Care Home: Oakland

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What the care home does well The staff team are caring and support people as individuals and follow their preferred routines. People feel secure and cared for. The manager ensures that staff is available in sufficient numbers, with experience and training to enable them to effectively meet people`s diverse needs. The activity programme is varied enough to enable all residents to experience social and recreational activities and opportunities that enables their involvement in the local community, keeps them motivated and interested in the world about them. Menus are varied and nutritious, and people enjoy the meals. Out of a team of 20 care staff, ten had successfully completed a recognised training course (NVQ) either at level 2 or 3 and another six staff were part way through the courses. This training included health and safety elements so they would know how to do their jobs safely, both for themselves and for the people they were supporting. The home has a manager who is good at her job and knows the importance of making sure that residents` needs are fully met by staff who understand their roles and who are committed to providing good care. Care plans are in the main individual to people`s needs. The staff were following the care plans and this had resulted in people being cared for, as they wanted. People were being weighed regularly so that if people started to lose weight, the staff could make sure the right people were consulted for advice, so the individuals would not be put at risk of being malnourished. Residents were being cared for by staff who understand the importance of making sure people`s needs are met in privacy and with dignity. The majority of the staff team completed all the appropriate health, safety and protection training so they would know how to keep the people safe. The expert by experience found the staff at Oaklands welcoming and said that "The welcome extended to me was warm and friendly". What has improved since the last inspection? CARE HOMES FOR OLDER PEOPLE Oakland Oakland Oakwood House Bury Road Rochdale Lancs OL11 5EU Lead Inspector Michelle Haller Unannounced Inspection 27th August 2008 08:45 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 Oakland DS0000040406.V369460.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. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakland Address Oakland Oakwood House Bury Road Rochdale Lancs OL11 5EU 01706 642448 01706 642389 oakland-rochdale@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Home Properties Limited 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) Care Home 40 Category(ies) of Dementia (40), Old age, not falling within any registration, with number other category (40) of places Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC, 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 - Code OP; Dementia - Code DE. The maximum number of service users who can be accommodated is: 40. 19th October 2007 Date of last inspection Brief Description of the Service: Oakland is a care home providing personal care for up to 40 older persons aged over 65 years in two separate units. One unit provides residential care for 22 people and is located on the first floor of the home. The ground floor unit is registered for dementia care for 18 older people over the age of 65 years. The home does not provide nursing care. All bedrooms are single, with a number providing en-suite facilities. A passenger lift serves both levels of the home. Oakland is situated approximately one mile from Rochdale town centre. A regular bus service to the centre can be accessed within several minutes’ walking distance of the home. A small car park is available to the front of the home, with the provision of a larger one to the rear. A safe, enclosed, wellmaintained garden is situated to the side of the home, which residents can access via the ground floor lounge. As at September 2008, the weekly charges ranged between £352.82 to £524 each week. The provider makes information about the service available upon request in the form of a Service User Guide and Statement of Purpose, which are given, upon admission, to each new resident. A copy of the most recent Commission for Social Care Inspection (CSCI) report is displayed in the entrance hall. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key inspection that included an unannounced visit to the service. This means the manager did not know in advance that we were coming to do an inspection. An expert-by-experience also assisted with this inspection. An expert by experience is a person who has accessed services that are regulated. This person assisted the inspection process by speaking to residents and staff, observing interactions between people in the home and sampling the lunchtime meal. During the visit we also looked around the building, talked to residents, relatives and staff, including the deputy manager and registered provider. We observed the interactions between people living at Oakland care home and examined care plans, files and other records concerned with the care and support provided to people in the home. We also looked at all the information that we have received or asked for since the last inspection. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Information we have about how Oakland care home has managed any complaints and any adult protection issues that may have arisen. What the manager has told us about things that have happened in the home through ‘notifications’. We also received seven Commission for Social Care Inspection (CSCI) surveys, which were returned to us by people using the service and from other people with an interest in the service, such as staff and relatives. There has been one protection of vulnerable adult (safeguarding) investigation. The safeguarding investigation which was conducted by the local authority with co-operation from the manager resulted in the dismissal of a member of staff. We have received no complaints about the home since the previous inspection. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 6 What the service does well: The staff team are caring and support people as individuals and follow their preferred routines. People feel secure and cared for. The manager ensures that staff is available in sufficient numbers, with experience and training to enable them to effectively meet people’s diverse needs. The activity programme is varied enough to enable all residents to experience social and recreational activities and opportunities that enables their involvement in the local community, keeps them motivated and interested in the world about them. Menus are varied and nutritious, and people enjoy the meals. Out of a team of 20 care staff, ten had successfully completed a recognised training course (NVQ) either at level 2 or 3 and another six staff were part way through the courses. This training included health and safety elements so they would know how to do their jobs safely, both for themselves and for the people they were supporting. The home has a manager who is good at her job and knows the importance of making sure that residents’ needs are fully met by staff who understand their roles and who are committed to providing good care. Care plans are in the main individual to people’s needs. The staff were following the care plans and this had resulted in people being cared for, as they wanted. People were being weighed regularly so that if people started to lose weight, the staff could make sure the right people were consulted for advice, so the individuals would not be put at risk of being malnourished. Residents were being cared for by staff who understand the importance of making sure people’s needs are met in privacy and with dignity. The majority of the staff team completed all the appropriate health, safety and protection training so they would know how to keep the people safe. The expert by experience found the staff at Oaklands welcoming and said that “The welcome extended to me was warm and friendly”. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Medicines for external use, such as creams, that are kept in the residents’ own rooms but administered by staff should be signed for and steps must be taken to make sure that they are always stored safely. The registered person should make sure that people always have their clothes returned to them from the laundry. This will ensure that they wear clothes they have chosen for themselves, which both fit and suit them. The registered person should make sure that if the television is on, then the sound is turned up and people are able to see the screen properly and are offered a choice about what programmes they watch. This is so the television can be used as a genuine source of entertainment and information. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 8 The manager should also make sure that a variety of music is played and not the same disc the entire day. This will means that there will be more of a chance of each person hearing something they like. 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. Oakland DS0000040406.V369460.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 Oakland DS0000040406.V369460.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): 3 (standard 6 is not applicable) Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People benefit from having their needs fully assessed and planned for prior to moving into Oakland, which ensures that only people whose needs can be met are admitted to the home. EVIDENCE: Since the last key inspection in March 2008 there has been sufficient improvement in care and management at Oakland to enable new admissions to take place safely and properly. The admission process for three of these people was examined. Each file contained an initial assessment form and a detailed pre-admission assessment. The information gathered during the admission process included: health needs, moving and handling needs, communication and sensory needs, such as vision and hearing, mental state, spiritual needs, medical or mental health diagnosis and independence skills relating to personal care. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 11 The pre-admission assessment also highlights potential areas of risk, such as dietary needs, history of falls and pressure care needs. In addition, as people move into the home a base line assessment is completed and this includes weight, a check for any marks or bruises, which is recorded on a body chart, and reassessment of any medication that is prescribed. Records also provided evidence that people are closely monitored when they first move in, this is to confirm that the assessment has been accurate and also make sure that all steps are taken to help with settling into the home. The manager provided information stating: ‘The manager always visits the resident in their pre-assessment location prior to admission and documentation incorporates a full range of personal and healthcare needs of the prospective resident. Where there is a complex case, a second health professional will accompany the manager so a second opinion can be formed.’ Staff have received specialist training called Yesterday, Today and Tomorrow (a training programme specifically for staff working with people with dementia), to give them the knowledge in how to work with and relate better to people with dementia. All who returned surveys felt that they had been given enough information about moving into the home and one person commented: ‘At the time I was impressed with the space and I relied on what I saw.’ Oakland DS0000040406.V369460.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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People at Oakland benefit from receiving health and personal care that is based on their individual needs and this is provided respectfully and in a manner that ensures dignity and privacy. EVIDENCE: The care plans that were examined had all been re-written or developed within the last four months. The information was detailed and related closely to the needs identified at the assessment stage. The attendance list showed that, where possible, the resident, their family representative and social worker were involved in the reviews of care that occurred two to four times a year. Care plans were also monitored and updated on a monthly basis or more often as necessary. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 13 The care plans were detailed and provided information that enabled staff to respond to people in a way that promoted their individuality and demonstrated that people were listened to and treated with dignity and respect. Aspects of support covered included likes and dislikes in relation to food, the preferred time of getting up or going to bed, preference for a bath or shower, and other aspects of personal care needs, such as wearing makeup or jewellery. Care plans informed staff of the actions they must take to show respect and provide people with dignified support, for example, ‘knock on the door before entering’. Care plans also detailed the action staff must take to meet health care needs that were identified. These included moving and handling, pressure area care, continence needs, sensory needs, such as hearing loss or wearing glasses, and communication needs and the individual effects of dementia. Risk assessments relating to all aspects of care had been completed in keeping with individual assessment. These included moving and handling and falls reduction, pressure area care and diet and nutrition. All risk assessments had also been reviewed and updated. Six care plans and assessments for residents were looked at in total. The care plans were person centred provided information that enabled staff to meet people’s needs consistently. The Malnutrition Universal Screening Tool (MUST) was being used. Those people who had been identified at high risk were being weighed on a weekly basis and their weights had been recorded on the care plans. Records confirmed that referrals were made to the general practitioner and dietician when necessary and that the chef at Oakland was aware of how to provide for special diets, including providing fortified meals for people with poor appetites. The professional visit records, daily records, monthly updates, letters and other correspondence confirmed that routine and specialist health care was sought as necessary. Health and social care professionals involved with the residents at Oakland included the dietician, speech therapists, district nurse, opticians, dentist, podiatrist and general practitioners. Records showed that people gained weight when they moved into Oakland. Most people were weighed monthly, though this increased to weekly if a poor diet was taken or if people lost weight. Fluid and dietary charts were used to monitor intake. Those that were looked at had not been fully completed and, for one very frail person, it was not possible to confirm that they had been offered drinks frequently. This matter was discussed with the manager. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 14 Personal hygiene records confirmed that people were offered baths. People looked clean and well groomed. One concern is that the temperature of the bath water for people on the ground floor often seemed cool, at about 38°C. This was discussed with the manager. People’s hair and nails were clean and clothes had been carefully laundered and ironed. People were fully dressed; the ladies wore tights, stockings or socks and shoes or slippers that were clean. Some men chose to dress more formally in shirts and ties and all wore socks and shoes or slippers. The area for improvement in relation to clothes and laundry concerned the labelling system. At the time of inspection the number of the person’s room was written into clothing instead of the owner’s name. This was discussed with manager because it is impersonal and checking demonstrated that it was also ineffective as, people had been given the wrong clothes either because they had changed room or staff may have misread the labels. The manager agreed to make sure that name labels were used on people’s belongings; this will make sure that their individual choices in what to wear are upheld and further promote a feeling of self worth and personal pride by wearing their own clothes. Staff who were spoken to say that they were well informed through staff handovers, daily records and care plans about people’s needs. Day to day care is consistent throughout because most care staff work 12-hour shifts. They were very knowledgeable about people’s needs in respect of emotional support, physical and dietary needs. Observations of interactions between people confirmed that residents were spoken to with respect and treated with dignity at all times. Daily diaries and other messages and notes written by staff were respectful and demonstrated that staff had a caring attitude towards the people living at Oakland. This information also confirmed that routines and care were flexible and able to respond to people’s choices if they differed from day to day. Moving and handling practices that were observed were safe and people’s cooperation was gained before any action was taken. A district nurse attending to residents at Oakland was interviewed. She felt that health care provided by staff was good, people were well monitored, additional advice was sought promptly and instructions were followed. The manager confirmed that, at the time of the inspection, no-one at Oakland was being treated for pressure sores or other wounds. