Inspection on 23/01/06 for The Oaks

This inspection was carried out on 23rd January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 02/07/07

The Oaks 17/01/07

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 Lindsey Withers Unannounced Inspection 23rd January 2006 08:40 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.V269883.R01.S.doc Version 5.1 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.V269883.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Oaks Address Oak Avenue Hindley Green Wigan Greater Manchester WN2 4LZ 01942 521485 01942 522141 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.V269883.R01.S.doc Version 5.1 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. 23rd February 2005 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 limited. 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 Oaks DS0000005755.V269883.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over a 4½ hour period and was unannounced. The main focus was on those areas not assessed during the previous inspection, so that over both visits all key standards were looked at. The Inspector had made one monitoring visit to the home between the two unannounced inspections. Part of the time was spent with the Manager, going through the paperwork that has to be kept to show that the home is being run properly. Part of the time was spent observing practice in the main lounge and dining area. The Inspector had good conversations with one member of staff, one student, and seven residents. The Inspector spoke to other staff and residents over the course of the inspection. What the service does well: What has improved since the last inspection? Access to specialist care for residents is recorded better, so it is clear when this extra help has been asked for and what the outcome has been. A training pack has been purchased which will be delivered to staff and which will enhance the knowledge they have in relation to the care of people with dementia. The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 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 Oaks DS0000005755.V269883.R01.S.doc Version 5.1 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 The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Residents moving into The Oaks on a longer term basis have a full assessment prior to admission. The process is less thorough for people accessing regular respite care, and improvements are required if the home is to be sure the person’s needs can still be met. Residents can be sure they will be referred to specialist services, as needed. EVIDENCE: A requirement was made at the last inspection for all pre-admission assessments to be thorough and properly recorded. To check whether improvements had been made, four residents’ files (known as “the care plan”) were looked at. Two of the files were satisfactory and referred to people who were staying at the home on long or permanent placements. A full pre-admission assessment had been completed, and based on this information, a plan of care had been developed. Any information provided by the Social Services Department had been attached to the pre-admission assessment. The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 Page 9 Two of the files referred to people accessing regular respite care and were not satisfactory. There was insufficient information available to demonstrate that, each time the person came to stay at The Oaks, staff knew what level of care the person needed. No care plan had been written so staff would not have been fully aware of how they were to care for the person. In the future, the Manager must make sure that at each period of respite care, the person is reassessed and any revisions are noted. A care plan must be in place that reflects the person’s needs. If the original assessment is revised, any amendments must be clearly identified, signed and dated by the person making the recording. This should be done before admission so that staff know they can still meet the person’s needs. A requirement had been made at the last inspection for people with mental health needs to have better access to specialist care. There was evidence in the residents’ records to confirm that access to specialist care was being arranged. The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8 Recording in care plans needs to be better if residents are to be sure their changing needs – determined through regular review – are properly identified. Records do not demonstrate that residents have agreed to their plan of care, so we cannot be sure that the plan is acceptable to them. EVIDENCE: A requirement had been made at the last inspection for care plans to be complete for all residents, and for reviews of both the care plan and the risk assessments to be done in a measurable way. Of the four files looked at during this inspection, errors and omissions were still in evidence. Weights had not consistently been recorded; new information had not been included in the care plan, for example, medical attention to an ear problem; files were not being reviewed. None of the files could provide evidence to show that residents or their families are involved in developing the care plan. The notes of the staff meeting showed that the Manager has been trying to make improvements in this area, and an audit of care plans was scheduled to The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 Page 11 take place during January 2006. A further period of time was agreed in which the Manager would ensure that the records were brought up to a good standard. At this point, the Inspector will make another visit to the home to monitor improvement. A matrix may help staff to focus on the care plans they need to review month on month. The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: This section was not assessed on this occasion. The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The home has a satisfactory method for learning about people’s complaints. Residents can be sure they will be protected from abuse because staff are properly recruited and are trained to care in a way that is not abusive. However, the home must acquire the local authority’s most recent guidance to make sure it follows the correct procedure in the event of an incident or allegation. EVIDENCE: The home has a complaints procedure that is widely advertised. It appears in the Service User’s Guide (the general information pack that is provided to residents or their relatives), and in the information file that is located at the main reception desk. A record is kept of all complaints and compliments. No complaints had been received at The Oaks since the last inspection and none had been received at the CSCI. The home has a Protection of Vulnerable Adults policy and procedure, which links to whistleblowing. Each new member of staff, as part of his or her induction programme, is required to complete a workbook relating to the protection of vulnerable adults, which highlights what is considered abusive and inappropriate behaviour. The Manager had not received the new Protection of Vulnerable Adults guidance from the local authority in Wigan and agreed to follow this up with them. She said she would also arrange update training for all members of staff when the new guidance is received. The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The Oaks is a clean, well-maintained home where residents say they are comfortable and where they appeared to be free to move about as they wished. Staff pay attention to good hygiene and infection control procedures, which keeps everyone protected from the risk of cross infection. EVIDENCE: During this inspection, The Oaks was clean, fresh, and tidy throughout. There was evidence of redecoration, routine maintenance, and renewal in communal and private areas. One gentleman had recently moved into The Oaks to join his wife. He said they shared a double room which was “very comfortable”. He liked the fact that there was someone to keep things clean and tidy for them. Another lady said she too was comfortable. She sat where she was away from the television because, she said, it didn’t interest her. Residents were seen to be moving about the home and sitting where they chose. There did not appear to be fixed places for people to sit. Asking a member of staff, “Whose chair is this?” she replied, “Anyone who wants to sit there.” The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 Page 15 The bathroom on the first floor was very cold, as was the conservatory. The Manager said that residents had complained about the temperature in the bathroom, and that both matters had been reported to Mr. Hall for attention. He found that the radiator thermostat in the bathroom had been turned down and the fuse had blown in the heater in the conservatory. Both were attended to during the inspection. The records showed that other repairs had been done quickly. Three residents enjoyed directing Mr. Hall during the replacement of a light fitting in the lounge. Hygiene and infection control procedures appear to be managed appropriately. There are satisfactory systems for transporting soiled and dirty laundry from bedrooms to the home’s laundry room, which is located away from the kitchen. There are adequate supplies of protective clothing, including aprons and gloves, which staff were seen to be using. The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30 The home is well staffed and, with the exception of the enhanced training in dementia care which has yet to commence, staff have the skills to meet the needs of residents. The home has a thorough recruitment process, aimed at employing only care workers who are fit to work with elderly people. Staff receive training appropriate to the work they are employed to do, so residents can be sure they are competent. EVIDENCE: An examination of the staffing rota showed that good staffing levels are maintained. The staffing rota is drawn up for several weeks in advance, and staff know that they may not make changes to the rota without permission from the Manager or the nominated person. The morning shift overlaps the previous night’s shift by one hour, so a good number of staff are on duty at this busy time of the day. Staff working on each shift (morning, evening, and night) have a set of tasks that they must complete, so there is clear guidance on what must be achieved. One task – clearing toiletries from communal bathrooms – was not being done, and the Manager needs to remind staff about this in order to prevent an accident. (See NMS 38.) Each resident has a nominated keyworker who is responsible for ensuring the residents is provided with the care that he or she needs or has requested. The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 Page 17 There have been no new recruits to the staff team for some time. However, the recruitment process was discussed with the Manager, to determine whether the process she followed would be satisfactory. The most recent guidance relating to Criminal Record Bureau checks was also discussed. No problems with the process were identified. The home was providing a healthcare student from a local college with the opportunity for some work experience. This was for one day per week over a 26 week period. The student had discussed a rota with the Manager, which she said she was happy with. There are regular meetings with the student’s tutor. The student does not provide personal care and is supervised at all times. The student said she was enjoying her course and being at The Oaks, and that she felt sure she had made the right career decision. There was evidence that staff are receiving training appropriate to the work they are employed to do, for example, optical awareness, hearing awareness, medication awareness, and diabetes. Some training is provided in-house under the direction of the Manager, and other training is provided by health professionals or training companies. A requirement had been made at the last inspection for staff to receive training in the care of people who have dementia. A training package has been purchased, but the programme of training was not due to begin until April 2006. The Manager is reminded of her obligations in relation to this requirement. The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, and 38. The home is managed by a competent person who has the residents’ best interests at heart. Residents are encouraged to live as they would wish, with assistance from staff as needed. The home has systems for canvassing opinion and auditing systems so that improvements can be