Inspection on 02/07/07 for The Oaks

This inspection was carried out on 2nd July 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 18/12/07

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 Kath Smethurst Unannounced Inspection 2nd July 2007 09:30 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.V340531.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.V340531.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 Mrs 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.V340531.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. The Home’s Manager, Senior Carers and Carers must be adequately trained to meet the specific needs of the individual service users with Dementia. The Statement of Purpose must be reviewed and updated to reflect the change to the registration. 17th January 2007 2. 3. 4. 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.V340531.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 two days. On the first day one inspector 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. The inspector also looked around the building. On the second day 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 the inspector spoke to a number of residents. The manager, activity organiser, two care staff and the cook were spoken with. Staff were also watched as they went about their work. Comment cards, asking residents and relatives and other visitors to the home for example doctors and the district nurses what they thought about the home and the care provided were sent out prior to the inspection. One relative returned a comment card. The relative was happy with the care provided. What the service does well: What has improved since the last inspection? A separate smoking area has been provided so the lounge/diner is no longer smoky. The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 6 Clearer signs have been fitted to bathrooms and toilets making it easier for residents to find their way around. The lounge/diner carpet is much cleaner and plans have been made to replace the flooring in this area. New carpets have been fitted in bedrooms. The garden areas have been improved for residents. New garden furniture has been purchased and a fountain installed. The manager makes sure that any concerns or complaints made are investigated fully. The laundry is cleaner and more organised. What they could do better: There were still some things needing to be put right in the home, which should have been done by February 2007. The manager needs to make sure that assessments (a record of what residents need help with) contains more information about the medication they need to avoid mistakes. The records kept on residents (care plans) needed improving to make sure staff have all the information they need so they can give the right care. Although risk assessments are completed, staff need to make sure they review them more often to make sure any risks to residents health and safety is known and planned for. Staff need to make sure they weigh residents more often to make sure they haven’t lost weight. Staff also need to make sure that when a resident has lost weight or is not eating they write down what they have done about it. Medicines must be administered to residents as prescribed and at the right time in relation to food intake, the paperwork to support this needs improvement for this to happen. Receiving medicines at the wrong dose, wrong time or not all can seriously affect the health and well being of residents. The competence of care staff in handling and recording medicines must be improved to ensure residents receive their medicines correctly. Checks (audits) on medicines must be carried out to show that they are being given to residents as prescribed and to prevent mistakes from happening again. The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 7 The security of the medicines storage cupboards must be improved to ensure medicines are safely locked away to help prevent mishandling and misuse. More outings outside the home need to be arranged and the type of social activities for residents with special needs (dementia) need to be increased. To make sure the home remains comfortable for people living there plans need to be made to decorate the lounge/diner and corridors. More care staff are needed so the manager has more time to spend on management tasks. Not all staff had received training to do their jobs properly. More training is needed in how to move people safely, fire safety and what to do if a resident wasn’t being treated properly. Staff need to have more training in order to better look after residents with special needs such as dementia. Although the owner visits regularly he needs to make sure he writes a report every month on the checks he makes during these visits. Some health and safety things need to be put right in order to protect the residents. Some staff need updated training in how to move and handle residents safely and what to do if there is a fire. Written information that gas installation is safe and has been tested needs to be forwarded to the CSCI (Commission for Social Care Inspection). 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 summary of this inspection report can be made available in other formats on request. The Oaks DS0000005755.V340531.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.V340531.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): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments are undertaken prior to people coming to live in the home, but some lacked significant information about medication, which could lead to care needs not being fully been met. EVIDENCE: While there had been no permanent admissions since the last inspection the home had admitted some residents for short-term care. The pre-admission assessments for two permanent residents and one short term care resident 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 The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 10 assessment information was used in writing the care plans (the information staff need to be able to meet residents care needs). During previous inspections concerns were raised in regard to the assessment process for residents admitted for respite care. It was noted that there was insufficient information for staff to know the level of care the residents needed. During this inspection some progress was noted but further improvements are needed. The pre-admission assessment for the resident admitted for respite care was examined. While brief the assessment covered all required areas and included information relating to physical and social cares needs. However the pharmacist inspector found staff did not obtain enough information in respect of medication prescribed. The absence of this information led to mistakes in medication administration. Issues relating to medication are discussed in more detail in the health and personal care section. 