Care Home: Oakhurst Grange

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What the care home does well Assessments are carried on physical, social and health care needs of prospective resident before they are admitted to the care home. This means that prospective residents will know if the care home is able to meet their needs. Communal areas of the care home are comfortable and homely. Residents have been able to personalise their own accommodation with their own furniture and other possessions. Relatives and friends of residents are able to visit when they choose. They are made welcome by the staff. A range of activities are provided within the care home for residents to enjoy. What has improved since the last inspection? No requirements were made at the last inspection. What the care home could do better: Care plans need to be reviewed and amended to ensure they include information about how staff should meet each resident`s identified needs in accordance with their wishes. Care plans also need to be reviewed and amended to ensure they accurately reflect the current care needs of residents. Records of medication administered need to be improved to include the reason why as required medication is given, together with the outcome. This will ensure residents are given the right amount of medication. Menus and food provision need to be reviewed and improved to ensure the dietary needs of residents from other ethnic groups are provided for. Staff who are expected to work with residents who have dementia need to receive appropriate training to ensure they have the skills and knowledge to meet their needs. Staffing levels need to be reviewed regularly against the changing requirements of residents to ensure they are sufficient to meet identified needs. Some areas of the premises have been affected by subsidence. Action needs to be taken to ensure the identified areas are safe to accommodate residents and for staff to work in. Key inspection report Care homes for older people Name: Address: Oakhurst Grange Goffs Park Road Crawley West Sussex RH11 8AY     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: David Bannier     Date: 0 5 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Oakhurst Grange Goffs Park Road Crawley West Sussex RH11 8AY 01293536481 01293612452 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.bupa.com BUPA Care Homes (CFHCare) Ltd care home 120 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 120 The registered person may provide the following category/ies 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: Old age, not falling within any other category ? OP Dementia ? DE Physical disability - PD Date of last inspection Brief description of the care home Oakhurst Grange is a care home registered to provide nursing care for 120 Service Users aged 65 years and over, 30 of who may have dementia. The home was purpose built and consists of four separate 30-bedded houses, Copthorne, Charlwood, Balcombe and Rusper. Each house is single storey and each has its own garden area. Under the current registration Copthorne and Charlwood provide general nursing care for elderly people; Balcombe House provides residential care for elderly people with Care Homes for Older People Page 4 of 33 Over 65 0 120 0 120 0 120 Brief description of the care home dementia, whilst Rusper House provides nursing care for elderly people with dementia. There is a further building which houses the reception area, administration offices, laundry and kitchen facilities. Each of the homes has a unit leader. The home is situated within a residential area, close to the town centre of Crawley. The Registered Provider of the home is BUPA. They have identified Ms Jacqueline Travers to be the responsible individual and to supervise the management of the care home. The current manager who is reponsible for the day to day running of the care home is not yet registered with us. We were informed on the 5th October 2009 that the current fees for the home range from #470 to #920 per week. Other services such as hairdressing and chiropody are not included in the fees and these are available from the home. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is zero stars. This means that the people who use this service experience poor quality outcomes. The inspection has followed the Inspecting for Better Lives methodology and is called a key inspection as it assesses those standards determined by the Commission as key standards. The quality rating awarded on completion of the inspection will also determine the frequency of inspections hereafter. The registered provider returned an Annual Quality Assurance Assessment when requested to do so. It was returned to us on 13th January 2009. A visit to the care home was made on Monday 5th October 2009. As this was an unannounced inspection we gave the manager and provider no notification of our intention to visit. The visit was conducted by two regulatory inspectors. We met and spoke to a number of residents in each of the units. We also observed care practices Care Homes for Older People Page 6 of 33 and interactions between residents. We also met and spoke to some relatives who were visiting at the same time. This helped us to form an opinion of what it is like to live in this care home. We also spoke to some of the staff who were on duty in order to gain a sense of how it is like to work at the care home. We also viewed some of the accommodation and examined some records. Prior to our visit we were made aware that the local authority has received a number of safeguarding adult alerts. As a result the local authority has conducted an investigation into the allegations made. The visit started at 9am and was completed by approximately 5pm. The manager and a representative of the registered provider were present during our visit and provided us with information about the service. We gave feedback of our findings to them at the end of our visit. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 33 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A care assessment tool is in place that has been used to assess the needs of prospective residents before admission. There was no evidence that confirmed Oakhurst Grange provides intermediate care to residents. Evidence: From evidence found during our last visit we formed a judgement that a thorough pre admission assessment has ensured that prospective residents were aware of whether the home could meet their health and personal care needs. It also allowed them to decide whether this home would give them a quality of life that they expected. During this visit we examined the care records of six residents. We noted that this care home uses the BUPA system called QUEST for all paperwork pre admission, for any assessments when admitted and for subsequent care plans. Documentation seen Care Homes for Older People Page 11 of 33 Evidence: indicated that the areas of need to be assessed included personal care, physical wellbeing, mental state and cognition, mobility and dexterity, sight, hearing and communication, oral health and foot care, continence, social interests, hobbies, religious and cultural needs. The AQAA stated that We carry out individual preassessments on all prospective residents covering all aspects of care, see QUEST care planning system, care managers assessment of needs prior to admission, up to date brochure. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans do not routinely include details of each residents needs and wishes. This means that residents social and health care needs have not always been met. Residents have not always been protected by the homes practices and procedures for dealing with medication. Residents are not always treated with respect and their right to dignity and privacy has not always been maintained. Evidence: We sampled a selection of care records during this visit. From observations we noted several occasions when staff were not implementing instructions given in care plans. For example one resident, who does not speak English as a first language, has a communication care plan. This states that staff should, take time to understand her and give her a chance to speak. May need gestures, pictures and sign language and able to use nods and smiles for better understanding. We did not observe staff doing Care Homes for Older People Page 13 of 33 Evidence: any of this. Another residents care plan stated that staff should Observe for non verbal cues re: pain. The care plan did not include any indication as to what they might be. There was no information with regard to pain management and how staff should support the resident when in pain. The care plan of another resident indicated that their weight needs to be monitored regularly. As the resident was immobile the care plan did not provide staff with instructions regarding how this should be done to ensure the residents safety and of those staff assisting. Care plans of some residents indicated that they had very sore bottoms. Whilst care plans indicated the treatment that each resident was receiving, we saw no evidence that residents were given pressure relieving cushions when sitting on chairs, and in particular hard dining room chairs. There was very little evidence of reviewing or following through treatment or actions, once an incident had been recorded. In July 2009 one residents care plan noted that redness was observed between their elbow joint. Whilst a photograph was taken of this, there was no indication of any further action taken or that it had been reviewed. We spoke to a trained nurse who was on duty about the needs of another resident whose first language is not English. We asked them how they communicated with the resident. The nurse was able to demonstrate they knew some words from a list which had been included in the residents care records. We asked the nurse what would happen if the resident was in pain. We were told they use a mixture of the residents own language and English. The nurse told us the resident asks for them by name. We asked what would happen when they were not on duty. We asked if other staff knew how to communicate with the resident. We were informed that, when the resident gets upset at night and starts to shout the staff will ring her son and ask him to speak to her over the phone in order to calm her down. This was information was not seen on the residents care plan. Information provided in the AQAA confirmed that, All residents have a plan of care that is initially drawn up from the pre admission assessment that is individual to their needs. Monthly reviews take place and families and residents are encouraged to participate. During the afternoon of our visit we observed care practices in one of the units. A Care Homes for Older People Page 14 of 33 Evidence: member of staff came into the lounge and suggested some music. One member of staff put on a CD, which was then changed by another member of staff. The residents were not asked if they wanted to listen to music, or what type of music they wanted. We observed some discussion among the staff as to whether there there was to be musical entertainment that afternoon. After it was agreed there would be, the staff began getting the room ready by turning chairs round and moving them across the room. The chairs were moved with residents in them. We did not observe staff talk to residents to explain what was about to happen before they were moved. We observed some residents were woken up by this activity and looked startled. One resident was moved over to the group that was formed. They had not been asked if they wanted to join the group. We noted the resident looked a little upset. Such practices gave us little evidence to confirm residents have been treated with respect and with dignity. We looked at a selection of care records and medication records. We noted that the nurse in charge of each house is responsible for the administration of medicines. A secure storage facility is provided in each unit. We noted that there were instances when records had not been signed for at the time the medication was administered. This means it is not clear if residents have received medication as prescribed by their GP. We also noted that several residents are being administered medication, mainly for pain relief, on an as required basis. However, when this has been administered records seen did not include details of the reasons why medication was administered and what the outcome was. On one occasion we noted that, whilst a resident had been prescribed medication on an as required basis, records seen indicated it had been given daily. Again, there was no record why this had been necessary and the outcome that had been achieved. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The majority of residents find the lifestyle experienced in the home matches expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. However, the needs of residents from religious and ethnic backgrounds other than Christian and British have not been met. Residents maintain contact with family, friends, representatives and the local community as they wish. Residents may not be helped to exercise choice and control over their lives. The majority of residents receive a wholesome appealing balanced diet which meets individual residents nutritional needs. However, the dietary needs of those residents from other ethnic backgrounds have not been met. Evidence: During our last visit we formed a judgement that the home provides choice and Care Homes for Older People Page 16 of 33 Evidence: variety for residents both in activities and at mealtimes. During this visit we noted that care records include details of each residents interests and hobbies. We were informed that activities coordinators have been appointed who are responsible for organising activities in each unit for residents to enjoy. During the morning of our visit we saw activities coordinators engaging with residents on a one to one basis. We were also informed that there is programme of activities which are arranged on a daily basis. We were shown a copy of the previous weeks activities programme and noted they included musical movement exercise sessions, quizzes, music sessions, reminiscence and bingo. Representatives of the local church also visit regularly to enable those that wish to receive communion . The programme is also on display on a notice in the front hallway of each unit. Also on display were photographs of activities and events which residents have enjoyed. We spoke to a resident in their own room. They informed us they enjoyed watching films; we noted the resident had an extensive selection of videos in their room. We were also informed that the resident enjoys needlework and making tapestries. We saw a selection of the residents work was on display in their room. The resident also informed us that they enjoyed going to bingo and the sing along sessions when they are arranged. For the rest of the time the resident informed us they are quite happy to spend their time in their room. The AQAA confirmed, A structured and varied schedule of activities is displayed in each unit. Events and social life is in place which has been tailored to residents individual preferences and always developing from service user feedback. During our last visit we found evidence which confirmed that residents have been supported in maintaining contact with their family and friends. Visitors were made welcome in the home at any reasonable time. During this visit we noted that care records include details of residents families and next of kin, including telephone numbers, so that they may be contacted. Information in the AQAA confirmed, The home has an open visiting policy. We noted that several residents were from an ethnic background other than English. These residents were accommodated mainly in the units that cared for residents with dementia. We examined the pre admission documentation and care plans for residents with diverse cultural needs. There was very little or no information about the needs of each individual in this area and how they should be met. For example one resident is Care Homes for Older People Page 17 of 33 Evidence: Buddhist. We asked a member of staff on duty about the food this resident enjoyed. We were informed the resident likes to use their fingers. The resident enjoyed todays meal as it was vegetable curry. The resident enjoyed the rice. When we asked if the member of staff knew of the other dietary needs related to the residents religion the member of staff did not know. We also noted that, according their pre admission assessment another residents religion was recorded as Zoroastrian and that they did not eat pork or beef. This information had not been transferred into the residents care plans. We also spoke to the chef on duty and asked about any special diets that were being catered for. The chef was unable to identify this resident as having any special dietary requirements. The cook told us about the main meal of the day that was being prepared. This consisted of a choice of shepherds pie or vegetable curry followed by a choice of lemon sponge pudding with lemon sauce or chocolate cheesecake. We were also informed that alternatives such as jacket potatoes, salads and sandwiches were also available for those residents who required a lighter meal. The cook also informed us of the Night Bite menu scheme, wherby a selection of food is available to residents on the kitchen of each unit when the main kitchen has closed. We were given copies of recent menus to look through. They demonstrated that a varied, wholesome and nutritious diet has been provided. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns and complaints have been addressed in an open, transparent and timely manner. Staff have received training in observing, identifying and reporting abusive practices and neglect to ensure vulnerable residents are protected. Following an investigation into a number of recent allegations of abuse the local authority has found evidence to substantiate the majority of them. Evidence: During our last visit to Oakhurst Grange we noted that documentation seen showed that residents could be confident that any complaints they may have will be dealt with in an open, transparent and timely manner. On this occasion we noted that the homes complaint procedure was on display in the front hallway in each of the houses visited. We examined records of complaints received. The care home has received seven complaints since 22nd June 2009. They had been dealt with to the satisfaction of the complainant and within timescales stated in the complaints procedure. The manager was unable to locate records before this date. The manager advised us that notes are kept on any investigation which has been undertaken. We were informed it is BUPAs policy to keep these notes separately from the record of complaints. We asked to see the managers notes of a recent Care Homes for Older People Page 19 of 33 Evidence: investigation but they could not be located. We recommended that such notes are made available at inspection so that evidence can be provided of investigations carried out. Information