Inspection on 05/04/06 for The Oaks

This inspection was carried out on 5th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 15/02/10

The Oaks 15/07/09

The Oaks 21/07/08

The Oaks 05/11/07

The Oaks 02/06/07

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 Unannounced Inspection 5th April 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oaks, The DS0000002143.V288510.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. Oaks, The DS0000002143.V288510.R01.S.doc Version 5.1 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 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.V288510.R01.S.doc Version 5.1 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. 21st October 2005 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.V288510.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit was unannounced. This inspection focused on issues and concerns highlighted at previous inspections. The CSCI have taken enforcement action since the previous inspection. The Registered Manager was not available for the visit. Information for this report was gathered by speaking with staff on duty, speaking with residents, speaking with relatives, observing staff working with the residents and reading documentation. Due to the timing of this visit the provider had not received a pre-inspection questionnaire. There continues to be a number of requirements set at previous inspections still outstanding, the Registered Manager must address these within the short timescale set in order to prevent further enforcement action being taken. Enclosed within this report is brief information of a complaint investigation carried out jointly with CSCI and Social Services. As a result of this investigation, enforcement action has been taken. What the service does well: What has improved since the last inspection? What they could do better: The Registered Manager must address issues highlighted within this inspection report as a number of them have been raised at previous inspections over the past 12 months. Oaks, The DS0000002143.V288510.R01.S.doc Version 5.1 Page 6 The assessments of need on each of the files examined were out of date, 1 resident had be re-admitted from hospital without an up to date assessment and his needs had significantly changed. One file did not evidence a date of admission for the resident. Staff should be made aware of the nutritional assessment and the Waterlow risk assessment, both were kept at the back of the files and staff spoken with were unaware of them. Manual handling training needs to be updated and the manager must ensure that the staff understand what is taught and then practice this, there was evidence on the day of the visit that staff were not carrying out appropriate moving techniques, putting the resident concerned at risk of falling and also causing her a great deal of distress. The manager should ensure that any records implemented to improve the service are completed by the staff consistently. Complaints need to be responded to within the timescale of 28 days following a thorough investigation. All staff records must contain a Criminal Record Bureau check and 2 written references, these must have been obtained prior to any appointment. As a result of this not being undertaken the CSCI have taken enforcement action, issuing a Statutory Notice. 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. Oaks, The DS0000002143.V288510.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 Oaks, The DS0000002143.V288510.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): 3,6 Quality in this outcome area is poor. Lack of updated assessments of needs and admitting residents without a new assessment of need potentially puts residents at risk and limits the staffs ability to meet the residents needs. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: Four residents files were case tracked during the visit. Each file had an assessment of need in place, however they were all 4 out of date, not being reviewed since writing. One resident had lived at the home for a number of months and had recently been admitted to hospital, on return his needs had changed considerably but there was no evidence of an up to date assessment of need to ensure the home were able to meet his needs, his needs had clearly changed. One of the four files examined did not have the date the person moved to the home, documented. It was evident in the files examined that there are needs highlighted within the dated assessment, which have no care Oaks, The DS0000002143.V288510.R01.S.doc Version 5.1 Page 9 plan or risk assessment in place. All of these issues were highlighted at previous inspections. The home does not offer intermediate care. Oaks, The DS0000002143.V288510.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): 7,8,10 Quality in this outcome area is poor. Lack of information and lack of staff knowledge of assessments completed prevents residents needs being met. Staff not using appropriate training techniques to move residents puts residents at risk of injury and falling. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: Each of the 4 files examined had a number of universal care plans in place, none were individual to the residents concerned. The holistic needs of the residents are not able to be met by the staff due to the limited information available within the assessments of need and one resident being admitted without an assessment of need. There was evidence within the files examined of input from neurology, chiropody, GP and tissue viability. Oaks, The DS0000002143.V288510.R01.S.doc Version 5.1 Page 11 Each of the care plans seen had been reviewed on a monthly basis, however a number were not signed or dated and stated that they should be reviewed weekly. Each file had a nutritional assessment, however it was kept at the back of the file and staff spoken with were unaware of it. The inspector observed staff working and communicating with residents, in the majority of cases staff communicated very well with the residents, however on one occasion 2 male staff were transferring a female resident from a wheelchair to a lounge chair and she was clearly not happy, they did not communicate about what they were doing and made no attempt to reassure her. The process used to move from one chair to another raised concerns about Manual handling training, however when asked both staff stated that they had received the training 3 months ago, however further training is needed and the manager must ensure that the staff practice what they have been taught. The process used was very undignified. One of the files examined did not have the residents preferred term of address, however it was clear that the staff were aware of the residents preferred name. Oaks, The DS0000002143.V288510.