Care Home: Oaklands Care Centre

What the care home does well This is a random inspection and therefore not all of the core standards were assessed. All of the standards will be assessed at the next key inspection of the home. Staff receive training so that they have the knowledge and skills to meet peoples needs individually and collectively. What the care home could do better: This is a random inspection and therefore not all of the core standards were assessed. All of the standards will be assessed at the next key inspection of the home. Care plans must be improved so that they give accurate and current information about people`s needs. Documentation must provide a clear audit trail and evidence what actions have been taken by the staff. People must be supported to have their positions altered as assessed so that the potential for skin soreness is minimised. Staff should have the knowledge to know what to do when equipment is faulty to minimise the risks to people. The managers must review the numbers of staff and allocation of work to ensure that there are enough staff to meet peoples needs in a timely manner. Random inspection report Care homes for older people Name: Address: Oaklands Care Centre 4 Oakland Road Moseley Birmingham West Midlands B13 9DN two star good service 13/05/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Lisa Evitts Date: 2 8 0 4 2 0 1 0 Information about the care home Name of care home: Address: Oaklands Care Centre 4 Oakland Road Moseley Birmingham West Midlands B13 9DN 01214496662 01214493097 Telephone number: Fax number: Email address: Provider web address: www.schealthcare.co.uk Name of registered provider(s): Name of registered manager (if applicable) Mrs Elaine Jean Lancelott Type of registration: Number of places registered: Conditions of registration: Category(ies) : Exceler Healthcare Services Limited care home 46 Number of places (if applicable): Under 65 Over 65 46 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is: 46 The registered person may provide the following category of service only: Care Home with Nursing (Code 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) 46 Date of last inspection Brief description of the care home Oaklands Care Centre provides 24 hour nursing care for 46 older adults. The home has been adapted and extended from an existing property and is situated on a quiet Care Homes for Older People Page 2 of 10 1 3 0 5 2 0 0 9 Brief description of the care home road not far from Moseley village. There is a range of community facilities nearby, and a number of bus routes are within a short walking distance of the home. There is off road car parking to the front of the property. There are lounges and dining rooms situated on two of the three floors of the home and the third floor has bedrooms only. Bedrooms are a mixture of four shared and 32 single rooms, which are spread over three floors. There are no en suite facilities. There are assisted bathroom and shower facilities to meet the needs of the people who live there. The home has hoists and pressure relieving equipment for use with people who are assessed as requiring this assistance. There is a passenger lift to all floors, a nurse call system and handrails, which would assist people with limited mobility. The home has a main kitchen, laundry and office space. There is a pleasant garden area to the rear of the home and this is accessible to people who use wheelchairs. Inside the home there are various notice boards, which display information about forthcoming events and other articles, which may be of interest. The last inspection report is available in the reception area, and this enables people to access this information if they choose to read it. The current scale of charges for the home are not included in the service user guide but are available from the home on request. Additional charges include, hairdressing, toiletries, newspapers and chiropody. Care Homes for Older People Page 3 of 10 What we found: The focus of this inspection undertaken by the Care Quality Commission (CQC) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. A number of concerns had been raised about the service provided at the home. There had been an increase in the number of safeguarding referrals being made in relation to tissue viability (skin sores). In March 2010 a meeting was held with senior managers of the organisation, the Primary Care Trust (PCT), Birmingham City Council and us to discuss the concerns that had been raised. The organisation said that they would not accept anyone else to come and live at the home until the issues had been resolved. They produced an action plan to address the concerns. This random visit was undertaken by two inspectors over five and a half hours. There were thirty six people living at the home but two of these people were in hospital. The home did not know that we would be visiting. The reason for the visit was to see if the home were making improvements in relation to the concerns raised. During this visit we looked at two peoples care plans and documentation and looked at daily handover records. We observed one person in their room, spoke to three people who live at the home and four staff. We reviewed two peoples bedrooms and the equipment that they used. These are our findings: An action plan had been produced by the home so that they had clear timescales and guidelines to work to so that improvements were made. On the day of our visit the manager and the quality manager were in the process of auditing the care plans. This is to ensure that staff were updating these to reflect peoples current care needs. Handover record sheets had been implemented so that the manager was aware of any changes or concerns that had happened throughout the shift. We looked at one file and found that the person had recently fallen out of bed. Crash mats were in place in the bedroom so that the person would have something soft to fall onto if they fell again. The falls risk care plan had not been updated with this information. Staff told us that a high/low bed had been ordered to minimise the risks of falling but there was no written evidence