Inspection on 21/07/08 for The Oaks

This inspection was carried out on 21st July 2008.

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

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 15/02/10

The Oaks 15/07/09

The Oaks 05/11/07

The Oaks 02/06/07

The Oaks 05/04/06

The Oaks 21/10/05

The Oaks 04/05/05

The Oaks 24/11/04

The Oaks 12/05/04

The Oaks 22/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOMES FOR OLDER PEOPLE The Oaks 114 Western Road Mickleover Derby DE3 6GR Lead Inspector Vanessa Davies Unannounced Inspection 21st July 2008 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 DS0000002143.V370377.R02.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 DS0000002143.V370377.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Oaks Address 114 Western Road Mickleover Derby DE3 6GR Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01332 510447 01332 519786 Mr Hassan Khan Ms Teresa Clare Boyce Ms Teresa Clare Boyce Care Home 28 Category(ies) of Dementia - over 65 years of age (28) registration, with number of places The Oaks DS0000002143.V370377.R02.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. 5th November 2007 Date of last inspection Brief Description of the Service: The Oaks is a detached home, which has been adapted and extended to provide nursing care for up to 28 older people with dementia. The home is situated in the residential area of Mickleover. The home has 26 single bedrooms all with an en-suite facility and 1 double bedroom. The home is set within its own well kept, pleasant gardens, which are secure. There are registered nurses on duty 24 hours per day. The Oaks DS0000002143.V370377.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for the service is one star. This means the people who use the service experience adequate quality outcomes. This inspection visit was carried out by 2 CSCI Inspectors and 1 Expert by Experience, this is a person independent of the Commission for Social Care Inspection who has some experience with older people with dementia. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. In order to prepare for this visit we looked at all the information that we received and asked for, since the last key inspection on 16th April 2007. During the site visit case tracking was included as part of the methodology. This involved the sampling of a total of three people representing a cross section of the care needs of individuals within the home. Discussions were held with those people able to do so. Their care planning and associated care records were also examined and their private and communal facilities inspected. Discussions were also held with staff about the arrangements for their care and also for staffs’ recruitment, induction, deployment, training and supervision. Following discussions it was agreed that the people who live in this service would be referred to as ‘residents’ for the purpose of this report. What the service does well: New potential residents are provided with sufficient information to enable them to make an informed choice about whether or not to live there. All potential residents have an assessment completed prior to admission to ensure that needs can be met by the staff team. Surveys and residents files evidenced that health care needs are met. Residents were offered the Flu vaccine with written agreement sought from relatives. Medication is stored and administered appropriately. Special diets are catered for, as are religious diets. The residents were given a choice of food. The Oaks DS0000002143.V370377.R02.S.doc Version 5.2 Page 6 Staff have very positive relationships with the residents and their relatives. Files have information relating to past histories of the residents. All staff receive a completed POVA and Criminal Records Bureau check prior to commencing work at the home. What has improved since the last inspection? What they could do better: Care needs are assessed and care plans developed, however the information gathered is not always acted upon, for example, one file seen stated in the care plan that a risk assessment was needed to address falling but there was no evidence of this risk assessment. One resident was diabetic and the care plan stated that the blood sugars are to be checked every week, however there was no evidence in the file that this was happening. Staff did not have a good knowledge of the previous histories of the residents. The Registered Manager must ensure that the Annual Quality Assurance Assessment (AQAA) is returned to the CSCI within the timescale, this is a legal requirement. Staff need to ensure that they are aware of where the residents are at all times to ensure that they are not at risk of falling or leaving the home. The home is in need of updating in a number of areas, these areas are discussed within this report. There was a malodour in one of the bedrooms and also in one of the toilets, this was permeating into the hall. The recruitment procedure needs to be made more rigorous, one application form had mentioned a prior job but this was not detailed under previous The Oaks DS0000002143.V370377.R02.S.doc Version 5.2 Page 7 employment, another application form stated no criminal convictions, however the CRB listed convictions and the manager had failed to see this. 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 DS0000002143.V370377.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Oaks DS0000002143.V370377.R02.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): 1,3 Quality in this outcome area is good. Detailed assessments of need are in place to ensure that residents receive the care appropriate to their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Evidence from a number of residents’ questionnaires indicates that people do receive enough information about the home prior to moving in. One questionnaire states “we went to visit and found the home to be very open and not quite so formal as some others.” Relatives spoken with were happy with the home. All of the four files examined had detailed assessments of needs in place. Each of the files had evidence of a pre-placement assessment. Care plans have been developed from the assessments of need. There was evidence of input from relatives throughout the care file. The Oaks DS0000002143.V370377.R02.