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 15 Each resident who returned surveys felt that they always received the medical assistance and care they needed. One person commented: ‘If the staff think I need my doctor they don’t hesitate to call him’. A relative commented: ‘Mum is cared for very well - this team is very good at getting help from the district nurse or doctors, they don’t leave things, they always seek professional assistance. They make sure things such as creams don’t run out.’ The medication routine and round were observed. Staff wear a tabard during the drug round so that people are less likely to disturb them and this in turn should help them to remain focussed on administering medication safely. The medication cabinets were clean and well organised and instructions were written so that people received all the medication they needed. Checking the medication record sheet confirmed that all medication was given and no gaps were seen. Medication that was given when requested by residents was recorded. Records also confirmed that food supplements were prescribed and given as instructed. At the previous inspection it was noted that staff did not always record when they had applied skin creams. In the main, this was now occurring, although the manager still needs to make sure that staff do this consistently. The expert by experience observed good practice in relation to staff conduct and the attention they paid to the residents. She wrote, ‘Throughout the four hours I was present there was contented chatter amongst the residents and staff, much teasing and laughter, amongst the gentle care and attention given to all the residents, for example, a gentleman who is very unsteady was helped by several carers during the morning and all handled him gently and in a way to minimise possible injury to themselves.’ And ‘I observed good handling technique also when residents were being transferred to wheelchairs and back, attention to footrests was given. Staff responded quickly to requests for help in going to the toilet.’ Staff who returned CSCI surveys felt that they were provided with enough information to meet people’s needs and comments included: ‘The service is working well at the moment with all efforts being made to improve service users’ quality of life.’ Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 16 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People who live at Oakland are able to make choices about their life style, and supported to develop their social and recreational skills and are offered activities meet individual cultural and educational expectations. EVIDENCE: An activities co-coordinator has been employed at Oakland. She has maintained records that include photographs displayed in the home, a personal diary and individual updates of the activities each person has participated in. These activities included taking an interest and raising money for the football team whose home ground is adjacent to the home, a visit from a falconer with their birds of prey, baking, gardening, attending tea dances, armchair exercises, floor games and parties to celebrate anniversaries, birthdays and saint days. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 17 One to one activities included compiling a life history profile and filling a personal box with memorabilia and information important to the person. Cross-referencing confirmed that activities were flexible enough to enable all people to participate in some aspect of the activities programme. The expert by experience observed that people were given access to materials, such as wool and knitting needles, so that they could pursue their hobbies independently. On the day of the inspection the activities co-ordinator was unavailable. Care staff organised games in the morning and afternoon. Staff also stayed and talked to residents. In the main, people enjoyed the games that were organised. Social profiles had been completed for people when they moved into the home and these had also been updated for longstanding residents. These provided good insight into the experiences and possible interests of each person. With regards to activities, this area could be improved further if it were shown that this information were taken into account when developing individual or group activities programmes. This area could also be improved in respect of the use of music and the television. On the day of inspection the same music was repeatedly played throughout most of the day, the television was also switched on with the sound turned down. Staff did not change the channel, or consult with people about what they were watching. In addition to this, some people were sitting in a position that meant that they could not see the television. In respect of activities one person commented: ‘Because I’m restricted in my movements I can’t join in everything, however the activities which I did take part in I enjoy’. Since the previous inspection the manager stated that a regular church services had been arranged and these now occurred on alternate months. The expert by experience was satisfied that the recreational needs of the people she saw were being met at Oakland; she wrote: ‘I didnt observe any organised activities during my time in the home but there were plans for a Bingo session in the afternoon. However, residents were interested in a “Homes under the Hammer” programme on television and some made relevant comments about it. When it ended, one lady suggested that they should now listen to music, which they did.’ Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 18 And ‘Two of the men had daily papers but the only magazine I saw was an old Christmas one nor did I see any books. Of four ladies I spoke to about how they like to spend their time, none enjoyed reading, one knitted, they all looked forward to having visitors but mostly they enjoyed talking amongst themselves.’ And ‘Photographs taken at the summer fair showed it to have been a successful event, giving everyone pleasant memories. Plans are afoot for a trip to see the Blackpool lights soon.’ The routines of the home were flexible and daily records and observation confirmed that people were able make decisions about what they did while living at Oakland. People walked around the home freely and participated in activities or events on their own terms. The relative who was interviewed stated that she could ‘come and go’ as she pleased. The manager stated in the information she provided that: ‘Contact with relatives and friends continue to be encouraged and they do not have to make an appointment to visit.’ People who returned surveys all felt that staff always listened to what they said. The meal at lunchtime was a choice of savoury mince or salmon fishcakes. The expert by experience sampled the fishcakes. She said that they were home made and were tasty. All the meals that she saw were well presented and served with care. People were offered a choice of meal each mealtime. Some people were on pureed diet. These meals were observed. Meat, potatoes and vegetables had been presented separately on the plate. Homemade cakes were served with afternoon tea. People who commented felt that adequate steps were taken to provide meals that would be enjoyed. One person wrote: ‘There’s a good choice for breakfast but I only want toast.’ Southern Cross, as an organisation, introduced four-week menus across all their homes, which were referred to as “Nutmegs”. Health care experts had formulated the menus to ensure they were balanced and nutritional. The menus gave choices at all meals. The menu available indicated that dishes included a variety of mainly traditional British foods. There was also always a vegetarian or fish choice. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 19 Dishes included: meat casseroles and stews, fishcakes and bakes and vegetable bakes, including Irish stews, fish dishes and were varied. Home baked cakes and biscuits are served at afternoon tea. The dining rooms were clean and tidy. A short period over lunch was observed. At the previous inspection it was found that people had to sit at the dinner table and wait for more than 15 minutes before the meal was served. This was still the case for people having their meals downstairs. However, on this occasion, more staff were going in and out of the room and people did not become agitated. General comments about the food can be summarised by the relatives who said: ‘There is a very good chef who makes appetising meals.’ The expert by experience found that mealtime was a pleasant occasion and the food provided was nutritional and tasty. ‘Mealtimes were high on the list of priorities. I spoke to four ladies and two men about meals. They all agreed that breakfast was ideal for them, they could get up at any time and cereals and toast would be served, drinks are available on request anytime. Mid morning cups of tea were served along with sliced bananas and oranges. A man I was chatting to said he enjoys the fruit snack most day.’ Lunch was at approximately 12:15pm and there was a very short wait from being seated at the table to the meal being served. A hot meal with a choice of first course, followed by dessert. Special diets are catered for and the chef is aware of residents’ preferences. One lady told me that when she came to live at Oakland her daughter went to see the chef to tell him how fussy she is and that he has catered for all her wishes. I had lunch with the residents, it was a good experience, and the tables were set nicely with glasses of fruit juice. The meal was enjoyed by all, I was so impressed that I asked to see the Chef to thank him.’ Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 20 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People who live at Oakland are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse. EVIDENCE: The complaints record was read through. The reports confirmed that complaints were dealt with fairly and steps taken to resolve any problems and prevent their repeat. The Southern Cross organsiation monitors and audits complaints each month. Residents who returned surveys each confirmed that they knew how to make a complaint and felt that they would be listened to. Comments included ‘I would speak to the management and social worker.’ The relative who was interviewed was satisfied that complaints would be dealt with and said ‘I ask as issues arise and they are always solved’. Since the last inspection there has been one protection of vulnerable adult (POVA) investigation concerning the behavior of a member of staff. This person has since been dismissed from the home. During the investigation it was clear that the manager of Oakland and the management team followed the correct safeguarding adults procedure to protect people living in the home. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 21 This person has also been submitted to the Department of Health for their consideration in respect of inclusion on the Protection of Vulnerable Adults register. A copy of Rochdale MBC’s Guide for the Protection of Vulnerable Adults was in place, as well as the Southern Cross Vulnerable Adult and whistle blowing policy. The training matrix confirmed that within the last 12 months all staff, including kitchen and domestic staff, have received training about protecting vulnerable adults. The most recent recruit was interviewed and she confirmed that she was going on the POVA within the next week. She said that she had attended POVA courses before joining Oakland. When questioned, she was confident about the types of behaviours and omissions that could be considered abuse and said that she would not hesitate to alert the manager or Social Services if she had any concerns. In the course of the inspection it was noted that, on one occasion, there was reference to an incident between service users. Although these matters had now resolved, it was difficult to evidence that the adult protection team had been alerted to ensure that it was not considered a safeguarding issue. The daily and professional visit records confirmed that social workers had been involved for the person who had initiated the incident, and it was clear that she had been spoken to and no further incidents had occurred. Also, it was difficult to confirm that the other person involved had been offered the option to make a formal complaint, an accident/incident form had been completed. It was stressed to the management team on the day of this inspection that we and the Rochdale safeguarding adult team must be informed about such occurrences, even if they appear minor, this is so that these matters are always assessed under the safeguarding adult protocol. The manager stated in the information she returned that: ‘A culture of openness and support ensures that residents and their representatives can feel confident in who to go to, to air their concerns in order to protect them from harm and abuse.’ Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 22 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The physical design and layout at Oakland enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: A tour of the building was completed and this included looking in a number of bedrooms, all the communal areas and some bathrooms and toilets. All areas that were seen were clean, nicely decorated and free from unpleasant odours. Some bedrooms had been fitted with easy wash flooring. This was to ensure that the environment in these rooms was as fresh and pleasant as possible. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 23 The bedroom doors have been made to look like front doors with knockers and letterboxes. The downstairs doors have been painted in different colours to help people to recognise which room may be theirs. Clear picture signs have been used to help people to recognise the toilets, bathrooms and dining areas. Arrows pointing the way to different areas of the building have also been put up in an effort to stop people becoming disorientated. Most doors have been decorated with name labels, which have been made by the residents. The lounge and dining areas were clean and neat. The furniture and fixtures looked clean and did not have any stains. The building is accessible for the people living there and people were able to walk and move around the home freely, either independently, using the aids and adaptations provided or with the assistance of staff in accordance with their care plans. In each bedroom there was a colour-coded guide that categorised that person’s moving and handling needs. This acted as a reminder to staff in relation to the level of assistance required and when a specific risk assessment was in place. For example, green meant that the person was completely independent in relation to moving and handling and ‘red’ meant that a care plan was in place that had to be followed, and that the person was dependant on one or two people in respect of moving and handling. Throughout the day staff consistently supported people around the home in keeping with the care-plans that were examined. The first floor dining room has a small kitchenette area so that drinks and snacks can be prepared there. The refurbishment and plans for redecoration continue, however some aspects have stopped because the home has been without a handyperson for a short while. The manager was in the process of filling this post on the day of inspection. The lack of a handy person, however, has not had a detrimental effect on people living at Oakland. The laundry was well equipped and non-slip flooring had been fitted. There were no complaints about the laundry and the laundry worker said that she was provided with all the right equipment to do her job. The issue over the labelling of clothes was discussed and the manager agreed that this would be dealt with as a matter of urgency. Staff wore blue aprons for serving and assisting with food and white ones for personal care duties, there was a good supply of gloves and disposable aprons, paper towels and liquid soap were supplied in all areas, including people’s bedrooms. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 24 CSCI has not received any notifications or reports about Oakland concerning poor infection control. The manager commented in the information she returned that: ‘Residents at Oakland Care Centre live in a pleasant, comfortable, safe and well-maintained environment. Residents are encouraged to personalise their bedrooms and where possible decide how they would like their bedroom to be decorated.’ The findings during the inspection confirmed that this was true. The ex–by-ex assessed the home as: ‘Pleasant spacious feel about the communal rooms staircases and corridors. Chairs were in appropriate places in the corridors, providing quiet spots away from the crowd. Good views across playing fields from first floor sitting area, inspiring a keen interest in football!.’ She also identified that: ‘Bedrooms, various sizes, all pleasant, the ladies’ rooms more personalised than the mens. All doors having numbers, knockers and colourful name plates.’ But felt that it was ‘A pity that more of the rooms dont have en-suite facilities.’ All who returned surveys confirmed that Oakland was always clean and free from unpleasant odours. One person wrote ‘The home is lovely and very clean’. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 25 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Staff at Oakland are employed in sufficient numbers and given relevant training so that they can meet the needs of the residents efficiently and safely. EVIDENCE: From checking the rotas and speaking to the manager, staff and looking at information received from the residents it was evident that the home was well staffed for the number of people currently living there. There were always four staff on at night, with a senior also on duty. There are two team leaders who are each responsible for their own units and also designated seniors. The new management team had been closely monitoring and supervising the staff to try and make sure they were working safely and caring for the residents so that their identified needs would be met. The team leaders were spoken to and both were confident about the care that needed to be provided to residents on their units. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 26 Recently, due to a positive change in management and systems at Oakland, there has been a higher than usual turnover of staff. This appears to have been well managed, as the relative who commented on this also conceded that the changes had not affected the care provided in the home. They said: ‘it took a while to get to know the new staff but from my mother’s point of view the transition has gone well; all her needs were met.’ Observation of staff interaction with people evidenced that staff were patient and kind to residents. They listened to them and encouraged people to participate in their own time. Staff spent time sitting with people and it was noted that paperwork was completed in the lounge areas, so that staff could continue to interact with the residents. A recent recruit was interviewed and she said that she enjoyed working in the home and that she had no concerns. Staff who returned surveys commented that: ‘The current manager has an excellent approach towards staff and keeps people informed.’ The manager stated that 71 of care staff have achieved National Vocational qualification (NVQ) in social care level 2 or above. Five staff files were checked. All contained completed application forms, two references, interview notes, Pova First checks and evidence that Criminal Record Bureau checks had been sent for. Training files were in place for each person and contained information such as workbooks and signed forms that confirmed that they had completed an induction programme that was in keeping with the guidance of the Skills for Care Council. It was difficult to confirm that the induction had been completed over a period of time that would allow the new recruit to assimilate all the information and clarify things that may not have been understood. This was because all the sections on the induction checklist were signed off in a single day. This matter was discussed with the manager and operational manager, who said that this was not a true reflection of what happened at induction. They also confirmed that for experienced new recruits the induction was more into the routines and running of the home and updates on safeguarding. The manager also produced a partially completed induction training pack that was been undertaken by recent recruit who was newly working in care. From checking the training matrix, the majority of staff have now attended training in fire safety, infection control, moving/handling and food hygiene, abuse, care planning, infection control, and Yesterday, Today and Tomorrow which is a course about working with people who have dementia. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 27 Ten staff had also attended nutrition training-courses, and 14 are waiting to have their places confirmed. On the day inspection the name of two first aiders was displayed in the home. In the information she returned, the manager reported that she assessed that the staffing provided a suitable skill mix to meet the needs of residents. She also described the recruitment process for new staff and this was thorough enough to safeguard against employing unsuitable people. People who returned surveys were content with the staff in the home. The majority felt that there were always enough staff on duty and comments included: ‘Very satisfied with the care and attention that my mother receives. She seems very happy and content’ and ‘Sometimes they are busy with toileting, etc., but they work very hard trying to please us and be there when needed.’ The expert by experience found that staff were pleasant and willing to learn and improve the standard of care they give. She wrote: ‘Staff members I spoke to were all relatively new to the home, one having been promoted from a home in Bolton owned by Southern Cross. Without exception, they were enthusiastic and keen to support the Manager in her aim to improve all aspects of care. Training is ongoing within the home and carers can attend courses at Boots Chemists to instruct them in the safe handling, storing and administering of medicines and other prescribed items.’ Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 28 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The management and administration of Oakland Care Centre is based on openness and respect, and people benefit from having effective quality assurance systems that are monitored by people who are competent. EVIDENCE: The home’s current manager has recently successfully completed the CSCI Registered Manager process, and the Registration certificate will be updated to reflect this. This confirms that she is considered to have the necessary skills to manage Oakland. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 29 Her training and experience includes being a registered general nurse and working in the nursing profession. She has completed the Registered Manager’s Award and also a dementia-training module for “Care of People with Dementing Illnesses”. She had also managed other Southern Cross care homes since 2001. A recent course she has completed is the Yesterday, Today and Tomorrow - a dementia care course devised by Alzheimer Care Society. This course provided her with the skills to train care staff employed at by Southern Cross. She has also completed a three-day health and safety-training course. The manager provides a lot of the in-house training and keeps herself updated with new ideas about best practice through liaising with and membership of specialist organisations such as Bradford University and National Association for Providers of Activities for Older People (NAPA). This person has worked hard to sustain the improvements that have occurred in the care provided by and the running of the home since October 2007. Staff meetings are held and minutes confirmed that topics discussed included planning for the summer fair, training needs and ideas for activities were discussed. The operations manager has continued to be closely involved with the management of the home and has sent in to the CSCI Regulation 26 provider reports and these have kept us updated about the quality of support and the environment since the previous inspection. These reports have shown that improvements have been sustained and where problems have occurred these have been dealt with appropriately. Staff feedback about the manager was positive and they commented: ‘The service is working well at the moment with all efforts being made to improve service users quality of life. I feel more service users would only enhance the environment and spirits of current service users and the prepared staff.’ A relative spoken to on the day of the visit said, “(the manager and deputy) are excellent they have employed good reliable staff’. A corporate quality monitoring and assurance system is in place and the audit tools were being used. The manager completes a monthly audit, which is validated by the operations manager. Audits of medication, weight and falls are also completed to ensure that these needs are met in keeping with the best practice. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 30 Questionnaires to relatives are sent out twice yearly. These are then returned to the regional office so that responses can be collated before they were returned to the home. When a result of the feedback is available, a copy should be forwarded to us (The Commission for Social Care Inspection), so that we can monitor that improvements are being maintained. Resident meetings were being held; the last one took place on 16th June 2008. At this meeting the summer fair was discussed, including entrance fee and stalls. People were asked about the food and there were no complaints. The notes also confirmed that residents did speak up and their views were recorded. The manager has also produced a newsletter called the Oakland Observer. This informs relatives and residents about important events for those involved in the home such as birthdays and anniversaries, meetings and outings. The newsletter highlights issues and events of concern for older people in general such as ‘action on elder abuse’ day. Where the home holds money for the residents, all income and outgoings were listed on the computer and printouts were given to residents and/or relatives upon request. Receipts for all transactions are also held. The organisation has detailed health and safety policies and procedures in place, which were reviewed and updated as needed. Information contained on the Annual Quality Assurance Assessment (AQAA), returned to us in July 2008, showed that the required maintenance checks had been carried out. A random sample of fire records and looking through the maintenance record confirmed that fire maintenance checks were in order and the servicing of the bath hoists was up to date. Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 31 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 X X 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations The registered person should make suitable arrangements for the recording, administration and storage of external medicines, such as creams, should be made to ensure they are always handled and stored safely. The registered person should make sure that clothes are labelled in a manner that shows that people are respected and also that clothes are returned to the correct people after they have been laundered. The registered person should ensure that entertainment equipment is used effectively for the benefit of the people living at Oakland. 2 OP10 3 OP12 Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Manchester Area Office Unit 1, 3rd Floor Tustin Court Port Way 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 Oakland DS0000040406.V369460.R01.S.doc Version 5.2 Page 34 - 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. 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