Inspection on 03/12/07 for The Oaks Care Home

This inspection was carried out on 3rd December 2007.

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 31/05/07

The Oaks Care Home 04/05/06

The Oaks Care Home 13/10/05

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 MIXED CATEGORY MAJORITY ADULTS 18-65 The Oaks Care Home 26-28 Corporation Oaks Woodborough Road Nottingham NG3 4JY Lead Inspector Linda Hirst Unannounced Inspection 3rd December 2007 10:30 The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 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.V355086.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 and 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.V355086.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Oaks Care Home Address 26-28 Corporation Oaks Woodborough Road Nottingham NG3 4JY 0115 962 1075 0115 962 1075 theoaksrch@tiscali.co.uk 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.V355086.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st May 2007 Brief Description of the Service: The Oaks is a large converted Victorian house situated close to Nottingham city centre. The home is on a quiet road with no through traffic, it has a garden to the front of the property and a hard standing area to the side and rear. The home is within walking distance of local shops and places of worship and has good local transport links, especially into the City Of Nottingham. The home provides care for younger adults with mental health issues. The accommodation comprises of two lounges, a conservatory area and a dining room which is the designated smoking area within the home. Smoking is not allowed in other areas of the home. The home is not fitted with a lift and has several flights of stairs, making it unsuitable for people with mobility problems. The current weekly fees for the service range from £290 - £350. These fees do not include hairdressing, holidays, cigarettes, newspapers, personal toiletries or clothing. The service gives all prospective service users a copy of the service user guide and the statement of purpose and a copy of the last inspection report is displayed on a notice board outside the manager’s office. The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. We received this back from the manager in good time and the form was well completed and helped us to plan our visit and to decide what areas to look at. We did this inspection with one inspector; it was unannounced and took place over two days, including lunchtime. The main method of inspection we use is called ‘case tracking’ which involves looking at the quality of the care received by a number of service users. We speak to them about their experience of living at the home; we look at records and talk with staff about their understanding of residents needs. We spoke with the manager, the deputy and a member of the care team and the cook. We spoke to many of the service users, three people in depth and asked for their views about the quality of the service. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of residents at the home. We did a partial tour of the building, including all communal areas and a sample of bedrooms to make sure that the environment is safe and homely. We have had concerns about the maintenance of the home for some time, and we found that this matter has still not been addressed during our visit. We therefore issued a legal notice under the Police and Criminal Evidence Act 1984 and took some photographs which may lead to further enforcement action being taken to make the owners comply with our requirements. English is the first language of all of the service users living at the home at the moment although they have a variety of cultural and racial backgrounds. We spoke to a person from a minority ethnic group to make sure that the home provides properly for the holistic needs of the service user. The staff team come from a wide variety of backgrounds and experiences. We took out a number of service user, staff and professional surveys to the home, and we received one from a Community Nurse, one from a staff member and four from service users to get their views on how they experience The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 6 the service and we also looked at the results of the quality assurance audit the manager has undertaken. What the service does well: What has improved since the last inspection? Some windows have been replaced, some bedrooms have been refurbished and others redecorated, some carpets replaced and liquid soap and paper towels are now present in all communal bathrooms and toilets. We found that most of the staff files we looked at have the information and documentation needed to make sure they are suitable to work with vulnerable adults. We have granted an extension to this requirement as only one person had a second reference missing. The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 7 The manager has sent out service user questionnaires, collated the responses and published these along with an action plan to tell service users how he intends to improve things and clarifying matters they are uncertain about. What they could do better: We found that the manager could make sure that he writes down what mental health needs prospective service users have, and what potential risks these create for the person or others so that staff know what they should do to minimise risk and meet their needs. We found that the service does not consider the cultural needs of service users from minority groups especially well. The care plans are not thorough enough, there is a lack of understanding about the specialist skin and hair care products needed and special dietary needs or preferences in this area are not well catered for. We found some practices and routines at the home were organised more for the benefit of staff