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 meeting with residents and staff. Many of the residents 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. The Oaks DS0000005755.V340531.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 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recording in care plans needs to be better if resident’s health and personal care needs are to be fully met. Medicines are not always given to the residents correctly, which can seriously affect their health and well being. Personal support is offered in away that promotes the resident’s privacy and dignity most of the time. EVIDENCE: During previous inspections requirements have been made in regard to ensuring all aspects of health, personal and social care needs to be identified and planned for. This requirement has still to be met in full. The care records for three residents were examined in fully. A further plan was looked at to check a resident’s weight. The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 12 Care plans are drawn up from the initial assessment and covered physical, mental health and personal care needs. Brief day and night care plans were also in place. In general, the level of information varied from care plan to care plan. Two of the plans were completed fully and had been regularly reviewed. However it was noted that significant information had not been recorded in some of the plans. There are still some areas of need or concerns not recorded or followed up. It had been identified that one resident had a very poor diet but the section covering nutrition was blank. There was no guidance for staff regarding this resident’s nutrition and his mealtimes. Staff indicated he was reluctant to eat therefore it would be expected that there would be more information on what action staff had taken in regard to this issue. It was also of concern that senior staff had not identified this care plan was being poorly maintained. Food intake charts were in place for this resident but they did not contain sufficient information in terms of actual quantity of diet taken. For example amount of fluid, how many slices of bread, quantity of cereal. It is important that this information is accurate, particularly when a residents nutrition gives rise to concerns. This residents weight record showed omissions in recording (not weighed in May or June) despite his poor diet and the care plan instructing staff to “check weight regularly”. This resident was weighed at inspectors request. It was also noted in another residents record that there were omissions in recording. A second record showed no evidence of the resident being weighed since January 2007. There was no indication in record of health professional’s visits of concerns being raised regarding this residents nutrition. The inspector asked what action had been taken in respect of this issue. The manager indicated that a dietician referral had not been made. It is understood that following the visit the doctor has visited this resident and a referral now made to a dietician. The manager also completed nutrition section of care plan during the visit. Staff spoken with were knowledgeable about the residents, which suggested some needs were being addressed even though this was not fully reflected in plans. This approach is dependent on staff memory and good communication. The reliance on verbal instruction and memory could easily break down resulting in residents needs not being met. As illustrated in the case of the resident with a poor diet where he had not been weighed and health professional’s involvement had not been requested. Risk assessments were in place in each of the files examined. They covered areas such as falls, environment, moving and handling and nutrition. Improvements to the system of reviewing risk assessments are needed, as some had not been regularly reviewed. The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 13 The care plans in place recorded involvement of health professionals and included visits from doctors, district nurses, chiropodist and optician. No residents were currently looking after their own medicines but examples were seen in past records that showed they are supported to do so. Written risk assessments and supporting care plans were seen that showed suitable arrangements are in place that ensure residents receive any support they might need. The morning medicines round is usually completed at approximately 10.30am, as seen on the day of inspection, and confirmed by the manager. The manager said, that medicines are given throughout the morning usually after the residents have had their breakfast and this was confirmed by speaking with care staff and residents. Several medicines are supposed to be given before food however staff said, and the records confirmed, that all medicines are given after food. Giving medicines at the wrong time in relation to food intake can affect the way they work and can increase the chances of side effects. The medication administration records were not always complete. Records of medicines received into the home and given to service users were not always accurate showing staff were not giving and recording medicines the right way. Several examples of medicines not “adding up” correctly were found and the manager confirmed that the mistakes had occurred. Handwritten records, notably for residents on respite care, were often incomplete or incorrect which had contributed to many of the mistakes. Past advice from CSCI inspectors had advised two care staff to check and sign these records but this has not been followed. There were no recent records of medicines returned to the pharmacy for safe disposal. The last entry was made four months ago. So, it was not possible to confirm that all medicines had been safely disposed of. Medicines prescribed as “when required” or, as a “variable dose” did not have clear written criteria for care staff to follow to ensure they are given correctly. This is particularly important for residents that are suffering with pain or who are agitated and have difficulty communicating. The cupboard used for spare stocks of medicines was not secure, this important in helping prevent mishandling and misuse. Regular checks (audits) on medicines records and stocks are not routinely carried out. Recent mistakes in recording and administering medicines have not been found, it is important to do this to ensure staff are handling medicines in the right way. The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 14 The manager said, all staff that handle medicines had attended a medicines awareness course. However, no formal assessment of competence is carried out and staff are not regularly supervised to ensure they are and remain competent. This lack of formal training for care staff has contributed to poor record keeping and mistakes when giving medicines, which could seriously affect the health and well being of residents. 