Inspection on 15/07/09 for The Oaks

This inspection was carried out on 15th July 2009.

CQC found this care home to be providing an Adequate service.

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 15/02/10

The Oaks 21/07/08

The Oaks 05/11/07

The Oaks 02/06/07

The Oaks 05/04/06

The Oaks 21/10/05

The Oaks 04/05/05

The Oaks 24/11/04

The Oaks 12/05/04

The Oaks 22/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Oaks 114 Western Road Mickleover Derby DE3 6GR Lead Inspector Angela Kennedy Key Unannounced Inspection 15th July 2009 10:00 DS0000002143.V376580.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Oaks Address 114 Western Road Mickleover Derby DE3 6GR 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) 01332 510447 01332 519786 Mr Hassan Khan Ms Teresa Clare Boyce Ms Teresa Clare Boyce Care Home 28 Category(ies) of Dementia - over 65 years of age (28) registration, with number of places The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home accommodates both service users outside the current age category and current registration Older People (OP) for the duration of their stay. 21st July 2008 Date of last inspection Brief Description of the Service: The Oaks is a detached home, which has been adapted and extended to provide nursing care for up to 28 older people with dementia. The home is situated in the residential area of Mickleover. The home has 26 single bedrooms all with an en-suite facility and 1 double bedroom. The home is set within its own well kept, pleasant gardens, which are secure. There are registered nurses on duty 24 hours per day. The fees charged at the time of this inspection visit ranged from £456 to £725 a week. The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection that took place over 2 days. Key inspections take into account a wide range of information and commence before the site visit by examining previous reports and information such as any reported incidents. The site visit is used to see how the service is performing in practice and to meet with the people using the service. The inspection was focused on assessing compliance with defined key National Minimum Standards. An Annual Quality Assurance Assessment (AQAA) had been completed by the service. This is a self-assessment for provider’s that is a legal requirement. This assessment gives the provider an opportunity to let us know about their service and how well they think they are performing. The information provided in the AQAA is reflected within this report. Two people were case tracked. Case tracking is a method used to track the care of individuals from the assessments undertaken before they are admitted to a service through to the care and support they receive on a daily basis. This includes looking at support plans and other documents relating to that persons care, talking to staff regarding the care they provide and if possible talking to the individual. Discussions with the people living at the home were limited, as many people where unable to express their views of the service provided due to their mental health needs. Observations of the care and support provided were undertaken throughout this inspection visit. Three relatives were spoken with at this inspection visit. The information provided in these discussions is included in this report. Some of the staff team were spoken with to gain their views on the service and support provided to the people using the service and the training and support given to staff. The comments from these discussions are reflected within this report. The registered manager was available throughout the inspection. The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 6 What the service does well: Observations of staff with people living at the home were positive and demonstrate a relaxed atmosphere with a good rapport between the staff and the people using the service. Comments from visitors were positive regarding the care and support provided, such as “the staff are very friendly, our mum gets more one to one here than her previous home” and “… is always content, he’s looked after very well by the staff”. Needs assessments were in place. These assessments demonstrated that detailed assessments were undertaken prior to admission Relatives that were spoken with were able to confirm that they had received enough information about the home and that they had been given the opportunity to visit the home before deciding if it was right for their loved one. The care plans seen included promoting choice and identified the skills and independence the individual had to ensure the staff team enabled people to maintain their skills. Medication practices were looked and demonstrated that safe practices were in place What has improved since the last inspection? All of the requirements left at the last inspection visit have been met. One of these requirements related to activities. Since the last inspection visit an activities coordinator had been appointed and there was evidence to demonstrate that this person had provided activities that were suitable and met the preferences of the people using the service. However this person is no longer working at the home. Since the last key inspection refurbishment of the home has been implemented. New curtains have been purchased for the communal areas and areas of the home have been repainted. Staff training records demonstrated that staff received mandatory training and were updated as required The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 7 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 8 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 The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs were assessed before admission was agreed to ensure the home was right for them. EVIDENCE: The homes self assessment stated that a comprehensive tour of the home was provided to anyone considering