than service users, such as medication administration and breakfast arrangements. We found that the staff at the home need to be encouraged to think and work in a different way to help service users become more involved in decisions affecting their own lives. More consideration could be given to the use of advocates in people’s Care Programme Approach reviews (if the service user is open to this idea) to enable people to have their views heard and recorded. We found that the service has not been proactive enough in supporting people to explore the possibilities of attending college, community centres, doing paid or unpaid work or engaging in activities of their choosing which they would enjoy whether this is in the day, the evening or at weekends. This has led to service users becoming bored and in some cases having no purposeful occupation. We found that there is minimal work going on with service users to promote their independent living skills, in spite of there being facilities to enable this to happen. Menu planning has done without consulting the service users and the food we saw was not nicely presented which could have an effect on the appetite of a person who is unwell. We found the arrangements for recording the receipt of medication and administration of medication could be improved to enable better auditing and ensure service users receive their medicines as prescribed by their Doctor. The arrangements for ensuring complaints are responded to professionally and within the timescales indicated in the home’s own policy need to be improved to make sure concerns are investigated and responded to promptly. The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 8 The managers and staff need to attend training on abuse, whistleblowing and safeguarding procedures to make sure they understand their reporting obligations and can protect service users from harm or abuse. There needs to be a regular and ongoing maintenance programme at the home to make sure that the environment is fit for purpose, safe, clean and warm enough for the people living there. We found that the staffing levels are too low, and the way in which staff are deployed is too rigid and these arrangements do not work well around the needs of the service users to meet their holistic needs and to provide them with a good quality of life. We found the owners have not been demonstrating their fitness to remain registered by ensuring the building is properly maintained and in a good state of repair. Furthermore, they have not been visiting the home and preparing a monthly report on how the home is being conducted. They cannot be certain that the home is being run in the best interests of the service users in the absence of this. We found the Portable Appliance Testing has not been done and this places the service users and staff at risk of injury from any unsafe electrical appliances. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4(YA) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are assessed by professionals before admission but as the service does not incorporate key information into their own assessment they cannot say with confidence that the service can meet the needs of all prospective service users. EVIDENCE: We looked at the care plan of the last person who came to live at the home, we saw evidence that the service has obtained a copy of the Care Programme Approach Care plan before admission. However, key information about the The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 11 mental health needs and the risk history of the person were not incorporated into the home’s own initial assessment. The staff we interviewed said they are not involved in the assessment process but they said they are given information verbally during handovers and can read the care plans, although they said they are too busy to do this sometimes. They said they try and help service users settle in well by talking to them, and helping them unpack, although they do not make a list of the personal belongings service users bring into the service. They said they try and get to know about their likes and dislikes during their pre admission visits. We spoke to the last person to be admitted to the home who told us he had been directed to live at the home by the Police. He said he came straight to the home and did not visit first, although when we looked in his records it seems he did visit the home a few times before deciding to move in. The other service users we spoke with confirmed they had come for a couple of overnight stays before they agreed to move in. Two out of the four service users returning surveys said they were asked if they wanted to move into the home, the other two said they were not consulted, though one of these commented, “but during the time I have lived here, I feel fairly satisfied. No home is perfect, but this is better than some I have been in.” One of the service users we spoke with told us he is “the best” he has felt in terms of his mental health since living at the home. The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 (YA) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are not involved enough in decision making within the home to ensure they feel in control of their lives. Care planning is not sufficiently robust to ensure the service users needs are fully assessed and consistently and safely met by staff. EVIDENCE: We looked at the care plans for three service users. The recent quality assurance questionnaires sent to service users by the manager indicates that The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 13 most people knew they have a care plan, where it is kept and that they can read it. We saw a letter from the manager to all of the service users indicating where their plan is and confirming they can read it when they wish and with staff support if they need