Inspection on 18/12/07 for The Oaks

This inspection was carried out on 18th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Oaks 23/04/08

The Oaks 02/07/07

The Oaks 17/01/07

The Oaks 23/01/06

The Oaks 11/08/05

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 Greater Manchester WN2 4LZ Lead Inspector Rukhsana Yates Unannounced Inspection 18th December 2007 10:00 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 The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 DS0000005755.V356450.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Oaks Address Oak Avenue Hindley Green Wigan Greater Manchester WN2 4LZ 01942 521485 01942 522141 hallkevin@f2s.com 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) Mr Kevin Hall Denise Bostock Care Home 31 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (31), of places Physical disability (3), Physical disability over 65 years of age (8) The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 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 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) The service should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. 2nd July 2007 2. Date of last inspection 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 provided at the front of the home. 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 fee is currently £367.50 per week. Additional charges are made for hairdressing and newspapers. The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit, which was part of a key inspection, took place over one day. During the visit we looked at records the home holds on residents (care plans) and other records the home needs to keep to ensure the home is being run properly, for example activity records, menus, staff files and staff training records. We also looked around the building. A pharmacist inspector visited to look at how well resident’s medicines were being handled. Staff at the home had not been told that the inspectors would visit. To find out more information we spoke to a number of residents. The manager, and two care staff were also spoken with. Staff were watched as they went about their work. There was a temporary manager on duty during this inspection as the registered manager is no longer working at the home. What the service does well: What has improved since the last inspection? The records kept on residents (care plans) are better so that staff have all the information they need to give the right care. The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 6 Staff now make sure they weigh residents more often to make sure they haven’t lost weight. The owner visits regularly and writes a report every month on the checks he makes during these visits. Staff have received training in how to move and handle residents safely and what to do if there is a fire. A new medicines trolley had been obtained, which has helped improve the general organisation of medicines. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Oaks DS0000005755.V356450.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 DS0000005755.V356450.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person, or their representative has their needs assessed and may visit the home before admission to ensure that the service is suitable for them. EVIDENCE: While there had been no permanent admissions since the last inspection the home had admitted people for short-term care. The pre-admission assessments for four people were examined. The two files of residents who had lived at the home for a long time contained assessments undertaken by local authority care managers. In addition staff at the home completed an additional assessment of the residents care needs. The assessment information was used in writing the care plans (the information staff need to be able to meet residents care needs). The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 10 The pre-admission assessment for people admitted for respite care covered all the required areas and included information relating to physical and social cares needs. Discussion took place with the manager regarding the admission process prior to a new resident coming to live at the home. The manager said she would visit prospective residents whether they were at home or in hospital to undertake an assessment of care needs. The manager also advised that prospective residents and their relatives were welcome to look around the home and spend time meeting with residents and staff. Many of the residents were unable to discuss their admission process but two spoken with indicated they had visited prior to their admission and had received sufficient information regarding the home. Standard 6 is not applicable to this service. The Oaks DS0000005755.V356450.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10: Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People receive the basic personal and healthcare they need. Medicines are not always given to the residents correctly, which can seriously affect their health and well-being. EVIDENCE: During previous inspections requirements have been made in regard to ensuring all aspects of health, personal and social care needs be identified and planned for. The care records for three residents were examined. Care plans have improved significantly since the last inspection visit. Care plans are drawn up from the initial assessment and covered physical, mental health and personal care needs. Day and night care plans were also in place. People were being weighed regularly, and food intake charts were in place for people at risk of poor nutrition. These were being better completed so that they contained sufficient information in terms of actual quantity of diet taken, and nutritional concerns addressed in the care plan. The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 12 Staff spoken with were knowledgeable about the residents and reported that good communication between them ensures that they are updated about changes in peoples’ needs. The care plans for people with mental health needs relating to dementia did not fully reflect the actions staff should take in response to certain behaviours, which could result in inconsistent care provided to the individuals concerned. It is recommended that detailed information about how to meet the dementia care needs of people is included in care plans to ensure they receive consistent and effective care. There was no evidence of each person’s agreement to their care plan, and this also needs to be addressed. Risk assessments were in place in each of the files examined. They covered areas such as falls, environment, moving and handling and nutrition. The manager has ensured that risk assessments have been reviewed, as advised at the last inspection. The care plans in place recorded involvement of health professionals and included visits from doctors, district nurses, chiropodist and optician. As part of this inspection the pharmacist inspector looked at the medicines records and the storage arrangements to ensure