Inspection on 02/06/07 for The Oaks

This inspection was carried out on 2nd June 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Oaks 15/02/10

The Oaks 15/07/09

The Oaks 21/07/08

The Oaks 05/11/07

The Oaks 05/04/06

The Oaks 21/10/05

The Oaks 04/05/05

The Oaks 24/11/04

The Oaks 12/05/04

The Oaks 22/01/04

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

CARE HOMES FOR OLDER PEOPLE Oaks, The 114 Western Road Mickleover Derby DE3 6GR Lead Inspector Vanessa Davies Key Unannounced Inspection 09:30 29th May 2007 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 Oaks, The DS0000002143.V338541.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. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oaks, The Address 114 Western Road Mickleover Derby DE3 6GR Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01332 510447 01332 519786 Mr Hassan Khan Ms Teresa Clare Boyce Ms Teresa Clare Boyce Care Home 28 Category(ies) of Dementia - over 65 years of age (28) registration, with number of places Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home accommodates both service users outside the current age category and current registration Older People (OP) for the duration of their stay. 4th July 2006 Date of last inspection Brief Description of the Service: The Oaks is a detached home, which has been adapted and extended to provide nursing care for up to 28 older people with dementia. The home is situated in the residential area of Mickleover. The home has 26 single bedrooms all with an en-suite facility and 1 double bedroom. The home is set within its own well kept, pleasant gardens, which are secure. There are registered nurses on duty 24 hours per day. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information for this report has been gathered via reading information provided by the manager prior to the visit, reading information, speaking with staff and service users during the visit. The fees for the home are £497 - £500 per week, with additional charges reported as £10 for chiropody and £2 - £10 for hairdressing. What the service does well: What has improved since the last inspection? Staff now receive regular supervision, which will help to improve their practice. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Limited information within the assessments of need, potentially prevents staff from meeting the holistic needs of the service users and could put service users at risk. EVIDENCE: Four service users records were examined during the visit. Varying information was evident within the 4 files examined. Nursing assessments were completed prior to admission in 2 files and 1 had detailed social history information. 1 file did have some information on the homes own assessment, however a large part of it was illegible, one had been completed by 3 different people on the day of admission, there was no evidence of information gathered prior to admission to assess suitability. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 9 There was limited social history information within 1 and none in another file. There was no evidence of a date of admission on 2 assessments. Assessments detailed religion but no other evidence of addressing equality and diversity. 1 assessment consisted of mainly a tick chart which did not provide sufficient information to address the needs. Only one of the files had a photograph of the service user and a personal profile, although that was at the back of the file. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Input from various professionals assists with meeting service users needs, however limited information within assessments, lack of follow-up on illness and out of date care plan reviews potentially puts service users at risk. EVIDENCE: Limited information was evident within the files examined as stated in the previous section. Evidence of input from dietician, GP, SW and optician. Files held copies of Mental Health assessment, Waterlow Risk Assessment, nutiritional assessment. 2 of the files had evidence of input from the family regarding use of bed rails. There was a risk assessment and agreement/authorisation from GP to give medication to one service user in a covert way. Medication is stored appropriately, administered by trained nurses and documented accordingly. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 11 Accident forms are completed, however the staff did not ask for information on the day of the visit of an incident witnessed by the inspector and no staff (details are documented later within this report) and there was no evidence of monitoring by the manager or deputy. One file documented a urine infection, urine tested report stated observe and test in the morning, no further info documented. A care plan stated review weekly; reviewed 17.03.06, 18.04.06, 20.05.06, continues monthly to Jan 07 then reviewed weekly to end of Jan and monthly to 15.03.07 no review since. Care Plan re: mobility reviewed monthly to 15.03.07 no review since, service user fell and fractured hip 19.05.07. One assessment was very difficult to read, part stated; can be anxious at times which can lead to aggression. The care plan states; history of aggression towards staff, physically aggressive and is frequently resistive to all interventions. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 12 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. Limited activities and poor supervision of service users potentially puts servcie users at risk from other service users and prevents them from meeting expectations. EVIDENCE: Very limited information regarding social history within 3 of the 4 files examined. Some of the staff were observed communicating very well with the servcie users, however it was evident that a number of staff found it difficult to communicate with the service users. The Inspector sat in lounge as 4 service users were brought in, staff left service users without supervision, one service user assaulted another and had to be seperated by the inspector. The home does employ an activities coordinator and she did arrange some painting with some of the service users during the inspection, however there was no evidence of an activity plan and the majority of service users were sitting around in lounges or dining room. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 13 Relatives continue to visit without restriction and are made welcome on visiting. There was no evidence of community contact, the home did have a summer fayre planned and a small notice on the home sign outside was asking for donations to the fayre. Meals are based on 4 week rolling rota, choice of menu is offered and kitchen staff were clearly aware of the likes and dislikes of the servcie users and tried to meet these. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 14 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 poor. This judgement has been made using available evidence including a visit to this service. Suitable policies and procedures for addressing complaints and Safeguarding Adults ensures that staff are able to address issues appropriately, however poor supervision of service users and inadequate staff checks prior to employment may lead to servcie users being at risk of harm. EVIDENCE: The Registered Manager was not available at the time of the visit and the Deputy Manager was off sick, although he did visit during visit. The Person in charge was not aware of where complaints record was, when asked she thought it may be in the office upstairs. A relative spoken with was aware of complaints procedure although had nothing to complain about. The Pre-Inspection questionnaire indicates the home has had one complaint and it was resolved. Home has complaints procedure. Staff records indicate staff have completed training on Safeguarding Adults, those spoken with were aware of their role and what to do in the event of a adult protection issue. Service users were left unsupervised for long periods of time during the visit, 1 service user assaulted another during the visit as no supervision. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 15 Staff records evidenced staff are still employed without a POVA First check or a Criminal Records Bureau check. Application forms were incomplete and written references were not clear of which employer had provided it. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clean environment free from hazards helps to ensure that service users are safe. EVIDENCE: The home was clean and free from any malodour, there are a number of domestic staff at least 1 per day 9-1. Laundry staff 1 per day 7-2. Rooms were examined, a few family pictures were evident to personalise, they were clean with adequate furniture. One service users room lock on the bedroom door had been dismantled preventing privacy being respected. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 poor. This judgement has been made using available evidence including a visit to this service. Staff are employed without POVAFirst and CRB checks, lack of previous employment history, lack of specific training potentially puts service users at a great deal of risk. EVIDENCE: The person in charge on day of visit started work at the home 02/05/07, she stated that the Deputy Manager was off sick ‘I think’ and she was not sure where the Registered Manager was, a member of staff spoken with stated that the Registered Manager was at the bank, the duty rota stated SN (supernumery). Staff spoken with stated that they did have supervision, records were not examined as the Registered Manager was not available. Three staff files examinedand evidence was found that staff had started employment before a check had been made against the PoVA list (a lsit which records people who are unsuitable to work with vulnerable adults), references were missing, there was an incomplete work history and no evidence of induction. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 18 There was little supervision of service users throughout the visit and 1 service user assaulted another, having to be seperated by the inspector, staff were informed, however no member of staff took details of the assault to document on an incident form. None of staff on duty have training in dealing with challenging behaviour. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 19 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): 31,33,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Poor managerment of staff files and incorrect completion of a Quality Monitoring document by the Registered Manager potentially puts service users at risk. EVIDENCE: The Registered manager has returned from maternity leave, however she was not available at the time of the visit, the duty rota states SN on all 4 days every week she works, the inspector was informed this meant Supernumery. The Nurse in Charge was not aware of where she was during the visit, 1 member of staff said she was at the bank. Staff records are poor, details are included within the previous section. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 20 The Registered Manager completes a Quality Monitoring document at the end of every month April 2007 is the last one completed, 4 service users were tracked, two of which were tracked by the inspector, the quality monitoring form states that social history for both is very good, the inspectors evidence shows both were poor, the quality monitoring form stated that monthly care plan reviews are very good, all those examined were not up to date with no review since 15/03/07. Fire checks undertaken according to regulations and all extinguishers checked. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 21 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X X X X 1 Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard OP3 OP3 OP7 Regulation 14.1 Sch. 3 17.1(a) Sch. 3 (3)(d) 17.1(a) Sch. 3 (3)(j) 18.1(a) 13.4(c) 18.1(c)(i) 17 Sch 2 (7) 24 Timescale for action A full assessment must be 30/07/07 obtained for all service users prior to moving into the home. A record of the date of admission 15/07/07 to the home must be kept on the service users file. A record of all 15/07/07 incidents/accidents affecting the health and welfare of service users must be kept. Staff levels must meet the needs 15/07/07 of the service users Staff must receive the training 30/08/07 suitable to the work they perform. Staff must have a POVA First 15/07/07 check and CRB check prior to appointment. A Quality Review to develop the 31/08/07 service must be carried out effectively. Requirement 4. 5. 6. 7. OP18 OP18 OP29 OP33 Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 23 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. 4. 5. 6. 7. Refer to Standard OP12 OP38 OP3 OP3 OP10 OP29 OP31 Good Practice Recommendations A formal programme of activities should be arranged. Risk assessments should be completed for each resident regarding missing person. Staff should ensure that all written work is clear and legible. Details regarding the social history of each service user should be kept. Service users should have working locks on bedroom doors to promote privacy. Staff application forms should be complete with full record of previous work history. The Registered Manager should ensure that the nurse in charge is clear about where she is if she is not at the home. Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Oaks, The DS0000002143.V338541.R01.S.doc Version 5.2 Page 25 - 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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