this. Two of the three people we spoke with said they has not read their care plans and did not know they could do this, although they expressed an interest in doing so. We found the care plans focus on the activities of daily living and there is good detail in relation to these areas of need. However, although the service holds details of mental health needs and risks from mental health professionals, in two out of three cases the care plans written by the home did not highlight the mental health needs of the person concerned, nor was there a plan to indicate the symptoms of worsening mental health. The community nurse who completed a survey told us that the Oaks have always met the needs of the individuals she places in terms of their “gender, age, faith and sexual orientation.” However, we found one person’s plan did not cover their cultural needs or issues around specialist hair and skin care and when we spoke with the person, they said that they had experienced some difficulty getting access to appropriate hairdressing and creams for skin care as a result of financial constraints. We saw evidence of potentially significant risks of self harm, harm to others and issues around misuse of alcohol which had not been risk assessed and no plan was in place to help staff minimise these risks. A staff member who completed a survey said that information on care plans was always kept up to date, and other staff we spoke with said the care plans that are in place give good levels of detail but they said they would value more information on the signs of worsening mental health and clear guidance on how to support people whose behaviour may challenge the service. The person we spoke with could not tell us the names of the people who presented a risk of self harm. Three out of the four people who returned service user surveys to us told us that they never make decisions about what they do with their day. Another service user told us that they feel very unconfident in Care Programme Approach Reviews and said they wanted to speak to a staff member about their concerns and feelings but, “they did not have the time to do with me.” The service user said the staff do their best but they are very busy, the person does not have any family involved and has never heard of advocacy services but was open to this idea. The service users we spoke with said that there have not been any service user meetings for some time, and there were no recent records of these. The manager said that newsletters are sent out, but these are infrequent. People we spoke with said they would value the chance to become more involved in decision making. The staff we spoke with said they The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 14 try and involve people in decisions as much as possible, but that sometimes there are not enough staff on duty to do this as much as they would like to. The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 (YA) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 16 Service users are not sufficiently enabled to make choices with regard to their lifestyle and the routines at the home operate more for the benefit of staff than those living at the home. This leads to very low expectations. EVIDENCE: The service users we spoke with do not attend day services, college or have jobs at the moment. Two of the three people said they felt unfulfilled and bored. One person has tried attending a college course but said it was aimed more at people with a learning disability and it could not hold his interest. Another said they would like contact with the Black community but was not aware that there is a centre for African Caribbean people nearby. Both indicated that the staff are too busy to accompany them and try and find places of interest to them, and the staff we interviewed confirmed that with the staffing levels they have been working with this has proved impossible. We saw a record of activities in each service users’ folder which indicates there are craft days, BINGO, Darts and people go out into the community, none of the people we spoke with take part in these in house activities one person said it was “ a bit insulting,” doing crafts and felt it was a child like activity, not something that is age appropriate or of interest. Service users told us they go out into town and walk around the local area or go to the shops, but there are no organised evenings out (E.g. to the cinema, bowling and so on). The staff we spoke to say there are not enough staff on duty to go out with the service users and the evening and night shifts are not adequately staffed to support this. The manager felt that changes could be made now that the staffing level has increased from two to three per shift. We have concerns about how a conflict with a neighbour has been handled, the manager has referred the person to the Police, but there is no risk assessment or care plan in place to try and support the service user identified with their behaviour or to promote positive local community relationships (See YA6 and 9.) The people we spoke with said their family and friends could visit when they like and they said the staff make them feel welcome. We overheard someone asking to speak with a parent and the staff immediately telephoned them. One person we spoke with said he spends time at his parents’ house sometimes. None of the service users we spoke with said they had a current partner, but the staff we interviewed said some people have partners and children and they make sure that people can have their privacy. Issues of sexuality are in most cases, considered as part of care planning, and the manager said that if contraceptive advice is needed, this is arranged by the nurse. The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 17 Two out of the four people returning service user surveys told us they can spend their