improvements in medicines handling had been made since the last key inspection. Although the majority of medicines had been given at the correct time we found that some medicines were still given after food instead of before. This was highlighted at the last inspection but has not been put right. Giving medicines at the wrong time in relation to food intake can stop them working correctly and in some cases cause side effects. We checked medicines records against current stock and found some medicines did not add up correctly. This was due to some medicines being given to residents wrong and in some cases due to poor record keeping. Records of medicines receipt were not accurately made and we gave further advice on how to do this better. The previous key inspection highlighted these issues but no significant improvements had been made. Handwritten records, particularly for new residents, continued to be inaccurate. Important information was either left off or incorrectly written, which could lead to mistakes when administering the medicines. Previous pharmacist inspections had advised two care staff to check and sign these records before administering but this had not always been followed. Medicines prescribed as ‘when required’ did not have detailed written care plans. In particular, two medicines used for agitation did not have enough The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 13 information to support their safe use. This could result in residents getting medicines that they do not need. Some improvements in the general storage arrangements had been made. However the arrangements for controlled drugs and for medicines requiring cold storage remain inadequate. Having secure storage helps prevent mishandling and misuse. We looked at how staff were trained in handling medicines. All staff had received some formal ‘medicines awareness training’ dating back over approximately three years. The manager had carried out an individual assessment of staff competence and a record of this had been made. The manager had also carried out audits of the medicines on a monthly basis and a record of these had been made. However given the number of recording and administration mistakes it was evident that some care staff still lacked the required skills to handle medicines safely. Those residents who were able to comment indicated that staff respected their privacy and dignity. During the inspection, staff were observed to treat residents with respect and consideration. Residents were nicely dressed in clean well maintained clothing. The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People feel they are supported in their choice of daily routines and meals, but the provision of activities is limited and does not fully satisfy each person’s social and recreational interests. EVIDENCE: Recent recorded activities include bingo, hairdressing and dominoes. No other activities were documented and there was no evidence of any trips out being organised. Discussion with residents indicated that not all activities that took place were documented. Two residents spoken with said they went out to local shops and took part in bingo. Since the last inspection, there has been a vacancy for the post of activity co-ordinator, and this has temporarily limited the number of activities taking place. However, staff members should ensure that they document all activities to demonstrate that the social needs and aspirations of people living at the home are being suitably considered and met. While some people use community facilities opportunities for more dependent people is limited. It is acknowledged some residents go shopping but the majority of residents don’t take part in activities in the community. There are plans to arrange outings when the weather improves. The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 15 Some of the people living in the home have communication and memory difficulties (dementia). These residents are able to take part in most of the activities arranged. However some consideration should be given to further developing the range and frequency of specialist activities for these residents. For example sensory activities such as baking, painting, massage etc. When their duties allowed care staff were seen acknowledging residents. A friendly but respectful banter was seen. However as previously noted care staff were very busy and did not have much time to sit and talk with the residents. Residents with religious beliefs are encouraged and enabled to maintain links. Care plans contain details of people’s preferred religion. Representatives from local churches visit regularly (RC weekly, C of E monthly). The home has an open visiting policy. There are no restrictions on the time people visit, evidence of which was highlighted in the visitors’ book. Entries showed residents friends and relatives visiting at different times during the day and the evening. The only time restrictions would be imposed is when requested by residents. A visitor spoken with at the last inspection said she visited regularly and confirmed she could come at any time and staff were always welcoming. The choices residents made each day varied, and depended upon their mental frailty but residents were able generally chose what time to get up, go to bed, what clothes to wear, what to eat, where to spend their day and whether or not to participate in activities. There is a 4 weekly menu cycle, which offered a varied choice of nutritional food. Meat and fish were offered on a daily basis, as well as a good assortment of vegetables. Menus offer residents at least two choices of meal at lunchtime and two more choices at teatime. Breakfast is served on a flexible basis between 9.30 and 10.30. A light meal is offered at lunch around 12. 30 and the main meal is offered at teatime around 4.30. All food is home cooked and very few convenience foods are used. A senior staff member is temporarily employed to cover the vacancy for a cook, which has occurred since the last inspection. The lunchtime meal was observed. The meal was freshly made and the portion size good. A hot or cold drink was available. Residents were given time to eat their meal and no one was rushed. Fresh fruit/vegetables and meat are delivered twice a week and dry goods weekly. Residents were very complimentary about the food describing the food as being “very good” and “lovely”. The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have information about how to complain and how complaints will be handled. Training arrangements for staff help to ensure the protection of residents. EVIDENCE: A complaints procedure is in place. The procedure was in the file displayed in the entrance to the home and was given to residents/relatives as part of the handbook residents receive when they move to the home. A system was in place for recording the concerns and complaints brought to the homes attention. Currently there is one complaint being investigated by the service. The complaint relates to the care received by a