Inspection on 11/08/05 for The Oaks

This inspection was carried out on 11th August 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

The Oaks 23/04/08

The Oaks 18/12/07

The Oaks 02/07/07

The Oaks 17/01/07

The Oaks 23/01/06

The Oaks 23/02/05

The Oaks 08/07/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE The Oaks Oak Avenue Hindley Green Wigan WN2 4LZ Lead Inspector Lindsey Withers Unannounced 11 August 2005 th 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. The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Oaks Address Oak Avenue, Hindley Green, Wigan, WN2 4LZ. 01942 521485 01942 522141 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) Mr Kevin Hall Mrs Denise Bostock Care Home Only 31 Category(ies) of Physical Disability 3, Old Age 31, Physical registration, with number Diability Elderly 8, Dementia Elderly 5. of places The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home is registered for a maximum of 31 service users to include:up to 31 service service users in the category of Older People (OP) up to 3 service users in the category of PD (Adults with Physical Disability) up to 8 service users in the category of PD(E) (Adults with Physical Disability over 65) up to 5 service users in the category of DE(E) (Adults with Dementia over 65) 2. The service should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. 3. The Homes Manager, Senior Carers and Carers must be adequately trained to meet the specific needs of the individual service users with Dementia. 4. The Statement of Purpose must be reviewed and updated to reflect the change to the registration. Date of last inspection 23rd February 2005. Brief Description of the Service: The Oaks is located in a quiet residential area of Hindley, close to the main bus route, local shops and amenities. Car parking for visitors is limited. The Oaks is registered to provide personal care services for up to 31 elderly service users, both male and female. Within the total number of 31 registered places, the home may accommodate up to eight elderly people with a physical disability, three people under the age of 65 who have a physical disability, and five people over the age of 65 with dementia or other cognitive impairment. The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over six hours on one day and was unannounced. As the Manager was away on holiday, the owner, Mr. Hall, assisted with the inspection. Part of the time was spent in the office looking at five care plans (the files containing the information about a person’s care needs), and other documentation that the home has to keep to show that the home is properly managed. The Inspector spent some time in the main lounge and had conversations with five residents, two visitors, and two members of staff. The Pharmacy Inspector had been to The Oaks in March and June 2005. A number of requirements and recommendations had been made, and monitoring of the home continues in relation to medication. Information relating to these visits is available to members of the public or other enquirers on request to CSCI. What the service does well: What has improved since the last inspection? What they could do better: Paperwork that related to residents’ care needs was not as good as it had been at the last inspection. Some areas of the records were poor, and there did not appear to have been a methodical approach to reviewing care. This was especially evident for residents who have dementia, and whose mental health was showing signs of changing or deteriorating. While they were doing all that they could to keep people comfortable and safe, staff were not knowledgeable enough to identify when it was time to contact a specialist health provider for support and advice. Further work still needs to be done in relation to the administration of medication for it to be brought up to the correct standards. The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 Page 6 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 Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 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 The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 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) 3 and 4 Pre-admission assessments are not thorough enough to assure a person that their needs have been properly identified and can be met by the home. Service users with dementia or other cognitive impairment cannot be guaranteed that their needs will be met as staff do not have sufficient knowledge or experience. Service users in general, however, can be assured that their needs will be met, with help from community and hospital services. EVIDENCE: Five residents’ files (known as the care plan) were looked at during this inspection. All care plans contained a pre-admission assessment together with supporting documentation from previous care providers or social workers. The standard of assessment for one person was poor and written in a disrespectful way. Two assessments mentioned the individual resident’s potential for verbal abusiveness or aggression, which had not been followed up on. Two assessments were satisfactory and recorded sufficient information from which to draw a plan of care. The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 Page 9 The Oaks is registered to provide specialist care services for 5 people with dementia, and the majority of staff had had appropriate training so that they could provide a good level of care. However, three residents’ files raised cause for concern because it was clear that staff could not demonstrate that they fully understood the point at which external specialist help was needed. In relation