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Inspection on 31/10/07 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 31st October 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 6 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

People are supported well to maintain family relationships. People are well supported in meeting their health care needs and medication is managed satisfactorily. Permanent staff are well trained and recruitment and induction of new staff is good.

What has improved since the last inspection?

Staff have had training in positive behaviour management. Risk assessments have been put in place for individuals. Each person now has a care plan. The programme of redecoration has made improvements to the environment of the home. People living at Oxfield Court are being included in the next quality survey.

What the care home could do better:

The process for admission is limited and not sufficiently well focused on the individual. Individual needs and choices and aspirations are limited by the service. People living there do not own their person centred plans. People who live at Oxfield Court have limited opportunities to live their chosen lifestyle. Some areas of personal support for people should be improved through a better staff attitude towards individuals. The service does not listen well to people living there and their welfare is not always protected by the way the service operates. The environment is improving but there is much still to do particularly in terms of water temperatures for bathing. There is too much reliance on agency and bank staff, which could compromise the welfare of people living at Oxfield Court. The management of the home is weak and needs to make improvements in monitoring quality and improving leadership at the home. Vigilance is needed in Health and Safety matters to make sure hazards are minimised.

CARE HOME ADULTS 18-65 Oxfield Court Nursing Home Oxfield Court Albany Road Dalton Huddersfield West Yorkshire HD5 9UZ Lead Inspector Cathy Howarth Unannounced Inspection 31 October 2007 10:00 Oxfield Court Nursing Home DS0000001124.V343870.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.V343870.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.V343870.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 norfolkroad@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.V343870.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd March 2007 Brief Description of the Service: Oxfield Court, which is operated by St Anne’s Community Services, is registered to provide nursing and personal care and accommodation for up to twenty-eight, male and female, adults with a learning disability. Oxfield Court is a complex of five purpose-built, brick bungalows situated in a quiet cul-de-sac. Bedrooms are for single occupation and have a wash-hand basin with toilet facilities 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 there is an acting site co-ordinator who manages the overall site. A day centre, which is also managed by the manager, is on the same site. The Commission was informed by the manager that the standard charge to individuals ranges from £431 to £469 per week. Additional charges are made for hairdressing, toiletries, and chiropody aromatherapy, hydrotherapy and transport. Information about the home, including the latest Commission for Social Care Inspection report, is available from the home. Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out using information supplied by the registered manager in the form of a self assessment, surveys returned from people living at Oxfield Court and their relatives and professionals involved with people living there. Staff working at the home were also sent surveys to elicit their views about how well the home performs. The inspection included a visit to the home by two inspectors who visited each bungalow and looked around, spoke with people living there and staff and observed practice. A sample of records relating to people living in the bungalows was also seen. Feedback was given to the acting manager two days after the site visit. The inspectors would like to thank all involved with this inspection for their assistance and welcome. What the service does well: What has improved since the last inspection? Staff have had training in positive behaviour management. Risk assessments have been put in place for individuals. Each person now has a care plan. The programme of redecoration has made improvements to the environment of the home. People living at Oxfield Court are being included in the next quality survey. Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, and 4 People using the service experience poor outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The process for admission is limited and not sufficiently well focused on the individual. EVIDENCE: The files for two people who have moved into Oxfield court in the last six months were seen. In both cases assessments had been done and in one case the process for admission appeared to have been carried out in a sensitive way. For the other there was little information about how this had occurred and the person in question said she had not been given information, nor had she really made an active choice to come and live at Oxfield Court. She said “they just brought me here.” The assessment did not really indicate a need for nursing care as such although there was a clear need for 24 hours support. Information from the home manager indicates that the person was supposed to have had a planned transition with several visits but only one occurred. The individual apparently did not like the placement and did not want to visit. No admission plan was seen and there are no records of any planned visits. Staff have said that the person was supposed to come with support workers who would stay and help her settle in for the first week. The inspector spoke with the team manager responsible for those staff, who said that this was not possible due to how funding was arranged. Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 9 The home manager reported that the person arrived with few personal effects and all new clothing, which upset her greatly. The person in question continues to be unhappy in this placement and all parties involved have indicated that they were aware of this, but at the time Oxfield Court was the only available placement. Following admission, the home has been slow to develop plans for this individual and although a PCP meeting has been held in September, there were few indications that this individual’s interests and aspirations are being supported at Oxfield Court. For example her daily activities do not appear on the weekly activity board in the office along with other people’s. The other person admitted, in July 2007, had a better admission process but again staff have been slow in developing some plans, for example the OK health check was not completed until October. Oxfield Court Nursing Home DS0000001124.V343870.