the service and their relatives. People were seen being given a guided a tour of the home during this inspection visit. The homes self assessment stated that a trial period was offered to enable individual’s to try out the service, before making a decision to stay permanently. The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 10 The homes self assessment stated that a full pre admission assessment is carried out prior to admission, to ensure the home can meet the individual’s needs. Needs assessments were in place in the files of the two people case tracked. These assessments demonstrated that detailed assessments were undertaken prior to admission that addressed the individual’s social, emotional and health care needs. This included an assessment in place from their care manager. The care plans seen demonstrated that this information was then used to develop the care plans for each person. The assessments provided detailed information on the reason for the admission and persons understanding of their admission to the service and their families understanding of the reason for admission. This information enables the staff at the home to effectively support the individual and their family during the admission process. Information within these assessments demonstrated that relatives were involved in the assessments process. Relatives that were spoken with were able to confirm that they had received enough information about the home and that they had been given the opportunity to visit the home before deciding if it was right for their loved one. The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans indicated that needs were met with regard to health and personal care. Risk assessments are undertaken but are not proactively monitored to ensure risks are minimised. The medication practices in place ensured that people were able to take their medication in a safe way. EVIDENCE: Generally the care plans seen were very good. The care plans included promoting choice and identified the skills and independence the individual had to ensure the staff team enabled people to maintain their skills. Not all care plans were signed and dated by the person that had written them. Care plans were in place that related to activities, these care plans instructed the staff to provide meaningful activities and encourage feelings of contact and The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 12 give praise and encouragement. However there was no information in these care plans that referred to preferred activities, hobbies and interests. The manager said that life histories had been gathered by the previous activities coordinator. Records of life histories were seen in the manager’s office upstairs but this information had not been transferred to care plans. Some care plans had been reviewed in July 09 and some not since May 09, therefore there was some inconsistency in reviews, even though all care plans should be reviewed on a monthly basis at least. The quality of the information within the care plan reviews varied and some read more like a daily log than a review. For example rather than reviewing if the persons support needs had changed they recorded what that person had done that day in relation to that area of support. No written evidence was seen to demonstrate that relatives were involved in care plans. One of the people case tracked had written confirmation within their care plan that stated that they lacked the capacity to consent. On discussion with this person’s relatives it was confirmed that they had attended two care reviews since their relative had moved to the home at the beginning of this year. One was shortly after moving in and the other was done 6 months later. They confirmed that throughout the reviews they were consulted and involved. No reference was seen in the care plans looked at regarding each person’s preference on the gender of staff supporting them with their personal care needs. Where a person is unable to state their preference regarding this, then this information should be sought from the person representing them, such as their next of kin. Risk assessments were in place, these included falls assessments, moving and handling assessments, wandering assessments , medication assessments and compliance with mediation regime assessments , aggression assessments , waterlow assessments (The waterlow score gives an estimated risk of a person developing a pressure sore)., nutrition assessments and weight records and bed rail assessments. Risk assessments linked to care plans and were generally satisfactory. The waterlow assessment for one of the people case tracked had been reviewed in July 2009 and the records showed that this person was at high risk, however no additional information was in place regarding the actions that were to be taken to minimise the risk. Weight records included a section to record weight loss or gain. Although the weight was recorded on the weight charts, the box for loss or gain merely recorded if there had been a ‘loss’ or ‘gain’ and not the actual amount of weight that had been lost or gained. This information would better alert the staff to any significant weight loss or gain. The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 13 Bed rail assessments and consent forms were in place, although the bed rail assessments needed to be more detailed, to ensure they met with safety guidelines. The registered manager confirmed that she was now in receipt of bed rail assessments from health and safety executive and said that these assessments would be undertaken in the near future. Information on one person case tracked regarding use of bed rails indicated that this person had bedrails in place but regularly got out of bed with the bedrails up. It was stated that the family of this person had requested that this person had bedrails in place to stop them