in the AQAA confirmed that, A complaints procedure is in place including leaflets available in each house. Verbal complaints are managed equally and are recorded and replied to within a given time frame. The section of the AQAA which requests information about the number of complaints received in the last 12 months before the form was filled in had been left blank. During our last visit we noted that staff had received adult safeguarding training and were aware of their responsibilities towards those in their care. During this visit we spoke to some staff who were on duty. They confirmed they have received training with regard to identifying different types of abuse. Following discussion the staff were able to demonstrate they knew the different categories of abuse that they might encounter. They were also able to explain who they should notify if they witnessed an incident where a resident had been abused. We also examined records of staff training which confirmed they had received training in this area. The AQAA confirmed, Staff are encouraged to whistle-blow. Any matters arising are followed through. BUPA has a robust policy to deal with allegations of abuse or neglect. There are well documented procedures for reporting under POVA (Protection of Vulnerable Adults) should it be required. Prior to our visit we were made aware that the local authority has received a number of safeguarding adult alerts. As a result the local authority has conducted an investigation into the allegations made. We have been informed that the outcome of the investigation is that the majority of the allegations have been substantiated. They relate to the delivery of care to residents. We have also been made aware that the registered provider has put together an action plan to make the necessary improvements and submitted it to the local authority, who will be monitoring how improvements have been implemented using its powers under safeguarding adults procedures. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have been evacuated from an area of the home which may not be safe for them to live in. Other parts of the home were well-maintained. However, the damage identified in Copthorne House could cause risks to residents in the event of an emergency evacuation. The home is clean, pleasant and hygienic. Evidence: During our last visit we found evidence which confirmed that residents live in a comfortable and clean home with pleasant communal facilities and gardens. We looked at the private accommodation of several residents in each of the four houses, along with the communal areas, including the dining room and the lounges. These areas were clean, decorated and furnished in a comfortable manner that met the needs of the residents accommodated. Residents have been encouraged to bring personal effects and small items of furniture in order to make bedrooms as individual as possible. We noted that each bedroom had been fitted with a linoleum type floor covering. It was not clear whether residents had been afforded a choice between this and carpeting. We expressed some concern about the damage which has occurred to some exterior Care Homes for Older People Page 21 of 33 Evidence: and inner walls in Copthorne House. Walls have large cracks in them which has resulted in some accommodation being evacuated. For further details please see the management and administration section of this report. Information within the AQAA confirmed, Planned maintenance takes place by the maintenance person and the grounds are maintained by the gardener. Good record keeping. The maintenance is supported by a team of experts within BUPA Care Homes. We also visited the kitchen area, the laundry, and several bathrooms and toilets. We noted that these areas have been maintained to a good standard of cleanliness. We noted that several cupboard doors that had been fitted with signage stating Fire Door Keep Locked were not locked. This was brought to the attention of the manager who confirmed they would deal with this. In addition, we noted that cleaning equipment and cleaning products had been left in the corridor near to the laundry. This meant that, in the event of a fire, staff and residents would have difficulty passing through this area to access fire exits and fire escapes. We also brought this to the managers attention and advised them of the dangers of leaving equipment in corridors in this way. Information within the AQAA also confirmed, A good housing keeping team is in place. They are trained and inducted needed. A schedule of cleaning is in place. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skill mix of staff are not sufficient to meet residents needs. This means residents may not be in safe hands at all times. Residents are supported and protected by the homes recruitment policy and practices. Staff have not been provided with training in understanding the care needs of residents who have dementia which has affected the welfare of residents. Evidence: From evidence gathered during our last visit we judged that not all areas of the home had sufficient staff over a twenty-four hour period to meet the varying needs of the residents. During this visit we examined a selection of staff rotas. Each house is has its own staff rota They showed that there is at least one trained nurse on duty in each house 24 hours a day. From 8am to 2pm on Copthorne House and on Balcombe House the trained nurse is supported by four care assistants. On Charlwood House the trained nurse is supported by five care assistants whilst on Rusper House there are six care assistants. From 2pm to 8pm on Copthorne House and Balcombe House the trained nurse is supported by three care assistants. On Charlwood House there are four care assistants whilst on Rusper House there are five care assistants. From 8pm to 8am each night care is provided to residents by a trained nurse and two care assistants who are awake and on duty. In Copthorne House the trained nurse is Care Homes for Older People Page 23 of 33 Evidence: supported by one care assistant. In addition to the care staff there are separate rotas for housekeeping staffing, including chefs and domestic staff who are responsible for the providing meals to residents and for keeping the premises clean. On the day of our visit we noted that there was a white board in each of the houses, which displayed the names of the nurses and care assistants