Inspection on 13/10/05 for The Oaks Care Home

This inspection was carried out on 13th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Oaks Care Home 01/07/09

The Oaks Care Home 04/06/08

The Oaks Care Home 03/12/07

The Oaks Care Home 31/05/07

The Oaks Care Home 04/05/06

The Oaks Care Home 26/07/05

The Oaks Care Home 17/02/05

The Oaks Care Home 17/11/04

The Oaks Care Home 20/07/04

The Oaks Care Home 26/03/04

The Oaks Care Home 20/01/04

Similar services:

Trevayler Residential Care Home

Thornham Grove

Thistle Hill Hall

Conifer Lodge

Westwood Lodge

Egerton Lodge Care Home

Alfred Minto House Care Home

St Matthews Unit

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

CARE HOME ADULTS 18-65 The Oaks Care Home 26-28 Corporation Oaks Woodborough Road Nottingham Nottinghamshire NG3 4JY Lead Inspector Susan Lewis Unannounced Inspection 13th October 2005 10:00 The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 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 Care Home DS0000002237.V250456.R02.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 Adults 18-65. 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 Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Oaks Care Home Address 26-28 Corporation Oaks Woodborough Road Nottingham Nottinghamshire NG3 4JY 0115 962 1075 0115 950 9996 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) Dr Prem Tiwari Dr Shobhi Tiwari Mr Lee Stuart Hackett Care Home 22 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (22) of places The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th July 2005 Brief Description of the Service: The Oaks is a large converted Victorian house situated close to the city centre, the home is on a quiet road with no through traffic it has an open aspect, with a lawned area to the side and front of the property. The home provides care for young adults with mental health issues. The accommodation comprises of two lounges, a conservatory area, a dining room and a separate smoke room. There are two small gardens to the front and side of the property. The home is not fitted with a lift and has several flights of stairs, making it unsuitable for people with mobility problems. The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place during one day was carried out by one inspector and was carried out as part of the annual inspection process the inspection was unannounced. A partial tour of the building took place, with communal areas and the alteration to the bungalow was also viewed. Residents were spoken with, as were staff, no visitors were present during the inspection What the service does well: What has improved since the last inspection? 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 Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 and 5 The needs of current service users are met within this setting. EVIDENCE: Records showed that where social services or Community Psychiatric Service referred residents then extended assessments were available showing that assessments were undertaken prior to admission enabling the manager to be sure that the home could meet the individual’s needs. Records showed that residents were assigned key workers to ensure consistency of care, although in discussion with some residents they were not all aware who this was. Throughout the day staff were seen interacting with residents and clearly able to communicate effectively with residents. Residents spoken with, although not certain, believed that they had visited the home prior to coming to live there and felt that they had had some choice as to whether they wanted to live in the home. Residents have a contract and these provide relevant information detailing what fees and what bedroom they occupy ensuring residents know what terms and conditions they enter the home with. The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 Individual plans have not been reviewed regularly therefore residents are at risk that their needs may not be met. Residents are able to choose how they live their life. EVIDENCE: Although individual plans are comprehensive in their format and each plan of need cross references with a risk assessment, many information sheets in the care plans were either not filled out or those that were, were not signed by anyone or dated. Individual records show no evidence of regular reviews; only two plans had been amended to include the residents’ change in health care needs. Residents spoken with were not aware of their plans nor had they been involved in their creation or asked to be involved in any review. As care plans may discuss restrictions on residents it is essential that the registered manager involve residents where possible in their creation and review. There was some evidence that residents had been involved in a user satisfaction questionnaire and were being consulted over the choice of décor in their bedrooms. The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 9 A copy of the manager’s reply to this was also seen. Although this is good practice it was of limited value as the questionnaire was not dated. Residents are able to come and go from the home as they wish and there is an unexplained absence procedure for staff to respond to if there is an unexplained absence. Residents spoken with felt that had a lot of freedom in the home to live how they chose and did not feel under pressure to behave in a particular way by staff. Residents also felt confident in staff that they would treat anything they said in confidence. Evidence was seen that residents’ records are stored securely ensuring that confidential information was kept confidential. The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 17 Lifestyle choices and opportunities for leisure activities are varied and appropriate. EVIDENCE: Individual records showed where residents had been involved in activities, these included a day trip to Skegness, a cruise on the Trent, playing darts as well as where they interacted with other residents. Residents spoken with said that they enjoyed going out and that it was much better now more activities were taking place. This was an outstanding requirement from the last two inspections and has now been met. The practice of putting sugar and milk in a large teapot prior to serving to residents was noted at the last inspection and was seen