Inspection on 08/11/05 for Tall Oaks Nursing Home

This inspection was carried out on 8th November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Tall Oaks Nursing Home 28/06/06

Tall Oaks Nursing Home 28/04/05

Tall Oaks Nursing Home 30/11/04

Tall Oaks Nursing Home 23/06/04

Tall Oaks Nursing Home 13/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Tall Oaks Nursing Home Charles Street Biddulph Stoke-on-trent Staffordshire ST8 6JD Lead Inspector Mr Peter Dawson Unannounced Inspection 8th November 2005 04:00 X10015.doc Version 1.40 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 Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 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 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. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Tall Oaks Nursing Home Address Charles Street Biddulph Stoke-on-trent Staffordshire ST8 6JD 01782 518055 01782 511772 tall/oaks@craegmoor.co.uk 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) Speciality Care (Rest Homes) Limited Craegmoor Healthcare Care Home 55 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (55), of places Physical disability over 65 years of age (55) Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd June 2005 Brief Description of the Service: Tall Oaks is a care home providing personal care including nursing care for up to 55 elderly service users. This includes care for up to 3 people with dementia and care for elderly service users with physical disabilities. The home is owned by a company – Speciality Care (R.E.I.T. Homes) Ltd – Craegmoor Healthcare. The home is located on the outskirts of the town of Biddulph in North Staffordshire. It is located close a short walking distance from the town centre where there are choice of shops, public houses, banks, churches and all community facilities. The home was purpose built several years ago. Accommodation is on 2 floors, there is a passenger lift. There are ample parking facilities and gardens are accessible from the home and includes wheelchair access. There are mainly single bedrooms and 6 shared rooms, most of which are used as single rooms. There are no en-suite facilities in the home. There is a large split lounge/dining area on the ground floor and smaller lounge on the first floor. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. At the time of this unannounced inspection there were 47 people in residence, including one person on respite care and one in hospital. - 28 people were receiving nursing care 19 were not. There is no Registered Manager in the home and an urgent application is required to remedy this. The person presently running the home has been doing so for the past 2 years and has previous experience as a Registered Manager. The 10 care staff on duty were seen and most spoken to. Additionally there were conversations with domestic support and laundry staff. All staff seemed relaxed and spoke openly about their work, showing interest and enthusiasm. There was an inspection of the environment, including all communal areas and a sample of bedrooms. A large proportion of residents were seen and about 10 spoken to. They all stated that they were happy with the care provided at Tall Oaks and had no complaints. All were asked about staff attitudes and care and all spoke with warmth and positively about the care they received and their relationships with staff. Three visitors were seen and spoken to one who also has some care experience stated she was more than happy with the reception her father had received when transferred in difficult circumstances from another nursing home. She said her father had settled well, that staff were attentive to need and that the family were involved in care planning and kept informed of any changes in his needs and care. She stated that the family were entirely satisfied with the care provided at Tall Oaks. She was also seen visiting another resident in his bedroom – an example of visitors feeling comfortable in the home and moving freely around. Some residents were accessing their bedrooms during the morning of the inspection and commented that routines were flexible and their choices known and acted upon. The main focus of the inspection was in relation to the 21 requirements made at the time of the last inspection. There has been considerable work done in relation to requirements including staff training, re-assessment of resident categories, staff recruitment, safety of the garden area and issues relating to food provision and health care. Four requirements have not been satisfactorily addressed and they are made further requirements of this report. Nevertheless the home had responded positively to the large number of requirements and a keenness to improve standards. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 6 Some changes have been made by the Provider and within the home in relation to recruitment and staffing. A new care planning format is being piloted elsewhere, meanwhile staff are reviewing and updating all care plans systematically. Further requirements are made in this report and relate to areas of recording of health care information, medication administration and other aspects of procedure. There was quite an upbeat atmosphere when staff were spoken to indicating good staff morale. The Acting Manager and Deputy were open and helpful in providing information across the range of inspection focus. What the service does well: What has improved since the last inspection? There have been many improvements particularly relating to the requirements of the last report: (some requirements were made in previous reports). Advice has been sought from the dietician relating to specific residents on liquidised diets. All staff have received Food Hygiene training, this includes catering, care and ancillary staff. All residents were given the opportunity of postal votes at the General Election. There has been some staff training in Protection from abuse, some further suggestions are made in this report. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 7 The laundry arrangements have been reviewed in consultation with the Health Protection Agency. Staff recruitment practices have improved considerably providing a more robust system to protect residents. Reassessment of some residents required to ensure compliance with registration categories have been arranged. All staff have received training in Dementia Care. Annual health reviews have been referred to GPs, some non-action can be pursued from health care recording and weekly visits from GP’s. The number of people using lap straps in specialist chairs has reduced, but those still in place must be subject to discussions with residents and relatives and outcomes recorded. A toilet seat has been fitted in toilet area identified in the last report. The garden fencing has been repaired and the area made safe with gates fitted at exit areas. Care plans are presently being systematically reviewed. There has been greater compliance with requirements made under regulation. What they could do better: A Registered Manager must be appointed as a matter of urgency. Four requirements of the last report should be actioned immediately these are: Moving & Handling training, amendment to complaints procedure, Quality audit results must be available in the home and an application for variation of categories of admission must be made to reflect the needs of residents. Recording of pressure area management and treatment should be improved to required professional standards to be able to monitor progress. Continued review and updating of care plans. Aspects of medication which can be improved are: Count of all medication, recording of variable dose medication numbers, date eye drops when opened and creams secured in medication cupboard and used only for the person prescribed for. The Statement of Purpose/Service Users Guide must be reviewed/updated. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 8 Residents should be checked at hourly intervals throughout the night. All staff should be given a copy of the Company’s policy/procedure relating to abuse. 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. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 9 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 Outcomes Statutory Requirements Identified During the Inspection Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 10 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 the following standard(s): 1-5 The Statement of purpose/service users guide must be reviewed and updated. The document should be concise and user friendly. Care Management and the homes own assessment of needs are obtained wherever possible prior to admission There has been re-assessment of some residents and staff training for all in dementia care as previously required. Application for increased category numbers must now be made. Relatives and residents spoke highly of staff support in settling well and quickly into the home. EVIDENCE: There is a statement of purpose/service users guide which is part of a larger Craegmoor document including some information that is not required and not including other information that is. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 11 The Statement of Purpose/Service Users guide should be revised and updated to present a concise readable document to include the 18 items under Schedule 1 and also to contain the results of surveys from relatives/residents carried out on a bi-annual basis by the home. It is the homes preferred option that prospective residents should visit prior to admission and spend time in the home. In relation to a person admitted a few days prior to the inspection this had not been possible, the person had declined to visit and there unusually had been no relative visit either. The Social Worker had made arrangements for the respite care period. Other admissions had followed the preferred option of pre-admission visits. In all other instances prospective residents are seen and assessed prior to admission. The homes assessment document was seen and is presently under review by Craegmoor Healthcare, the revised assessment document should include all items under 3.3. of this standard. New residents were seen and spoken to and reported that they had settled well into the home and were supported by a caring staff group. A visiting daughter of a new resident spoke very highly of the admission process, the warm welcome given to resident and family. This was in contrast to a brief stay in another nursing home which was unsatisfactory and an unpleasant experience for all. The home has category to admit up to 3 people requiring dementia care (DE). At the time of the last inspection this number was exceeded and a requirement was made to reassess the needs of other residents who may fall into this category and to make application for increase in the number of people in DE category. Assessments have been carried out and dementia diagnosed in relation to 2 residents. The home must now make application for an increase in the numbers of residents in this category. This is a requirement of this report. All staff have received training in dementia care since the last inspection in order to ensure dementia care needs can be met and as a pre-requisite for increase in category numbers. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 7 - 11 Care plans provided quite comprehensive information but some update/revision of plans is needed and presently being carried out by staff. There were many examples of health care needs being appropriately met. The recording of the treatment and management of pressure areas sores should include information relating to measuring/mapping and grading to adequately record progress. There is a basically safe system of medication in place with good recording on MAR sheets but some aspects of practice could be further improved. EVIDENCE: A sample of care plans were examined and case tracking undertaken. Craegmoor Healthcare are presently piloting a changed format for care planning in other homes. Care Plans seen at Tall Oaks contained some good and comprehensive information but some require updating. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 13 This is presently being done by the Acting Deputy Manager and other staff – 5 plans per week are being revised/updated and all plans will be so revised. There is a care plan monitoring form to identify areas requiring change to the plan of care. This will ensure all information required to provide care is based upon current needs. Risk assessments were seen to be in place relating to all resident activity. Care plans (including risk assessments) were seen to be reviewed and signed by staff on a monthly basis as required. The Acting Manager has implemented a process for montoring the dependency levels of residents with the Bartel scale. It is intended that this will be completed on a monthly basis. The recording of information relating to pressure area management does not contain required professional information in relation to measurement/mapping of sores and there was no grading to provide a monitoring tool to assess progress of treatment. This must be provided. There are presently only 2 residents requiring treatment in relation to tissue viability and daily dressings with swabs for analysis indicate improvements due to treatment. This should be monitored and confirmed with recording as required above. Records were in place relating to waterlow and nutritional assessments and a range of pressure relieving equipment was in place as a preventive measure. There are 8 alternating mattresses in use in the home and a range of pro-pad mattresses/cushions as required. Special chairs and beds are provided as required. The Acting Manager reports that Craegmoor Health care supply requested equipment without question and it is not subject to fixed budgeting. There are 19 residents not assessed as requiring nursing care and their needs are met by the District Nursing Service who are currently visiting only 2 people to provide leg dressings. The home receives a reported good service from 2 GP practices located in Health Centre close to Tall Oaks. GP’s visit each Wednesday to examine residents as required and obviously at other times when urgent visits are required. There was a requirement at the last inspection to ensure that all residents had at least annual checks from GP’s. Requests have been made and received with a lack of enthusiasm from some GP’s. It is clear that GP’s see most residents during a 12 month period when health checks are inherent, and also medication reviews. There are health care record sheets for each resident recording interventions by health care staff and it is suggested that where residents have not been seen during a 12 month period requests should be made for specific checks. Medication records and the MDS system were inspected. An excellent service is reported to be provided from the local pharmacy. MAR sheets had been completed correctly with no omissions. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 14 At this time there is no self-medication in this home. Some aspects of medication require action: The list of sample signatures and initials was not complete and must include new staff administering medication. Co-Codamol prescribed PRN had been given 2 days previously but a supply for the named person was not in the medication trolley or the store of medication. This will be pursued by staff. There is a count of medication for some but not all drugs and where variable dose medication had been given the amount/numbers given were not recorded. It is important to complete a count of all medication in order to identify the trail of medication through the home Eye drops in the fridge had not been dated when opened and this must be done. A prescribed cream was found in the bedroom of a resident it was not prescribed for, in fact the cream had been prescribed for a now deceased resident. The home will investigate this and ensure all medication including creams are secured in the medication area. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 12 – 15 There is evidence of chosen lifestyle being accommodated, confirmed by residents. Visiting relatives expressed satisfaction with care provided and their involvement in care. There is a good programme of activities both inside and outside the home. Residents were highly satisfied with food provision. All standards relating to Daily Life & Social Activities were found to be met. EVIDENCE: The home employs an Activities Co-ordinator for 20 hours per week, she was not see on this visit but staff and previous reports indicate that she provides a good service to residents. Individual, large and small group activities are provided to meet the diverse needs of the resident group. There are the usual indoor activities. Additionally weekend activities are provided in response to residents request when visiting entertainers are arranged in the home. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 16 There is a Residents/Relatives/Staff Committee established which meets regularly and arranges a programme of internal and external fund raising activities. Relatives are involved in activities and staff volunteer to assist with day trips, bingo nights, Halloween party etc – an indication of their commitment and example of working together with residents and relatives. Individual resident choice and chosen lifestyles are at the centre of the homes philosophy. Many examples were seen and discussed with both staff and residents during the inspection. Breakfast was served until mid-morning, some having breakfast in their bedrooms. Residents reported that their preferences were known to staff and acted upon. Several residents were accessing their bedrooms throughout the morning of the inspection, some receiving visitors in their bedrooms as well as the lounge areas. Several residents have telephones installed in bedrooms, many have TV and one has satellite TV with premium channels as he wishes. Visitors were seen to arrive throughout the morning, there were friendly exchanges with staff and visitors clearly feel comfortable in the home, moving around freely and speaking to other residents. There were good humorous exchanges between residents, staff and visitors and a very relaxed atmosphere in the home. Visitors confirmed they were able to visit without restriction and were kept informed of all events affecting the lives of their relatives. There was a unanimous approval about food from residents spoken to. The quantity and quality of food is clearly good. There is choice of menu at all mealtimes, a cooked breakfast being an option available daily. For one resident who likes oriental food the chef prepares specialist “hot” dishes and the home purchases curry from the local take-away on occasions. Another lady eats only Warburtons bread with stewed vegetables and gravy, this was recorded upon admission and is provided as she wishes. – Examples of individual food choices and also residents choices being known, recorded and acted upon. There are 15 people on soft (liquidised) diets. A requirement of the last report was to involve the dietician to monitor those individual dietary needs. This has been done with referrals to the GP’s with only some referrals made by them for specialist assessments. Four catering staff and 15 care staff have all undertaken basic Food Hygiene training following a requirement of the last report. Certificates are en-route to the home. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 17 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 the following standard(s): 16 – 18 There is a clear and concise complaints procedure displayed in the home, the telephone number of the Commission must be added. Training for staff in Adult Protection has been actioned and further recommendations are made. EVIDENCE: There is a complaints procedure on display in the reception area of the home for residents and visitors. The telephone number of the Commission has not been added as required in the last report and the Acting Manager will ensure this will now be done. There have been no complaints to the home or to the Commission since the last inspection. There were concerns at the time of the last inspection that postal votes had not been sought for residents to vote at the General Election. The Manager reports that this was arranged and all residents wishing to had a postal vote. There was a requirement of the last report to ensure that all staff in the home receive training in the Protection of Vulnerable Adults. All staff including ancillary staff have used a specialist video in the past year relating to abuse training and completed accompanying questionnaire. Abuse has been discussed in recent staff meeting and the home were advised to discuss aspects of abuse in staff supervision. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 18 Craegmoor Healthcare have an excellent policy/procedure outlining the broad definitions of abuse and defining the procedures to be followed by staff in reporting suspected or actual abuse. This is available for all staff on the policy’s file but it is recommended that all staff are given a copy of the procedure. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 19 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 the following standard(s): 19 - 26 The environment is safe and well maintained. Several requirements made on the last inspection in relation to the environment have been addressed, although further discussions and recording of outcomes are required in relation to consents for lap straps in wheelchair/specialist chairs. The home was clean, comfortable, well furnished and maintained and met the required standards. EVIDENCE: The home was purpose built in the 1990’s . Room sizes, both bedrooms and communal areas meet required minimum standards. There are 6 shared bedrooms but 2 on the ground floor are currently used only as single rooms. There is an ongoing redecoration programme in place. This was not discussed on this visit. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 20 There are no en-suite facilities in the home but there are 4 bathrooms and 2 walk-in shower rooms located strategically throughout the building. Bathrooms are spacious and have assisted facilities. They are adequate in number and type for the resident group. Residents have commodes in their bedrooms if they wish. The standards of cleanliness and hygiene throughout the home were seen to be excellent on this visit. Domestic staff confirmed there were clear and strict cleaning routines in place. Continence management presents difficulties for some residents, but there was no evidence of mal-odours in the home at all. The laundry arrangements identified potential hazards on the last inspection and requirement made to liase with the Health Protection Agency about this. This has been done. The laundry was inspected on this visit. The red bag system is used for foul laundry and was separated from other soiled laundry. There is only one commercial washer and one dryer. The laundry operates 12 hours per day and the laundry assistant felt the facilities were adequate. Bed linen is sent off-site for laundering and appropriate records maintained. There was no evidence on this visit that foul and soiled linen were present in the laundry area together. All communal areas were seen on this visit and a sample of the 49 bedrooms also. Bedrooms were pleasant, comfortable, warm and well furnished. All were personalised to reflect the individual interests of the occupants. There were privacy arrangements in place in shared bedrooms seen. A trailing cable in bedroom 17 had not been actioned to avoid potential trip hazard as identified in the last report and is a further requirement of this report. Other aspects of the environment made subject to requirements in the last report had been addressed, these included toilet seat fitted in toilet area 23. Fencing in the garden area has been repaired and additional gates installed at each end of the garden to make the area secure. The use of lap belts in specialist chairs were identified in the last report and the implications of their use as potential restraint discussed. This has been reviewed and the Acting Manager reports that lap belts are still in use relating to 3 people, one in a wheelchair and two in specialist chairs. This was considered to be in the interests of the safety of the residents concerned. The Acting Manager confirmed that 2 of the residents have capacity and one does not. It is recommended that the matter is fully discussed with the residents and relatives in all cases and the matters recorded in care planning information with signed consents if possible. A resident in a wheelchair with lap strap in use told the inspector he wished to have the strap secured and felt safer with it in place, this was confirmed by his visiting relative. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 21 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 There is a good mix of staff in relation to training and experience. Areas of staff training identified previously have been positively addressed, only Moving & Handling training is required in relation to new staff. Recruitment procedures have been strengthened since the last report – sampled files contained all required documentation. There was an upbeat atmosphere from staff about care provision and the changes taking place in the home to further improve standards. New appointments have been made and posts created and staff have responded with interest and enthusiasm. The impression gained was of high staff morale. EVIDENCE: There are 7 Nurses and 31 care assistants employed with additional ancillary staff for catering, housekeeping, maintenance and administration. The home operates the last staffing notice as required at April 2002. The daily care staffing level is 10: 9 : 5 There are 2 nurses on duty throughout the day and one at night – included in the above figures. The staffing levels are good and adequate for the current dependency levels of residents. There are adequate numbers of ancillary staff supporting the home. There has been no use of agency staff since the last inspection. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 22 There is a good mix of staff, several have worked at the home for many years. There are currently more than the required 50 of care staff trained to NVQ standard and further NVQ study in process. A new post of Shift Leader has been established and 6 care staff recently appointed to those positions. Most staff on duty were spoken to and appeared quite relaxed and spoke warmly in discussions regarding residents, having a clear knowledge of the needs of particular residents when asked. Staff morale seems good and sensitive and friendly exchanges were noted between all staff and residents. The Acting Manager reports a keen staff group – keen for knowledge and training. This was evident in discussions with staff. There is a staff training matrix (copy given to inspector). Requirements were made in the last report for training in Dementia Care, Food Hygiene, Adult Protection and Moving & Handling Training. All have been met with the exception of Moving & Handling Training which was has been provided by the Deputy Manager (approved trainer) who is on long-term sick leave. This means that newly appointed staff have not received this training and a further requirement is made in this report. The Acting Manager was advised that staff should not provide personal care until such training has been carried out in order to protect residents and the home. As stated above the Deputy Manager is off long-term sick and an Acting Deputy Manager has just been appointed, she is currently working on the updating of care plans and will be reviewing other areas of work. Inspection of staffing records showed that all information and documents required in Schedule 2 for recently appointed staff had been obtained. This was in contrast to the last inspection when a requirement was made after documents required in Schedule 2 had not been obtained. The home have strengthened the recruitment procedures to ensure protection of residents. Craegmoor Healthcare now handle all required documentation from their central HR section, ensuring procedures for recruitment provide all relevant documentation, checks etc. Clinical updates for nurses were not checked on this inspection, gaps were identified on the last inspection and this will be further pursued on the next inspection. Craegmoor are presently changing procedures relating to Clinical Governance this will also be discussed on the next inspection. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 23 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36 – 38 Standards relating to the Management of the home cannot be assessed until a Registered Manager is appointed and this is an urgent requirement. Staff were reported to be appropriately supervised, which they confirmed but records were not seen. Aspects of Safe Working Practices inspected were generally satisfactory, requirements are made in relation to Moving & Handling training and trailing cable in bedroom. EVIDENCE: At the time of this inspection there was no Registered Manager in the home. The prospective manager has been in post for 2 years. A timescale was given in the last report to submit an application for Registered Manager. The prospective manager says an application was sent to the Commission in August, but checks on the day showed this had not been received. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 24 It is a requirement of this report that an immediate application is made for Registered Manager. As there is no Registered Manager in post, it is impossible to assess standards 31 and 32 at this time. In relation to Quality Assurance, the home carried out a survey of residents and relatives every 6 months. Results are not available in the home as they are kept by Craegmoor Head Office. These should be available in the home and included in the Service Users Guide as part of the service users views of the home. This should be addressed. There is reported regular supervision of staff although records were not inspected on this visit. In relation to Safe Working Practices: Moving and Handling training is required for new staff who should not be involved in personal care until training has been arranged. Fire records were not inspected on this visit, although fire fighting equipment seen throughout the home had checks recorded in April 2005. A requirement of the last report was to provide regular fire drills for all staff. The Acting Manager reported that this had been done, but records were not checked. Food Hygiene training has been provided as required for all staff. Infection control procedures in the laundry area have been improved with advice sought from the Health Protection Agency. A window restrictor was broken in a first floor bedroom and a notice posted in the window to that effect. The resident in the bedroom is aware of the situation, has competence and there are now immediate risks. A trailing cable in a bedroom presenting a potential trip hazard has not been re-sited as required in the last report. This must now be done. The kitchen was not inspected on this visit. An inspection by the EHO earlier in the year was reported to have been satisfactory with no requirements. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 25 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 3 3 N/A 3 3 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 x x 3 3 2 Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP31 Regulation 8 Requirement Application must be urgently made to appoint a Registered Manager. Previous timescale not met Results of quality surveys must be kept in the home and available for residents/visitors. Previous timescale not met. Complaints procedure must include telephone number of CSCI. Previous timescale not met Application must be made for variation of registration to reflect the needs of residents. Previous timescale not met. Pressure area treatment & management must be recorded to required professional standards to adequately monitor progress Updating of some care plans are required and in process.s s There must be a count of all medication including variable dose medication to allow audit of medication. Eye-drops must be dated when opened and prescribed creams DS0000026969.V264174.R01.S.doc Timescale for action 08/11/05 2 OP33 24 08/11/05 3 OP16 22(7)(a) 08/11/05 4 OP4 14 08/11/05 5 OP8 12(1) 08/11/05 6 7 OP7 OP9 15(1) (2) 13(2) 31/12/05 08/11/05 8 OP9 13(2) 08/11/05 Tall Oaks Nursing Home Version 5.0 Page 27 9 10 11 12 OP38 OP1 OP27 OP38 13(5) 4 12(1) 13(4) only used for person prescribed for New staff must receive training in moving & handling prior to providing personal care The statement of purpose must be updated and include all items in Schedule 1. Residents should be checked at hourly intervals throughout the night Trailing cables in bedroom identified to be made safe. 08/11/05 31/12/05 08/11/05 08/11/05 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 OP18 Good Practice Recommendations All staff should be given a copy of the homes policy/procedure relating to abuse. Tall Oaks Nursing Home DS0000026969.V264174.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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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