Care Home: Oaken Holt House Nursing & Residential Home

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What the care home does well What has improved since the last inspection? The home has reviewed and updated the written information and has produced a separate Residents Guide as required following out last inspection. The recruitment procedures have been reviewed and improved to ensure that all the required checks and references have been undertaken and are satisfactory before starting new employees, reducing the potential for putting residents at risk from unsuitable or disqualified workers. Action has been taken to improve the homes management, training and practices in relation to infection control in line with the recommendations made by the Health Protection Agency in a report made following a serious viral infection outbreak at the home in September 2008. The training programme is more extensive, and the proportion of staff who have achieved a nationally recognised qualification in care (NVQ) has increased, so that the outcomes for residents should continue to improve, because of the increased knowledge and skills of the staff. What the care home could do better: Further updating of the information about the home is needed to ensure that it is current and reflects the new owner organisation details and management arrangements. Care plans should include information about how people`s social and recreational needs and preferences will be addressed. Care plans should include regular evaluation comments to make sure that any changes in people`s care and support needs are documented, and there is evidence to show whether the care given continues to meet people`s needs effectively. Though the homes systems for medication appear to be safe overall, there were some discrepancies and omissions in a sample of the medication administration record (MAR) sheets seen in the nursing unit. Nurses should always follow best practice guidelines for the recording and administration of medication to make sure that alterations made to the dosage or frequency of medicines have been correctly made on the MAR and confirmed with the GP and pharmacist, to avoid errors that may have a detrimental effect on residents` treatment. Accurate records of administration and doses of `as required` medication should be kept so that homes staff can report the effectiveness of prescribed medication for the individual resident. CARE HOMES FOR OLDER PEOPLE Oaken Holt House Nursing & Residential Home Eynsham Road Farmoor Oxfordshire OX2 9NL Lead Inspector Delia Styles Unannounced Inspection 28th November 2008 11:15 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 Oaken Holt House Nursing & Residential Home DS0000027166.V373869.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. Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oaken Holt House Nursing & Residential Home Address Eynsham Road Farmoor Oxfordshire OX2 9NL 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) 01865 863710 01865 864831 j.k.h@oakenholt.co.uk Oaken Holt Care Ltd Mrs Mandy Vettraino Miss Alison Kay Valentine Care Home 80 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - DE Old age, not falling within any other category - OP The maximum number of service users who can be accommodated is: 80 30th October 2006 2. Date of last inspection Brief Description of the Service: Oaken Holt House is owned by Caring Homes Healthcare Group Ltd, and is situated in 23 acres of landscaped grounds in a secluded elevated position 3 miles from the city of Oxford. The home is registered to provide nursing and residential care for up to 80 residents. The main building is a substantial Victorian house and provides nursing and residential accommodation over three floors, serviced by lifts. Accommodation in the residential area of the main house is provided in a variety of rooms, from single rooms to large self-contained apartments with en-suite facilities or separate facilities. The Coach House is a separate building and also provides residential accommodation for less dependent residents. The nursing wing is an extension arranged over two floors, with accommodation provided in single en-suite rooms. The communal rooms are spacious and well furnished. The residents can use the terraces and well-tended gardens. There are two registered managers, one for the nursing wing and one for residential, supported by a team of nurses, care assistants, housekeeping, maintenance, gardening and contract catering staff. The fees range from £595.00 to £1,200.00 per week. Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced ‘key inspection’ to look at those standards (national standards for care homes for older people) that the commission considers to be most important and to follow up on required or recommended actions taken be the home since our last visit. Prior to the visit, the registered managers completed an annual quality assurance self-assessment (AQAA) about the home and the service it provides. We left questionnaires (surveys) for relatives, carers and advocates, and residents for people to complete and return to us with their views. Surveys were also left for health and social care professionals. Information from the total of 3 completed surveys, and conversations with residents, staff and managers during the visit is included in this report. We also took into account information we had received from relatives, the Health Protection Agency and from the home since our last inspection. During the inspection visit discussions took place with the registered managers and some of the nursing, care and ancillary staff. A tour of the premises and examination of a sample of the records that the home is required to keep – for example, residents’ care plans and medication, complaints, staff files, duty rosters and training records – was also undertaken. The homes approach to equalities, diversity, privacy and dignity of residents was considered throughout the inspection process. We would like to thank residents, staff and managers for their assistance in the inspection process. What the service does well: The staff team achieve a high standard of care and support for residents. Residents’ accommodation is of a very good standard and the homes setting, in its own well-maintained and extensive grounds, provide a very attractive environment that residents value and enjoy. The quality of cleanliness, catering and décor is very good. There is a wide range of activities on offer that means people have opportunities to be involved in meaningful and enjoyable pastimes and social events that suit their preferences, interests and abilities. Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 6 The people who live here are encouraged to maintain their independence and to make choices about the way they spend their time. What has improved since the last inspection? What they could do better: Further updating of the information about the home is needed to ensure that it is current and reflects the new owner organisation details and management arrangements. Care plans should include information about how people’s social and recreational needs and preferences will be addressed. Care plans should include regular evaluation comments to make sure that any changes in people’s care and support needs are documented, and there is evidence to show whether the care given continues to meet people’s needs effectively. Though the homes systems for medication appear to be safe overall, there were some discrepancies and omissions in a sample of the medication administration record (MAR) sheets seen in the nursing unit. Nurses should always follow best practice guidelines for the recording and administration of medication to make sure that alterations made to the dosage or frequency of medicines have been correctly made on the MAR and confirmed with the GP and pharmacist, to avoid errors that may have a detrimental effect on residents’ treatment. Accurate records of administration and doses of ‘as required’ medication should be kept so that homes staff can report the effectiveness of prescribed medication for the individual resident. Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 7 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. Oaken Holt House Nursing & Residential Home DS0000027166.V373869.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 Oaken Holt House Nursing & Residential Home DS0000027166.V373869.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. There is a good range of information about the home and the services provided so that prospective residents can make an informed decision about whether it is likely to be right for them. The personalised needs assessment means that people’s diverse needs are identified and planned for before they move into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since our last inspection and the change of ownership to Caring Homes, the home has updated its written information (the Statement of Purpose and Residents Guide) for prospective and new residents. Overall these are clearly written and describe the home and facilities well. However, some parts of the Statement of Purpose need to be further amended, for example, the registration details should match the details of the new certificate of registration issued in April 2008, and the information about contacting the Commission for Social Care Inspection (CSCI) should be clarified to indicate that the Commission is not the lead organisation for investigating complaints, but people can refer a complaint to the CSCI at any stage, should they wish Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 10 to. Neither document mentions how people can access the most recent CSCI inspection report for the service. The website address provided in the homes AQAA (dated August 2008) was visited. The website information has not yet been updated to show the current ownership and management team details. The website is not advertised in the Statement of Purpose (09/10/08) and Residents guide (July 2008). All residents receive a brochure, Statement of Purpose and Residents Guide. A copy of the current brochure, which includes full details of fees, was not available for inspection. Residents whom we talked to, or who had completed one of our surveys, were satisfied that they had received enough information to help them decide whether it was the right place for them before they moved into the home. Potential residents and their families are encouraged to visit the home prior to moving in, although many move in following a stay in hospital. All prospective residents are visited and assessed by the relevant manager to discuss the individual care and support needs and preferences of the individual. A sample of assessments seen in the nursing wing showed that these are detailed and have relevant information about all aspects if the individual’s care needs, including a biography and the person’s preferred pattern of their day. Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents’ personal, health and medication needs are met in a way that promotes their dignity and wellbeing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was evident from conversations with residents, and the written comments in the completed surveys we received, that people were very satisfied with the care and support they receive. Comments about the staff were very positive – they are ‘kind’, ‘very good’ and ‘always’ provide the care and support needed ‘willingly’. The sample of care plans looked at were detailed and included risk assessments for falls, skin damage (pressure sores) and malnutrition. Risk assessments had a summary of significant findings. Where relevant, the physiotherapist had written a care plan for people’s continuing exercise programmes and assessment for any walking aids required. People’s care records include a record of GP visits, podiatry, optician, and outpatient appointments. The numbered care plans are signed by the individual (or their relative or representative, if the person is not able to do so for themselves) Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 12 indicating their agreement with the actions to be taken by staff to meet their care needs. The care plans seen relate largely to the physical care needs of residents with no specific plans about how their recreational and social needs will be met. We recommend that residents’ care plans include the assessment