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Inspection on 31/05/05 for The Oaks Nursing Centre

Also see our care home review for The Oaks Nursing Centre for more information

This inspection was carried out on 31st May 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 but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The manager was committed to providing training for all staff. A number of care assistants had completed NVQ2 and some had completed or were doing NVQ3. The manager had arranged for the Bradford University Dementia Unit to visit and assess the premises and they planned to work with staff on `care mapping` for residents in the near future. The Commission would like to see a copy of their assessment of the environment.

What has improved since the last inspection?

The environment continued to improve with the implementation of the refurbishment programme. Although care plans had improved the manager agreed these required further development to ensure they reflected residents individual needs. Medication management had improved on Knole Unit. Menus and activity programmes were provided in both word and picture format to assist residents make choices. The manager had started a `gardening club` on one unit and participated in this with the residents. She planned to extend this to other units.

What the care home could do better:

Management must address the ventilation in the home and it was evident at this inspection that addressing this was being given a high priority. It was disappointing to see there had been a drop in the standard of the bathing facilities and improvements must be made to ensure residents enjoy bathing in a pleasant environment. Residents must have individual social care plans and where possible residents or relatives must be actively involved with care planning. Residents, particularly on Belvedere Unit must be properly positioned, provided with the assistance and equipment the need to ensure they manage to enjoy their meals independently.Torn and worn bed linen must not be used and pillows must be comfortable, in good condition and provided adequate support.

