Care Home: Oaklands Care Home Limited

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What the care home does well Oaklands Care Home provides a clean, well maintained and very homely environment. Standards of personal and healthcare are good. There is good monitoring of healthcare needs and prompt referral to a GP or district nurse as needed. The home is seen as part of the local community and relatives/visitors are able to access at any reasonable time. There is good liaison with district nurses and general practitioners. Residents who are from the local area are able to keep their own GP. Some issues have been identified but in the main, the standards for administration and recording of medicines are good. Independence is promoted by staff through care practices and access to appropriate equipment to aid mobility. Residents have a nutritional risk assessment on admission and those identified at risk are referred and prescribed nutritional supplements as relevant. Staff work well as a team. Recruitment processes are robust with the required checks obtained prior to appointment. There is a low staff turnover meaning residents are cared for by staff who know them. Communication is good with regular staff supervision and annual appraisals provided. What has improved since the last inspection? The number of staff attending NVQ training has increased and now exceeds the standard. Staff training has taken place in health and safety, manual handling, fire safety, palliative care, first aid and deprivation of liberty. Care planning continues to develop and is regularly reviewed. Activity records have improved to provide individual plans for residents that provides evidence of consultation with them and enabled choices. Decoration and refurbishment of some residents` rooms has taken place and an ongoing programme of maintenance has continued. What the care home could do better: Whilst the home is clean with no odorous smells there is a lack of hand washing facilities (liquid soap, paper towels and foot operated pedal bins) in the laundry and kitchen and bedrooms where personal care is provided. There were a few omissions in the medication administration records that had not been followed up with the reason recorded. The Controlled Drugs register did not include the name and address on receipt or disposal. The temperature of the refrigerator used to store medication had not been monitored to ensure that it remained within safe limits. Individual residents` rooms had no door locks or a lockable facility to store personal items or medication in the event of self administration. The quality assurance programme needs further development to include audits and a report from the annual surveys to develop an annual plan for the home. The AQAA needs to be completed in more detail to include specific detail of how the service is meeting the aims of the people who live there and where and how they plan to improve. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oaklands Care Home Limited 34A/B Church Road Brightlingsea Essex CO7 0JF     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diana Green     Date: 0 8 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 31 Information about the care home Name of care home: Address: Oaklands Care Home Limited 34A/B Church Road Brightlingsea Essex CO7 0JF 01206305622 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Oaklands Care Home Limited care home 14 Number of places (if applicable): Under 65 Over 65 1 14 dementia old age, not falling within any other category Additional conditions: 0 0 One named person, over the age of 65 years, who requires care by reason of dementia Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 14 persons) The total number of service users to be accommodated in the home must not exceed 14 persons Date of last inspection Brief description of the care home Oaklands is a care home, registered for fourteen older people. The category of dementia, for one specific service user only, is included in the homes conditions of registration. The home is situated in the town of Brightlingsea, Essex. The property is situated on the main road into the town and close to all amenities, the seafront and the beach. Mr & Mrs Cahoolessur are the Directors, and Mrs Cahoolessur is the Registered Manager. Care Homes for Older People Page 4 of 31 Brief description of the care home The home has fourteen single rooms, with the bedrooms located on the ground floor and the first floor. Access to the first floor is by stairs, a chair lift and a passenger lift. Communal areas are situated on the ground floor and consist of a large lounge and a dining area. The home also has a smaller lounge and a conservatory dining room. Both the kitchen and laundry areas are located on the ground floor in the central area of the property. There is driveway access to the property, with some parking areas and garden areas at the front of the home. Gardens to the rear of the home are large, mainly laid to lawn, with some garden seating. Access is through the conservatory,and dining room. The fees are £370.00 to £390.00. Additionals costs apply for chiropody, haridressing, newspapers and toiletries. This information was provided to the Commission on 8th June 2009. Care Homes for Older People Page 5 of 31 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: two star good 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 2 star. This means that people who use this service experience good quality outcomes. This unannounced inspection took place on 8th June 2009. All of the Key National Minimum Standards (NMS) for Older People, and the intended outcomes, were assessed in relation to this service during the inspection. This report has been written using accumulated evidence gathered prior to and during the site visit, including the homes Annual Quality Assurance Assessment (AQAA). The Annual Quality Assurance Assessment (AQAA), a self assessment that focuses on how well outcomes are being met for people using the service, was completed by the home and returned to us prior to the visit to the home. Information received in the AQAA provided us with some detail to assist us in understanding how the registered Care Homes for Older People Page 6 of 31 persons understand the services strengths and weaknesses and how they will address them. The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at in relation to residents, staff recruitment and training, staff rotas and policies and procedures. Time was spent talking to staff and the manager. Surveys were sent to service users and their representatives and to staff. The manager and staff were welcoming and helpful throughout the inspection. 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 set out on page 4. Care Homes for Older People Page 8 of 31 The report of this inspection is available from our website www.cqc.org.uk. 