of the order on the care file. It was of concern that the night time records appeared to have been written early in the night stating that the person had slept well. The records had then been added to at 02:45 to say the person had fallen out of bed. Timing of the reports should be an accurate reflection of the events and this was discussed with the managers during feedback. Staff check that the mattresses are working and we saw on one record made by night staff that the mattress was faulty. On the handover sheets we saw that this was recorded at 05:00. This had been passed on to the day nurse who had resolved the problem when Care Homes for Older People Page 4 of 10 they came on duty at 08:00. The staff member spoken to said that the emergency cord had become disconnected and the mattress had deflated and some staff didnt know what to do. It was not clear from the records what action the staff had taken between 05:00 and 08:00. It was concerning that an area of sore skin had been documented the following day. Staff must have the knowledge to act when equipment is faulty to ensure that any risks to people are minimised. Care plans had been written for the sore skin and stated that the person should be nursed in bed to relieve the pressure. On the day of our visit we saw the person sitting out in the lounge and two staff spoken to were not aware that the person should be in bed for pressure relief. One person had been assessed for being at risk of malnutrition in February. In March they had been reassessed and they were now at very high risk. Whilst some changes had been identified to affect the scoring and severity of the risk, no changes had been made to the care plan. We were unable to determine if the person should be weighed weekly or monthly as different documents were available which were not consistent. Staff spoken to were unable to confirm if the person should be weighed weekly or monthly. This may mean that peoples weight is not monitored as required. We looked at the turning records for one person who was in bed and required two hourly position changes due to having sore skin. It was of concern that there were times when there were no entries made regarding turns sometimes of up to six hours. We observed this person in bed and saw that they were lying on their right side; turning records indicated that they should be on their left side and therefore the records were not an accurate reflection of the care being given. Recommendations from the tissue viability nurse specialist had said to only position the person on their back for meals, however records demonstrated that the person had been placed on their back at times throughout the night. This means that staff are not always following the advice from the specialist nurses. One person who lives at the home said Im very well and happy, they look after me well. We spoke to four members of staff and they all told us that they felt there needed to be more staff on duty particularly in the morning. They told us that a number of people needed assistance with eating their meals. They said that often it was 10am before they had finished helping people to eat their breakfast. Many of the people living at the home require the use of a hoist to move their position and we saw that some people were still being washed at 12 noon. Staff told us that morale had been low in the home. They said that they had been short of staff due to sickness and people taking their leave at the end of the year. They said that agency had not been booked to cover. The manager told us that she had to get authorisation from the area manager to book agency but this had now changed and she could book this herself when needed. Managers told us that repeated staff sickness was to be addressed following the organisations own policies. Staff told us that things were improving but they also said there were still some things that needed further work. We looked at the regulation 26 visit report for March. This is a report by an external manager of the organisation about the quality of the service being offered. The report said that the person had spoken to two people who live at the home and one of these felt that the home was short staffed. Three relatives were spoken to and two of them had commented about shortness of staff and staff being busy. Four staff had raised concerns Care Homes for Older People Page 5 of 10 that agency staff did not turn up. We discussed this with the managers on the day. The quality manager told us that they had completed a visit to the home to observe the shifts and found them to be unorganised. The home must review the numbers of staff and allocation of work to ensure that there are enough staff to meet peoples needs in a timely manner. On the day of our visit there were nineteen staff in the home receiving training on the Mental Capacity Act and Deprivation Of Liberties Safeguarding. This will enhance their knowledge so that they should know how to safeguard people and work with them in their best interests. What the care home does well: 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 set out on page 2. Care Homes for Older People Page 6 of 10 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 10 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, 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 12 Documentation and care plans must be current and demonstrate what actions have been taken by staff. So that peoples needs are met. 09/06/2010 2 8 12 People must have their 28/05/2010 position altered as they have been assessed and this must be recorded accurately. To minimise the potential for sore skin to develop and to promote healing. 3 27 18 The managers must review the numbers of staff and allocation of work. To ensure that there are enough staff to meet peoples needs in a timely manner. 02/06/2010 Care Homes for Older People Page 8 of 10 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 1 30 Staff should have the knowledge to know what to do when equipment is faulty to minimise the risks to people. Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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