CARE HOMES FOR OLDER PEOPLE The Oaks Nursing Home 904 Sidcup Road New Eltham SE9 3PN Lead Inspector Pauline Lambe Unannounced 31 May 2005 09.55 st 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 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service The Oaks Nursing Centre Address 904 Sidcup Road, New Eltham, SE9 3PN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8857 9980 020 8851 0261 Speciality Care (EMI PLC) Lyn Carol Jones CRH 113 Category(ies) of DE(E) 113 registration, with number of places The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. 5 Places for people with Mental Health problems 40 - 59 years excluding learning disability and dementia 2. A futher 3 places in the above category for named service users as agreed in the letter from the NCSC 10/12/03 3. The registered person must provide additional supernumary management time in each unit as detailed. Knowle Unit 10 hrs per week, Burstead Unit, 10 hrs per week, Oxleas Unit 10 hrs per week, Joydon Unit 15 hrs per week,Lessen Unit 15 hrs per week 4. Category DE(E) agreement was in place to allow admission of service users from 60. 5. Maximum numbers of service users at any one time must not exceed 113. Date of last inspection 22nd December 2004 Brief Description of the Service: The Oaks Care Centre is owned by Speciality Care (EMI) plc and is part of Craegmoor Healthcare. The home is registered to provide nursing care for 108 older people with dementia and 5 younger adults with a mental health disorder. The home is located on the busy A20 dual carriageway between Eltham and Sidcup. The home is within walking distance of public transport or local shops. The building is divided into six self-contained units. The largest unit accommodates twenty-five service users and the smallest thirteen. Each unit is accessed through a combination lock and has a number of bedrooms, bathrooms, toilets and open plan dining / lounge area with kitchenette to accommodate service user groups. Accommodation is provided on two floors. The home has 71 single and 21 shared rooms, all have en suite toilet and washbasins. The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors from the Commission completed this unannounced inspection over 7 hours. The service was last inspected on 22nd December 2004. The manager was in charge of the home at the time of this inspection. The inspection included talking to residents, staff, management and relatives. Records required by regulation such as care plans, medication, accident, safety and maintenance and employee files were inspected and the inspectors toured the premises. What the service does well: What has improved since the last inspection? What they could do better: Management must address the ventilation in the home and it was evident at this inspection that addressing this was being given a high priority. It was disappointing to see there had been a drop in the standard of the bathing facilities and improvements must be made to ensure residents enjoy bathing in a pleasant environment. Residents must have individual social care plans and where possible residents or relatives must be actively involved with care planning. Residents, particularly on Belvedere Unit must be properly positioned, provided with the assistance and equipment the need to ensure they manage to enjoy their meals independently. The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 6 Torn and worn bed linen must not be used and pillows must be comfortable, in good condition and provided adequate support. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 5. Standard 6 does not apply to the home. Residents were admitted following a full assessment of need undertaken by a member of staff from the home. Care manager assessments were also obtained where possible. EVIDENCE: In was evident in residents records that care needs assessments had been undertaken prior to admission. Some of the files seen also included care manager assessments. A relative said she was present when the preadmission assessment was completed and the process included getting information from the resident Written confirmation that the home could meet assessed care needs was provided to residents or relatives. Residents, relatives and other interested parties were welcomed to visit the home prior to deciding on the suitability of the home to meet the needs of the prospective resident. The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 Residents had prepared care plans but the format used did not encourage these to be individualised. Records showed attention was given to meeting resident’s healthcare needs. None of the residents managed their own medication and medication systems inspected on three units were assessed as safe. EVIDENCE: The format used for care planning did not make this process easy to individualise however there was evidence in some care plans seen to show efforts were made to ensure they reflected individual care needs and show how these were to be met. For example how to manage a resident’s challenging behaviour was detailed. However other care plans were very similar. A relative said they had been shown the care plan but had not been involved with preparing this. All residents were registered with a GP and were supported to access other health care services such as dental and optical routinely. It was evident from care plans and a tour of the units that procedures were in place to prevent and treat pressure sores. It was evident equipment to prevent or treat pressure sores was provided and staff said they got advice from a tissue viability nurse when required. The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 10 None of the residents were assessed as being able to manage their own medication. Medication systems were inspected on three units and were found to be generally safe. A little more attention was needed to ensure medication administration charts were signed at the time of administration. A record must be kept to show the administration of topical medicines such as creams and lotions. Staff were observed interacting appropriately with residents. It was not possible to get meaningful comments from residents as to how the service met their expectations and needs. Relatives seen voiced their satisfaction with the care provided and the improvements made to the environment and in stability of staffing in the units and in staff attitude. Requirement 1 and recommendation 1. The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13, and 15 Menus seen showed meals were varied and nutritious. To assist residents make meal choices word and picture menus were provided. Staff must ensure residents are seated in a way that enables them to enjoy their meals independently. Further work was needed to ensure residents had activity care plans prepared based on their interest and ability. EVIDENCE: In the opinion of the staff residents from the upstairs units rarely participated with activities taking place on the ground floor. The cook said she had planned to have a BBQ for each unit and organised with the care staff getting residents who were able to attend down to the garden for these events. Individual social care plans needed to be prepared for all residents. A record was kept in resident’s files of the activity they participated with. The manager had started a gardening club on one unit and was working towards extending this to other units. The residents involved were very proud of their achievements so far. Relatives said they were welcomed when visiting the home and that staff kept them informed of matters relevant to their resident. Relatives meetings were held two monthly and minutes kept. The minutes of the meeting held in May 2005 were seen and showed the meeting was informative. Lunch was observed on Lessnesss and Belvedere Units. A choice of meal was provided. Staff said that for residents who were unable to make choices they The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 12 did this based on their knowledge of the residents likes, dislikes and observed preferences. On Lessness the meal was served in a calm manner with residents getting assistance as needed. The portions were very large and one resident indicated this to the staff by returning the meal to the person serving. On Belvedere Unit it was also noted that large portions of food were served. Residents did get assistance but for some this help was slow which meant their meal was probably too cold to eat. A high percentage of residents had their meal while seated in armchairs. They did not have tables and struggled to manage the meal from their laps. One resident said the sprouts were not nice. The inspector sampled these and agreed they were undercooked and greasy. On both units cold and hot drinks were readily available for residents and relatives confirmed this was usually the case. Requirement 2 and recommendation 2. The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 There were procedures in place to ensure complaints and allegations or suspicions of abuse were appropriately investigated. Systems were in place to record any incidents that would adversely affect the health or welfare of the residents. EVIDENCE: The home had a