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.V340531.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s interests and links with visitors are encouraged, but the provision of social activities and integration into community life needs to be improved to fully satisfy each resident’s social and recreational interests. Residents enjoyed the meals and food is nourishing and presented in a way that meets their needs. EVIDENCE: A part time activity co-ordinator is employed. A programme of activities is in place and details of the activities residents take part in are recorded. The record of activities was examined. 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 and the activity co-ordinator indicated that not all activities that took place were documented. Two residents spoken with said they went out to local shops. While the activity co-ordinator said she undertook a lot of one to one activities. This needs to be addressed to ensure there is evidence of the range of activities offered. The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 16 While some residents use community facilities opportunities for more dependent residents is limited. It is acknowledged some residents go shopping but the majority of residents don’t take part in activities in the community. The manager was asked what arrangements were made to arrange outings for residents. She indicated there had been no recent trips out (due to the poor weather) and no outings had been arranged. Some of the residents 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. During the afternoon the activity coordinator organised a game of dominoes which some of the residents took part in. All appeared to enjoy participating. It was however noted that a number of residents spent their day unoccupied possibly due to staff being busy. One resident was seen walking about the home alone for long periods. The inspector spent some time with this resident as she walked and it was evident she would have appreciated some staff contact. 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 socialise with the residents. Residents with religious beliefs are encouraged and enabled to maintain links. Care plans contain details of resident’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 visitor’s 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 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. The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 17 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. Good practice was noted in that at lunch the snack offered hot options. Lunch on the day of the visit consisted of sausage or fish cake and chips followed by fruit crumble. All food is home cooked and very little convenience foods are used. The chef is very experienced and it was evident he knew the residents likes and dislikes very well. The chef was seen speaking with residents and having a laugh and joke with them. 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. It was observed that tea was served from a very large institutional teapot. An alternative to this should be used. Discussion with the chef indicated the budget was sufficient. 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 “good”. The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 18 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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system with some evidence that residents feel their views are listened to and acted upon. Protection policies and procedures are in place, but not all staff have yet received up to date training in how to detect and refer potential abuse, which could lead to residents being at risk of harm. 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. The complaint log was examined to find there had been two concerns raised formally with the home. These related to cleanliness in the home and care practice (resident being unshaven). These concerns appeared to be resolved. Currently there is one unresolved complaint being investigated by Wigan Social Services Customer Care section. The complaint relates to the care a former respite care received while living in the home. The complainant The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 19 originally complained directly to the home. The manager undertook an investigation but the complainant was dissatisfied with the outcome. 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 and feedback in the returned comment card indicated 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 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. The manager has undertaken POVA training. Discussion with the manager indicated she is aware of what to do in the event of an allegation or suspicion of abuse. For example when concerns were raised regarding a former member of staff she referred the individual for inclusion on the POVA register. Since the last inspection there has been one POVA referral relating to the care of a former resident. It is understood from the manager that the home has been exonerated. The report of the investigation has not yet been forwarded to the home or CSCI. Examination of training records showed staff had not undertaken POVA refresher training for some time. This was discussed with the manager who indicated training was in the process of being arranged. This needs to be addressed to ensure all staff know what to do in the event of an allegation or suspicion of abuse. The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 20 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 and 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. The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 21 Since the last inspection the home have gained a capital grant to undertake improvements. So far a garden fountain has been installed and new garden furniture purchased. With the remaining funds new lounge lighting is being fitted and new flooring installed. In the main the home is well maintained but some areas of the home are becoming “tired” looking and would benefit from some redecoration in particular corridors, lounge and some bedrooms. While looking around the home it was noted that two fire doors in the upstairs corridor were wedged open. This was discussed with the manager. She was advised that if these doors were usually kept open either self-closing devices or noise-activated magnetic doorstops should be installed. The communal lounge/dining area provides a light comfortable area for residents to relax in. As previously noted this area would benefit from redecoration. The carpet in parts is worn and damaged but is due to be replaced. Fluorescent lighting is fitted in the lounge/dining area. This gives a somewhat institutional appearance-the plans to change the lighting with a more domestic style fittings will enhance the appearance of this area for residents. 