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): 13,15 Quality in this outcome area is adequate. Positive relationships between relatives and staff helps to support both the resident and their relative receiving care. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: Relatives of residents were visiting throughout the inspectors visit. They were made to feel welcome by the staff on duty. When spoken with they were happy with the care offered to their relative and felt that they were involved as much as they liked with the care. The home offers a choice of foods at mealtimes. Since the last inspection the home documents the food residents eat, however in the files examined a number of meals had not been documented and it looked as though the residents had not eaten from one evening to the next. Oaks, The DS0000002143.V288510.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): 16,18 Quality in this outcome area is poor. Lack of appropriate employment procedures (failure of the provider to ascertain CRBs, POVAfirst and suitable references) puts residents are risk of abuse. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: There have been complaints made to Social Services since the last inspection. Although the home has a complaints procedure, complaints have been referred to Social Services or CSCI as the complainant has not received a response within the timescale or are not satisfied with the response from the manager. These have been investigated jointly by Social Services and CSCI. As part of one of the investigations CSCI examined staff records, none of the care staff records examined had a Criminal Records Bureau check and many did not have 2 written references. CSCI have since commenced enforcement action. Oaks, The DS0000002143.V288510.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): EVIDENCE: None of the standards within this area were assessed on this occasion. Oaks, The DS0000002143.V288510.R01.S.doc Version 5.1 Page 15 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): 28,30 Quality in this outcome area is poor. Lack of appropriate employment checks and staff training potentially puts residents at risk of abuse and/or harm. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: There were 5 care staff and 1 registered nurse on duty at the time of the visit, however only the registered nurse had a Criminal Records Bureau check, although the inspector was not able to view this as the registered nurse on duty said it was with the manager. The CSCI have taken enforcement action regarding the concerns about CRBs and references. The inspector spoke with staff on duty regarding personal care of residents, they stated that they had carried out personal care with residents out of site of the registered nurse and the registered nurse spoken with stated that this was the case. 2 of the staff spoken with stated that they had received manual handling training, however this was not evident when observing techniques of moving a lady from a wheelchair to a lounge chair. One staff member spoken with had not received manual handling training or training in the use of a hoist, however she was practicing both. Oaks, The DS0000002143.V288510.R01.S.doc Version 5.1 Page 16 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 Quality in this outcome area is poor. Employment practices and the amount of requirements from previous inspections not addressed bring into question the fitness of the Registered manager. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: In employing staff without appropriate checks the provider/registered manager is potentially putting the residents at risk of abuse. Requirements left at previous inspections have reappeared within this report as they have not been addressed. Oaks, The DS0000002143.V288510.R01.S.doc Version 5.1 Page 17 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 X X X X X X X X STAFFING Standard No Score 27 X 28 1 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X X X X X Oaks, The DS0000002143.V288510.R01.S.doc Version 5.1 Page 18 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. 2. Standard OP30 OP8 Regulation 18.1(c)(i) 12.1, 13.1(b) 14.1(b) Requirement All staff must receive training appropriate to their work Arrangements must be made for service users to receive treatment from other health care professionals A completed assessment of need must be on file for all service users. (previous timescale 31.07.05 & 30.11.05)) All assessments of need must be regularly reviewed. (previous timescale 31.07.05 & 30.11.05) Service users/relatives must be consulted about their care. (previous timescale 31.07.05 & 30.11.05) Staff must be suitably supervised. (previous timescale 31.07.05 & 30.11.05) The home must have a record of the date of admission of residents. A safe system for moving and handling must be implemented. Appropriate training for staff must be offered. Complaints must be responded DS0000002143.V288510.R01.S.doc Timescale for action 28/04/06 28/04/06 3 OP7 28/04/06 4 5 OP3 OP10 14.2 15.1 28/04/06 28/04/06 6 7 8 9 10 Oaks, The OP36 OP3 OP30 OP30 OP16 18.2 17.1(a) sch 3 (3)(d) 13.5 18.1(c)(i) 22.4 28/04/06 28/04/06 28/04/06 31/05/06 31/05/06 Page 19 Version 5.1 to within 28 days. 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 Refer to Standard OP10 OP10 Good Practice Recommendations The manager should ensure that training offered to staff is understood and carried out. The manager should ensure that staff are aware of the assessments for residents and the contents. Oaks, The DS0000002143.V288510.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. Extracts may not be used or reproduced without the express permission of CSCI Oaks, The DS0000002143.V288510.R01.S.doc Version 5.1 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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