made. Staff are supervised so they are effective in the work they do. There are good systems for ensuring the health, safety, and well-being of residents and staff. However, care must be taken to ensure all preventable risks are identified and removed. EVIDENCE: The Manager has the relevant experience and qualifications to manage a care home, and is responsible for The Oaks only. She can demonstrate that she and her other senior staff are familiar with the conditions and diseases that are associated with old age. The owner of the home, Mr. Hall, lives next door and works alongside the Manager. Their roles are clear and distinct, as are the roles of the Manager and her staff. The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 Page 19 From observation of her manner, from examination of the written record, and from conversation with the Manager, it is evident that she conveys an approach to care that puts the resident in the centre. While she is open to the views and suggestions that are put forward to her, her focus is on what is best for the residents. Staff are guided by the Manager who will encourage members of staff to think how they might be affected in a certain situation. She will then make a recommendation on how staff should act, but leave decisions to their discretion. The Manager expects the staff team to work together, not pull apart, and will periodically re-emphasise this message during supervision sessions or at staff meetings. The Manager has a planned approach to her work, and sets timescales within which to complete tasks. Sometimes, however, these timescales can become tight and add unnecessary pressure, for example, completing care plan audits and staff supervision sessions in the last week of the same month. The Oaks was recently awarded 4 Stars by the RDB, the company that the home uses to measure the quality of the service it provides. Satisfaction questionnaires were sent to residents, their relatives, and other interested parties such as health professionals, in November 2005 asking for their opinion of The Oaks. Looking at the questionnaires that were returned, it was evident that most people were generally satisfied. Where any dissatisfaction was expressed (for example, in relation to lack of activities), the Manager said she had taken account of the comments so that improvements could be made. The home employs an external company who makes sure that policies and procedures are kept up to date with changes to legislation and current best practice. The company also provides an advice service to the Manager. A little money is kept on behalf of residents, which they use for hairdressing or the occasional purchase from the local shop. The records and funds for three residents were looked at and found to be in order. There are good systems for making sure residents do not build up too much cash money and that it is managed properly. Monies transferred to safe-keeping on behalf of a resident are made in the resident’s own name. A copy of the policy and procedure for ensuring residents’ financial interests are safeguarded is kept at the front of the recording folder. The staff supervision records were made available to look at. There was evidence that staff are being regularly supervised - for example, one person had sessions in June and November 2005 and in January 2006 - and that the content of the supervision session is appropriate. Both the Manager and the member of staff had signed each record of supervision. There was evidence to show that – for the most part - the health, safety and welfare of residents and staff are promoted and protected. All staff undertake The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 Page 20 mandatory training in safe working practices, as well as attending update training. The systems and services used within the home, such as the hot water system and the equipment used in the kitchen, are serviced and maintained. The home has a set of policies and procedures that relate to health, safety and welfare. Risk assessments are in place, where the potential for harm has been identified, for example, cleaning vinyl floors. Staff must be reminded to remove toiletries from bathrooms and to return them to residents’ rooms. Liquids such as shower gel and shampoo can pose a risk to residents with a cognitive impairment. This shortfall is significant and affects the scoring for this standard. Accidents, injuries and incidents are properly recorded and the relevant authorities advised. Accidents are audited on a monthly basis, in order to identify what types of accidents have occurred, and the times of day when they have taken place. This information is used to inform the Manager about changing care needs of residents. The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 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 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 2 The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 Page 22 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 OP3 Regulation 14 Requirement Pre-admission assessments must be thorough and properly recorded. Timescale 15th September 2005 not met. Care plans must be complete for all residents, and reviewed in a measurable way. Timescale 15th September 2005 not met. Residents and/or their relatives must be involved in developing care plans. If they choose not to be, this should be recorded. The Manager must acquire the most recent PoVA guidance from the local authority. Staff must receive further formal training in relation to dementia care. Timescale 31/12/05 not met. Preventable risks must be identified and removed, e.g. toiletries left in communal bathrooms. Timescale for action 02/03/06 2. OP7 15 02/03/06 3. OP7 15 02/03/06 4. 5. OP18 OP30 13 18 02/03/06 01/04/06 6. OP38 13 03/02/06 The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 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 Refer to Standard OP7 Good Practice Recommendations A care plan review schedule would help staff to focus on which files needed to be reviewed and the timescale in which the review should be completed. The Oaks DS0000005755.V269883.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 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. 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