to providing specialist care for younger people with a physical disability, one resident said she had been referred to the hospital for investigation following a health problem. She was fully aware of the reason for the referral and was looking forward to “getting to the bottom of it”. The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 Page 10 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) Residents have a plan of care that records what action needs to be taken to ensure that the resident’s health care needs are being met, and some good practice points were seen. For some residents, though, the content was insufficient. The record could not show that proper action was being taken to ensure needs were being fully met. Reviews do not take account of all the information available, including that which is written in the staff communication sheets. Care plans are not developed quickly enough for newly admitted residents. Staff are not quick enough at getting advice and support for people with dementia or other cognitive impairment. Staff did not know what to do when a resident showed signs of severe or different behaviour. Residents can be assured that they will be treated with dignity and respect. EVIDENCE: Not all care plans making up the sample had been developed using the assessment completed during the admission process. Some gaps were noted, for example, in relation to a person who was inclined to wander, a person who occasionally showed aggression, and a person who was a diet-controlled diabetic. There were good practice points identified, for example, the inclusion The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 Page 11 of heatwave care plans in line with Department of Health guidelines, and where the daily diary in the care plan had been cross-referenced to the medication sheets. To assist staff with following care plans, particularly during review, it would be better if the care plans letters, for example A, B, C, D, etc. were brought forward to the summary sheet. Risk assessments in relation to the prevention of falls, skin viability, nutrition, and moving and handling were in place, but not all of them on all care plans. These are essential risk assessments that would be relevant to all residents. Additional risk assessments would have been appropriate, for example for residents who were at risk of leaving the premises unsupervised, or smoking in smoke-free areas. Care plans had been reviewed at least monthly but some points of amendment had been missed, for example, in relation to indiscriminate elimination by one resident. Reviews did not clearly state how they had been measured so there were fewer clues about a person’s improvement or deterioration. The care plan for one resident stated “sleeps quite well” at night, and the review with social services records that the resident “appears more settled”. However, the daily communication sheet completed by staff clearly states that the resident does not sleep well and is regularly unsettled at night. Furthermore, for this resident, the care plan states that the resident uses the toilet with minimum supervision – yet the communication sheet shows that the resident is frequently incontinent. On two records there were entries where staff were asking for a resident to be observed perhaps when a resident was feeling off colour i.e. “please observe” or “p/o”. However, there were no entries to show that this observation had been done. For another resident, the number of occasions when the person has tried to leave the building is alarming. The level of agitation and aggression shown by the resident has been increasing, and staff have recorded their complaints about the level of care having to be provided for this person, at the expense of other residents. A carer said that the situation was “difficult”. She did not know what else she could do to help this person. A care plan had not been completed for a newly admitted person other than a moving and handling risk assessment. This is significant given the resident’s medical background and the information contained within the pre-admission documentation. There was no way of knowing whether this person’s needs or expectations were being met. Another resident had recently been transferred from a different care facility. This resident cries out continually and the care plan records that the resident mentions pain. Nothing has been done to investigate the pain or to determine The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 Page 12 why the resident cries out. While at The Oaks, the resident had suffered an unwitnessed bruise and an unwitnessed graze, and there were two incidents recorded that involved another resident. These are significant issues as other residents shout “be quiet” or “shut up”, which is not an acceptable situation. At best it is disrespectful, and at worst it could be considered to be abusive behaviour. Residents themselves considered that the care provided by staff at The Oaks was good and that staff were helpful. One said she was “happy” and another that she was “satisfied”. The two relatives who gave their views on this occasion said they could not find fault with the service. Staff were described as “responsive” and quick to sort out minor ailments, such as a problematic sore toe. Residents were seen to be treated with respect by the members of staff, who worked hard to ensure that each resident’s right to privacy and dignity was maintained. That being said, the menu board in the dining area does display the dietary needs of residents. This should now be removed to the kitchen. The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 Page 13 