Care Home: Oakfield House

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What the care home does well Before people are admitted to the home their needs were assessed. They were consulted about the level and type of care they required, and could visit the home to look for themselves at the facilities offered. Important information needed to support them in every day living was recorded and used to decide if Oakfield House could provide the right care, staff expertise and facilities needed. Good care planning meant residents had their assessed and changing needs met in a way that was suitable to them. Residents benefited the support of a named worker referred to as a Key worker who took responsibility to make sure care needs for individuals was personalised. Assessments linked well to care plans. These included health, personal and social care needs. Communication difficulties linked to dementia were also considered in ensuring care was given in a sensitive manner. Relatives who sent written comments considered their relatives well cared for. Comments included `All the staff I have seen appear to have skills and right temperament to deal with the severe mental illness suffered by patients/clients. Also there appears to be plenty of staff to cope.` The expert by experience present during the inspection reported `I only had the opportunity to speak with one visitor, and she is very pleased with her mothers care at the home.` The daughter lives some distance away so can only Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 6visit about once a week, but feels peace of mind that her mother is content and well looked after`. Most residents considered they received the care and support they needed and staff were available when needed. Healthcare needs were also monitored. Medication practice, policies and procedures, and staff training, reduced the risk of errors being made. There were no unnecessary rules imposed on residents and their routines in the home were flexible and special to them. Residents were generally satisfied with the activities and entertainment provided at the home. Birthdays and festive celebrations were catered for. Relatives commented, `in my mums case she likes to walk miles! She is able to and allowed to do this within the home and within it`s gardens as there is enough space and she does a circular tour. Other peoples needs seems to be met by what I have seen.` And `It also has a full time therapist/entertainer person to encourage residents to participate in activities. They also give trips out to various places/events.` `They seem to care for my mum pretty well`. The expert by experience reported, `Residents do appear to have freedom of choice over their lives within their capability.` Catering arrangements were to the resident`s satisfaction. Written comments from the expert by experience included, `Meals at Oakfield House appear to be of a very high standard. All residents who could communicate, spoke well of, and enjoy the food.` Visiting times were flexible so friends and relatives could call at different times, the residents could see people in private. Relatives visiting said they were always made to feel welcome at the home. The complaints procedure was clear which helped residents/relatives have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues. This meant residents rights, safety, and welfare was promoted. The home was very clean and in most areas fresh smelling. Residents could bring their own furniture with them and personal possessions when they came to live at the home. The level of staffing maintained, training provided, and supervision of staff was good which meant competent qualified staff cared for residents. The residents considered the staff as being `very good`. Written comments from relatives included, `Staff extremely supportive at all times. They always have time to listen and have a conversation. Lots of laughter helps to provide a pleasant, happy and caring atmosphere.` Staff were happy in their work. They were mainly long serving employees. Written comments from staff included, `I feel confident in my role, to be able to know, understand, and feel supported to care for any individual in my care.They considered `the service provides excellent care that is of a high standards. And `Always puts the needs of residents and their families first.`. A high percentage of staff were trained in National Vocational Qualifications in care and training was generally being given high priority. Staff had a positive attitude to continuous learning and development. There was a warm and friendly atmosphere in the home. Team work amongst staff and management was good with everyone working together for the benefit if the residents. Residents appeared to be very happy. One relative wrote `I would like to say I researched quite a lot of homes before deciding on this one, as there always seems to be plenty of staff. The service, gardens in summertime, different sitting areas, conservatory etc. and walking space. It also offers good value for money.` People living and working in the home were `listened to`. They had regular meetings to have their say on issues that affected them. The manager is praised for `continuous improvements always on the agenda.