day, evening and weekend as they wish, the other two told us they cannot spend this time doing the things they would like. We found the routines at the home to be organised around the needs of the staff rather than those of the residents. E.g. the service users told us they have to come to the treatment room to receive their medication, the staff told us that this has been necessary as there were only two staff on duty per shift, but there has been an increase in the staffing levels. Service users told us there have been no changes in the way the service is being delivered. We saw evidence that some service users have independence skills as a goal in their care plans, but the staff told us that in reality the only task service users do is to make their own drinks in the service users’ kitchen. The staff member said she thought the washing machine was broken but the manager said this had been fixed, it is not being used by service users to develop and maintain their skills. Service users told us that they could lie in if they do not want any breakfast and that the kitchen is closed after 09.30 which was confirmed by the staff and manager. As the service users only have cereal it is difficult to see why a supply could not be provided for people to help themselves to in the service user kitchen. The manager said this is something to be considered. The manager and staff acknowledge that menu planning is an area, which needs to be improved upon. The service users we spoke with have varied opinions about the quality of the food, some feeling it was ok, others feeling it was basic and they would like changes. The existing menus were done by the cook and the service users said they were not involved in planning this, the manager said this is something he plans to change. Staff told us the food budget is small and there appeared to be low stocks of food for the number of service users in the home, but the manager said a delivery was expected. We observed lunch and found that the food looked poorly presented, heaped up on the plate, but the service users seemed to enjoy the food they were given and ate it all. There was no evidence of the provision of culturally appropriate meals. The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 (YA) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The healthcare needs of service users are well provided for, although the systems for managing medication are not robust enough to ensure that people receive their medication as prescribed by their Doctor. EVIDENCE: None of the service users we spoke with needed any help with personal care other than staff prompting them to shower or bathe. They said they could have a shower or bath when they like, but other routines were less flexible (see YA 16). The records held on service users’ preferred routines varied in The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 19 detail but the staff we spoke to gave good examples which indicates they know the preferences of service users. There is good evidence in the records and from comments from the service users to indicate that their mental health needs are well provided for. The staff report very good links with the local psychiatric services and the community nurse who completed a survey told us that her clients, “have varied degrees of behaviour issues, and severe, enduring mental health needs which the management and staff work very hard to meet.” She said she is kept up to date on any physical needs service users may have by the staff and said that the staff and managers, “always respond appropriately” if she feels there are any issues regarding service users’ mental health or their medication. None of the people we spoke with self medicate and they said the staff give them their tablets which they are happy with. We looked at the Medication Administration Record sheets and found several gaps in the records without any code entered to explain the omission. We found good records of medication returned to the pharmacist and the receipt of medication is recorded on the Medication Administration Record, although the failure to record medication in stock makes audit trails more difficult. There is appropriate storage for Controlled Drugs but the lock was broken, this was rectified by our second visit to the home. The storage for medication was acceptable and the temperature of the medication fridge is checked regularly. The staff we spoke with confirmed that they have had training on the safe handling of medication and talked us through the correct procedure for administration. The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 (YA) Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The arrangements for investigating complaints and safeguarding service users are not robust enough to ensure they are safe, protected and that concerns are properly responded to. EVIDENCE: The complaints procedure for the service is clear and contains the timescales for response to concerns, however it was not on display. This was immediately rectified when we brought it to the attention of the manager. Two of the four people who completed service user surveys for us told us that they know who to speak to if they are unhappy and they also know how to make a complaint. The other two who responded do not. We have received two complaints since the last inspection, one concerning an untrained staff member giving out medication which was referred to the provider. We have yet to receive a response to this complaint and the owners have failed to meet the timescale we set for response and has not responded The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 21 in line with the policy of the home. This is not acceptable and is the subject of a Provider Warning letter, which is the first stage of enforcement action. The second complaint was from a neighbour (YA13) and was