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 31 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 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People planning to live at Oaklands Care Home can expect to have an assessment of their care needs prior to admission but not to be provided with full and accurate information about the home to enable them to make a decision. Evidence: The home had a statement of purpose and service user guide. Copies of both were provided during the visit to the service. We were informed that both documents had been reviewed on 4th April 2009. However the statement of purpose did not meet regulatory requirements, for example it did not include the name and address of the registered provider, the age and sex of service users, size of rooms and whether nursing was provided etc. Furthermore several staff were stated to be qualified nurses. This was confusing as the home was not registered to provide nursing care and staff were not registered with the Nursing and Midwifery Council to provide nursing care. Details for fire precautions and emergency procedures were too brief. The visiting Care Homes for Older People Page 11 of 31 Evidence: arrangements did not reflect what actually happened in practice (see outcome 3). The service user guide also needed some development to provide more detail for service users and current details of the Care Quality Commission. Completed surveys received from the relatives of two residents stated they had received sufficient information about the home before making a decision about their loved one being cared for there. The admission procedures were discussed with the owner/manager of the home. Referrals were accepted by telephone and information on care needs obtained. Prospective residents and /or their relatives were encouraged to visit the home and view the accommodation. Assessments were undertaken either in the persons home or hospital a visit made to the prospective. A pre-admission assessment was undertaken using a pre-assessment form as a prompt to discuss care needs. Information was used following admission to complete a full assessment within forty eight hours. Two residents care plans were viewed during the visit to the service. Both included a pre-admission assessment detailing information that had been obtained prior to admission to the home. This enabled staff to understand their care needs to ensure they could be met at the home. The home does not provide intermediate care. Care Homes for Older People Page 12 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Oaklands can expect to have their personal and healthcare needs met by respectful and professional staff but environmental facilities do not ensure that privacy and dignity will always be respected. Evidence: Two residents care records were viewed during the site visit. Both contained a preadmission assessment detailing the residents care needs ensuring staff were aware of the residents needs. A full assessment had been completed and used to develop a care management plan to enable care staff to provide appropriate care to meet residents needs. Additional assessments had been undertaken in regard to specific needs as recommended to meet this standard. For example assessments were seen for physical need, personal care, continence, tissue viability, mobility, mental state, sight, hearing, risk of falls, diabetes etc. Nutritional risk assessments were undertaken on admission and reviewed with weight monitoring also undertaken monthly. Risk assessments were seen for risk of falls, use of bed rails, use of hoists. Completed surveys from relatives indicated that they were very satisfied with the care provided Care Homes for Older People Page 13 of 31 Evidence: and were kept well informed of changing needs. One relative told us all the care staff are very caring and have the residents well being at heart and another relative told us they look after the residents very well. Any changes in my x welfare I have always been informed of. Residents access to healthcare services was discussed with the manager and confirmed in discussion with residents together with an examination of care plans and completed surveys received. Residents were mainly from the local community where there were five GP practices who continued to support them following admission. This enabled them to have confidence in the care they received at the home. One residents care records viewed during the visit to the home confirmed they had received five visits from their GP during a period of nine weeks, on initial request of the care home. Another residents care record confirmed they had received three visits during one week, also on initial request from the care home and had been seen regularly by the district nurse for treatment. During the visit to the home one GP was seen to attend the service. The care records also showed residents had received services from chiropodists, opticians, dentists, wheelchair services, phlebotomists (for blood tests) and social workers for reviews. One relative told us I feel the home is very attentive to my mothers health care needs and health care always seems to be a high priority. The medication systems were discussed with a senior care assistant. Medication was given by all care staff employed at the home who had received medication training. A list of staff signatures and initials was held to enable appropriate follow up in the event of an adverse incident. Two staff files viewed confirmed that both had received medication training since the previous key inspection showing they were skilled to give medication. The home had a medication policy and procedures for staff guidance that were kept under review. Medication was stored in a locked trolley, two wall cupboards and a controlled drugs (CD) cupboard that were located in the staff office. The trolley was not secured to the wall and a recommendation has therefore been made in this report to that effect. All medication was received from the local pharmacy in monitored dosage systems (MDS) and individual containers and appropriate procedures were in place for the receipt and disposal of medicines that were seen to be well adhered to. Room temperatures were recorded and monitored to ensure medicines were stored within safe recommended levels (maximum 25degrees centigrade). However staff had misinterpreted advice given by the Environmental Health Officer (EHO) that it was no longer a requirement to record temperatures for the fridge as this related to food and not medicines storage which does need to be monitored. The medication storage and medicines administration records for the same two residents were examined. All medication was available as prescribed. The records were completed accurately and in full apart from two omissions and no reason or