` What has improved since the last inspection? To avoid any misunderstanding a copy of the contract issued to residents is kept on their file for reference. In supporting staff to recognise symptoms to administer `when required` medication prescribed by doctors, particularly for people with dementia, more detail as to circumstances or symptoms it would be given, is now recorded. Handwritten medication is signed and checked by two people to avoid any error being made. For residents comfort a contractor shampoos the lounge carpet and bedroom carpets regularly to keep them fresh smelling. The furniture provided for residents is no longer labelled. This means residents privacy and dignity is considered. To keep bedrooms sufficiently illuminated and safe for residents, the up lighter shades have in some rooms been replaced with a more suitable type. Staff have been provided with adequate toilet facilities. To make sure residents are safe at all times a risk assessment of the building had been carried out and relevant action taken where required, therefore a safer environment is maintained. What the care home could do better: Although staffing levels are very good, the arrangement for staff cover on the residential unit would benefit reviewing. This would be to improve response to the doorbell and any resident requiring assistance when the delegated carer for this unit is carrying out other care duties. For people occupying the room with en suite facilities on the ground floor, redecoration, and new floor covering is required. Although the home was kept very clean, there are areas in the home needing odour control linked to problematic continence management. On receipt of appropriate checks carried out for new staff, it is essential outcomes of these checks be considered and risk assessed to show a position is offered to a person considered to be fit to work in the care home. To support applicants complete a good application for a position as a carer, the application form currently used should be reviewed and updated. CARE HOMES FOR OLDER PEOPLE Oakfield House 2/4 Edith Street Nelson Lancs BB9 9HU Lead Inspector Mrs Marie Dickinson 11 & 13 th th Unannounced Inspection December 2007 10:00 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 Oakfield House DS0000052388.V351906.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. Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakfield House Address 2/4 Edith Street Nelson Lancs BB9 9HU 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) 01282-612788 Oakfield Care Ltd vacant post Care Home 37 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (18), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (4), Old age, not falling within any other category (14) Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Within the overall registration of 37, a maximum of one named service user who falls into the category DE may be accommodated. Should the service user referred to in 2 above be no longer resident in the home, registration should revert to fifteen people over the age of sixty five who fall into the category Older People (OP) 4th January 2007 Date of last inspection Brief Description of the Service: Oakfield House is a detached residence, situated close to several shops. Most community resources are located within Nelson town centre. There is a bus stop near the home. There are steps leading to the front of the home and a ramp pathway with handrails. The garden areas at the front of the home are also ramped to allow access for residents. There is an enclosed outdoor garden area for residents use. Accommodation provided is single and double bedrooms. accessible via stair lifts. There were aids and adaptations provided to assist people, and all rooms in the home had for the residents. There were several sitting rooms and a The upper floors are such as walk in bath a call system installed dining room. Information about the service is available from the home for potential residents in a Statement of purpose and Service User Guide. Weekly charges for personal care and accommodation range between £35o and £386. Residents are responsible for purchasing optional extras such as hairdressing, and private chiropody. Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection was conducted in respect of Oakfield House on the 11th and 13th December 2007. The inspection involved getting information from an Annual Quality Assurance Assessment completed by the manager, staff records, care records and policies and procedures. It also involved talking to residents, staff on duty, the provider, manager, and an inspection of the premises including resident’s bedrooms. An expert by experience was used in this inspection. She observed daily life and social activities in the home and provided a written report on these issues. Seven relatives, four residents, and two staff provided written comments direct to the Commission giving their view of the services provided. Areas that needed to improve from the previous inspection were looked at for progress made. The home was assessed against the National Minimum Standards for Older People. What the service does well: Before people are admitted to the home their needs were assessed. They were consulted about the level and type of care they required, and could visit the home to look for themselves at the facilities offered. Important information needed to support them in every day living was recorded and used to decide if Oakfield House could provide the right care, staff expertise and facilities needed. Good care planning meant residents had their assessed and changing needs met in a way that was suitable to them. Residents benefited the support of a named worker referred to as a Key worker who took responsibility to make sure care needs for individuals was personalised. Assessments linked well to care plans. These included health, personal and social care needs. Communication difficulties linked to dementia were also considered in ensuring care was given in a sensitive manner. Relatives who sent written comments considered their relatives well cared for. Comments included ‘All the staff I have seen appear to have skills and right temperament to deal with the severe mental illness suffered by patients/clients. Also there appears to be plenty of staff to cope.’ The expert by experience present during the inspection reported ‘I only had the opportunity to speak with one visitor, and she is very pleased with her mothers care at the home.’ The daughter lives some distance away so can only Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 6 visit about once a week, but feels peace of mind that her mother is content and well looked after’. Most residents considered they received the care and support they needed and staff were available when needed. Healthcare needs were also monitored. Medication practice, policies and procedures, and staff training, reduced the risk of errors being made. There were no unnecessary rules imposed on residents and their routines in the home were flexible and special to them. Residents were generally satisfied with the activities and entertainment provided at the home. Birthdays and festive celebrations were catered for. Relatives commented, ‘in my mums case she likes to walk miles! She is able to and allowed to do this within the home and within it’s gardens as there is enough space and she does a circular tour. Other peoples needs seems to be met by what I have seen.’ And ‘It also has a full time therapist/entertainer person to encourage residents to participate in activities. They also give trips out to various places/events.’ ‘They seem to care for my mum pretty well’. The expert by experience reported, ‘Residents do appear to have freedom of choice over their lives within their capability.’ Catering arrangements were to the resident’s satisfaction. Written comments from the expert by experience included, ‘Meals at Oakfield House appear to be of a very high standard. All residents who could communicate, spoke well of, and enjoy the food.’ Visiting times were flexible so friends and relatives could call at different times, the residents could see people in private. Relatives visiting said they were always made to feel welcome at the home. The complaints procedure was clear which helped residents/relatives have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues. This meant residents rights, safety, and welfare was promoted. The home was very clean and in most areas fresh smelling. Residents could bring their own furniture with them and personal possessions when they came to live at the home. The level of staffing maintained, training provided, and supervision of staff was good which meant competent qualified staff cared for residents. The residents considered the staff as being ‘very good’. Written comments from relatives included, ‘Staff extremely supportive at all times. They always have time to listen and have a conversation. Lots of laughter helps to provide a pleasant, happy and caring atmosphere.’ Staff were happy in their work. They were mainly long serving employees. Written comments from staff included, ‘I feel confident in my role, to be able to know, understand, and feel supported to care for any individual in my care. Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 7 They considered ‘the service provides excellent care that is of a high standards. And ‘Always puts the needs of residents and their families first.’. A high percentage of staff were trained in National Vocational Qualifications in care and training was generally being given high priority. Staff had a positive attitude to continuous learning and development. There was a warm and friendly atmosphere in the home. Team work amongst staff and management was good with everyone working together for the benefit if the residents. Residents appeared to be very happy. One relative wrote ‘I would like to say I researched quite a lot of homes before deciding on this one, as there always seems to be plenty of staff. The service, gardens in summertime, different sitting areas, conservatory etc. and walking space. It also offers good value for money.’ People living and working in the home were ‘listened to’. They had regular meetings to have their say on issues that affected them. The manager is praised for ‘continuous improvements always on the agenda.’ What has improved since the last inspection? To avoid any misunderstanding a copy of the contract issued to residents is kept on their file for reference. In supporting staff to recognise symptoms to administer ‘when required’ medication prescribed by doctors, particularly for people with dementia, more detail as to circumstances or symptoms it would be given, is now recorded. Handwritten medication is signed and checked by two people to avoid any error being made. For residents comfort a contractor shampoos the lounge carpet and bedroom carpets regularly to keep them fresh smelling. The furniture provided for residents is no longer labelled. This means residents privacy and dignity is considered. To keep bedrooms sufficiently illuminated and safe for residents, the up lighter shades have in some rooms been replaced with a more suitable type. Staff have been provided with adequate toilet facilities. To make sure residents are safe at all times a risk assessment of the building had been carried out and relevant action taken where required, therefore a safer environment is maintained. Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 8 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 summary of this inspection report can be made available in other formats on request. Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 9 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 Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 10 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): 2,3,4. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Contracts issued, protected residents legal rights by informing them about the terms and conditions of living at the home. Assessments were completed properly which helped plan personalised care. EVIDENCE: Comments from people completing surveys; indicated they had received enough information about the home before they moved in. Since the last inspection there had been a number of admissions. Records made during the admission process showed how the home managed this. The pre-admission assessment was thorough and covered all aspects of personal, health and social care needs and abilities. The assessment also contained essential information, providing staff with knowledge about the resident’s circumstances and level of support required to plan the right care for them. Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 11 Records held at the home showed each person had been issued with a contract. Residents placed in the home by the local authority were given a contract for financial arrangements for payment. This was in addition to the service user guide, and all combined, outlined the terms and conditions of residency in the home. The range of needs of residents had been considered. Staff training programme-included full induction and essential training for example, moving and handling, dementia care, and protecting vulnerable adults. Training staff was ongoing as part of staffs development. Records kept, showed staff consulted other professionals such as visiting district nurses, and General Practitioners to support resident care. Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 12 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): 7,8,9,10. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Care plans written for residents helped staff to provide the right personal care for them. Healthcare was monitored and care was given in a manner, which promoted privacy and dignity and independence. Medication was managed safely. EVIDENCE: The majority of residents’/relatives surveys indicated that residents ‘always’ receive the care and support they needed. Residents able to communicate their experience independently, made positive comments about the care and attention they were given at Oakfield House. They also considered staff were available when needed. Staff worked to a key worker system, having responsibility to make sure care needs were personalised for residents. A brief record was made of residents past history. This helped staff to understand people as individuals, their likes, Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 13 and dislikes. Residents care plans linked to their assessment. Resident’s wishes for daily living was recorded and provided sufficient detail for staff to follow and the assistance each resident required with personal care. For example ‘is quite able to wash face and hands, support required to complete washing and dressing’. Reviews of residents needs were carried out and there was evidence relatives were invited to take part with these. Communication difficulties linked to dementia were also considered and staff had good guidelines to provide the care required to suit specialist needs, for example what not to do if someone is particularly agitated. Staff were also instructed to be mindful of peoples privacy. Resident’s benefited additional specialist support where needed. This included healthcare. Pressure care was promoted and pressure-relieving aids were used on medical advice. Risk assessments had been completed for moving and handling and were used as guidance for staff to help care for residents safely. The rights of residents to be treated with dignity and respect was included in staff training. Residents spoken to in the residential unit, generally felt the staff respected their right to privacy. Complimentary remarks about the staff, such as ‘very good’, and ‘helpful’ were made. Written comments from relatives included ‘Due to the extreme nature of my mums illness and others at Oakfield House, it would be impossible to meet the needs of my mum all the time but I am generally satisfied.’ And ‘All the staff I have seen appear to have skills and right temperament to deal with the severe mental illness suffered by patients/clients. Also there appears to be plenty of staff to cope.’ The expert by experience present during the inspection reported ‘I only had the opportunity to speak with one visitor, and she is very pleased with her mothers care at the home.’ The daughter lives some distance away so can only visit about once a week, but feels peace of mind that her mother is content and well looked after. The home operated a monitored dosage system for the administration of medication. Information received at the Commission showed a number of staff had been trained in medication procedures. Records showed the receipt, administration, and disposal of medication was managed efficiently. Oakfield House DS0000052388.V351906.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): 12,13,14,15. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents had a degree of independence, opportunity to take part in activities, and make choices and decisions about their lives. Visiting arrangements were good. Residents were offered a balanced, varied, and nutritious diet that provided for their tastes and choices. EVIDENCE: The residents’ preferences in respect of social activities had been sufficiently recorded as part of their assessment. Activities for residents were organised and offered a good variety. An activities co-ordinator was employed to make sure all residents social needs were considered as the high dependency needs of residents meant staff could not be guaranteed to be available to do this for them. Staff were encouraged however to give residents one to one attention. Comments from residents/relatives returned to the Commission as part of the inspection show everyone thought there was activities arranged by the home they could join in. One relative commented, ‘in my mums case she likes to walk miles! She is able to and allowed to do this within the home and within Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 15 it’s gardens as there is enough space and she does a circular tour. Other peoples needs seems to be met by what I have seen.’ And ‘It also has a full time therapist/entertainer person to encourage residents to participate in activities. They also give trips out to various places/events.’ ‘They seem to care for my mum pretty well’. The expert by experience reported, ‘Residents do appear to have freedom of choice over their lives within their capability. One resident who liked to go to her room for an “afternoon nap“ was readily helped to her room on request. It was good to see that residents with dementia were not unnecessarily sedated, and those without mobility problems wandered from room to room at will. Residents were encouraged to join in with the activities but not pressurised.’ She also considered however, ‘if the carers spent more time with the residents their time and energy could be assessed and more usefully channelled.’ This was discussed with the manager. Residents were supported to continue with their chosen religion. As part of the assessment consideration is given to equality and diversity with a record made of religion or cultural needs, such as identifying if other residents/staff share the same beliefs; special religious days to be observed; cultural preferences such as food, bathing/personal care; Time for prayer or visiting from priest/rabbi/elder etc. Currently only one representatives from a local church visits the home on a regular basis for prayers and communion. The residents were able to receive visitors at any time and were able to entertain their guests in private. There was evidence seen in care records that relatives regularly visited the home. Comment cards supported this, and observations of relatives visiting showed how staff were considerate to their needs and made them feel welcome. Staffing levels in the home were very good and had been recently increased to provide a staff presence on the residential unit at all times. How this is managed could be managed better to help organise support, for example to answer the doorbell for visitors, and attend to residents when this member of staff is otherwise engaged in care activities. Reidents bedrooms were personalised. They were able to bring in personal belongings and arrange their rooms how they wished. The routines in the home were flexible to suit the residents, such as when they went to bed or got up. Preferred routines had been recorded. Residents could choose where to eat their meals and were observed sitting at the dining tables, sat in their chairs or had a meal in their room. The expert by experience reported ‘Meals at Oakfield House appear to be of a very high standard. All residents who could communicate spoke well of, and enjoy the food. (The lunch I had with the residents was appetising, tasty, and nicely presented) Most residents go into the dining room for breakfast where the time is flexible. Almost anything will be provided from cereals to full English Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 16 breakfast. One person told me “I didn’t feel like cereals this morning so they offered me a poached egg on toast”. There is a choice of main course at both lunch and tea. Also a substantial snack is provided between 7pm and 8pm. If a resident expresses a particular choice for something every effort is made to provide, even if it means it being bought in specially. Every thing the residents told me about the meals tallied with the menu displayed.’ Oakfield House DS0000052388.V351906.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): 16,18. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The complaints procedure was clear which helped residents/relatives have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues. This meant residents rights, safety, and welfare was promoted. EVIDENCE: Residents spoken to said they had no complaints against the staff. Staff were described as being ‘very good’. One relative visiting said she would know who to speak to if unhappy about anything, but up to present never had any reason to make a complaint, as the management and staff were very good and available to speak to. Another relative said ‘I have raised one or two issues and they were dealt with satisfactorily. The manager is very good and listens’. The complaints procedure was given to residents when they were admitted to the home. This was in the service user guide. A complaints recording system was in place. The manager said they encouraged people to speak up and have their say and openly invited relatives to raise any issue they may have. Residents were encouraged to say what they wanted and are asked regularly if everything was all right. Any concern or suggestion was acted upon and taken seriously.’ Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 18 Staff working at the home said they were trained in adult protection and were aware of the abuse policies and procedures, which included whistle blowing. Staff confirmed they had regular contact with the manager and owner who worked with them. Any concern would be reported directly to them. Oakfield House DS0000052388.V351906.