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Inspection on 08/08/06 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 8th August 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 management team worked together to raise standards of care. Staff training was well planned and attention given to ensuring mandatory training and updates were provided. Food provided was varied and meal times were well managed. Visitors were welcomed in the home and comments made by relatives indicated they knew the management team and would feel felt comfortable discussing concerns they had with them. Recruitment procedures were good and complied with regulation. Staff had access to training relevant to their work and had access to a training programme.

What has improved since the last inspection?

Care plans continued to improve but the quality of these varied as to how person centred they were. A new and safer system to manage medicines had been introduced. The environment continued to improve although this was quite slow and was not happening within the timescales originally planned. New kitchen units had been fitted in Belvedere, Lessness and Oxleas Units. The bathroom on Oxleas Unit was nicely refurbished and made homely.

What the care home could do better:

Care plans should be more person centred and show how individual assessed needs will be met. The risk assessment for use of bedrails must be improved and the correct height bedrails fitted to beds when pressure relief mattresses are being used. Wound care records must reflect the treatment provided and the condition of the wound. A system must be in place to follow up unexplained injuries sustained by residents and to show what action will be taken to reduce or prevent these. Some improvements were needed to medicine management particularly regarding the temperatures in the medicine storage areas. These areas were too hot. Also records must be kept for disposal of medicines on Joydens and Belvedere Units, records must be kept for all medicines brought into the home including those brought in by resident. Homely remedy policies must only be administered with the agreement of the GP. The refurbishment of bedrooms and bathrooms must be completed and a revised programme to finalise this work must be sent to the Commission. The maintenance and hygiene issues included in the environmental standards must be addressed. Social care plans lacked detail and more efforts must be made to reflect the residents` interests and to show how this would be met.

CARE HOMES FOR OLDER PEOPLE The Oaks Nursing Centre 904 Sidcup Rd New Eltham London SE9 3PN Lead Inspector Ms Pauline Lambe Key Unannounced Inspection 8th August 2006 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Oaks Nursing Centre Address 904 Sidcup Rd New Eltham London SE9 3PN 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) 020 8857 9980 020 8851 0261 the.oaks@craegmoor.co.uk Speciality Care (Rest Homes) Limited Miss Lynn Carol Jones Care Home 113 Category(ies) of Dementia - over 65 years of age (113), Mental registration, with number disorder, excluding learning disability or of places dementia (5), Mental Disorder, excluding learning disability or dementia - over 65 years of age (113) The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 5 places for people with mental health problems 40-59 years excluding learning disability or dementia A further 3 places in the above category for named service users as agreed in the letter from the NCSC dated 10/12/03 The Registered Person must provide additional supernumerary management time on each Unit as detailed below:Knowle Unit 10 hours per week Burstead Unit 10 hours per week Oxleas Unit 10 hours per week Joydens Unit 15 hours per week Lessness Unit 15 hours per week Belvedere Unit 18 hours per week Category DE(E) agreement was in place to allow admission of service users from 60 years of age prior to the implementation of the Care Standards Act 2000. The Commission for Social Care Inspection endorses this agreement. Maximum number of service users at any one time must not exceed 113 25th November 2005 4. 5. Date of last inspection 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 and 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 residents 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 resident groups. Accommodation is provided on two floors. The home has 71 single and 21 shared rooms, all bedrooms have en-suite toilet and washbasins. There are parking spaces to the front of the property. The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 5 The current fees in the home ranged from £483.48 - £2,107.83 and residents pay privately for personal items, hairdressing, chiropody and physiotherapy. The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Four inspectors from the Commission completed the site visit for this unannounced inspection on 8th August 2006 over 8.75 inspection hours. The manager and staff assisted with the inspection. The service was last inspected on the 25th November 2005. At the time of this inspection one hundred and three residents were in the home and one resident was in hospital. This inspection included a review of information held on the service file, a tour of the premises, reviewing comment cards sent to the Commission by residents and relatives, time was spent talking to residents, relatives, staff and the manager. Records required by regulation were inspected and compliance with previous requirements and recommendations reviewed. Thirteen visitors provided feedback during the inspection and seventeen relative comment cards were returned to the Commission. Comments received were generally positive about the service, the staff and the quality of care provided. Seven residents completed and returned comment cards to the Commission and these too indicated satisfaction with the service. What the service does well: What has improved since the last inspection? Care plans continued to improve but the quality of these varied as to how person centred they were. A new and safer system to manage medicines had been introduced. The environment continued to improve although this was quite slow and was not happening within the timescales originally planned. New kitchen units had been fitted in Belvedere, Lessness and Oxleas Units. The bathroom on Oxleas Unit was nicely refurbished and made homely. The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 7 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 Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 did not apply to this home. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. Residents were admitted based on pre-admission assessment of need. Adequate information was provided about the service and the manager said that residents received written confirmation that the home could meet their assessed needs. EVIDENCE: Pre-admission assessments were seen in a number of the resident’s files inspected. Some files contained assessments and care plans prepared by other professionals such as care managers and a psychiatrist. The manager or senior staff from the home completed pre-admission assessments. The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 10. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to the service. Care plans had improved but were rather generic and needed to be more reflective of individual needs. A system to follow up unexplained injuries sustained by residents must be introduced. A new and safer system to manage medicines was in place but some concerns were noted in relation to medicine storage. No concerns were noted in relation to residents’ dignity and respect. EVIDENCE: Eleven care plans in total were inspected over different units. Those seen included risk assessments and care plans to show how assessed needs were met. The care plans varied in quality with some being more person centred than others. For example some provided details on how to manage challenging behaviour while others did not specify how this was to be done. The risk assessment used for the use of bedrail was considered inadequate and some bedrails fitted were not of a height suitable to ensuring the safety of the resident. This applied particularly to bedrails fitted when the bed had an additional pressure relief mattress provided. Additional height bedrails were required in these situations. Some concerns were noted regarding wound care records on Belvedere unit. The wound care records for one resident admitted The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 11 with a pressure sore were unclear as to the condition of the wound or the frequency of the dressing. However advice had been obtained from the tissue viability nurse, the resident had the appropriate pressure relief equipment provided and photos seen showed the wound was healing. Wound care plans seen on other units were satisfactory. Care plans and risk assessments seen were up to date and kept under review. A number of files seen included care plans that were considered irrelevant. For example one resident had a risk assessment kept up to date for bedrails but did not have this equipment provided, other residents had been assessed as not having spiritual needs or the ability to mange finances yet they had up to date risk assessments and care plans in place related to these issues. On Lessness Unit one resident was receiving one to one care. The care plan reflected this and the residents care had been discussed with staff from the PCT. Feedback from relatives and those seen indicated they were satisfied with the care provided. Requirement 1 and recommendation 1. All residents were registered with a GP and supported by staff to access other healthcare services such as dental, optical, chiropody and physiotherapy. The GP was seen in the home during the inspection and from observation the interaction between staff, residents and the GP was positive. Staff obtained advice from a tissue viability nurse, psychiatrist, community psychiatric nurse and other professionals as needed for the benefit of the residents. Accident records were inspected in Joydens and Belvedere Units. These were well completed and incident forms were also completed. The accident records showed that a high number of residents sustained unexplained minor injuries. Some of the incident forms showed that efforts were made by staff to ascertain how the injuries occurred. However there was no evidence to show that unexplained injuries had been followed up or investigated adequately by management or that any action had been taken to reduce the incidence. Requirement 2. None of the residents managed their own medicines. Since the last inspection a new system was introduced to manage medicines. Medicines were now supplied in blister packs and came with pre-printed administration charts. A safe system had been introduced to dispose of medicines however records were not being kept of these on Joydens and Belvedere Units. The home had a stock of homely remedies but did not have a written agreement with the GP to use these. Internal and external medicines were stored together in the homely remedy container. On Lessness Unit some administration charts had not been signed by staff. The medicine storage areas were noted to be too hot and an immediate requirement was left with the registered person to address this. At the time of writing this report the Commission had been informed in writing of the actions taken to comply with this requirement. Requirements 3 and 4. Residents were well presented. Many rooms were for single occupancy and shared rooms had screening to provide privacy for residents. Staff were observed interacting appropriately with residents. Feedback received from The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 12 residents and relatives was positive in relation to staff interaction and the respect staff displayed towards residents and visitors. On the ground floor units residents were supported to use the conservatory and garden areas or to access these independently. The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. Activity provision had improved but social care plans needed further developing. Relatives said they were made welcome and kept informed about their resident. A varied and nutritious diet was provided and residents said or indicated they enjoyed their meals. EVIDENCE: Staff said there had been improvements to the activities provided in recent months. However social care plans seen did not show how individual social needs were to be met. Four activity organisers were employed and had worked hard to prepare ‘activity boxes’ which were brought to the units daily on a rotating basis. These contained items such as puzzles, games, reminiscence material and art & craft materials. Staff on the units assisted with activities. Since the last inspection two of the activity organisers had received training on reminiscence therapy and had created an old fashioned sitting room complete with appropriately dated furniture and fittings in the annex. Residents were brought to this room for reminiscence sessions. The garden areas were well maintained and some residents enjoyed the ‘garden club’ where they were supported to plant shrubs, flowers, tomatoes and sweet corn. Garden furniture and parasols were provided to enable residents to The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 14 