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, 13, 14, and 15 Residents were satisfied with the lifestyle provided at The Oaks, as were two visitors. Residents are helped to exercise choice and control over their lives. Residents are provided with sufficient good quality food. Nutrition is monitored to ensure good health in residents. EVIDENCE: Residents are encouraged to join in with the daily activities of daily living at The Oaks. For example, one resident enjoys working with the owner in the garden, and others were seen to help by setting or clearing the dining tables. Some residents like to spend time with others in one of the lounge areas, while others prefer their own company. A number of residents knew others as they lived in the same area, and several friendships have developed while residents have been living at The Oaks. Access to organised activities is limited at the current time as there is a vacancy for an activities organiser. However, residents said they can read the paper or magazines, watch TV, listen to music, or play dominoes or bingo. Several residents spoke about a recent trip to Southport which had included a visit to the pub. The good weather had encouraged some of the residents to sit outside in the garden at The Oaks, which they had enjoyed. Some The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 Page 14 residents go out regularly with family and friends, and some less often. The majority of residents do, however, receive regular visitors at the home, and visitors are welcome to call at any time. Staff encourage residents to exercise choice and to speak up if they are unhappy about anything. Where residents are unable to make a choice, staff will do this for them but with the best interests of residents in mind. Residents are offered a good choice of food at each mealtime. The food served at lunch-time was seen to be plentiful and of good quality. There were three choices plus a dessert. Residents said they enjoyed their meals. One said she only liked small amounts and that staff knew this and made sure she was not ‘overfaced’. A visitor said that residents “always seemed to be eating” and qualified this by saying they had morning coffee and afternoon tea, as well as the three main meals of the day. Special diets are catered for including diabetic, soft, and reducing diets. Residents who are not eating are given gentle encouragement by staff. Staff were seen to be checking and monitoring intake, and then re-checking with residents to make sure they had eaten sufficient for their needs. Those residents being provided with assistance were engaged in conversation so that the procedure was dignified and, therefore, made to feel normal. Staff did not assume that they knew what a resident wanted, and asked each resident what they would like, and how much or how many. Residents who did not wish to (or could not) sit at the dining table were served in the adjoining lounge, but were still kept under supervision so that any help the residents needed did not go unnoticed. Residents were not rushed through the meal, were given sufficient time to eat at their own pace, and to sit and chat over extra cups of tea, as they wished. The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 Page 15 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) EVIDENCE: This section was not assessed on this occasion. The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 Page 16 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) EVIDENCE: This section was not assessed on this occasion. The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 Page 17 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) 30 Staff are not sufficiently equipped to meet the changing needs of people with dementia. EVIDENCE: The majority of care staff had undertaken dementia training. However, training in relation to meeting the changing needs of people with dementia has not been sufficient for staff to identify when external professional help is needed. Training in this area, therefore, is required. The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 Page 18 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) EVIDENCE: This section was not assessed on this occasion. The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 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 x x 2 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 Page 20 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. 4. Standard 3 4 7 7 Regulation 14 12 15 13 Requirement Pre-admission assessments must be thorough and properly recorded. Access to specialist care must be arranged for people with changing mental health needs. Care plans must be complete for all residents, and reviewed in a measurable way. Risk assessments must be included in care plans that are relevant to the person, and reviewed in a measurable way. Residents psychological health must be monitored in a measurable way, and action taken in the event of significant changes. Staff must receive further formal training in relation to dementia care. Timescale for action 15th September 2005 1st September 2005 15th September 2005 1st Septemebr 2005 1st September 2005 31st December 2005 5. 8 12 6. 30 18 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. The Oaks Refer to Standard Good Practice Recommendations F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 Page 21 1. None. The Oaks F06 F56 S5755 The Oaks V231089 10.08.05 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Turton Suite, Paragon Business Park, Chorley New Road, Horwich, Bolton, BL6 6HG. 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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