Inspection on 05/11/07 for The Oaks

This inspection was carried out on 5th November 2007.

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 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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Oaks, The 114 Western Road Mickleover Derby DE3 6GR Lead Inspector Vanessa Davies Unannounced Inspection 5th November 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oaks, The DS0000002143.V354022.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.V354022.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.V354022.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. 2nd June 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. Oaks, The DS0000002143.V354022.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information for this report was gathered by reading information within the home, observing 3 service users closely over a 1.5 hour session to establish outcomes for service users, the observation took place in the dining room/lounge area. Also speaking with service users, staff, the manager and a relative. The fees for the home are £479 - £525 per week. What the service does well: What has improved since the last inspection? Staffing levels now appear to meet the needs of the service users. All accidents and incidents are recorded and service users have completed assessments of need prior to admission. Staff have a CRB in place prior to admission. Oaks, The DS0000002143.V354022.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.V354022.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.V354022.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 good. This judgement has been made using available evidence including a visit to this service. Assessments completed prior to admission helps to ensure that staff are able to meet service users needs and expectations. EVIDENCE: Three service users records were examined during the visit. Varying information was evident within the 3 files examined. Assessments were completed prior to admission in the 3 files and all held social history information. 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. Oaks, The DS0000002143.V354022.R01.S.doc Version 5.2 Page 9 Writing within the files continues to be difficult to read and understand, again this was highlighted with the Registered Manager. Oaks, The DS0000002143.V354022.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 good. Input from various professionals assists with meeting service users needs and regular reviews of plans ensures that the changing needs of service users are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was evidence of input from dietician, GP, SW and optician. Files held copies of Mental Health assessment, Waterlow Risk Assessment, nutiritional assessment. There was a risk assessment and agreement/authorisation from GP to give medication to one service user in a covert way. Assessments were seen to be reviewed on a monthly basis. Medication is stored appropriately, administered by trained nurses and documented accordingly. Whilst observing one service user for 1.5 hours it was Oaks, The DS0000002143.V354022.R01.S.doc Version 5.2 Page 11 noticed that she slept throughout, not waking for drinks, this was raised with the manager. Accident forms are completed and reviewed by the manager. It is difficult to establish whether the service users feel they are treated with dignity and respected, due to their condition. A detailed 1.5 hour observation was completed during this visit to establish outcomes for service users, although there was little interaction between the staff and the three service users being observed, the verbal interaction which did take place was positive. Oaks, The DS0000002143.V354022.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. Limited activities, poor supervision and lack of communication between service users and staff potentially prevents staff meeting the needs and expectations of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One service users file examined stated that he needs social stimulation and interaction, however the monthly review states that he is not intersted in homes activities and gets agitated when asked to join in. During a 1.5 hour observation the service user was spoken to only twice and on one of those occasions held a conversation with the handyman without any signs of aggression. Very limited information regarding social history within files examined. Some of the staff were observed communicating very well with the servcie users, Oaks, The DS0000002143.V354022.R01.S.doc Version 5.2 Page 13 however it was evident that a number of staff found it difficult to communicate with the service users. Although following the observations the service user who remained awake throughout did appear in a positive state on a number of occasions, interactions with staff and service users was poor, one member of staff stood over the service users for about 10 minutes without speaking to anyone at all, another member of staff walked into the dining room turned off the tv and turned on the radio, again without communicating to any of the service users. The home does employ an activities coordinator and she did arrange some painting with some of the service users during the inspection, however the activity plan in the dining room stated something else, the majority of service users were sitting around in lounges or dining room, only 2 service users joined in with the activities. Relatives continue to visit without restriction and are made welcome on visiting. 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.V354022.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 adequate. A detailed complaints procedure and staff training in Safeguarding Adults helps to ensure service users are protected and listened to, however incomplete application forms and lack of appropriate references potentially puts service users at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A relative spoken with was aware of complaints procedure although had nothing to complain about. The manager stated that there have been no complaints made since the previous inspection. The home has a detailed complaints procedure available with relevant information detailed. 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. Staff records evidenced staff are employed with a POVA First check and a Criminal Records Bureau check. Application forms were incomplete and written Oaks, The DS0000002143.V354022.R01.S.doc Version 5.2 Page 15 references were not clear of which employer had provided it, this was highlighted at the previous inspection. Oaks, The DS0000002143.V354022.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 adequate. A clean environment helps to ensure that service users are safe, however poor upkeep of the furniture and flooring does not promote a homely environment, potentially preventing service users feeling comfortable. This judgement has been made using available evidence including a visit to this service. 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. The dining/lounge area had no curtains and all of the vertical blinds were pulled fully open, there are no shades on the lights, the lino is torn with a Oaks, The DS0000002143.V354022.R01.S.doc Version 5.2 Page 17 number of cigarette burns apparent, the seats in the lounge area are torn and the dining room furniture is very worn. Oaks, The DS0000002143.V354022.R01.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. Criminal Records Bureau checks ensure that service users are safe, however incomplete application forms and inappropriate references could potentially put service users at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff spoken with stated that they did have supervision and records evidenced this, however all the new staff needed to have supervision sessions arranged. There were a large number of staff on duty as training had been arranged and cancelled. Three staff files examined and evidence was found that staff have a PoVA first check and CRB check prior to employment, however application forms were incomplete and written references were not clear of which employer had provided it, this was highlighted at the previous inspection. Staff receive regular training to ensure that they are able to meet the needs of the service users. Oaks, The DS0000002143.V354022.R01.S.doc Version 5.2 Page 19 Oaks, The DS0000002143.V354022.R01.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): 31,33,38 Quality in this outcome area is good. Appropriate management and suitable quality monitoring helps to ensure that the service changes to meet the changing needs of the service users and is able to meet those needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered manager arrived during the inspection and since returning from maternity leave she works in addition to the staff. The Deputy Manager had worked at the home for 6 weeks and the manager stated that she intended to apply for Registration for her to enable the Manager to work solely on improving the care provided. Oaks, The DS0000002143.V354022.R01.S.doc Version 5.2 Page 21 The Registered Manager completes a Quality Monitoring document at the end of every month, she has also introduced a suggestion box in the reception area and reviews suggestions on a monthly basis. Fire checks undertaken according to regulations and all extinguishers checked. A fire officer visited the home July 2007, recommendations were left and the home completed them, these were checked by the fire officer October 2007. An Environmental officer visited the home the week before this visit, no recommendations were left. The manager has a record of a number of incidents, however she has not informed CSCI about the incidents, this was discussed with her and she stated that she was unaware of the need to inform of the incidents. Oaks, The DS0000002143.V354022.R01.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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Oaks, The DS0000002143.V354022.R01.S.doc Version 5.2 Page 23 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 OP12 OP19 OP31 Regulation 12.5(b) 23.2(b,c) 37 Requirement Timescale for action 31/01/08 Staff must develop good positive relationships with service users. Furniture and flooring must be in 31/01/08 a good state of repair. CSCI must be informed of 31/01/08 incidents, accidents and all other incidents which have an affect on service users. 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. Refer to Standard OP12 OP38 OP3 OP10 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. Service users should have working locks on bedroom doors to promote privacy. DS0000002143.V354022.R01.S.doc Version 5.2 Page 24 Oaks, The 5. 6. OP29 OP9 Staff application forms should be complete with full record of previous work history. The service users should receive regular medication reviews. Oaks, The DS0000002143.V354022.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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.V354022.R01.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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!