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. Appropriate, detailed care plans and risk assessments help to ensure residents needs are met within a safe environment, however failure to complete appropriate risk assessments and other recording s potentially puts residents at risk of not having their needs completely met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each file had care plans in place to address needs highlighted in the assessment. All of the questionnaires received stated that they were happy with the support offered. One resident is a diabetic, which is insulin and diet dependant, the care plan states that the blood sugars are to be checked every week, however there was no record within the file of these tests. In another file the care plan states that a risk assessment needed to be completed for falls, however there was no evidence of this. There was evidence within the files examined of relatives being contacted regarding incidents affecting their relative. The Oaks DS0000002143.V370377.R02.S.doc Version 5.2 Page 11 There was evidence within each of the files of input from various other professionals as necessary. Each file held nutritional risk assessments, Waterlow risk assessments, continence assessments if needed, all assessments had been reviewed on a regular basis. Within the files seen the residents had received the Flu vaccine with written agreement from a relative. Residents who refuse to accept their medication are reviewed by the GP and an agreement is reached with the relatives, GP and staff at the home to give the medication covertly. It is evident that the staff are monitoring the health of the residents and acting on any concerns found. One resident was having difficulty sleeping this was monitored and then the GP contacted to review medication, on another occasion the incontinence nurse was called to assess a resident due to frequent episodes of incontinence. The medication was examined, the home record medication received, administered and disposed of, appropriately. Any medication given covertly is documented with appropriate agreements in place. The Oaks DS0000002143.V370377.R02.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. Improvements in staffing and recording has provided safety for residents and reduced the risk of harm, however not completing relevant safety paperwork potentially puts highlighted to be at risk, at further risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a large number of staff on duty on the day of the visit, they were expecting to be attending a training session which was cancelled. There was little evidence of activities throughout the visit. Two members of staff were seen sitting with residents listening to music. The surveys received from relatives indicate that there are sometimes enough activities happening within the home, one stated that the home has an excellent Christmas Party and all are invited. Staff surveys stated “off sick is used too often and not always covered”. The majority of the surveys indicated that there are usually enough staff on duty to meet the residents needs. There are details in the dining room of activities taking place although this is not always accurate. Each of the files examined held information about past history of the residents, although this was quite brief, for example “Past employment” Land Registry, with no other information. When staff were asked about what certain residents The Oaks DS0000002143.V370377.R02.S.doc Version 5.2 Page 13 did prior to retiring and moving into care they found it difficult to remember, however they did remember when they spoke to each other. There have been 2 incidents at the home where a resident has left the home unaccompanied, since the last key inspection. Since this time the Manager has implemented a monitoring system for residents, there are details about the resident and then each day the staff complete a form detailing what they are wearing, however on the day of the visit one of these forms was not completed until 11.39am. This was discussed with the manager who agreed it was not acceptable. The Annual Quality Assurance Assessment (AQAA) had not been received at the time of visit, although it was due 27th May 2008. The lunch looked well presented and plentiful. Where meals were liquidised, the meat and vegetables were served separately. All residents were given a drink of orange squash. One lady, who was constantly walking round, was given a plastic bowl with her lunch in it. It was in chunks so that she could pick it up. Most residents needed help with eating. Several staff were involved in helping. The Oaks DS0000002143.V370377.R02.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 adequate. Detailed Safeguarding Adults and Complaints policies and procedures help to ensure the safety of the residents, however lack of rigorous employment procedures and staff without training potentially put residents at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a policy and procedure for dealing with complaints and Safeguarding Adults. There have been 2 incidents since the last key inspection both leading to safeguarding referrals. A resident was missing for a while before the home realised. A digital key pad has now been fitted to the front door along with an alarm and all external doors are now alarmed. A lock has also been fitted to external gates. Missing persons risk assessments are in place, however they are not individual and do not tell staff what to do if the person does go missing. One incident involved a resident who fell in the dining room whilst it was being decorated, this happened prior to staffing being looked at and staff being made aware of the need to be aware of where residents were at all times. There was one anonymous complaint, a random visit was completed by CSCI, requirements are included within this report. The Oaks DS0000002143.V370377.R02.S.doc Version 5.2 Page 15 10 staff files were examined although a number had completed mandatory training there are still a 3 of the 10 who had not completed Safeguarding Adults training. The manager did state that training was now booked on a rolling scheme and that they would complete in the next session. A number of the files examined did not have the information required for appointment, further information is detailed within the staffing section. All incidents affecting the residents are now recorded and CSCI are informed via Reg 37 forms. The Oaks DS0000002143.V370377.R02.