who are on duty for the whole day. The information provided included the times each member of staff was due to work. For example, on Charlwood House, the white board confirmed that between 8pm and 2pm there were two trained nurses on duty supported by five care assistants. Between 2pm and 8pm there were two trained nurses supported by four care assistants. During the night, between 8pm and 8am there would be one trained nurse supported by two care assistants. It was not clear from documentation seen how the manager assesses staffing levels required for each house. Risk assessments and dependency assessments were present in each of the care records seen. However, we noted that they have not been reviewed regularly and kept up to date. It was also not clear if they are used to work out the staffing levels required to ensure all residents needs are met. Information provided in the AQAA confirmed that, Proper staff rotas are in place to record all staff on duty including last minute changes. We looked through the recruitment records of three staff who have been appointed since our last visit. These records demonstrated that the registered providers have obtained appropriate checks for staff, including criminal records checks, written references and proof of each persons identity. Where necessary, there was evidence that confirmed that, before appointment, the registration of trained nurses have been checked with the Nursing and Midwifery Council (NMC). During the afternoon we observed interactions and care practices on Balcombe House and Rusper House. Each of these house accommodate elderly people who have dementia. We noted staff arrive for the afternoon shift on one house. They were asking what they should do as they did not usually work on this house. A resident answered them and told them what they should be doing. A visitor commented that it was good that someone knew what they should do. After lunch we observed staff kept putting a blanket on a residents legs whilst the resident kept removing it. They did not establish what the resident wanted and said, Heres your blanket each time they put it back on. When the resident removed for the last time a care assistant said, Oh, are you hot? We did not observe any verbal interaction between the resident and staff, or between other people using the service. Care Homes for Older People Page 24 of 33 Evidence: During this visit we looked at staff training records. They demonstrated that newly appointed staff are expected to complete a Skills for Care portfolio which has been published by BUPA for new staff to use. We were informed that the contents mirror the Skills for Care induction standards and forms the basis of a structured induction training programme provided to all newly appointed staff. This includes providing an understanding of the principles of good care practices and covers the promoting of residents rights, independence, choice and dignity. Training records also provided evidence that confirmed staff have been provided with mandatory training including fire safety, health and safety, manual handling and food hygiene. During our last visit we noted that few of the trained nurses in daily charge of the units that accommodated residents with dementia were registered as mental health nurses. It was also recognised that there had been a difficulty in recruiting such nurses to posts in care homes. As a result we recommended that trained nurses with a general nursing qualification who are expected to work on the units specified should undertake training in caring for people with dementia. This would enhance their skills and knowledge in this area and ensure that the care provided is in line with current practices. During this visit we found no evidence that identified nurses had been provided with such training since our last inspection. Our observations of care practices have demonstrated staff do not have the necessary skills and knowledge to work with people who have dementia. We have therefore made a requirement that all staff who work in these units be provided with training in line with the work they are expected to perform. The AQAA confirmed, Staff have received NVQ and ongoing training. Many staff in place have good educational levels and are developed accordingly into their role. The AQAA also confirmed that, of the 91 permanent care workers employed, ten have obtained the National Vocational Qualification (NVQ) in Care or Health and Social care at Level 2 or above. 33 staff have completed the induction training expected by national minimum standards (NMS) and as recommended by Skills for Care. We examined a selection of recent records of supervision sessions . They demonstrated staff have received supervision on a regular basis and as expected by the minimum standards. The AQAA confirmed, A robust recruitment, selection and induction process is in place with continuing induction and supervision being carried out. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Changes in the management of Oakhurst Grange made in the past year have had a detrimental effect on the day to day running of the care home. The home has not been run in the best interests of residents. Residents financial interests are safeguarded. The health, safety and welfare of residents and staff may not be promoted and protected. Evidence: The post of registered manager has fallen vacant since our last visit. Oakhurst Grange has been without a registered manager since August 2008. The previous manager took up the the post of manager in another care home run by BUPA. A manager was appointed, but was not registered with us before they resigned. The previous manager has been asked to return to Oakhurst Grange in response to recent concerns that have Care Homes for Older People Page 26 of 33 Evidence: been raised. The manager took up the vacant post on 15th June 2009. We were advised that the manager is in the process of registering with us again. We were shown copies of minutes of several meetings. They included meetings chaired by the manager with senior staff and with residents and relatives. We noted that that such meetings have been arranged since the current manager has been in post. There was no evidence to confirm that such meetings were taking place beforehand. The manager advised us that meetings with care staff should take place at least on a monthly basis. We were also advised that it