rolling out of bed when they were asleep. The manager confirmed that this person did not climb over the bedrails to get out of bed. It was agreed by the manager that an assessment was required regarding the safety of this practice, as this practice potentially putting this person at risk if they attempt to climb over and fall. An assessment would determine if an alternative bed may be more suitable for this person to eliminate this risk. Evidence was in place of good communication with health care professionals and this demonstrated that health care needs were met. This included records of doctor’s visits and visits from other health care professionals. Prior to this inspection visit information received by the home was reviewed. This information included notifications by the home regarding any accidents such as falls that had occurred. From the 29th July 2008 to the 30th 2009 we had received twenty notification regarding falls. These notifications demonstrated that in the months of August, September and October of 2008 there had been a total of 15 incidents of falls. This is considered to be a high amount of falls. Some of these falls resulted in injuries that were skin tears however one fall resulted in a fractured femur. The accident records for people case tracked were also looked at. One person had good mobility and therefore no incidents of falls had occurred. The other person had 11 accident reports that ranged from 15.01.2009 to 12.04.09, out of these 7 were regarding falls and 1 resulted in safeguarding referral being made by an outside agency to the local authority. Discussions took place with the manager regarding these falls and we were advised that during this period (Jan – April 09) this person was unsteady on their feet. A letter was seen from physiotherapist regarding this individual’s mobility improvements since moving to The Oaks. People were able to move around the home freely and it was clear from observation that staff promoted independence and freedom of movement. Although this is clearly a positive attribute to the service, it is important to ensure that any falls are investigated, assessed and actions put in place to try and reduce the risk occurring, without restricting independence as much as possible. Discussions took place with manager regarding auditing falls on a The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 14 weekly basis to identify any trends such as, if falls occur at a particular time of day ( busy times or times when less staff are around ), in a particular area, the numbers of staff in the vicinity and on duty. This will then enable any trends to be identified and the appropriate actions be put in place to reduce risk. It will also ensure that any potential safeguarding issues or concerns are identified and forwarded to the local authority. Medication practices were looked and demonstrated that safe practices were in place to ensure medications were received, stored, recorded, administered and disposed of correctly and in line with legal requirements. Only trained nurses administered the medications. Observations of staff with people living at the home were positive and demonstrate a relaxed atmosphere with a good rapport between the staff and the people using the service. Comments from visitors were positive regarding the care and support provided, such as “the staff are very friendly, our mum gets more one to one here than her previous home” and “… is always content, he’s looked after very well by the staff”. The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s social and recreational needs were not always met. People were supported to maintain contact with family and friends. The quality and variety of meals provided was enjoyed by the people using the service. EVIDENCE: As stated the activities care plan did not provide information on hobbies and interests. There was information in the admissions assessment regarding life histories and as stated there was evidence to show that life histories had begun to be gathered by the previous activities coordinator, but this information had not been transferred to the care plan regarding activities. However life histories had not been gathered for everyone. Two visitors spoken with confirmed that they had not been asked to provide life histories for their relative but confirmed that they would be happy to do so. There was no scheduled activities plan in place and on day one of the inspection visit no activities were seen to be undertaken. On the second day of The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 16 this inspection visit, activities were being undertaken and these were being provided by the laundry assistant. The registered manager confirmed that she was advertising to appoint a new activities coordinator. She stated that since the last inspection an activities coordinator had been appointed but had since left employment. Discussions took place with the manager and staff regarding rostering an additional staff member on shift to enable daily activities to be undertaken. The information provided by the registered manager prior to this inspection visit stated that there were plans to provide a sensory room for the people using the service. However from discussions it was confirmed that these plans had been put on hold for the present time due to financial constraints. The registered manager stated that members of the local church visited the home on a regular basis for anyone that wished to participate in these services. Visiting times were open and this was confirmed by the visitors that were spoken with. Who said, “I visit quite often and am always made very welcome” and “we are always made welcome, whenever we visit”. As stated earlier in this report the people using the service were observed moving around the home freely and from observation the staff promoted independence and freedom