again at this inspection. This is very institutional practice and the registered manager should find alternative methods of providing milk and sugar for residents. The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 Personal support needs are met however residents are at risk of health needs not being met. EVIDENCE: Personal support needs are detailed in the individual plans. Medical appointments are recorded; however on some plans it was noted that medical needs were recorded such as needing to see a dentist or urine sample but there was no apparent follow up. The registered manager must ensure that where residents have health care needs which require follow up that this is arranged. Medication is stored in a locked cabinet in an office. Medication is only signed for once a resident has taken it and procedure for recording is followed. Individual plans show that risk assessments have been carried out for residents and whether they are able to self medicate. Medication that needs refrigerating is currently stored in the fridge in the kitchen. If this practice is to continue suitable secure storage must be arranged. Although individual plans have a record sheet to detail the wishes of the resident regarding ageing, illness and death this are not always filled in. The manager must ensure that residents wishes are recorded to minimise distress should their health needs change significantly. The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Service users are aware of how to make their views known. Staff protect service users. EVIDENCE: Residents spoken with said that they knew who to complain to and said that they felt safe. One resident said ‘staff are friendly and you can talk to them’. Systems are in place to ensure that residents are not financially abused; recording of residents finances are of a very high standard. The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 and 30 Although some improvement has been made on ensuring residents have choice over their environment, the environment remains dirty and shabby placing residents at significant risk. EVIDENCE: Environmentally the home continues to be of a very poor standard. Internally and externally building work has not started. Alterations to the bungalow annex has almost been completed, this has changed the building from a single dwelling that could accommodate two people with their own lounge, kitchenette and shower room to two individual bedrooms with ensuite facilities. The manager must ensure that the security on the front door to these rooms meets standards set for by the insurance company, as they are external doors. The manager must carry out a risk assessment showing what risk and what action is needed to ensure residents who choose to live there are safe. • The carpet on the stairs near the manager’s office has holes in it and is a trip hazard. • The carpet between the identified bedrooms was also a trip hazard as it was raised and damaged. • There was a very strong smell of urine outside an identified bedroom. • When a blind at a landing window was adjusted it fell off the wall. The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 14 • • • • • • • • • • The radiator identified at the last inspection as leaking remains in this state. The stairs were very dirty and what appeared to be chocolate smeared along a banister. It was noted that one bathroom door had a window in it without any covering allowing full view of anyone using the facilities. A downstairs toilet near the dining room had a broken seat. The visitors’ bathroom on the ground, which had a leak in it over a year ago, has still not been redecorated. There is wallpaper hanging off the walls and is extremely unpleasant environment. It was noted that there is a significant damp patch with bubbling paintwork on internal walls above the porch entrance. Externally rendering is falling off the walls. The front drive is cracked and badly potholed. The window mentioned in the last inspection, as not having a restrictor on it had not had any remedial work done on it. The manager was made to carry out the work during the inspection. The potholed pathway to the side and rear of the building has yet to be repaired but the manager has blocked it off and made it inaccessible for anyone to walk on it until it is repaired. New bedding has been purchased for residents. This was an outstanding requirement and is now met. The registered proprietor must ensure that improvements are made to the environment for all residents. This has been an outstanding requirement from the last four inspections. A request for copy of the programme of renewal as required at the last inspection has been provided but timescale set in this programme has yet to be met. Evidence was seen that residents are now able to choose their own colour scheme for their personal space. This was a requirement from the last inspection and has now been met. The washing machine in the small kitchen has now been plumbed in enabling residents to be able to do their own washing if they so choose. This was an outstanding requirement from the last three inspections and is now met. The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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, 34 and 36 Staff are clear about their roles and staffing ratios meet the needs of service users. Recruitment practices are not robust and place residents at potential risk. EVIDENCE: Staff spoken with felt that they had a clear understanding of their role to enable them to work effectively with residents. Staff understood the need to involve other professionals and liaise with the Community Psychiatric Nurses. Residents spoken with felt there were enough staff on duty and they were friendly and approachable. Staff files looked at did not have PoVA first checks or a relevant Criminal Records Bureau check. The manager must ensure that staff are not confirmed in post prior to having suitable police checks. A number of staff files were incomplete this appeared to be as a result of the proprietor taking the files and not returning them. The proprietor must ensure that these files are returned to the home as soon as possible. All records regarding staff employed in a care home must be kept in a care home as stated in Schedule 4 of the Care Home Regulations 2001. The manager has now started the process of