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): 6,7,8 and 9 People using the service experience adequate outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. Individual needs and choices and aspirations are limited by the service. EVIDENCE: Many of the people living at Oxfield Court have lived there for some time and are well known to the permanent staff that work there. Needs in relation to physical well being and nursing are well documented. Inspectors found on this visit that some good work has been done on Person Centred Plans (PCPs) but very little evidence was seen of how people are involved with developing their plan. Also the plans are written up in words with no pictures or photographs. This gives the impression that there is little or no expectation of ownership of these by individuals. One manager was asked about the process for this and indicated that there was little involvement directly by the person concerned and little expectation of this. Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 11 On several people’s files their goals for the year were somewhat limited and unimaginative. For example one person was going to buy a full-length mirror to improve their self-esteem, without any further indication of how this was going to occur or be supported by staff. Another person’s said they would carry on going to the Day Centre three days a week. Even where specific goals have been set that may be helpful often they have not been acted upon. One person’s goals from the their review meeting in August included the development of a photo communication book. No work had been started on this and the manager said the key worker had planned to get a digital camera at Christmas in order to achieve this. It is not acceptable for there to be such a delay in supporting something as important as communication, particularly as this individual has some history of challenging behaviour associated with frustration. For one person who is a Muslim, goals included having a halal diet and celebrating cultural festivals. The notes revealed that although it was Eid recently there was no in house celebration of this, the person visited family for celebrations there. Although this person needs a halal diet, the menu records show that this is only really provided on average about once a week. The majority of meals are fish in sauce and cheese sandwiches with some Quorn meals on occasions. When halal meals are provided, they are take-aways bought in from a local shop, not freshly prepared food. One person’s moving and handling plan was examined after inspectors observing a transfer from wheelchair to lounge chair. This plan was contradictory on the one hand instructing staff to encourage the person to stand before moving into the chair and another instruction to use a hoist for all transfers. The person is clearly at risk of injury because of a propensity to lunge for the chair. When asked staff confirmed that this was the person’s normal method of transfer. The acting manager indicated that staff wish this person to remain independent as far as possible by transferring himself. The moving and handling plan needs to be reviewed and clear instructions given for staff in order to keep this person safe and staff must be clear in which circumstances a hoist should be used. A requirement has been made in relation to this. There have been some improvements in the home in relation to the development of behaviour management plans for individuals, where these were lacking on previous inspections. There is evidence that the system for ensuring that reviews or Person Centred Planning meetings take place has improved. Most people have had a meeting and the outcomes for the meetings were found on individual files. As mentioned above however the ownership and involvement of people in these and achievement of goals needs to be improved. Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 12 There is little evidence of people being involved in decision-making about how the bungalows operate. There is no official forum for this to occur and discussions with managers indicated that there is little expectation of this from the majority of individuals. It is an area for improvement. Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 13 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, 14, 15, 16 and 17 People using the service experience poor outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. People who live at Oxfield Court have limited opportunities to live their chosen lifestyle, but contacts with families are good. EVIDENCE: On this visit inspectors noted that throughout the bungalows there was generally a very low level of activity. Most people do have some kind of day activity for some parts of the week. However some individuals have no regular day activity. In the bungalows most of the activity appeared to be task based around meals and personal needs. There were some exceptions; in No 6 two people had been out for a short walk with carers and in No 2 one key worker had gone Christmas shopping with one person and their relative. One person was seen knitting and another spent some time in a sensory room. However staff reported that they often do not have time to spend in activities Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 14 in house with people because they are too busy on tasks they have to do. For some individuals the low level of activity was the cause of some concern. One person in No 6 has a plan that says he will go out twice a week and have 1:1 time in house twice a week. Although it was noted that staff had documented when staffing levels are low the outings had has not occurred. When he does go out it is mainly out for a drive. The home manager said he just likes drives and behaves badly when out in places e.g. on a trip out for lunch lately would not sit down and eat. However it was noted that he spent almost all the time inspectors were present pacing around corridors and going into other people’s bedrooms. There are no locks on bedrooms doors to prevent this, despite it being a long-standing problem. There is no plan for developing his skills in being in the community. This severely limits his choices for participation and occupation and should be part of his Person Centred Plan goals. Another person in No 8 only went out 4 times between 29/9 and 31/10 one of these was for a drive. She is supposed to go to hydrotherapy once a month; this was not recorded for last month. Her goals say to maintain and develop friendships with people of similar ability and interests. It is difficult