of movement. The people case tracked had records in place regarding their preferred routines, such as what time they liked to retire to bed or rise in the morning. The menus ran over a 4 week rolling programme to ensure that a variety of meals were provided. The menus seen demonstrated that cooked breakfasts were available each day, two choices were provided at the main meal and assorted sandwiches or soup was available at the teatime meal. There was evidence on the rota that grapefruit and prunes were available on the breakfast menu. There was little reference to fresh fruit on the menu but the registered manager confirmed that fresh fruit and yoghurts and ice cream were always available as a dessert. The manager agreed that this information should be provided on the menus. The manager demonstrated that talking books had been purchased, for people that were unable to read the written menus. These books had recently been purchased and were not yet in use. Observation of the lunch time meal took place and staff were seen supporting individuals in a respectful and friendly way. Some people were spoken with following the meal and were able to confirm that they had enjoyed their meal. Visitors spoken with felt that their relatives enjoyed the meals provided. The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clear complaints policy was in place to ensure concerns could be addressed. Lack of understanding regarding the safeguarding practice that should be followed and lack of proactive measures regarding falls potentially puts individuals at risk. EVIDENCE: Information provided by the manger prior to this inspection visit stated that the service had not received any complaints since the last key inspection. Forms were available to record any complaints that were made. Visitors spoken with confirmed that they were aware of the complaints procedure and said that if they had any concerns they would speak with the manager, they appeared confident that their concerns would be addressed promptly. The complaints procedure was seen and included the timescale that complaints would be addressed in. Staff spoken with had a clear understanding of the meaning of abuse; however they were not clear regarding the policy that should be followed in the event of them suspecting abuse. For example they did not realise until told that the lead investigators in safeguarding adult’s referrals and investigations The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 18 was the local authority. However the home did have a copy of the local authority procedure and training records and discussions with some of the staff confirmed that training was provided by a training organisation regarding safeguarding adults. As stated earlier in this report records demonstrated that since the last inspection there had been several falls within the home. Although there was accident records in place regarding these falls, there was no evidence in place to demonstrate that risk assessments had been reviewed following these falls or that any actions had been put in place to reduce the risk. None of the falls recorded had been referred to the local authority by the home as safeguarding alerts, even though some of the records seen indicated that they should have been. The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Oaks provides a comfortable and clean home for the people living there. EVIDENCE: Since the last key inspection refurbishment of the home has been implemented. New curtains have been purchased for the communal areas and areas of the home have been repainted. Bathrooms that were used housed appropriate moving and handling equipment to assist people with reduced mobility. Visitors and people living at the home that were spoken with confirmed that the home was kept clean. No unpleasant odours were noted. The manager The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 20 confirmed that a sanitizing machine had been purchased to ensure any odours were eliminated. The laundry was looked at and was found to be well equipped. The washing machine had a built in sluicing facility to ensure any soiled clothing was washed thoroughly. The laundry staff confirmed that individuals could have their clothing washed separately if they preferred. It was stated that this preference was ascertained on admission. They also confirmed that any soiled clothing was washed separately. Visitors that were spoken with said that they were happy with the laundry service provided and said that their relative’s clothes always looked clean and nicely pressed. Observations on the day of this inspection confirmed this. The garden area was secure and provided seating areas for the people using the service and their visitors. The manager confirmed that following a recent fire risk assessment the garden gates were to have new locks with a break glass key system to ensure the garden could be exited promptly if required in the event of a fire. The manager also discussed plans to reduce the length of the window restrictors following consultation with the Health and Safety Executive, as these were found to be longer than the recommended length, which meant that the windows were able to open too wide which could potentially be a falls hazard to people using the service. The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient numbers of trained staff are employed to meet the needs of the people using the service. The recruitment practices are not robust enough to ensure the people living at The Oaks are safeguarded from abuse. EVIDENCE: At the time of this inspection visit there were twenty two people using the service. The staffing levels in place were six staff in the morning; this consisted of one nurse and five care staff and five staff in the afternoon, again one of these being a nurse. An additional member of staff worked between 7.30am and 4pm, although it