complaints and adult protection procedure. The complaints procedure was included in the statement of purpose and a copy was displayed in the front entrance. Since the last inspection no complaints had been referred to the Commission. In that time the home had received two allegations of abuse, which on investigation were not substantiated and one complaint in relation to the hygiene of a residents room, which on investigation was partly substantiated. Records seen showed these matters had been managed in line with procedures. Relatives said they knew how to make a complaint and who to talk to if they had concerns. They also said that if they made suggestions these were well received and acted upon. The manager ensured the Commission were informed of complaints or allegations of abuse occurring in the home. The manager also informed the Commission when residents were admitted from hospital with pressure sores. The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 to 26 Over the past 12 months a programme to refurbish the environment had been in progress. This had improved much of the environment for the benefit of the residents. Areas that require attention were the bathing facilities and the ventilation of the home. EVIDENCE: The refurbishment programme had improved the environmental standards in many areas. Lounges and bedrooms were either upgraded or in the process of being upgraded. Some of the bedrooms seen had been refurbished but some were quite bare and impersonal. Some bed linen was quite worn and some of the pillows were flat, lumpy and would not provide any neck support. The laundry manager said he had new linen in stock and would put this into circulation. The manager agreed to audit the pillows and provide new ones where needed. The manager had got Bradford University dementia care department involved with the service. It was hoped that their assessment of the home would include recommendations to ensure the environment meets the needs of residents with dementia. The standard of the bathing facilities seen were not satisfactory. The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 15 The poor ventilation and slow process to refurbish the bath and shower rooms meant some of these did not provide a pleasant environment. The bathroom on Lessness Unit was very cluttered with laundry bags, clinical waste bags, wash bowls containing various unnamed toiletries, the bath seemed to have a leak underneath and there was a very unpleasant odour present in the room overall. This was the only bathing facility used for the residents on the unit. There was unpleasant odours noted in other bath and showers rooms on this unit and on Knole and Oxleas Units. These issues did not present a problem on Belvedere Unit. The ventilation problem added to the persistent malodour in the bath and shower rooms and addressing this was included in the refurbishment programme. The manager said the ventilation problems were to be addressed as a matter of urgency. At the time of the inspection surveyors were on site to discuss this at a management meeting. Requirements 4.5.6.7 and recommendation 3. The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 The home did not adhere to its agreed staffing levels at all times. The manager has had a positive influence on staff training with many care assistants had obtained level 2 and 3 NVQ. A;; staff were included on the NVQ programme including domestic staff. EVIDENCE: Each unit had a designated staff team consisting of a part time care manager, qualified nurses, care assistants and domestics. Staff said and rotas seen showed that staffing levels were not adhered to for all shifts both in qualifications and number of staff. This was a concern on Belvedere Unit, which should have two nurses and four care assistants in the morning but occasionally fell below this both in number and qualifications. Care staff who obtained NVQ were unhappy that this did not equate to an improved salary. Staff said that because of this once care assistants got their NVQ they tended to leave. The manager supported this information and said care staff had left for this reason and that staff retention needed to be addressed. Staff said they were provided with training relevant to their roles and felt this had improved the quality of care they provided. The cook said that the quality of work by the kitchen staff had improved based on their NVQ training. Three employee files were inspected. These were well organised and contained the information required by regulation. Requirement 8 and recommendation 5. The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,36 and 38 The home manager is registered with the Commission and has worked hard to improve standards in the home. Staff received formal supervision and felt this helped to improve the care they provided. Records seen showed attention was given to providing a safe environment. EVIDENCE: The manager is registered with the commission and has been assessed as fit to manage the service. She had gained the respect of staff and relatives and worked to improve the environmental and care standards. She presented as committed and energetic in fulfilling her role. A process to ensure staff received formal supervision quarterly was in place. Although the supervision process had begun it had not settled into a regular routine. Staff who had received supervision spoke positively of the benefit this had on the quality of care they provided and their own professional development. Not all safety systems were inspected on this occasion. A selection of safety records seen included service of moving and handling equipment, electrical The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 18 certificate and portable appliance testing. Fire safety records were satisfactory and up to date. The fire alarm was checked weekly and fire drills monthly. The names of staff attending fire drills were not recorded and there was no evidence to show fire drills were held to include night staff. Requirement 9 and recommendations 5 and 6. The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 19 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. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION 2 3 2 3 3 2 3 2 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x x 2 x 2 The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 20 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 9 Regulation 13 Requirement The Registered Person must ensure staff sign medication administration charts at the time of administration A record must be kept for the administration of all prescribed medicines including topical preparations. The Registered Person must ensure social and activity care plans are prepared for residents. The Registered Person must ensure residents have appropriate seating and tables to enable them to enjoy their meals independently. The Registered Person must send copies of the plumbing, heating and ventilation survey reports to the Commission with any relevant remedial action plans. (Timesclae of 21st January 2005 was not met) The Registered Person must ensure the bath and shower rooms are kept clean, well maintained and provided a suitable environment for residents. This applied G51s6767theOaksv221765.31.05.05 stage4.doc Timescale for action 29th July 2005 2. 3. 12 15 16 16 29th July 2005 29th July 2005 4. 19 23 15th July 2005 5. 21 23 29th July 2005 The Oaks Nursing Home Version 1.20 Page 21 6. 7. 24 26 16 16 8. 9. 27 and 27 38 18 23 particularly to Lessness, Knole and Oxleas Units. The Registered Person must ensure bedlinen and pillows provided are in good condition. The Registered Person must ensure the home is kept free from offensive odours. This applied particularly to the bath and shower rooms. The Registered Person must ensure the agreed staffing levels are adhered to at all times. The Registered Person must ensure fire drills are held to include all staff including night staff. 29th July 2005 15th July 2005 15th July 2005 15th July 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 7 15 Good Practice Recommendations The Registered Person should ensure residents or relatives are involved with care planning and not advised that care plans are in place. The Registered Person should ensure staff serve meals in amounts that make the meal appealing to the residents. Care should be taken to ensureing vegetables are cooked in such a way as to make them soft enough for the residents to enjoy. The Registered Person should ensure key workers work with residents and relatives to make bedrooms personal to the occupant. The Registered Person should review the salary paid to care assistants when they obtain NVQ to encourage staff retention. The Registered Person shuld ensure staff receive formal supervision 6 times a year as stated in this standard. The Registered Person should ensure a record is kept of the names of staff attending fire drills. 3. 4. 5. 6. 24 27 36 38 The Oaks Nursing Home G51s6767theOaksv221765.31.05.05 stage4.doc Version 1.20 Page 22 Commission for Social Care Inspection Riverhouse 1 Maidstone Road Sidcup Kent DA14 5RH 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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