to see how this will occur if she does not leave the bungalow. One issue relating to activity levels is availability of transport. The home has the use of several vehicles, minibuses and adapted Kangoo. However there are problems with availability of drivers and some staff do not like driving the minibuses and the fact that the vehicles are often unavailable for use because they have been booked out by other bungalows. Drivers do not work weekends when additional vehicles are also available and most people are at home and might want to go out for the day. Public transport is rarely used, but some individuals do use taxis sometimes when other transport is not available. The Access bus is not used. Where some people have a little more ability to be independent it is hard to see how this is promoted. One person newly admitted who is able but reluctant to do activity has no clear plan of guidance for staff of how their skills may be developed. For example the person was sitting next to a CD player but unable to operate it to put the music on that he wanted. Staff could be helping him to develop these skills to improve his independence and self-reliance. The home manager indicated that she was aware of the problem but said staff needed to develop their skills in approaching the individual as they simply left him if he refused as he has a history of becoming aggressive. Contacts with families are good, and feedback from them is positive from surveys. Relatives have confidence in staff to keep people safe and look after them physically. They also report that generally staff are good at keeping Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 15 them informed of any issues such as health problems. There was evidence that relatives and visitors are made welcome at the home. All bungalows shop for food locally and there was some evidence of people living there being involved in shopping. Some menus appeared repetitive, with sandwiches and crisps being repeated for tea on a regular basis such as on No 8. As mentioned in the previous section the provision of halal food for one person is weak. In No10 the fish tank was so dirty the fish could not be seen. If this is to relax and entertain people then the fish should be visible. Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People using the service experience adequate outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. Health care needs are met well and medication is managed satisfactorily. However some areas of personal support for people should be improved. EVIDENCE: Health care for individuals living at Oxfield Court is generally good. People’s health needs, particularly where these are complex, such as physical dependency and assistance with feeding is required. One person has recently stopped having food orally and staff have risen to the challenge of tube feeding well. Relatives report that they have found responses when people have been unwell to be prompt and efficient. The home has started using the Boots Monitored Dose System (MDS) for medication and the sample of medication seen by inspectors showed that this system was working well and being audited. There were protocols in place for medicines that are to be taken ‘as required’. However where this is part of Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 17 behaviour management, staff should record the whole process in daily notes. e.g. in one case .a person on No 6 was given as required medication as part of their behaviour management plan when they had a series of incidents but form the notes it was unclear that other strategies were used first before medication was given. For a new admission, the health care planning documents have been slow to get completed. However, there were notes on file of their health needs from their original assessment, and there was evidence that these had been acted upon. The main area for concern in this outcome area was in terms of personal support for people. Inspectors observed some poor practice in relation to individuals. For example staff moving one person who uses a wheelchair and has low vision, without warning them first. Staff were also observed assisting people with feeding without speaking to them. There was also some inappropriate language such as “has she been done yet?” in relation to helping someone with toileting needs. Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience poor outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The service does not listen well to people living there and their welfare is not always protected by the way the service operates. EVIDENCE: There is a complaints procedure for people living at Oxfield Court to use but this is not user-friendly and there was little evidence of it being used. No complaints have been recorded in any of the bungalows. Many of the people living there would find it difficult to use such a process without support but those that are able to voice their feelings and opinions are not provided with any other forum for this on site either. There is currently no system of meetings for people to raise their concerns or to be consulted about decisions to be made in the running of the home. Since the last inspection staff have received some training in relation to managing challenging behaviour of some people within the service. This is positive, but staff skills clearly need to be improved both in relation to preventing behaviour through engagement of people in meaningful activity and in recording as stated in the previous section regarding the use of ‘as required’ medication. St Anne’s have introduced a Positive Behaviour Management Group to help address management of individuals within the services. Staff are making Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 19 referrals to this group in order to get the support they need to learn skills to address these issues. This is a positive step forward. One area that needs to be improved is in reporting incidents of aggression between people living at Oxfield Court. People need protection and should not be subject to physical aggression within their own home. Local safeguarding referrals need to be made so that commissioners are aware of this and can act accordingly. Staff have received training in Protection of Vulnerable Adults. Finances for some individuals were sampled at this visit. The accounting for individuals was found to be satisfactory. However the inspectors had some concerns about finances. Each person living at Oxfield Court pays £19 per week for use of the site transport. However not all people get a fair use of this. For example the individual cited earlier who only went out 4 times in a month, effectively paid £19 per trip. Certain other individuals were likewise seen to be having a relatively low use of the transport. On