enjoy the garden areas. Relatives and residents seen were satisfied with the activities provided. Recommendation 2. The home had an open visiting policy and feedback from relatives was positive and indicated that they were made feel welcome in the home. Resident files contained a record of contact with relatives and relatives seen said staff communicated well with them in relation to the health and well being of their resident. Most of the residents had only limited ability to make decisions about their lifestyles, which made it difficult to assess standard 14. Relatives seen indicted they were involved in making decisions about residents’ lives. The inspection began early and residents were seen enjoying breakfast. A choice of meal were provided which included cereal and cooked breakfast. Lunch was observed in all units except Knole. The meal was served calmly and staff were attentive and helpful. Plate guards were provided and tables properly prepared. Meal portions were appropriate and residents were observed or said they enjoyed the meal. Relatives present said the meals were always good and that the menu was followed. On some units staff did not communicate much with the residents and did not tell them what the meal was. Foods were pureed separately to make them look appetising. A bowl of fresh fruit was left in each unit daily and residents were seen helping themselves to this or staff offered them help to enjoy the fruit. The kitchen was not inspected on this occasion. A satisfactory environmental health inspection was completed on the kitchen on 21st July 2006. The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. Adequate procedures were in place to manage complaints and ensure safety for residents. EVIDENCE: Policies and procedures were provided in relation to management of complaints and adult protection. Since the last inspection three complaints were made to the home. Records seen showed these had been appropriately managed. The home manager kept the Commission informed about complaints and concerns raised about the service. Seventeen completed comment cards received from relatives indicated all of them were aware of the home’s complaints procedure. Relatives seen on the day of the inspection were aware of this procedure. No adult protection investigations had taken place since the last inspection. The home manager was involved in a multidisciplinary working party representing private providers and said this helped her to keep up to date with practice. Staff spoken with displayed a good understanding of adult protection and records seen showed that since the last inspection a high percentage of staff had received training on this topic. The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 and 26. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to the service. The home was clean and tidy and attention given to the safety. Repairs and hygiene issues noted are included below. The refurbishment and redecoration programme must be updated and a revised programme sent to the Commission as this work was progressing very slowly. EVIDENCE: On Oxleas Unit the area was clean and tidy and new armchairs had been provided since the last inspection. On this unit the wardrobe in one bedroom had no hanging rail, in another bedroom the drawer unit required repair and a ceiling tile was missing in the corridor. Burstead Unit was clean and tidy and during a brief tour no maintenance issues were identified. Belvedere Unit was generally clean and tidy but the lounge carpet needed cleaning. The manager said the carpet cleaners were due in the next day and said that communal carpets were cleaned on a rolling programme. New units had been fitted in the kitchen area. A number of armchairs in the lounge and bedrooms were split and not very hygienic. An audit of these must be completed and replacements The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 17 provided where needed. On Joydens Unit the communal area was clean and tidy. Lessness Unit was clean and tidy, new units had been fitted in the kitchenette since the last inspection. The furniture and décor were satisfactory. No unpleasant odours were noted in the home. On Oxleas Unit the bathroom had been redecorated and made homely since the last inspection. The bathrooms on Burstead and Belvedere Units could have been cleaner and the paintwork needed attention. The bath on Belvedere Unit was stained and must be cleaned. On Joydens Unit the shower room was being used as a storage area, the shower tray and basin were stained and needed cleaning. Also on this unit the bathroom required some attention. The seal round the bath and taps was loose. The floor and WC pan were stained and needed cleaning. On Lessness Unit the bathrooms and shower room were satisfactory; however the cistern was leaking in the separate w.c and there was no shade on the ceiling light. Hot water temperatures checked in bathrooms were at safe levels. On Oxleas Unit the bedrooms were clean, tidy and furnished to a satisfactory standard but were considered bare and impersonal. On Burstead and Belvedere Units a number of bedrooms were viewed and were noted to be clean and tidy. Shared bedrooms had screening provided for privacy. Some bedrooms had been personalised and others were quite bare. On Belvedere Unit one en-suite door in bedroom 4 needed repair. The programme to refurbish and redecorate the bedrooms was completed on Joydens, Knole and Burstead Units. Management must now plan how to complete this work on the other units and must send a copy of the revised programme to the Commission. On Joydens Unit three bedrooms were viewed. The WC pan in bedroom 17 was very stained otherwise the bedrooms were satisfactory. On Lessness Unit two bedrooms were viewed. These were clean and tidy but considered bare and impersonal. Disposable razors were seen in both bedrooms and were removed by staff as they were considered a risk to the occupants. Staff had access to adequate supplies of protection clothing. Hand washing facilities were provided in areas where waste was handled. Systems were in place to safely dispose of clinical and other waste. Requirement 5. The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. The home maintained minimum staffing levels and additional staff as needed to provide one to one care for residents. NVQ training continued and over 50 of care staff had achieved this qualification. Staff received training relevant to their work and recruitment procedures complied with regulation. EVIDENCE: Care staff rotas were viewed including those for the day of the inspection. These showed that the home adhered to minimum staffing levels with additional staff on duty