substantiated. None of the people we spoke with has made a complaint, one person said they would not have the confidence to complain, others said they would if they had a concern. A staff member told us in a survey that they knew how to respond if someone makes a complaint, and the staff member we interviewed said she would pass the information on to the manager. There have not been any safeguarding allegations since the last inspection. The service has a copy of the new safeguarding procedures in addition to their own policy. The staff member we spoke with was unclear about what constitutes abuse and said she would not necessarily report issues of concern to the manager but would try and deal with the matter herself. This is very dangerous and the manager needs to reinforce the whistleblowing policy with staff to ensure he can take appropriate action to protect service users. The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 30 (YA) Quality in this outcome are is poor This judgement has been made using available evidence including a visit to this service. Residents do not live in a comfortable, well maintained and homely environment. The home is not fit for the purpose of delivering a safe and pleasant place for service users to live in. EVIDENCE: The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 23 The community nurse who completed a survey commented that the “home is large, old and in need of repair.” There has been a requirement to ensure the home is well maintained, odour free and fit for purpose since May 2006, this is still outstanding. During the course of our visit we issued a Code B Notice under the Police and Criminal Evidence Act 1984 to allow us to take photographs of various parts of the home with a view to taking further enforcement action to secure compliance with the outstanding requirement. We found that although there have been some improvements to the environment (some bedrooms have been redecorated and refurbished, some carpets and windows have been replaced and some toilets and bathrooms have paper towel and liquid soap holders,) there is a failure to provide the regular ongoing maintenance a building of this age and experiencing the use it does needs. We found the following areas needed essential maintenance: • • Several windows need replacing, the wood has perished and they are either ill fitting (one service user had put toilet roll in the large gap in his window, “to stop wasps getting in,”) or draughty. There is an ongoing problem with the radiator in one bathroom which is being continually repaired. The room is extremely cold when it is not working making it uncomfortable for the service users at the home and it needs to be properly resolved. There has been water damage in one bedroom to the ceiling, the plaster has dried out but the ceiling had not been redecorated. (The manager arranged for the matter to be investigated, resolved and the ceiling redecorated before our return visit to the home.) One bedroom has boarded up windows which the owners will not replace. The room is not currently in use. There is damaged linoleum in one bedroom, which affects the ability of the cleaners to keep the room clean and odour free, and this needs urgent replacement to provide a pleasant and safe environment for the service user. The conservatory and smoking room floor are uneven and damaged. There is damp to the wall in the conservatory (this was repaired and resolved before we returned to the service.) • • • • • We found the following equipment was needed: • • • A new mattress is needed for the identified resident whose bed was uncomfortable to sit on. New curtains are needed in the double bedroom along with privacy screens or curtains to ensure the service users in the room have their dignity maintained. Only half of the communal bathrooms and toilets had paper towel and liquid soap dispensers, the remaining rooms had nothing for service users to wash and dry their hands on when they have used the toilet. The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 24 • The risk of the spread of infection is very high in such circumstances. (This matter was attended to before we returned to the home.) The extractor fan in the smoking room is not adequate and does not remove the smoke effectively which presents a risk of smoke travel and of the risks of passive smoking for service users who are non-smokers. Three of the four people who returned service user surveys to us said the home is always fresh and clean, one person said it sometimes is. We found the odour control in some parts of the home to be inadequate, some carpets needed intensive cleaning or replacement and the sealant around some sinks and baths needed replacing. A service user told us that the home was, “old fashioned, not comfortable and unclean.” The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 (YA) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff have good access to training and are supportive of the service users but there are not enough staff deployed in a way which ensures that the service users needs can be fully met. EVIDENCE: There are twelve care staff employed at the service, only one person has obtained their National Vocational Qualification Level 2, though a further eight are working towards this. If all staff complete this training successfully the The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 26 service will exceed the target of 50 of staff trained to National Vocational Qualification Level 2. The community nurse who completed a survey told us that the staff training has “improved dramatically.” This was confirmed by a staff member commenting in a survey that, “I have learned a lot more about the care residents need than in any other home I have worked in.” This person confirmed that there was training to enable them to do their job and the induction prepared