Inspection on 17/06/05 for Oak Tree Court

This inspection was carried out on 17th June 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Oak Tree Court 10/02/10

Oak Tree Court 24/07/09

Oak Tree Court 05/07/07

Oak Tree Court 29/06/06

Oak Tree Court 01/11/05

Oak Tree Court 16/12/04

Oak Tree Court 22/06/04

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE Robins Close Nursing Home Middle Green Road Wellington Somerset TA21 9NS Lead Inspector Barbara Ludlow Unannounced 17 June 2005 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 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 Older People. 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. Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Robins Close Nursing Home Address Middle Green Road Wellington Somerset TA21 9NS 01823 662032 01823 665010 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Majestic Number One Limited Care Home with Nursing 61 Category(ies) of Old Age registration, with number Physical Disability of places Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 35 places for elderly persons of either sex, not less than 60 years, who require general nursing care. 2. Up to four persons of either sex, between the age range of 50 - 59 years, who require general nursing care. 3. To include up to 31 beds for personal care. 4. Registered for a total of 61 places in Categories PD(e) and OP. 5. The manager must commence a Registered Managers training within 6 months and achieve a relevant Managers qualification by 2005. Date of last inspection 16 December 2004 Brief Description of the Service: Robins Close has been part of Majestic Number One since September 2001. The home offers nursing and residential care. The Deputy is currently the Acting Manager. The Home is situated in the countryside on the outskirts of Wellington, surrounded by lawn and gardens, the home is well presented and has ample parking. The home accommodates up to 61 service users in total. Thirty nursing places are provided. Where nursing is provided the corridors are spacious and wheelchair users can be accommodated. There is a large passenger lift between floors. The facilities for functions and some activities are in the older part of the house previously known as the residential unit. The home has been suitably adapted to provide general nursing care and personal care for an elderly client group. The home is adequately equipped and adjustable beds are provided in the nursing wing. There is a registered nurse on duty at all times. A refurbishment programme has been undertaken and the communal rooms have been attractively finished. A new kitchen has been installed and is run by an outside catering company. Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken by two inspectors for CSCI as part of the planned annual programme. The Deputising Manager (current Deputy) was on duty and made herself available throughout the inspection period. This was a positive inspection and progress was noted with both the observed care practices and the general cleanliness of the home. The staff were seen and spoken with throughout the day and all were helpful and positive. A tour of the premises was made. Service users were seen during the tour of the premises and in the communal areas at mealtimes. Records required were presented for inspection and care plans were reviewed. Service users were asked for their feedback on the care and the service they receive at the home. Feedback is valued and comments are incorporated into this inspection report. One of the Company Directors came to the home late in the afternoon, giving her time to receive feedback with the Deputising Manager and to update the inspectors with the ongoing development plans for the home. What the service does well: This care home is situated in the countryside and has a pleasant rural outlook and attractive grounds; access to the grounds has been improved for the benefit of the service users. The home is well presented and provides spacious accommodation on the nursing wing. There is ongoing investment in the redecoration and refurbishment of communal and individual accommodation. The home has been suitably adapted for purpose in the older wing for residential care and has a purpose built nursing wing. The home has sufficient staff and provides an adequate level of staffing. Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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. Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5. NMS 6 does not apply The home provides sufficient service user information to enable prospective and new service users and their carers or families to make an informed choice and decision about this care home. EVIDENCE: The home has a Statement of Purpose and Service Users Guide and encourages visits to the home and contractually the first month is considered the trial period. Examples in care plans of detailed pre-admission assessments were seen. The home has pressure relieving equipment and hoists; further manual handling equipment has been purchased. General nursing and residential care needs can be met at the home. Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The home could use the pre-admission information to more effect when planning care. Medication management requires some attention to practice. Nursing or frail service users residing on the residential wing must receive adequate supervision and care to meet their needs. EVIDENCE: Photographic identification was missing from one new care plan. Photographs on the care plans would personalise and assist staff especially where the service user is new to the home. Information gathered at the pre-admission stage could be used more effectively, for example, where a service users next of kin is not explicit. Service users had medication for self-administration that was not clearly risk assessed and documented. Medication receipts were not all signed for. Hand transcribed entries did not all have two signatures for checking. Medications that were recorded for administration ‘as required’ had no indication for Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 10 administration documented. One person had gaps in medication administration and on another drug written instructions that had not been carried out as documented. Where a pulse rate is recorded before administration of a medication, the lowest level indicated before medication is omitted should be recorded. Evidence was seen where a decision had been taken without this guidance for a service user receiving personal care only. The Acting Manager must review medication administration across the whole home to ensure consistent and good practice is carried out and is maintained. Service users were addressed appropriately and observed interactions between service users and staff were kindly and respectful. Particularly good communication prior to manual handling manoeuvres was witnessed between a member of the care staff and a service user. One person receiving nursing care on the residential wing was identified as not receiving checks as frequently as needed. The evidence was shown to the Acting Manager; fluids and turns charts demonstrated some overlong gaps between visits by staff. It is necessary for the allocated care and nursing staff to closely monitor the more dependent service users who may have nursing needs, or about to become nursing service users, who reside on the residential wing, as frequently as those residing on the nursing wing. The Acting Manager agreed to attend to this urgently. Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14,15 Service users at the home are fairly well catered for, activities are organised at the home. EVIDENCE: A church service was held in the lounge during the inspection, eight service users attended this. A varied programme of activities is organised and is led by the activities coordinator. Service users are able to choose where they spend their time and have those who are able can use the grounds independently. Service users were seen at lunchtime, the nursing wing’s dining room has been rearranged since the last inspection to improve access. The ground floor dining rooms were well managed and service users were observed spending lunchtime together. Meals can be taken in the privacy of the service users room, if they choose; some service users had made this choice. Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18. Service users are protected from abuse by the home’s practices, policies and procedures. EVIDENCE: The home has a complaints procedure and a whistle blowing procedure in place. Three complaints had been received at the home and had been investigated and dealt with appropriately. Service users were enabled to vote at the recent general election. Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 The environment was clean and well maintained. A programme of refurbishment is ongoing. EVIDENCE: A tour of the premises was made and the majority of the bedrooms were sampled. Some carpets were identified as needing further cleansing or replacement due to staining. It was confirmed that these are due to be replaced, as the company had recently carried out a room audit. Hard floor covering in two rooms is also due for replacement. Redecoration of some bedrooms has been identified by the management and will be carried out. Bedrooms had been personalised and provided comfortable accommodation. The bedrooms on the residential wing are smaller than the nursing bedrooms. Care must be taken if service users needs increase to ensure that their care needs can be met in these rooms. Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 14 Aids and adaptations are sufficient to meet the general personal and nursing care needs of the service users at Robins Close. The Acting Manager confirmed that there are sufficient manual handling hoists and new equipment such as handling belts have recently been purchased. Pressure relieving equipment was identified in care plans and was seen in use. Bed rails are risk assessed and checked; one set was identified for adjustment, these were brought to the attention of the home’s Acting Manager at the inspection. A wardrobe was identified that had come away from the wall this was identified for re-securing to the wall; others should be checked to ensure the safety of the service users. Infection control standards were good; staff hand washing facilities were available. Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 On the day of the inspection there were sufficient staff on duty and the duty rota demonstrated home is adequately staffed. Staff receive training to enable them to carry out their duties safely. Recruitment, induction and supervision procedures are robust and promote safe practice. EVIDENCE: On the day of the inspection there was an adequate staff number and skill mix on duty at the home. Staff receive training and a system has been devised to record training given for individual staff members. A copy of the inspection week’s duty rota was requested and was sent to CSCI after the inspection. This confirmed that the home adheres to previous Somerset Health Authority and Somerset County Council guidance relating to staffing levels. There is a registered nurse on duty 24 hours a day. Staff personnel files were sampled for new starters. Eight files were examined in detail. There had been start dates that were dated before POVA First had been received; faxed duty rotas were sent to CSCI to demonstrate that these staff had not commenced work until their clearance had been obtained. All other aspects of recruitment were clear and satisfactory at the time of the inspection. Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 16 Staff training records were forwarded to CSCI to evidence staff receiving manual handling training. New staff receive induction training and supervision. Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,37,38 The home was being well managed by the Deputy Manager who is open and approachable in her management style. All records were safely stored and managed appropriately. Policies and procedures are in place to protect service users from harm and staff from risks to their health and safety. EVIDENCE: The home’s deputy was Acting Manager at the time of this inspection. It was clear from the achievements that have been made and the staff and service user feedback that she was carrying out her duties effectively. Maintenance records were examined and were up to date. Assisted baths were serviced in April 05, the sit on scales in February 05, adjustable beds June 05, Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 18 bed rail fitment June 05. The fire equipment and alarms had been serviced, in June 05 and regular fire drills were logged for March, May and June 05. The hot water delivery temperatures were checked in June 05. Accident records had been completed. One wardrobe that was not secured was identified for re-securing; others should be checked to ensure they are all safe. One set of bedrails required review, as the rails were not evenly adjusted. Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x x 3 x x x 3 2 Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 20 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 7 Regulation 15(1) Requirement The registered person must ensure that all photo identification and pre-admission information is incoprporated into care plan. The registered person must ensure that clear directions are in place to support the supervision and support of service users with incerased/nursing needs who are accomodated on the residential unit. The registered person must ensure that sysytems for medication amangement are reviewed to take account of all the issues raised in this report. The identified bed rail requires review to ensure that it is fitted correctly. The identified wardrobed must be secured to the wall. Timescale for action 30.07.05 2. 8 12(1)(a) 30.07.05 3. 9 13(2) 30.7.05 4. 38 13(4) on receipt of report RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 21 No. 1. Refer to Standard Good Practice Recommendations Robins Close Nursing Home D53 - D02 S3284 Robins Close Nursing Home V223769 170605 stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL 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. 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