and plans about these important aspects of daily life. However, it was noted that records of people’s attendance and enjoyment of various activities and events are made. The care records seen have little in the way of evaluation comments to show whether the residents have been asked about the extent to which the planned care and staff actions have met their needs and preferences. These are aspects of record keeping that could be improved and that was discussed with the nursing wing manager. The care plans are kept under daily review (in the nursing unit) and updated as needed if people’s care needs change. The managers of both residential and nursing wings do regular audits of the care records: it was noted that where there were some omissions for, example, in a resident’s initial admission assessment information, the manager had already identified this and said she would follow it up with the responsible staff members. The home has access to a good range of disability aids and equipment, such as air mattresses and seat cushions for those with poor mobility and who are at risk of pressure related skin damage. A physiotherapist offers treatment free of charge twice weekly, and residents have the choice to attend the Keep Fit group or have individual sessions. Residents may continue to see their own doctor if that GP is happy to continue caring for them at Oaken Holt. Two of the GPs from a local surgery attend the home regularly and the residents can choose which one they would like to see. Examination of a small sample of resident’ medication administration records (MAR) in the nursing unit showed that medication is well managed overall. Since our last inspection the home has changed to a new system of medication, using a ‘monitored dosage system’ supplied from a national High Street chemist with residents’ medication packaged in individual blister pack cards. Recommendations made at our last inspection about the arrangements for the return of unwanted and unused medications for disposal, and storage for certain classes of medicines, have been carried out. However, at this inspection there were some discrepancies found in the records for two residents. For example, on one person’s MAR chart, changed dosages and times of medication had been made by the GP but the altered instructions were not clearly written for nurses to follow. Another resident had not been given the prescribed doses of a medication to be taken three times a day. These instances show that there is a potential for staff to make mistakes in medication that could be detrimental to the residents concerned and make it Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 13 difficult for the homes staff and the GP to know whether prescribed medicines are effective in the treatment of the individuals. A brief check of other MAR charts in the nursing unit showed that there were several places where the nurse had not initialled the chart to show that the prescribed medication had been given, nor had a code letter been used to indicate the reason for not giving it been entered. The nurse manager promptly discussed these observations with the nurse in charge to request that the GP and pharmacist review and amend the MAR charts identified. Observation of staff members’ approach towards residents, conversation with a number of residents and written comments received, showed us that the home achieves its stated objectives, namely ‘the service is delivered discreetly, flexibly, attentively and in a non-discriminatory fashion’ and that ‘the residents right to make informed choices, take risks, independence, privacy and dignity are respected at all times’. Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. There is a wide range of activities available so that residents have opportunities to participate in stimulating and motivating activities. Meals are an enjoyable and social occasion and the menu choices on offer are varied, well balanced and nutritious. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a very good range of activities available for all residents and two activities organisers who plan these. Feedback from our surveys and conversation with residents showed that this aspect of life in the home is much appreciated. One person wrote ‘One of the great things about Oaken Holt is the activities they arrange for the residents’. Of the two residents’ survey replies, one person answered that there are ‘usually’ activities that they can join in, and the other that this is ‘sometimes’ the case. These responses may reflect that many people are able to pursue their own hobbies and arrange their own social lives and/or do not always wish to join in organised activities. During the afternoon of the inspection visit, a number of residents had gathered in the residential drawing room to decorate the Christmas candle table decorations they had made. Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 15 The homes AQAA lists quizzes, games, walks in the grounds, gardening club, pottery group, art appreciation, coffee mornings, Bingo and reminiscence as some of the regular activities on offer. In addition there are outings ‘at least once a week’ that include trips to the theatre, pub lunches, visits to local places of interest and canal trips. The home has its own minibus that is adapted to take a number of wheel chair users. A variety of outside organisations and entertainers visit the home – the AQAA mentions ‘The Welsh Male voice choir, theatre groups, a magician, bell ringers, Radley school jazz band, a harpist and many other musical entertainers’. Residents can also access (at additional cost to the fees for the home) an aroma therapist, and a beautician whose treatments include pedicures, manicures, and facials, hand and foot massage and Hopi ear candles. Church of England and Roman Catholic priests visit the home every week and a monthly Holy Communion Service is held in the home, led by a Church of England minister. If residents wish to attend other Christian denominational services, transport can be arranged from the home. The Residents Guide assures people that ‘all religious needs and wishes are respected and upheld and all denominations can be catered for’. Visitors