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. The manager advised that new bedroom carpets had been fitted since the last inspection. While some bedrooms were painted in warm colours the décor in others was somewhat stark and cold looking. Consideration should be given to making the décor more homely after consultation with residents. In one of the bedrooms there was pipe work on open display again this detracts from the appearance. Ways to enclose the pipes need to be looked at. 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. The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 22 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. 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.V340531.R01.S.doc Version 5.2 Page 23 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 and 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 to the residents 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. Recruitment information needed to be improved to ensure residents’ safety and protection. EVIDENCE: A sample of duty rosters was examined to find that normally there are three care staff on days and two at night. Catering and domestic staff are also employed. Some improvements are needed in regard to the duty rosters. The rotas looked at did not provide detailed information as to the designation of staff working at the home. For example senior on duty, care assistant, activity co-ordinator etc. This needs to be addressed. The manager’s hours are used as part of the rota, which means that when she is undertaking management duties only two staff are caring for residents. Discussion took place with the manager as to whether current staff ratios were sufficient. The manager she felt there were enough staff on duty, however staff The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 24 spoken with felt an additional carer should be provided. It was also noted that a number of residents had complex needs and staff were very busy. In addition some of the inspection findings indicate the manager needs more time to concentrate on management tasks. A review of staff ratios needs to be undertaken to ensure there are sufficient staff to meet the needs of the residents and for the manager to fulfil her role. The staff group reflects the same cultural background as the residents, white Caucasian. The recruitment files for three staff were examined. It was noted that some information was missing from files. In one file there was no POVA/CRB (protection of vulnerable adults/criminal records bureau) reference number. While in two files a second reference was missing. This was discussed with the manager who that the information was missing due to a misunderstanding about advice given by a previous inspector. The manager was advised not to retain returned CRB checks once seen. The manager misinterpreted the advice and thought she had to destroy references as well. More recent files shows all necessary information including two written references, identification, health declaration and application form are retained. While it may not be possible to obtain references again the manager needs to ensure POVA/CRB checks have been returned and indicate what has happened in regard to any missing information. 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 sample of training records examined showed that some areas of mandatory training needs to be updated including moving and handling, fire safety, medication and POVA. The manager said moving and handling training was in the process of being arranged. She advised that the manager of the sister home (The Acorns) had completed training to become a trainer and would provide moving and handling refresher training. While training records show staff had completed some medication awareness training, the pharmacist inspector noted that staff’s competence to administer medication had not been undertaken. All these areas need to be addressed in the homes training plan. The home is registered to provide a specialist service for people living with dementia but staff have not yet completed dementia awareness training. During the last inspection the manager indicated staff were undertaking the The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 25 “yesterday, today and tomorrow” training (dementia awareness). However discussion with the manager and examination of workbooks during this inspection showed 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. Information provided by the manager in the pre-inspection materials indicated 50 of staff were in receipt of NVQ (National Vocational Qualification) level 2. However training records in the home showed 48 were in receipt of NVQ level 2 with 2 staff working towards the award. Once they have completed training the home will have reached the required percentage of trained staff. The manager needs to monitor this to ensure progress is maintained. The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 26 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, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager of the home has the resident’s interests at heart but needs additional support to ensure management tasks are fully undertaken. Quality assurance systems are in place but improvements are needed to ensure the performance of the home is regularly monitored. Health and safety practices are on the whole satisfactory, but some shortfalls were identified which need to be addressed in order to minimise the risk of harm to residents and staff. EVIDENCE: The registered manager has seventeen years experience in managing residential care services. The manager has an NVQ 4 in care and a registered The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 27 managers award (RMA). The owner lives next door and visits daily. The deputy manager is currently on maternity leave. The manager currently works part time. As previously noted the does not have any supernumery hours to attend to management tasks. The findings in this inspection indicate this arrangement needs to be reviewed particularly as the deputy manager is on maternity leave. Although improvements were noted in meeting some requirements made during the last inspection others remain outstanding. Important