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): 19,20,23,24,25,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were provided with a warm, comfortable, clean, safe, environment that suited their needs. EVIDENCE: Oakfield House is a large adapted Victorian building, which is situated on a main road and close to Nelson town centre. Since the last inspection a planned programme for upgrade had been put in place. This included the two lounges at the front of the home professionally decorated as well as the large lounge and dining room at the back of the home. Eight bedrooms had been redecorated and new carpets have been purchased for a number of bedrooms. The large conservatory had also been redecorated and new roller blinds fitted to ensure residents comfort, especially on Sunny days. Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 20 Despite the difficulties in continence management with very dependent residents, the overall standard of hygiene and cleanliness in the home was very good. However, although having carpets professionally cleaned on a regular basis, odour control linked to continence management needs to be further addressed. This will support the noticeable effort of the housekeepers in sustaining a pleasant environment for the residents. Comment from a relative show in their opinion, there has been a continuing improvement in this area. Chair lifts were fitted on staircases enabling people easier access around the home. Generally the bathrooms and toilets met with residents’ needs. The downstairs bathroom was being redecorated during inspection and work was near complete. Residents said they liked the home. It was ‘warm’ and ‘comfortable’. They liked their bedrooms, which staff kept ‘nice and clean’. Attention was required to reduce the rippling in one carpet, to relocate a television wire and consideration be given to improve continence management by having satisfactory floor coverings. One room recently upgraded with new manageable floor covering had a significant drop in the floor level. This had been risk assessed for the occupant, however some method of reducing the drop in level should be investigated. Residents who were able managed their own bedroom door keys and staff had the responsibility to keep other residents rooms private for them. There were no restricted areas and residents had access to outdoor facilities that included a safe garden area with decking and garden furniture provided. Staff had been provided with adequate toilet facilities. Oakfield House DS0000052388.V351906.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): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels were satisfactory in aiming to ensure the resident’s needs are effectively and safely met. Recruitment practices were mainly satisfactory in protecting residents. Staff received training and daily supervision, which meant they had the skills and knowledge to care for residents. EVIDENCE: Staff who provided written comments for the inspection indicated good recruitment practice had been carried out. Most residents/relatives who sent written comments to the Commission considered staff were always available when they needed them. Comments included, ‘Staff extremely supportive at all times. They always have time to listen and have a conversation. Lots of laughter helps to provide a pleasant, happy and caring atmosphere.’ There is a good record of stability of the workforce, with a small turnover of staff. Since the last inspection there had been two new staff employed. Records showed how recruitment practice was carried out. Satisfactory references, Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register check had been applied for, prior to employment. However information received via the Criminal Record Bureaux check for recruitment purposes must be documented and risk assessed for approving a person to Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 22 work with vulnerable adults. The application forms used would benefit a complete review to offer more guidance for the applicant completing it. On appointment members of staff were issued with a contract of terms and conditions of employment, and a job description to ‘Provide high standad of care that respects the individuals right to choice, dignity, fulfillment and promote independence and individuality’. Staff who provided written comments considered, ‘The induction contained everything relevant for me to carry out my role in confidence and safety.’ All the staff in the home had attended training following their induction. Records were kept showing carers individual training profile showing the homes commitment to providing both specialist and mandatory training such as dementia care and moving and handling. ‘In the last six months I have attended first aid, moving and handling, palliative care and dementia care.’ The staff have shown a continuing dedication to improve their knowledge and care provided. Payment for attendance should be considered to support this commitment. Information received at the Commission show training was planned and arranged for all staff during the year. The percentage of staff having completed a national vocational qualification in care level 2 and above was very good. Staff interviewed felt the home was run in the interest of the residents, and they were committed to give residents a high standard of care. They were supervised in their work. Written comments included, ‘I have a discussion with my manager on a regular basis to discuss how I am working and for support. Staff supervision is carried out to provide time to discuss this.’ And ‘I feel confident in my role to be able to know, understand, and feel supported to care for any individual in my care. ‘I do feel that new staff are given enough training to deal with some of the more advanced dementia sufferers’. ‘I think the service provides excellent care that is of a high standards. The care team is dedicated and mostly knowledgeable when dealing with individuals in our care’. And ‘Always puts the needs of residents and their families first. Rotas showed good levels of staffing maintained on all shifts. Staff had delegated responsibilities and an activities co-ordinator was employed to support staff meet with resident’s social needs. Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 23 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): 31,33,35,36,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well organised and managed efficiently. This ensured it was run in the best interests of residents. EVIDENCE: The manager who has been in post since last year has applied at the Commission to be registered. An application is currently being processed. She has relevant qualifications in care and holds the Registered Managers Award. Mr Catherine has continued to support the manager and two senior carers have been appointed deputy managers to offer continuous management presence in the home at all times. The manager and provider had regular meetings. Minutes of these showed a professional approach was taken by the manager to Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 24 improve the overall running of the home. For example topics discussed and resolved included, banking arrangements; staffing matters; management structure upgrade; physical upgrade of the home, current work including bathroom, bedrooms and downstairs toilet; new compliment slips; policies and procedures reviewed etc. Staff confirmed they were supervised, and had an appraisal. Records showed supervision included the homes policies and their understanding, and work performance. Observation of work practice was recorded. Staff also had formal meetings. Topics discussed were relevant to work. Staff meet together daily and have ‘shift meetings’ to discuss residents and other issues relevant to their work for the day and night. Residents also had meetings. Records showed they were informed of changes such as the upgrade of the bathroom and the Christmas programme of entertainment. They were informed of staff success with training. Residents were reminded ‘if any problems to see manager or deputies’. A quality assurance for the home had been carried out for the year. The results were published published and made available for all interested parties. Comments noted included, ‘mum on the whole is quite happy with everything and accepts this is now her home. She seems better than she was before she came here as she has company and has stimulation whenever she wants’. And ‘it’s just right.’ Outcomes included ‘families are encouraged to participate with care planning and are invited to attend reviews. Staff always knock on bedroom doors. Likes and dislikes are always noted on care plans. One relative who provided written comments for the inspection stated, ‘I would like to say I researched quite a lot of homes before deciding on this one, as there always seems to be plenty of staff. The service, gardens in summertime, different sitting areas, conservatory etc. and walking space. It also offers good value for money.’ Insurance cover was in place to meet any loss or legal liabilities. The home encouraged residents/relatives to manage their own financial affairs. Residents who are able manage their own finances continue to do so. Some money was managed for residents wanting this service. A random selection of records were checked and provided a clear audit trail. Arrangements are in place for all new for staff to have mandatory training such as fire safety procedures, food hygiene and first aid training. Information contained in the annual quality assessment completed by the manager indicated that the electrical safety certificate was valid, gas installations had been approved by an engineer. Policies and procedures were available and reviewed as ‘no change’. Safety certificates were up to date. The storage of cleaning products was also satisfactory. Management kept the Commission informed of any significant incident. A full risk assessment of the building had been completed. Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 25 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 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X 3 3 3 2 STAFFING Standard No Score 27 4 28 3 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP23 Regulation 16(2) Requirement The en suite facility in the ground floor bedroom must be upgraded. Previous timescale of 30/04/07 not met The home must be kept odour free where possible and alternative floor coverings provided where this cannot be achieved. One carpet identified as ‘rippled’, must be made safe. It is essential that the outcome of a Criminal Record Bureaux police check be considered and risk assessed to show the person is fit to work at the care home. Timescale for action 30/05/08 2. OP26 16(2) 01/02/08 3. OP29 19(1)(a) 01/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP19 Good Practice Recommendations It is recommended the lounge upholstery is professionally cleaned and a programme of cleaning put in place to reduce the possibility of malodours. DS0000052388.V351906.R01.S.doc Version 5.2 Page 27 Oakfield House 2. OP29 It is recommended the application form currently in use be reviewed to support applicants using them. Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oakfield House DS0000052388.V351906.R01.S.doc Version 5.2 Page 29 - 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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