are free to visit whenever they like, with the resident’s permission and they may invite guests to join them for meals. The home provides facilities for parties for special occasions such a birthdays or anniversaries. From information we had from residents and staff during the inspection, it is evident that the catering service and attention to detail in relation to menus and food presentation is of a high standard. The two residents who completed our survey question about meals said that they ‘usually’ like the meals at the home; one person added that meals are ‘varied, well cooked and served’, whilst the other felt that the food is ‘far too bland. A little salt in vegetables would help’. The chefs visit residents regularly to discuss their opinions of the meals and menu choices and will amend the daily menu for an individual resident if required. The choice of menus from the set menu at mealtimes is impressive with a selection of dishes from each of the three courses for both lunch and dinner. In addition there are always salads, sandwiches and omelettes available. There is also an ‘a la carte’ menu, though this incurs an additional charge. Each part of the home has its separate dining room: dining areas in the main house and Coach House are elegant and provide very pleasant surroundings for people to enjoy their meals and conversation. The nursing unit has a smaller ground floor dining room that provides a less formal setting for residents. The first floor has a shared lounge where staff can assist more Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 16 dependent residents with their meals. Everyone has a choice about where they take their meals and can eat in their rooms if they prefer. Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The home has a satisfactory complaints system with some evidence that residents feel that their views are listened to and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Feedback from our surveys and from conversation with residents show that people know who to speak to if they are not happy or wish to make a complaint. A relative wrote that they could not remember the process for making a complaint – ‘but I know where to find the information’. The home has a complaints policy that sets out the stages and timescales for investigating any complaints made. The homes AQAA (completed in August 2008) tells us that it had received 5 complaints in the preceding 12 months, 1 of which was partially upheld. All were resolved within 28 days. The CSCI has been notified of one formal complaint raised by relatives with the company owners, Caring Homes, in relation to the management of an outbreak of the Norovirus (‘winter vomiting bug’) that affected 28 residents and 8 staff members between 27/08/08 to 11/09/08. We also received a report about the outbreak from Thames Valley Health Protection Unit (Health Protection Agency) whose authors stated that they ‘shared the concerns of the environmental health team that the home’s management of the outbreak was sub-optimal’. Copies of correspondence between the relatives and company indicate that the issues were satisfactorily addressed. Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 18 Postponement of a meeting planned for August 6th with relatives and residents and delayed distribution of minutes of the meeting subsequently held on 2nd September were sources of further concerns raised by relatives about perceived lapses in communication now that senior managers are no longer available on site since Caring Homes acquired the home. Copies of the provider’s responses to concerns raised by relatives include acknowledgement of this and how they propose to improve contact with residents and relatives. Training in adult safeguarding (SoVA) and how to identify and report suspected abuse is included in the induction for all new staff. All staff have updates in safeguarding and how to deal with aggressive behaviour. The CSCI and Adult Protection Officer have been notified appropriately by the home about any incidents that may adversely affect the well-being and safety of residents. Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The internal and outdoor environment is well maintained and an on-going programme of improvements and refurbishment ensure the safety and well being of people living and working here. Rooms and communal areas are very clean, comfortable and attractive, providing people with a high standard of accommodation and facilities. Infection control measures have been reviewed and improved throughout the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The standard of the environment both within and outside the home is extremely good. Regular maintenance and an on-going programme of redecoration and refurbishment ensure that the home is comfortable and the character and individuality of the buildings and residents’ own rooms are preserved. Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 20 Residents are invited to bring in furniture, ornaments and pictures when they move into the home, so that their rooms suit their needs and preferences. All rooms are for single occupancy (but with flexibility to use adjacent rooms or larger rooms for sharing) and all but two have en-suite facilities. A relative wrote that it was good that Oaken Holt ‘is able to accommodate married couples (not all care homes do)’. The homes AQAA tells us that their future plans for improvement include extending the small rooms in the nursing wings. A tour of the home during this unannounced visit and conversation with several residents confirmed that the standard of cleanliness and housekeeping is very high. The residents’ survey answers to the question ‘Is the home fresh and clean?’ both answered ‘always’: one person added ‘and anything extra and spillage [is dealt with]’. This is commendable, especially as the numbers cleaning staff appear to be few in relation to the size and spread of the buildings. There are no cleaning staff on duty at weekends. There are designated laundry workers in the daytime. Residents’ personal laundry (clothing) is managed over night by care staff. Health professionals from the Health Protection Unit (HPA) visited the home to advise staff about infection control and to check that their advice was carried out, during and after an outbreak of the Norovirus that affected a large number of residents and several staff in August 2008. An Environmental Health Officer also inspected the home and reported that he had no concerns with the general environment or kitchen facilities; the kitchen was ‘operating satisfactorily with good controls and records [and] observed practices were satisfactory’. However, the report of the HPA findings (October 2008) included several recommendations for the home to improve the practices and knowledge of staff in relation to infection control in cleaning and laundry procedures, effective use of chemical and heat disinfection measures, and availability and use of disposable personal protective clothing by staff. During this inspection, the managers of both the nursing and residential units confirmed that action has been taken to address the shortfalls highlighted by the HPA report. Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The number and skills of the staff team meet the assessed care needs of the people living here. There is a good programme of training in place for staff that results in positive care and support outcomes for residents. The systems in place for the recruitment and screening of prospective employees have improved since our last inspection so that residents can be confident that they are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection the numbers and skill mix of staff was satisfactorily meeting the care and support needs of the residents. In the nursing wing, the manager confirmed that one registered nurse (RN) and 4 care staff are on duty in the mornings (08:00 to 14:00) and one RN and 3 care staff from 14:00 to 20:00. Overnight there is one RN and one care assistant (from 20:00 to 08:00). On the day of this inspection there were 20 residents in the nursing wing. The three survey respondents and discussion with residents showed that overall people are satisfied that staff are always available to them when needed, are responsive, kind, hard working and sufficiently skilled in their work. The homes owners and local managers recognise that there were staff shortages at the time of the outbreak of the Norovirus in early September Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 22 2008. This was because a number of the staff themselves were ill and had to remain off duty until symptom free and agencies could not supply workers to work in the home during the outbreak. The nursing unit manager said that at the time of the inspection the home was actively recruiting to fill a part time RN vacancy and for care assistants for all units. The AQAA tells us that the recruitment of staff has improved because Caring Homes human resources department has been able to source potential overseas candidates through their own preferred agency. The staff files for 3 staff members recruited recently were looked at to check that all the recruitment information and checks that are required had been obtained. At our last inspection we found that the home had failed to get all the recruitment information about prospective new employees before they started work at the home, and we made a requirement about this. At this inspection we found that the home has improved the system of record keeping so that there was evidence that satisfactory checks peoples’ suitability to work with vulnerable older people had been received before they are employed. However, there were some minor discrepancies. For example, it was noted that a reference for one person was addressed ‘to whom it may concern’ and that there was no indication that a verbal verification of the reference had been sought so that there was no evidence that the home has asked about the specific suitability for the applicant to work in the role for which they had applied. Another employee’s file did not include a recent photograph of them – it is good practice to have an original photograph rather than a photocopy of a passport or driving licence picture, so that there is a good likeness of the person as part of the verification of their identity. These omissions were discussed with the residential unit manager who said that she would ensure that all information relevant to new staff members’ appointments was recorded in their files to evidence the actions taken to follow up overdue or missing data. Induction training is largely computer-based, and is a 2 day programme with new care staff being mentored, supported and assessed by more senior and experienced staff during their induction period (lasting approximately the first 6 weeks of their employment). The programme meets the requirements of the Skill for Care Council approved induction standards. New staff are not included in the staff numbers for the first two weeks of employment. Induction workbooks are issued for new care workers to complete and when each of the 5 sections is successfully completed, a trained member of staff assesses their competencies. Staff spoken with confirmed that mandatory training sessions and updates in topics relevant to their work are regularly arranged. The managers confirmed Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 23 that there is a training plan for each member of staff with two ‘pathways’, one covering the induction and mandatory training and pathway 2 covering more care-related topics such as dementia awareness and ‘end of life’ care. The HPA report (following the viral outbreak that affected residents and staff in 2008) identified a need for all staff at the home to have regular updates in infection control education. They also recommended that all staff who serve food to residents should receive training to the Chartered Institute of Environmental Health (CIEH) Level 2: Award in Food Safety in Catering, Retail or Manufacturing. Managers confirmed that these recommendations have been addressed. The AQAA, completed in August 2008, shows that out of 27 permanent and 2 bank care staff 14 have National Vocational Qualification (NVQ) Level 2 or above. This means that the home is close to achieving the target of 50 of all care staff in the home having this qualification or its equivalent. At the inspection it was confirmed that a further 7 staff were registered to start their NVQ training. Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Since our last inspection, the ownership and corporate management arrangements have changed, but the continuity provided by the experienced local registered managers and the introduction of new management systems, ensure that the quality of the service is maintained. The home has taken action to improve its policies and practices in infection control. There are good health and safety systems in place that protect the safety and welfare of the people living and working here. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both registered managers – one for the residential and one for the nursing unit – are very experienced and have the necessary qualifications and skills to carry out their roles. Both have worked at the home for many years. Since the change of ownership of the home in 2008 they have taken on new Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 25 responsibilities in budgetary management and quality audits that were formerly done by the previous ‘responsible individual’ and owner. From conversations with residents and communication from relatives, there is an impression that the change to a large corporate ownership has inevitably caused some concern and anxiety for people that will take time to resolve, for example, the changes in the fee payment system, and less frequent ‘face to face’ contact with senior managers. However, the availability and accessibility of the two registered managers in the home provides continuity and stability for residents, their relatives and staff at the local level. As noted in Section 3 – ‘Complaints and Protection’ – the new owners are aware of the concerns of residents and their families and are looking at ways to improve the communication and sharing of information with people. There is a comprehensive system of quality assurance auditing for all aspects of the home environment, services and staff practices. An annual questionnaire is sent to residents to gather their views about the service. A copy of the most recent questionnaire findings (collated in July 2008) was available for people to read in the reception hall in the main house. Both unit managers are readily available to meet with residents and visitors. Regular staff meetings are held with all grades of staff to ensure there is good communication and an understanding of each other’s roles and responsibilities. All staff have individual formal supervision meetings with senior staff and an annual appraisal from their managers so that staff have opportunities to discuss their progress and can highlight any further training needs they may have. A monthly visit from a manager from Caring Homes is carried out as required under Regulation 26 of the Care Standards Act. A copy of the most recent ‘provider’s visit’ was available in the home. The registered managers undertake monthly ‘managers audits’. The AQAA (completed in August 2008) contains clear, relevant information and lets us know about changes the home has made and where they need to make improvements. All residents have a family member or appointee to assist them with their personal finances if they are no longer able to manage their financial affairs. The home does not deal with residents’ personal monies but will assist residents to find a suitable independent advocate if necessary. Any small purchases made for residents by staff at residents’ request are receipted and ‘double-signed’ by staff and the resident. Health and safety is well managed throughout the home. A sample of the maintenance and accident records was looked at and entries were up to date. A routine check of fire safety equipment was undertaken during the inspector’s Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 26 visit. Residents spoken with were aware of what to do in the event of the fire alarm sounding. One resident said that the night staff were always alert to safety matters at night – for example, checking that ground floor door and window locks are secured. The staff training records and adverts for planned sessions show that staff are required to attend training in First Aid, Safe Moving and Handling, Control of Substances Hazardous to Health (COSHH), Fire Safety and Food Hygiene. As mentioned earlier in this report, a HPA report made recommendations that the home should ensure all staff have updates and on going training about infection control. They also made recommendations about the standard of training required for all staff that they consider ‘essential for adoption in order that residents and staff live and work in a safe and secure environment’. Other recommendations included making improvements to laundry processes and cleaning and disinfection practices to reduce the risk of transmission of infection between residents, staff and visitors. The home has confirmed that all the recommendations have been addressed. Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 27 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 2 X 3 X X N/A 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 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 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 Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP1 OP7 Good Practice Recommendations Review and update the written and website information about the home so that it is current and reflects the new provider organisation information Ensure that the social, spiritual and recreational aspects of residents’ care are reflected in their care plans. There should be regular written evaluation of care to show that any changes in peoples’ care needs or preferences are identified and recorded, and so that the home can demonstrate to what extent the care provided has been effective. Staff should ensure that they always follow best practice guidance in relation to record keeping for residents’ prescribed medications made in the homes records of administration (MAR). 3. OP9 Oaken Holt House Nursing & Residential Home DS0000027166.V373869.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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