them for working with the service users very well. We saw staff training records for 2007 which provides evidence of the following training, Skills for Care induction, Dementia awareness, Medication, Fire Safety, Abuse awareness, Care assistant training, Epilepsy Awareness, Basic First Aid, Autism, National Vocational Qualification 2 in cleaning, Mental Health awareness, issues of Equality and Diversity and there is evidence of historical training on managing challenging behaviour, though this was not recent, (see comments raised in YA9). The service users we spoke with said the staff try really hard and they said they are, in the main caring and competent. When questioned about the staff, three out of the four service users returning surveys said that the staff always treat them well, but only two said they always listen and act upon what service users need. One person felt they never do this. A service user commented in a survey that the staff, “try their best to help and care for the residents.” The nurse commented that, “the staff work very hard to cater for the client’s needs,” but commented that more ‘staff are needed to support people properly.” We looked at the staff rota and found that there has been an increase to three staff on some daytime shifts. Where this is an improvement, the service users we spoke with said that they had not noticed any positive lifestyle changes since the increase (see YA 7, 12 and 15). The staffing levels and deployment of staff needs reviewing to ensure the holistic needs of service users can be met. We looked at the files of four staff members and found that they all had Criminal Records Bureau checks in place and had completed application forms and three of the four had two written references, the manager was asked to chase up the second reference for the person concerned. A staff member who completed a survey told us that she had all of the necessary pre-employment checks before she started work at the home. The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 (YA) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 28 The manager has made some improvements to the service but there are a number of requirements and recommendations that have not been addressed and this means the service users are not enjoying the quality of life that they should. The owner is not demonstrating a commitment to the service nor providing evidence that he is fit to remain registered by regularly maintaining and monitoring the service to ensure it is run in the best interests of service users. EVIDENCE: The manager has achieved his National Vocational Qualification Level 4 in care home management and also has achieved National Vocational Qualification Levels 2 and 3. We saw evidence that he has attended various training courses to update his knowledge and skills throughout his employment. The staff and service users we spoke with praised him as an approachable and caring person, though one person said he is “a bit too soft,” sometimes. A nurse who filled in a survey commented to us that she has “a good relationship” with the manager and she said that she has “seen the home slowly improve.” A service user commented in a survey that the manager does a “great job,” and a staff member commented that the manager is “the best” she has worked for. It is clear that the manager has worked hard to secure improvements over the years and a better environment and staffing levels to support service users. However, the nature and number of requirements set as a result of this inspection (YA6, YA9, YA12, YA 23, YA 24, YA30, YA 33, YA35, YA37) indicates that the service is not being managed in a way which is safe and enhances the quality of life of the service users by providing user focussed care. A quality assurance questionnaire was sent out to all of the service users in October and the results were published in November. The people we spoke with said they completed these. We saw evidence that these responses have been collated, published to service users and action points have been raised with them and with staff. We found the owner has not been undertaking monthly visits to the home and providing a report on his visits. The last record we could find was from February 2007 and this appears to have been written by the manager rather than the provider. There are a number of requirements the owner is directly responsible for (YA 24, YA30, YA33) which are not being addressed and which have a negative impact on the people living at the service. These matters must be addressed without further delay to avoid further enforcement action being taken. The manager provided written evidence of the dates of Health and Safety testing and servicing and we found this was all in order with the exception of Portable Appliance Testing which should have been done in September and is now well overdue. The staff we spoke with were happy that their health and safety is well supported and protected at the service and no concerns were raised in this area by service users. The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 29 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 2 27 1 28 1 29 X 30 1 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT Standard No Score 37 2 38 X 39 2 40 X 41 X 42 2 43 X 2 2 X 1 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 X 15 3 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Oaks Care Home Score 3 3 2 X DS0000002237.V355086.R01.S.doc Version 5.2 Page 30 Yes Are there any outstanding requirements from the last inspection? 