former short term resident. The outcome has yet to be notified. Many compliment/thank you cards were seen in both the entrance to the home and the office. The messages showed that families had appreciated the care given to their relative. Residents able to comment said they felt able to approach staff with any concerns and these would be taken seriously. None had made a complaint but all indicated they were aware of how to do so if the need arose. The home has a protection of vulnerable adults (POVA) policy and procedure. New staff cover what is considered abusive and inappropriate behaviour as The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 17 part of their induction. Abuse procedures are also covered in NVQ training. The home also has a copy of Wigan Social Services safeguarding adult’s policy. Since the last inspection, the current manager has made arrangements for staff to receive refresher training in safeguarding procedures so that they know what to do in the event of an allegation or suspicion of abuse. The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most areas of the home are clean and safe with furniture and fittings that provide comfortable surroundings for residents. EVIDENCE: The Oaks is a purpose built two storey residential home with level access providing twenty-eight bedrooms (three are double rooms and are available for couples). It is situated near to Hindley and within walking distance of local amenities. Parking is available at the front of the home. Garden areas are pleasant and safe providing seating areas and raised beds for residents. A passenger lift is provided. This year, the service has gained a capital grant to undertake improvements. So far a garden fountain has been installed and new garden furniture purchased. New lounge lighting has also been fitted and new flooring installed. The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 19 In the main the home is well maintained but some areas of the home would benefit from some redecoration in particular corridors, lounge and some bedrooms. The communal lounge/dining area provides a light comfortable area for residents to relax in. The conservatory is now used as the smoking area. This means that smoke no longer drifts into other areas of the home, but other residents may not now wish to sit in the conservatory because of the smoke. Staff are not allowed to smoke in the building. A random selection of bedrooms was inspected. New bedroom carpets had been fitted in some rooms over recent months. While some bedrooms were painted in warm colours the décor in others was somewhat stark and cold looking. At the last inspection, the manager was advised to make the décor more homely after consultation with residents. This is being addressed, and a maintenance person has been employed to carry out repair work and redecoration where it is most needed. Some of the bedrooms were well personalised with residents personal mementoes on display. The ‘blown’ double-glazing unit on the landing still needs to be replaced. During the last inspection it was noted that signage throughout the home needed to be improved as the home is registered to provide specialist care to people living with dementia. Some progress has been made to address this with new signs fitted to toilet and bathroom doors. Recommendations regarding the provision of other orientation aids had not yet been addressed. The provision of personalised plaques, memory boxes, and painting doors different colours would help with identification of bedrooms and toilets. This should be considered in order to ensure residents living with dementia have a supportive environment in order to compensate for any cognitive difficulties they have. On the day of the visit the home was clean and odour control was generally good. Policies and procedures were in place for infection control. However, the use of a wooden bath seat in one shower and a rubber mat in a bath raises a risk of cross contamination. The manager was advised of this and agreed to the removal of both items. Equipment that was needed when assisting residents with personal care was provided for all staff. Liquid soap and paper towels were situated near to hand washing facilities. The laundry was situated away from the food preparation area. The laundry although small had sufficient equipment. The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff team, were committed to providing good care but the staffing levels were not meeting the social and emotional needs of the permanent and respite care residents. A staff development programme is in place but this needs to be maintained to ensure staff are equipped with the skills and knowledge required for their roles. EVIDENCE: A sample of duty rosters was examined. Usually to find that normally there are three care staff on days and two at night. Catering and domestic staff are also employed. The manager’s hours are now not included as part of the rota, which means that when she is undertaking management duties there are still sufficient staff on duty to meet residents’ needs. The manager felt there were enough staff on duty most of the time, but recognised that another care assistant should be on duty during the busy morning period, and this is being addressed. The staff group reflects the same cultural background as the residents, white Caucasian. The recruitment files for two staff were examined. One of the files contained the POVA/CRB (protection of vulnerable adults/criminal records bureau) reference number, but gaps in the person’s employment history had not been explored. This was an oversight by the manager appointing the member of staff concerned. The current, replacement manager was aware of all the The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 21 checks required for new staff and was taking steps to explore gaps to ensure safe and consistent recruitment processes were being followed. A staff development programme is in place and records of training are maintained. Training completed by staff includes, NVQ (National Vocational Qualification), basic life support, health and safety, moving and handling, medication, optical awareness and diabetes awareness. While an induction programme is in place further development is needed to ensure the induction staff receive covers all areas documented in the “Skills for Care Induction Standards”. In one of the staff records examined there was no evidence of induction training having been completed. The manager was in the process of carrying out a full training audit and booking courses to ensure all staff receive updated mandatory training. This was confirmed in the training records and in discussions with staff. The training includes moving and handling, fire safety and medication. As advised at the last inspection, staff competence has been assessed with regard to administering medication. During this visit, the pharmacist inspector noted that mistakes were still being made, and that this indicated further training needs for staff that need