was confirmed that this person was not always providing care, as they could be undertaking other duties. At night three staff were on duty, one of these being a nurse. Although the numbers of staff on duty indicated that the staffing levels were sufficient to meet the needs of the people using the service, there had on occasions, sometimes months at a time been a high incident of falls. The manager has therefore agreed that she will audit accidents on a weekly basis. This will identify any deficits in staff deployment and enable staff to be deployed as effectively as possible, ensuring the people using the service are supported safely at all times. The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 22 As stated in standards 12 to 15 discussions took place with the manager and staff regarding rostering an additional staff member on shift to enable daily activities to be undertaken, until an activities coordinator is appointed. As stated in the information provided by the manager prior to this inspection visit, fourteen out of the eighteen care staff employed have achieved or were working towards a National Vocational Qualification (NVQ) in health and social care at level 2 or above. At the time of this visit eight staff had achieved this qualification and six were working towards this qualification. This means that once these eight staff have achieved this qualification, the home will have met the national target of 50 or more of the care staff team having an NVQ 2 or above in health and social care. This will also demonstrate that the people using the service are supported by staff that have the relevant qualifications required. The recruitment records for two members of staff were looked at. Both files contained the documents that are required by law, such as criminal records bureau checks, pova first checks and required references. The dates on these documents confirmed that these two members of staff had not commenced work prior to these being received. Employment application forms were looked at and did not provide full employment histories. These are required by law to ensure the manager can identify all employment and any gaps in employment. This enables the manager to check the reasons for any gaps and identify if the individual has in the past worked with children or vulnerable adults and the reason why they left that employment. The law also states that the reasons the person left any employment that involved working with children or vulnerable adults should be clarified with these employers. This should be done before the person commences in post. However this is not possible if a full employment history is not provided, and therefore potentially puts the people using the service at risk. As the manager cannot demonstrate that she made thorough checks to ensure that the staff working at the home are safe to do so. Staff training records demonstrated that staff received mandatory training and were updated as required. The records demonstrated that the following training had been undertaken since the last inspection visit: Food hygiene, safeguarding of vulnerable adults, first aid, moving and handling and infection control. Records of training that were specific to the needs of the people using the service included continence, Liverpool care pathway, training on The Deprivation of Liberty Safeguards and The mental Capacity Act. However no training updates regarding Dementia Care was seen. The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A qualified and experienced manager is in post. But the recruitment practices, moving and handling practices, lack of proactive measures regarding falls and lack of evidence regarding staff supervision potentially puts people at risk. EVIDENCE: Staff spoken with felt that the manager was very supportive and had an open door policy, which enabled them to discuss any concerns or questions they had. Visitors spoken with were also complimentary about the manager and said that they would not hesitate to speak with her if they needed to. The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 24 Supervision records were not in place for all staff, this must be implemented to ensure that all staff receive regular supervision to support them in their work, monitor their performance and identify any training needs. The manager was able to demonstrate that she had sent out quality assurance surveys six months ago and had audited the results. However she had not published this to provide the people using the service and their relatives with this information and any actions that were to be taken following the results of this audit. The manager had also sent out letters to relatives regarding implementing regular meetings to discuss any issues or ideas on the home and the service provided. She confirmed that she had received positive feedback to this idea. However these meetings had not been implemented at the time of this inspection visit. Satisfactory systems were in place for managing individuals monies, which were held by the home for safe keeping. This ensured the finances of the people living at the home were safeguarded. The self assessment provided by the manager stated that all equipment and appliances at the home had been serviced as required. A sample of service certificates and records were seen and all were up to date. Fire safety records such as fire risk assessments, servicing of fire fighting equipment and emergency lighting checks were all up to date. Weekly fire alarm checks were two weeks overdue. During this inspection staff were observed using moving and handling equipment to support people with transfers from chairs to wheelchairs. There were two occasions when staff were seen not following the correct procedure. On one occasion, although a member of staff was standing behind the wheelchair and holding it in position, the breaks were not