information was absent from pre-admission assessments and care plans. Concerns were also identified in regard to medication practices in the home, which could potentially put residents at risk. While it is clear the manager is open to ideas and suggestions if care plans, medication and other areas are to be improved additional management hours will be required. Internal and external quality assurance systems are in place. A complaints procedure is in place. The manager has recently sent satisfaction surveys to relatives. To date three relatives have responded. In the main all were satisfied with the care 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. There was no evidence of regular staff meetings taking place. These should be arranged. The owner visits every day however there were no written reports of these visits. This needs to be addressed. Each month the owner must visit the home audit records and speak to staff and residents following which a written report needs to be produced. Residents and a visitor confirmed the owner visited regularly and asked them for their views and opinions about the home. It is therefore unfortunate these discussions are not documented as they would provide further evidence the homes performance was being monitored. This is an area, which needs to be addressed. 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 The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 28 offering support. The personal allowances for three residents were examined and were found to correspond with documentation. A staff supervision and appraisal system is in place. The random sample 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. Although as previously noted moving and handling training needs to be updated. Accidents have been recorded appropriately. With the pre-inspection materials, the manager provided a list of maintenance and associated records. A sample of equipment service records was examined including the lift, hoist and gas. While the lift and hoist had up to date service certificates there was no gas safety certificate. The owner said that a service had been arranged and would be completed by the 12/7/07. It was agreed a copy would be forwarded though to date no correspondence has been received. This needs to be addressed. Fire safety records showed that that all fire tests and maintenance procedures had been undertaken regularly. It was noted that the owner undertook the checks. The inspector asked what happened when the owner was on holiday. The manager advised the checks were not undertaken. Another member of staff needs to undertake this task in the absence of the owner. A fire risk assessment is in place but had not been reviewed annually. This needs to be addressed. The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 29 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 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 2 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15 (1) (2) Requirement To ensure residents receive the care they need care plans must contain details of all the residents needs and state the actions necessary to meet those needs; to ensure the health and welfare of residents are met. Timescale 28/02/07 not met. To ensure residents health and well being is maintained weight must be monitored and recorded regularly. Timescale 28/02/07 not met. 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. 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 DS0000005755.V340531.R01.S.doc Timescale for action 14/08/07 2 OP8 12 (1) b 06/08/07 3 OP9 13(2) 06/08/07 4 OP9 17(1)(a) Schedule 3(i) 06/08/07 The Oaks Version 5.2 Page 31 health and well being of residents. 5 OP9 13(2) Medicines storage must be improved to ensure medicines are stored securely within the home to help prevent mishandling and misuse. 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. Adequate arrangements must be made to protect those using the service if a fire should break out by ensuring fire doors are not wedged open. To demonstrate staffing ratios are appropriate a recorded rota must be maintained which details all staff on duty at any time and in what capacity. 06/08/07 6 OP9 18(1)(a) 06/08/07 7 OP19 23 (4) (c) 06/08/07 8 OP27 17 (2) Schedule 4, 7. 06/08/07 9 OP29 17 (2) Schedule 4, 7 In order to ensure staff working 31/08/07 at the home are properly vetted and with a view to protecting resident’s evidence of current CRB checks must be documented and made available. To ensure staff have the skills 31/10/07 and knowledge to provide a good standard of care for resident’s mandatory training including, induction, moving and handling and fire safety must be completed. To ensure staff have the skills 31/10/07 and knowledge to provide a good standard of care for residents with cognitive difficulties as planned dementia care training DS0000005755.V340531.R01.S.doc Version 5.2 Page 32 10 OP30 18 (1) (a) 11 OP30 18 (1) (a) The Oaks must be provided. 12 OP33 26 To ensure the service is being run in the best interest of the resident’s the person responsible must each month visit the home and prepare a written report on the conduct of the home. 06/08/07 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 OP9 Good Practice Recommendations 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. The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 33 2 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. 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, updated training should be arranged. To ensure the environment does not fall below an acceptable standard for residents plans must be made to redecorate the lounge/diner and corridors. Consideration should be given to fitting self-closing devices or noise-activated doorstops to fire doors residents like kept opened. To assist residents with memory loss to remain as independent as possible more aids to orientation should be provided in the home. To ensure the well being of residents at risk of poor nutrition is maintained food intake charts should be completed fully. To ensure standards don’t fall below an acceptable standard for residents to live in the “blown out” doubleglazing unit should be replaced. To ensure the environment is safe for residents evidence the gas installation is safe should be forwarded to the CSCI. To ensure staffing levels are sufficient to meet residents care needs a review of ratios should be undertaken. 3 OP12 4 OP18 5 OP19 6 OP19 7 OP19 8 OP8 9 OP19 10 OP38 11 OP27 The Oaks DS0000005755.V340531.R01.S.doc Version 5.2 Page 34 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.V340531.R01.S.doc Version 5.2 Page 35 - 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. 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