carrying out supervision amongst staff this was an outstanding requirement from the last two inspections and is now met. The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42 and 43 EVIDENCE: Both the registered manager and deputy manager are undertaking the Registered Mangers Award. The registered manager has over the last year made marked improvements in the standard of care provided at the home. However, the proprietor is constantly getting the manager to carry out tasks, which are above and beyond what one would reasonably expect a manager to do, this is undermining progress. The proprietor must ensure that the manager only carries out tasks that are directly linked to the management of the care home. A quality assurance system has been introduced and evidence was seen including the manager’s response. The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 17 Improvements have been made in meeting requirements set at previous inspections and the proprietor has now started to carry out his regulation 26 visits ensuring his understanding of what is happening within the home is improved. This was an outstanding requirement from the last inspection. Records are kept secure and are stored in accordance with the Data Protection Act 1998 ensuring confidentiality. It was noted that a new Bain Marie has been purchased to ensure that residents receive their meals hot. The fridge in the kitchen remains very shabby. The storage of the food in the fridge was poor and the manager must ensure that where food has been opened and not used it is resealed and labelled appropriately. The residents smoke room remains extremely badly ventilated. This has been an outstanding requirement from the last two inspections. The oscillating fan currently in use does not ventilate the room simply move the smoke around. The registered manager must find a suitable method of ventilation. Staff confirmed that they are receiving mandatory training and are aware of safety policies and procedures. Staff spoken with confirmed that their induction covered all aspects of health and safety; they spoke positively about the manager and his support saying they found him approachable and helpful. In discussion with one resident it became apparent that they had had recently had an accident. A record of this had not been made as the manager said no one witnessed it. All accidents must be reported whether they are witnessed or not. The proprietor has now provided the Commission with a copy of the home’s finances and a business plan. This has been an outstanding requirement for the last five inspections. The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 2 26 X 27 X 28 3 29 X 30 1 STAFFING Standard No Score 31 3 32 X 33 X 34 1 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 2 3 3 3 X 3 2 3 The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 19 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 YA6 Regulation 15 Requirement The Registered Person must ensure, that unless impracticable, consultation is carried out with the service user, or representative when preparing a written care plan. The Registered Person shall keep the service users’ plan under review. The Registered Person must ensure that all parts of the home that service users have access are as far as reasonably practicable free from hazards to their safety. Where hazards have been identified such as damaged carpets these must be repaired or replaced. The Registered Person must ensure that unnecessary risks to the health and safety of service users are identified and eliminated. The manager must risk assess the new bedrooms doors on the annex as to their suitability and security for the service users prior to any service user moving into the rooms. Timescale for action 31/12/05 2 3 YA6 YA24 15 13 01/12/05 31/12/05 4 YA24 13 01/12/05 The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 20 5 YA24 23 6 YA30 13, 16 7 YA34 19 schedule 2 8 YA42 16 9 YA42 13 10 YA42 Schedules 3&4 The Registered Person shall ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. Where work has been identified this should be repaired or replaced. The Registered Person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home and ensure that their satisfactory standards of hygiene. The home must be kept clean. The Registered Person has obtained all information and documents specified in Schedule 2. A relevant and up to date PoVA and Criminal Records Bureau check must be obtained for all employees prior to them being confirmed in post. The Registered Person must ensure that food stored in the fridge complies with advice given by the environmental health authority. The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from avoidabe risks. The identified windows must be risk assessed and provided with restricters if assessed as required. (Outstanding requirement 26/07/05) Immediate Requirement met during inspection. The Registered Person must ensure that all accidents are recorded. 31/12/05 01/12/05 01/12/05 01/12/05 13/10/05 01/12/05 The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 21 11 YA42 23 12 YA42 23 1 YA6 15 The proprietor shall having regard to the number and needs of the service users ensure that ventilation, heating and lighting suitable for service users is provided in all parts of the care home which are used by service users. The registered person must look at improving the ventilation in the smoke room other than opening the door. The proprietor must ensure that the windows in the smoke room can be opened. (Outstanding requirement 31/05/05 and 01/09/05) The proprietor shall having regard to the number and needs of the service users ensure that equipment provided at the care home for use by the service users or persons who work at the care home is maintained in good working order. The proprietor must make arrangements for the fridges to be repaired or replaced. (Outstanding requirement 01/09/05) The Registered Person must ensure, that unless impracticable, consultation is carried out with the service user, or representative when preparing a written care plan. 01/01/06 01/12/05 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Oaks Care Home DS0000002237.V250456.R02.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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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