to be addressed to ensure their competence. The home is registered to provide a specialist service for people living with dementia but staff have not yet completed dementia awareness training. As at the last inspection, staff were undertaking the “yesterday, today and tomorrow” training (dementia awareness). However discussions with the manager and care staff confirmed that this training had not yet been completed. This needs to be addressed to ensure staff are equipped with the skills and knowledge they need to provide a good standard of care to residents with memory and communication difficulties. Training records in the home showed 48 of staff were in receipt of NVQ level 2 with 6 staff working towards the award. Once they have completed training the home will have reached the required percentage of trained staff. Since the last inspection, the manager has held meetings with staff at all levels, to ensure that planned improvements in recording and work practices are understood by everyone involved for the benefit if the residents. The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An improvement in management arrangements is helping to ensure that people living at the home have their best interests protected and promoted. EVIDENCE: Since the last inspection, the owner has taken steps to improve management arrangements at the home, and this has proved to be effective in addressing many of the requirements made. At the time of this visit, the service was being temporarily overseen by a qualified, and competent, manager with several years of experience. There are plans to recruit a manager to replace the previous registered manager who no longer works at the home. It was noted at previous inspection that internal and external quality assurance systems are in place. A complaints procedure is in place. Satisfaction surveys had been sent to relatives, and in the main all were satisfied with the care The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 23 provided. Comments received included “Service excellent”. Two relatives indicated some dissatisfaction with the laundry service and décor. Comments received included “Laundry a problem” and “home requires a refurbishment programme”. Formal resident meetings are not held although staff do consult residents on an informal basis. Evidence of which was seen on the day of the visit with residents being consulted about their food preferences. The manager should consider recording these discussions to provide evidence residents have been consulted. The owner visits every day, and as required at the last visit, now audits records, speaks to staff and residents, and produces a written report, providing evidence that the quality of the service is being monitored. Residents confirmed the owner visited regularly and asked them for their views and opinions about the home. The Contracts Section of Wigan Social Services Department, in conjunction with a company called RDB Limited, has undertaken a voluntary star rating of homes in Wigan. As part of the rating process an annual audit of quality is undertaken. This includes consultation with service users and staff. All monies held for safekeeping are kept individually. Income and expenditure was recorded The home does not act as an agent for any of the residents. Currently none of the residents manage their own monies, with relatives offering support. A staff supervision and appraisal system is in place. The random sample of records examined showed supervision was being held on a regular basis. Health and safety policies and procedures were in place. The staff team have completed health and safety training. Accidents have been recorded appropriately. Fire safety records showed that that all fire tests and maintenance procedures had been undertaken regularly. The home’s fire risk assessment is currently being reviewed by the manager. The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 24 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 25 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 OP9 Regulation 13(2) Requirement Medicines must be given to residents as prescribed and at the right time in relation to food intake. Receiving medicines at the wrong dose, wrong time or not all can seriously affect the health and well being of residents. Timescale 06/08/07 not met An accurate record must be kept of all medicines received into the home and administered to residents to ensure mistakes do not happen that can affect the health and well being of residents. Timescale 06/08/07 not met Timescale for action 08/02/08 2. OP9 17(1)(a)S chedule 3(i) 08/02/08 3. OP9 13(2) Medicines storage must be improved to ensure medicines are stored securely within the home to help prevent mishandling and misuse. Timescale 06/08/07 not met 08/02/08 The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 26 4. OP9 18(1)(a) All care staff that handle medicines should be assessed as competent and if necessary receive further training to help ensure residents receive their medicines correctly. Timescale 06/08/07 not met 08/02/08 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. 2. 3. Refer to Standard OP7 OP7 OP9 Good Practice Recommendations In order to maximise individual involvement and choice, residents or their representatives should be consulted about, and agree to, the contents of the care plan. Detailed information about how to meet the dementia care needs of people should be included in care plans to ensure that people receive consistent and effective care. Medicines prescribed as when required or, as a variable dose should have clear written criteria for care staff to follow to ensure they are administered correctly. Patient information leaflets should be used for all medicines kept in the home to ensure medicines are administered correctly. All handwritten medicines records should be an exact copy of the pharmacists dispensing label, which should be double-checked and countersigned, this should help prevent mistakes. 4. OP12 In order to offer interest and stimulation to people living in the home the programme of activities should be developed to include more trips outside the home. The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 27 5. OP12 To ensure residents living with dementia lead a stimulating life consideration should be given to providing more sensory activities such as baking, painting, massage etc. To ensure residents are protected and staff know what to do in the event of an allegation or suspicion of abuse, as planned, updated training should be arranged. To assist residents with memory loss to remain as independent as possible more aids to orientation should be provided in the home. To ensure standards don’t fall below an acceptable standard for residents to live in the blown out doubleglazing unit should be replaced. 6. OP18 7. OP19 8. OP19 The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Oaks DS0000005755.V356450.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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