into account service users’ dependency needs. Service users’ views must 30/09/06 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. Following a visit to the 30/08/06 home by the registered provider under regulation 26, a copy of the report must be supplied to the Commission. An audit must be carried 25/08/06 out on all items of lifting equipment to identify those that require servicing and where appropriate the equipment must be serviced so that service users are not placed at unnecessary risk. Oxfield Court Nursing Home DS0000001124.V303057.R01.S.doc Version 5.2 Page 29 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 YA8 Good Practice Recommendations The planning tools used should be standardised across the service and detailed plans should be available for each individual service user. The service provider should look into the provision of independent advocacy/peer support for service users to increase their opportunities for involvement in decision– making. 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. The format of the home’s complaints procedure should be made more accessible to service users. The home’s monthly management visit reports should evidence that service users’ views about the service have been sought. A review of staffing levels should be conducted and necessary adjustments made to ensure that service users needs are met in all areas and service users are enabled to access community based activities more frequently. The registered person should continue working towards 50 of all care staff achieving NVQ level 2 or above. Where a service user is to be immersed in hot water, whether this be in the bath or the shower, a temperature reading should be taken to ensure it is at a safe level and the reading recorded before the person is immersed in the water. 3. 4. 5. 6. YA20 YA22 YA41 YA33 7. 8. YA32 YA42 Oxfield Court Nursing Home DS0000001124.V303057.R01.S.doc Version 5.2 Page 30 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.V303057.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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