to provide one to one care for specific residents in line with assessments and care plans. Domestic staff spoken with said they had adequate hours to complete their work. A system was in place to check that nurses employed were registered with the Nursing and Midwifery Council. Over 50 of care staff have achieved NVQ 2 and a number of care staff were doing NVQ 3. Kitchen and domestic staff were also being supported and encouraged to achieve NVQ qualifications. Six employee files were requested to view. Five files were available but one could not be found. The five files inspected contained the information required by regulation. The file that could not be found was brought to the Commission office the next day and contained the information required by regulation. The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 19 One of the unit care managers had responsibility for planning and monitoring staff training. The care manager said that staff training needs were identified during supervision sessions and also at these sessions how staff implemented training received was monitored. Staff spoken with said they felt they received the training needed to fulfil their roles. Records seen showed staff received regular updates in mandatory training such as moving & handling, fire safety and food hygiene. Other training provided since the last inspection included adult protection, diet & nutrition, wound care, managing challenging behaviour and death & dying. The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. The home was well managed. Satisfactory quality assurance systems were in place. Satisfactory systems were in place to manage resident’s personal allowances. Records seen showed attention was given to providing a safe environment for residents and others. EVIDENCE: The manager was registered with the Commission and presented as committed and energetic in fulfilling her role. The care managers employed supported the manager in her role and they worked together to improve standards in the home. Staff, residents and relatives spoke positively about the management of the service and the support provided. Regulation 26 reports were sent to the Commission regularly. The manager held regular relative meetings and minutes of these were seen. The last The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 21 meeting was held on 15th June 2006 and was quite well attended. In view of the category of resident in the home resident meetings were not held. Management completed internal audits such as health & safety, medicine management and care overviews. The procedures in place to manage residents’ personal allowances were assessed as satisfactory. Very little resident cash was held in the home and residents requiring money got this from the petty cash and were then invoiced by the company. Receipts were kept for money received and spent on behalf or by residents and a computer record was for kept for each resident showing how much money they had. The home had an annual financial audit, which include an audit of resident’s money. The last audit was completed on 25th April 2006. The audit graded the home as 4 stars (good) for its financial control. A copy of the audit was given to the inspectors. Two staff were trained to administer first aid and plans were in place to train a further 12 people. Regulation 37 notices were sent to the Commission appropriately. A number of safety records were checked and found to be up to date. This included fire safety, gas, clean water, moving & handling equipment and electricity. Fire drills were held for both night and day staff. Records were kept and seen for routine maintenance checks such as hot water temperatures, bedrails and wheelchairs. The manager said that successful efforts had been made to reduce the number of bedrails being used in the home. The manager had a ‘health & safety’ committee, which included staff representatives from the different designations to monitor and improve safety in the home. The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 Requirement The registered person must ensure care plans reflect how individual care needs will be met including strategies on how to manage challenging behaviour. Bedrails provided must be of a height to ensure safety for the resident. Wound care records must reflect the treatment provided and the condition of the wound. The registered person must ensure a system is in place to follow up unexplained injuries sustained by residents and action taken to reduce the incidence. The Registered Person must ensure safe management of medicines. Medicines must be stored at the correct temperature. An immediate requirement was left with the registered person to address this issue. The Registered Person must ensure safe management of medicines. Records must be kept for all DS0000006767.V297814.R01.S.doc Timescale for action 18/09/06 2. OP8 13 18/09/06 3. OP9 13 18/08/06 4. OP9 13 18/09/06 The Oaks Nursing Centre Version 5.2 Page 24 5. OP19 23 medicines brought into the home including those brought in by residents. Medicines records must be signed at the time of administration. Staff must not administer homely remedies unless these have been agreed with the G.P. Records must be kept for medicines disposed of on Joydens and Belvedere Units. Internal and external medicines must not be stored together and topical medicines must not be included in the homely remedies. The registered person must ensure the home is kept clean and well maintained. The maintenance and hygiene issues included under the environmental standards must be addressed. An updated programme for the completion of the refurbishment and redecoration of the bedrooms and remaining bathrooms must be sent to the Commission. Furniture must be repaired when needed. WC pans and baths must be kept clean. Carpets and flooring must be kept clean and stain free. 18/09/06 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 OP7 Good Practice Recommendations The registered person should discourage staff from DS0000006767.V297814.R01.S.doc Version 5.2 Page 25 The Oaks Nursing Centre 2. OP12 spending time completing and updating care plans and risk assessments that are not relevant to resident care. The registered person should ensure social care plans are prepared to reflect the interests of the resident and shows how these will be met. The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup 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. Extracts may not be used or reproduced without the express permission of CSCI The Oaks Nursing Centre DS0000006767.V297814.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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