one person’s finances record there were examples of them having to pay for taxis to go out in addition to the weekly transport charge when the transport was not available. There is an “opt out” for people if they decide not to use the transport but in reality there is no mechanism for checking this and supporting people to make such a decision. Inspectors have required that the use is monitored for a period of three months to identify if some individuals might be better off making their own arrangements and refer them to a relative or advocate to support them to make such a decision. There was also an issue about people being asked to pay for basic furniture items that should be provided by St Anne’s as part of the contract. For example it was suggested that one person would be asked to provide a coffee table in the lounge for him to put his drinks on. At the time of this inspection he was using a dining chair with a chopping board on it as there was no table available. Another person had had to buy a chair, which was needed as part of a behaviour management plan. These items should be purchased by the service rather than charged to individuals. It was also noted that receipts showed that for one person Boots Advantage points had been collected on a purchase. The person in question did not have a card themselves and it was unclear who had collected the points. This is poor practice and should cease. Since the last inspection there have been a small number of reported thefts/missing items of value. This has been investigated without any conclusive evidence being found. There was some suggestion that agency staff may have been involved. The high use of staff who are not known to the service may increase the likelihood of this kind of problem. A requirement has Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 20 been made in respect of use of agency staffing at the home. Staff have not had training in understanding the implications of the Mental Capacity Act 2005. This is extremely relevant for this service and staff should be clear of their duties under the Act to make it clear how decisions have been made. For example around consent for treatment or financial decisions Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 21 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): People using the service experience adequate outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The environment is improving but there is much still to do particularly in terms of water temperatures for bathing. EVIDENCE: Since the last inspection there have been some improvements in the environment in most of the bungalows. A number of bedrooms have been redecorated to people’s individual choices. There is still a considerable amount of redecoration to be done especially in corridors and bathrooms. However there is a plan for this and a rolling programme of redecoration is underway. Details of areas highlighted by inspectors were shared with the manager at feedback. Most communal areas were adequate in terms of décor; the lounge in No 4 needs to be redecorated however. Some of the inadequacies in the environment can be addressed easily with a little attention from staff and only a small outlay of money. For example Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 22 handwritten ‘post it’ notes on bedroom doors indicating whose room it is look scruffy and are unlikely to assist people living there to locate their own rooms. Photos, large print notices in bright colours or objects of reference would be more useful. One person was seen using a dining chair with a chopping board on it as a coffee table. This was potentially dangerous as well as sad. Inspectors found throughout the home, problems with water temperatures. These were mainly too low for people to enjoy a comfortable bath. One shower in No 8, had temperatures recordings as low as 31°C. Most of the baths temperatures recorded in all the bungalows were around 38/39°C. The problem of low water temperatures was outlined in the last inspection report and has not improved. This needs to be addressed without a delay and a requirement is made in this respect from this visit. Most areas were found to be generally clean and tidy and laundry facilities were good. Where it is needed equipment needed to help people move is provided, such as ceiling tracking in lounges and bedrooms. Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 23 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 and 35 People using the service experience adequate outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. Permanent staff are well trained and recruitment and induction of new staff is good. However there is too much reliance on agency and bank staff, which could compromise the welfare of people living at Oxfield Court. EVIDENCE: St Anne’s recruitment process is generally thorough and new staff spoken to on the day of this visit confirmed that the process covered all the required checks. Details of those checks are kept at Head Office and have been checked by a Commission for Social Care Inspection officer and found to be good. New staff confirmed that they have had a thorough induction and one person said she had felt that she received a good level of support from her manager and team when starting in her new role. Staff surveys also confirmed this. On going training for staff, provided by St. Anne’s is good. Recently staff have had updates in basic courses and this is being managed well. Also training Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 24 has been provided around positive behaviour management as recommended at the last inspection, to help staff deal with some of the difficult behaviours they are faced with from individuals living at Oxfield Court. This is a positive step. The registered manager confirmed in the self-assessment that the percentage of staff with NVQ level 2 or equivalent is now at 27 . The home needs to continue progress towards the 50 recommended in the National Minimum Standards. The home unfortunately continues to rely heavily on bank and agency staff to cover rotas. This was identified as a problem in the last report. The registered manager confirmed in the self assessment that in a three month period leading up to completion of the self assessment, 465 nursing shifts had been covered by agency or bank staff. This is very high and needs to be addressed in order to help improve the quality of consistent care experienced by people living at Oxfield Court. The acting manager confirmed that every effort is made to use consistent agency staff wherever possible. On the day of this visit inspectors noted that one bungalow was covered by an agency worker and a staff member from another bungalow, neither of whom knew the individuals living there very well. A requirement is made in respect of this matter. On the day of this visit it was noted that staffing levels on all bungalows was adequate. There is a striking gender imbalance in the staff team. The self-assessment document showed that there were 58 female and 2 male staff working at the home. The document also indicated that of the 28 people living at Oxfield Court 16 are male. It would be desirable for more male carers to be recruited in order to offer a choice for males of having their personal care given by male staff. Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 25 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): People using the service experience poor outcomes in this area. This judgement has been made using a range of available evidence including a visit to this service. The management of the home is weak and needs to make improvements in monitoring quality and improving leadership at the home. Health and Safety matters are adequately managed at present overall. EVIDENCE: The registered manager for the home is currently taking a 6-month secondment to another service. The manager had also been off sick for a lengthy period earlier this year. This has meant that the home has lacked consistent management for some time. The role is now being covered by an acting manager who had been in post for two weeks at the time of this visit. There is a clear need to address issues of staff morale and culture as evidenced by some of the issues highlighted earlier in this report. The acting Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 26 manager demonstrated an awareness of these issues and agreed that he has some priority areas such as the use of agency staff on his agenda for early resolution. The registered provider has made arrangements to carry out monthly visits as required and these are sent to the Commission for Social Care Inspection. They do not highlight some of the issues raised in this report and therefore it might be useful to review the effectiveness of these reports in informing management of the quality of the service. One of the improvements that is needed is in getting people who live at Oxfield Court’s views about the service. There is no forum for this on a regular basis at present as noted earlier in this report. The service does carry out annual stakeholder surveys but this process was not completed at the time of this visit. The acting manager said that people using the service would be part of this survey as required at the last inspection Health and Safety issues were generally found to be managed effectively. There have been some problems with the fire system in past months but this appears to have been resolved and was managed effectively by staff within the home to minimise risks. On this visit there were a few unsafe practices seen, for example in No 6 a sharps box in bathroom containing syringes was accessible to people living there, staff were asked to remove this. There was also a key left in the lock of the cupboard containing cleaning materials, and clinical waste was left in an open bin in a toilet on No 10. Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 27 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 2 3 X 4 1 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X 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 3 33 2 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 2 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 2 X 1 X X 2 X Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO 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 YA4 Regulation 12(2)(3) Timescale for action The registered provider must ensure 30/11/07 that people admitted to the home have been offered real choices, through a process of introduction that means they have had a good opportunity to make their choice an informed one. People living at Oxfield Court should 31/12/07 be supported to make decisions about their lives and to have ownership of those decisions. Appropriate moving and handling 30/11/07 plans must be in place for each person who may require assistance to minimise risks to those people. Support must always be provided to 14/11/07 people living at Oxfield Court in a way that respects their dignity. The registered person must set up a 30/11/07 system to ensure that the usage of transport is equitable and monitored so that some people are not at risk of being financially abused by the current system. The home must provide sufficient 31/12/07 staff who are familiar with people living there in order to provide consistent care for them. Requirement 2 YA7 12(2) 3 YA9 13 (5) 4 5 YA18 YA23 12(4) 13(6) 6 YA33 18(1) Oxfield Court Nursing Home DS0000001124.V343870.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. Refer to Standard YA8 Good Practice Recommendations 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. Some people living at Oxfield Court should have more opportunities to participate in local community life. There should be more opportunities for leisure activities for people living at Oxfield Court particularly within the bungalows. People’s individual space should be protected by locks on doors if necessary. There should be better processes in place for listening to people’s views and encouraging participation in decisionmaking in the home. 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. 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. Improvements in the environment outlined to the manager from this inspection should be addressed within the home to continue to improve the living environment for people living there; namely: • In No 2 TV aerial needed in bedroom for person who is spending a lot of time in their room. • In No 2 Toilet needs new seat and redecoration • In No 10 Toilet was dirty and needs redecoration. • In No 4 Lounge needs redecoration. • Stained and soiled carpets in each bungalow need cleaning or replacement. 3 3 4 6. 7. YA13 YA14 YA16 YA22 YA22 8 YA24 9 YA24 Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 30 10 YA32 The registered person should continue working towards 50 of all care staff achieving NVQ level 2 or above so that service users are in safe hands. It would be desirable for more male staff to be recruited in order to offer greater choice to people living there if they wish it, to have their personal care assisted by male staff as well as female. The home should have a consistent manager to lead improvements in the service. The organisation should seek to improve its quality monitoring systems within the home. Staff and managers need to be vigilant about hazards to people’s safety within the home. 11 YA33 12 13 14 YA37 YA39 YA42 Oxfield Court Nursing Home DS0000001124.V343870.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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