is the responsibility of the managers of each house to arrange them. The manager was unable to confirm that such meetings had taken place. We were shown records which demonstrated that care staff have attended individual supervision sessions on a regular basis. This ensures they receive the support the require and there is a means of identifying training needs for each member of staff. We have been made aware of the outcome of a recent investigation into a number of allegations of abuse conducted by the local authority under safeguarding vulnerable adults procedures. The majority of the allegations have been substantiated. The investigation highlighted weaknesses in the management of care provided to residents. We have also found evidence during our visit when the delivery of care has been poor. Care plans have not been reviewed and updated to ensure they reflect the current needs of residents. The provision of care, particularly to those residents with dementia, is not in line with information documented in care plans. Care staff and nursing staff have not been provided with sufficient training to ensure they understand the needs of residents, particularly those with dementia. The AQAA confirmed that, Regular meetings with families and residents, and regular distribution of questionnaires take place and comments acted upon, with BUPA having an annual customer satisfaction survey. The manager was unable to provide us with evidence that confirmed a quality assurance audit was in place. We looked at records of accidents and records of medication administered. We could find no evidence that such records are scrutinized to look for trends and reasons why accidents or errors have occurred. Such auditing would assist the manager in reviewing such practices and procedures to ensure they are safe and are meeting the needs of residents. It would be expected that such auditing should cover all aspects of practice within the care home. Representatives of the registered provider also visit the home on a monthly basis to monitor and evaluate Care Homes for Older People Page 27 of 33 Evidence: how well the home is being managed. We examined copies of the reports of such visits. This report is known as an Early Warning Audit Tool (EWAT). They confirmed that they had been undertaken regularly and had been used to monitor the service provided. As it was not clear from reports we examined we would recommend that they include comments made by residents or relatives who were spoken to. We did not examine records of monies kept by the care home on behalf of residents during this visit. The AQAA confirmed, Residents finances are managed securely with individual records in place and they have the choice of managing their finances if desired. During this visit we noted that there were deep cracks to the exterior and interior walls of Copthorne House. The manager has advised us, as a result, one room has been evacuated. However, it has also affected the door frame of a bedroom in which a resident is being accommodated. As a result the door cannot be opened or closed without some difficulty. it also uncertain whether this has affected the ability to the door to safeguard the resident in the event of fire. We noted with concern that the does not appear to have occurred recently. We have not been notified of this even though the damage could be affecting the wellbeing of residents accommodated in this areas of the care home. When we raised this with the manager we were informed that BUPAs internal maintenance department has been contacted. The manager has requested they visit to carry out a survey to establish the extent of the damage and what should be done to rectify it. We advised the manager to notify us of the outcome of the survey and to advise us of the action taken to ensure the safety of residents and staff. Information supplied in the AQAA confirmed the registered provider has taken appropriate steps to ensure the premises and equipment within the care home is safe for use. For example, gas and electrical appliances have been checked and maintained regularly. We found evidence that a programme of training provided to all staff includes health and safety issues, fire prevention, manual handling and first aid. Information provided in the AQAA also confirmed, Regular health and safety meetings are held that enable us to record and report to BUPA any areas of concern. The Quality and Compliance Directorate receive matters of concern raised by the home. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be reviewed 16/11/2009 and amended to ensure they give clear information to staff with regard to the needs and wishes of each resident. All staff will know what is expected of them when delivering care to residents so that their needs are met in accordance with residents wishes 2 10 13 Records of medication 16/11/2009 administered to residents must include the reason why the medication was given together with a record of the outcome. This is with particular regard to medication given on as an as required basis. This will ensure residents receive the correct levels of medication Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 15 16 There must be sufficient and 23/10/2009 suitable food provided for all residents accommodated. This is in relation to the dietary needs of residents from other ethnic backgrounds This will mean the dietary needs of residents from other ethnic groups are provided for. 4 27 18 Staffing levels must be provided in sufficent numbers at all times. This will ensure staffing levels provided are sufficent to meet the assessed needs of residents, including nursing care, physical care and social interaction . 16/11/2009 5 30 18 All staff who are expected to 16/11/2009 work with residents who have dementia must be provided with training appropriate to the work they are expected to perform This will mean staff will have the appropriate skills and knowledge to provide care to people who have dementia. Care Homes for Older People Page 31 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 6 38 23 The registered person must ensure the premises are of sound construction and kept in a good state of repair internally and externally. This will ensure they are safe for residents who live there and for staff who work there. 16/11/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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