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 *RQN Regulation 17(2), Sch 3(10) Timescale for action You must maintain a record of all 28/02/08 items of furniture or electrical equipment owned by service users to ensure their property is protected. You must make sure that you 28/02/08 have care plans in place regarding the mental health needs of each service user and indicate the signs and symptoms of them becoming unwell to ensure staff have clear guidance and can support service users appropriately. You must ensure that you have 28/02/08 assessed the cultural needs of service users (where relevant) and provide for their care needs by ensuring they can obtain the correct hair and skin care products to maintain their health and wellbeing. You must make sure that the 28/02/08 risk of self harm, harm to others, supporting people with challenging behaviour and alcohol misuse are properly assessed and clear actions to DS0000002237.V355086.R01.S.doc Version 5.2 Page 31 Requirement 2. YA6 15 3. YA6 12(1)(a), 12(4)(b) 4. YA9 14(1)(b) & (d), 14 (2) The Oaks Care Home 5. YA12 minimise the risks are highlighted in service users’ care plans to make sure that service users’ health and safety is promoted and the staff are given clear guidance. 16(2)(m & You must consult with service n) users about their interests and lifestyles and • • Review the suitability of the in house programme of activities with service users Enable service users to access appropriate community facilities such as college courses, culturally appropriate facilities or to try and find paid or unpaid opportunities for employment if this is their wish. 31/03/08 6. YA20 13(2) 7. YA23 13(6) 8. YA24 23(2)(b) 9. YA24 23(2)(b) (d) & (p) You must ensure that the Medication Administration Record sheet is filled in accurately so it is possible to identify whether the service user has received their medication as prescribed by their Doctor or Consultant to maintain their health. Arrange for staff to attend training on abuse, whistleblowing and the local safeguarding procedures to ensure they are clear about their reporting obligations and can properly protect service users from harm or abuse. You must ensure the home is fit for purpose, safe and comfortable for the service users by replacing the rotten, ill fitting and damaged windows. You must ensure the home is fit for purpose, safe and DS0000002237.V355086.R01.S.doc 15/02/08 31/03/08 30/04/08 31/03/08 The Oaks Care Home Version 5.2 Page 32 comfortable for service users by: Replacing the radiator in the bathroom identified. • Replacing the damaged linoleum in the identified bedroom • Repairing the damaged flooring to the smoke room and conservatory. • You must replace the mattress in the identified bedroom • You must provide new curtains in the double bedroom which close fully to • You must provide privacy screens or curtains in the double bedroom. You must ensure the home is clean, hygienic and safe for service users to use by: • Cleaning or replacing identified carpets • Replacing old and worn sealant around baths and sinks. You must review the dependency levels and holistic needs of service users and ensure that your staffing levels are appropriate to meet these needs. You must provide up to date training for all staff on supporting people whose behaviour may challenge the service so that they can provide care in a consistent manner. You must address the issues we have highlighted in this report and change the culture at the home to ensure that service users enjoy a good quality of life and the home is run in their best interests. The owners must undertake a DS0000002237.V355086.R01.S.doc • 10. YA30 16(2)(j) 30/04/08 11. YA33 18(1)(a) 28/02/08 12. YA35 18(1)(a & c) 31/03/08 13. YA37 10(1) 31/03/08 14. *RQN 26 28/02/08 Page 33 The Oaks Care Home Version 5.2 15. YA42 13(4), 23(2)(c) monthly visit to the home and produce a written report covering the areas specified in this Regulation. Copies of these reports must be sent to us every month until further notice to demonstrate continued fitness to remain registered. You must arrange for the Portable Appliance Testing to be undertaken without delay to ensure that service users and staff are safe from harm and injury. 15/02/08 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 YA2 Good Practice Recommendations You should make sure that your initial assessment takes full account of the mental health needs and associated risks to service users and others in order to be sure that you can meet the needs of prospective service users. You should refer the person highlighted (with their consent) to an advocacy service to help them express their opinions in Care Programme Approach review meetings. You should restart the service user meetings and enable people living at the home to determine the agenda to make sure they are fully involved in decision making at the service. You should consider how staff are deployed to ensure they are available to support service users to pursue leisure activities in the evening or at weekends if they choose. You should address the institutionalised ways of working that exist at the care home (specifically around medication, breakfast arrangements and the provision of independent living skills training and support), and make sure that the routines are flexible to the needs of service users and in place for their benefit. You should review the menus with the service users and provide for their preferences and cultural needs and DS0000002237.V355086.R01.S.doc Version 5.2 Page 34 2. 3. YA7 YA7 4. 5. YA12 YA16 6. YA17 The Oaks Care Home 7. 8. YA18 YA30 tastes. The presentation of food should improve to promote appetite. You should ensure that the preferred routines of service users are fully documented following consultation with them to ensure their preferences are respected. You should provide more effective smoke extraction in the smoker’s room to prevent the travel of smoke through the building and the dangers of passive smoking. The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. The Oaks Care Home DS0000002237.V355086.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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