applied to the wheelchair, prior to the person being transferred from the hoist to the wheelchair. This is unsafe practice and could result in the chair moving or tipping, leading to a fall or injury. On the second occasion three male staff were observed attempting to transfer a person using a moving and handling belt. The three staff did not appear very confident with this procedure and the belt was not positioned correctly. This information was passed directly to the manager, as incorrect moving and handling procedures are a potential hazard to the person being supported and to the staff. It is therefore very important that the manager ensures that all staff are following the correct moving and handling procedures. The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 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 3 3 X X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 26 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 OP8 Regulation Requirement Timescale for action 09/09/09 2. OP8 3. OP8 13 (4) (c ) When a waterlow assessment review shows that a person is at high risk of pressure sores, additional information regarding the actions to be taken to minimise the risk must be recorded. This will ensure the staff have all the required information to ensure that person’s health care needs are met. 13 (4) (c ) As identified in this report, an assessment must be undertaken regarding the person who is at risk if they attempt to climb over their bedrails. This is to enable alternative beds or equipment to be identified that may be more suitable for this person and eliminate this risk 13 (4) (c) Falls must be audited on a weekly basis to identify any trends. This will then enable any trends to be identified and the appropriate actions to be put in place to reduce risk. It will also ensure that any potential safeguarding issues or concerns are identified and forwarded to the local authority. DS0000002143.V376580.R01.S.doc 13/08/09 03/08/09 The Oaks Version 5.2 Page 27 4. OP29 19 Schedule 2 5. OP36 18(2) (a) Full employment histories and a 15/12/09 satisfactory written explanation of any gaps in employment must be in place and recorded for all staff working at the home. This includes identifying any previous employment that involved working with children or vulnerable adults and confirming the reason why that person left that employment. This is to ensure that people living at the home are protected by the homes recruitment policy and practices Staff must receive formal 15/12/09 supervision on a regular basis. Supervision records must be in place for all staff. This must be implemented to ensure that all staff receives regular supervision to support them in their work, monitor their performance and identify any training needs. All care and nursing staff working at the home must be reassessed regarding their competence in moving and handling procedures. This is to ensure that all staff are following the correct moving and handling procedures. 30/09/09 6. OP38 13 (5) 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 OP7 Good Practice Recommendations All care plans should be signed and dated by the person that has written them. As this validates the care plan. The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 28 2. OP7 Care plans should be reviewed monthly and provide information on any changes in the persons support needs in that area of care. Where people are assessed as lacking the capacity to consent, information should be given in each area of care regarding this. This will ensure the staff team are aware of all areas of support and daily life where capacity requires assessment on an ongoing basis. As some people may have the capacity to consent in some areas and not other areas. Or they may have the capacity to consent on some occasions but not on other occasions. Written evidence should be in place to demonstrate that individuals (when possible) and / or their relatives are involved in the development of their care plans. Written evidence should be in the care plans regarding each person’s preference on the gender of staff supporting them with their personal care needs. Where a person is unable to state their preference regarding this, then this information should be sought from the person representing them, such as their next of kin The column for loss or gain on weight charts should record the actual amount of weight gain or loss. To alert the staff of any significant weight loss or gain. Bed rail assessments should be more detailed to ensure they meet with safety guidelines. Information in activities care plans should include preferred activities, hobbies and interests Activities should be offered on a daily basis to meet the needs of the people using the service. An additional staff member of staff should be on shift to enable daily activities to be undertaken, until an activities coordinator is employed. Information should be provided on the menus to demonstrate that fresh fruit is available to people using the service at all times. Staff should read local authority policy to ensure they are aware of practice to follow Training up dates regarding dementia should be undertaken by all nursing and care staff. Quality assurance should be published, to provide the people using the service and their relatives with DS0000002143.V376580.R01.S.doc Version 5.2 Page 29 3. OP7 4. OP7 5. OP7 6. 7. 8. 9. 10. 11. 12. 13. 14 OP8 OP8 OP12 OP12 OP12 OP15 OP18 OP30 OP33 The Oaks 15. OP38 information on the results of the surveys and any actions that are to be taken following this. Weekly fire alarm checks should be undertaken. This is to ensure the fire alarms are in working order and any faults can be identified and rectified. The Oaks DS0000002143.V376580.R01.S.doc Version 5.2 Page 30 ---- Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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