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 adequate. Poorly decorated areas, a malodour in areas of the home, do not promote a positive, clean home for residents to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An inspector toured the building and spoke with staff. Some of the areas of the home are in need of updating and refurbishment. Plaster in the hall was cracked and paint had peeled off in areas of the home. Toilet opposite lounge 2, the floor was not sealed around the toilet. There were a number of noisy extractor fans throughout the home, the manager stated that the electrician was due to look at and repair extractor fans the week of the visit. The bathroom on the first floor was not in use as the hoist had been condemned for the past 6 months, therefore there are only 3 bathrooms in use, whilst the residents numbers are down this is not a problem but when the home is full this will need to be replaced and back in use. The Oaks DS0000002143.V370377.R02.S.doc Version 5.2 Page 17 There was a malodour one of the bedrooms. There was also a malodour in the toilet near the dining room, which permeates into the hall. The manager has recently installed alarms on external doors to ensure the safety of the residents. There are also locks on gates in the back garden. The Oaks DS0000002143.V370377.R02.S.doc Version 5.2 Page 18 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. Although there appear to be sufficient staff on duty to meet the needs of the residents, poor recruitment procedures potentially leave the residents open to abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rota evidenced that there is 1 Registered Nurse on duty throughout the day and night. There are 4 or 5 staff on duty during the day and 3 during the night. Although the home has a rigorous employment procedure there were errors found within the 10 staff files examined. The application clearly states that should the applicant fail to complete the form honestly they will be dismissed, however clearly on one occasion this has not happened. When the manager was questioned about this she said she had not realised. A number of the staff files examined had incomplete application forms. Dates for employment were months and years or just the years. One file, had detailed under “additional information” “Managed Residential Home in Birmingham” however there was nothing of this within the area of previous employment, again the manager was not aware of this. The Oaks DS0000002143.V370377.R02.S.doc Version 5.2 Page 19 Each of the files had a completed POVA and CRB check. The home keeps a record of Registered Nurses PIN numbers. Each of the files seen had a number of forms of identity. There was little evidence of regular supervision sessions with the staff. The Manager has improved the training for the staff and it is now contracted out to a company who provide it on a rolling system. The majority of the staff team have now completed mandatory training and the manager stated that those who have not will complete on the next booked session. The Oaks DS0000002143.V370377.R02.S.doc Version 5.2 Page 20 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): 31,38 Quality in this outcome area is adequate. Although there have been a number of positive improvements within the home, shortfalls detailed throughout this report evidence that residents are still potentially at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager has made improvements since the previous inspection, however there is evidence throughout this report that there is still a great deal to do in order to ensure the complete safety of the vulnerable people being cared for. Application forms are incomplete, the manager is not aware of information held within the files. There was little evidence of regular supervision. Although staff meetings have been held they are irregular, April & July. Given the lack of The Oaks DS0000002143.V370377.R02.S.doc Version 5.2 Page 21 supervision and the issues the home have had the staff meetings should be more often. Staff training has improved and the majority of the staff have now completed mandatory training, although there are still a few to complete. There was evidence of a monthly audit of accidents and incidents. Portable appliances had been tested May 2008, the hoist 9th June 2008, all fire safety tests were up to date. The Manager failed to return the Annual Quality Assurance Assessment within the stated timescale. The Oaks DS0000002143.V370377.R02.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X X 2 The Oaks DS0000002143.V370377.R02.S.doc Version 5.2 Page 23 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 OP19 Regulation 23.2(b,c) Requirement Furniture and flooring must be in a good state of repair in order to prevent accidents and to promote a clean environment. (previous date 31/01/08 & 31/07/08)) Timescale for action 31/10/08 2. OP12 16.2(m)(n Service users should have the ) opportunity to participate in a variety of activities in order to maintain and develop social interaction. 18.1 (c)(i) 31/08/08 3. OP18 4. OP19 23.2 Staff must receive the training 31/10/08 needed to carry out their duties in order to meet the needs of the residents. The premises must be in a good 31/10/08 state of repair in order to prevent accidents. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. The Oaks DS0000002143.V370377.R02.S.doc Version 5.2 Page 24 No. 1. Refer to Standard OP38 Good Practice Recommendations Risk assessments should be completed for each resident regarding missing person. Staff application forms should be complete with full record of previous work history. Staff should be encouraged to know the social histories of the residents in their care. Appropriate care records should be kept. The malodours identified should be cleaned. Further improvements need to be made as highlighted within this report in order to ensure the safety of the residents. 2. OP29 3. 4. 5. 6. OP7 OP8 OP26 OP31 The Oaks DS0000002143.V370377.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 DS0000002143.V370377.R02.S.doc Version 5.2 Page 26 - 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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