Care Homes for Older People Page 14 of 31 Evidence: explanation had been recorded on the MAR sheets to demonstrate this had been followed up. There was a cupboard for CD storage that met requirements and a CD register that was well recorded. However entries of the name and address were made on receipt of CD drugs (usually the supplying pharmacy) but were not completed fully on discharge/disposal. Staff were observed to be friendly but respectful to residents during the visit to the home and to be courteous in their conversations with them. Personal care was provided in private and from observation it was evident that efforts were made to maintain privacy. However there was no lockable facility/drawer in residents rooms and no door locks provided should a resident wish to have their room locked. Neither the statement of purpose or service user guide made reference to the lack of facilities. One relative stated that as a casual visitor I see nothing to feel that privacy and dignity is not always considered. Two relatives told us privacy and dignity was always respected and two told us usually. Care Homes for Older People Page 15 of 31 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. People living at Oaklands can expect to maintain contact with their families and friends and receive nutritious meals in a comfortable environment but not to be have their lives enhanced by a full programme of varied and stimulating activities. Evidence: We were informed that the home had an activities coordinator who provided activities on three days per week. There was no set programme and residents were able to choose what activities took place and whether or not they took part. Activities comprised bingo, quizzes, puzzles, ball throwing, knitting and listening to music. Birthday parties were also arranged and local outings to the seaside. The records were viewed and each residents file was seen to include a personal profile of their background and their likes and dislikes and an activity plan that included a record of activities they took part in. The manager said that barbecues were also arranged when weather permitted. Residents were mostly observed watching television during the inspection and one was observed knitting. A survey was received from a relative stating that I would like to see the residents stimulated more. It was disappointing to note that the AQAA stated there were no plans for improvement in this area. Care Homes for Older People Page 16 of 31 Evidence: We were informed that the home encouraged relatives and friends to visit the home and that they can come and go as they choose. The statement of purpose included the homes visiting arrangements stating that visitors were welcomed at any time. However this was not reflected in the following statement visiting times are: 09:00 to 17:00. Appointments can be made at all other times and we strongly advise not to visit during mealtimes. This is not conducive to residents choice and does not allow flexibility for relatives and friends who work during these hours. However one relative did tell us that one can go in at anytime of the day indicating that the statement of purpose was not a true reflection of the actual visiting arrangements. During the visit to the home residents were observed to have a choice of where they ate their meals and how they spent their day. However one relative who completed a survey stated that the residents are prepared for bed a little early as elderly people do not like sitting in their nightclothes before tea. This does not promote choice and potentially compromises dignity for residents. Residents rooms were seen to be personalised with their own belongings (photos, pictures,ornaments etc.) Information on advocacy services was seen on display in the home and the statement of purpose contained details of advocacy services that could be arranged on behalf of residents. The statement of purpose stated that the home obtained publications from the Alzheimers society that enabled staff to keep up to date with current practice. The kitchen was viewed during the visit to the home and was seen to be domestic in size, clean and well organised. However there were no staff hand washing facilities (liquid soap and paper towels) to ensure staff were able to follow safe practice and minimise the risk of infection. Residents were observed enjoying the lunchtime meal which comprised roast chicken, roast potatoes and green beans with a choice of salad or prawns followed by a desert of trifle and ice cream. Residents records viewed confirmed that a nutritional risk assessment was undertaken on admission to the home and weights monitored with nutritional supplements provided as needed ensuring that residents did not lose weight unduly. There were no specialist diets but arrangements were in place to seek guidance from a dietitian where needed. Care Homes for Older People Page 17 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Oaklands can expect to have their concerns listened to and acted upon and to be safeguarded by the homes recruitment procedures, staff training and practices. Evidence: The home had a complaints procedure that was included in the statement of purpose and service user guide. No complaints had been received either by the home or the Commission since the previous key inspection. Completed surveys were received from five relatives. All five confirmed they knew how to make a complaint and indicated that any issues were listened to and quickly resolved. One relative told us if I have any problems I always speak to the management and it is sorted out and another told us I am always listened to concerning my x care. The home had safeguarding procedures in place and the records confirmed that all staff had received updated training in safeguarding adults during November 2008. The manager confirmed that there the Essex safeguarding procedures were available for staff guidance in the event of needing to refer an allegation. A whistle blowing policy was also available to support staff should they witness an allegation of abuse. There had been no allegations made since the previous inspection.The homes recruitment procedures were inspected and were confirmed to protect residents by ensuring all relevant checks were undertaken prior to appointment. Care Homes for Older People Page 18 of 31 Care Homes for Older People Page 19 of 31 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. People living at Oaklands can expect to live in a comfortable, clean and well maintained home that has facilities to meet their mobility needs and promote independence. However a lack of staff hand washing facilities could compromise their health and safety. Evidence: A tour of the premises was made during the visit to the home. The home was secure with a door entry system in place. One relative told us security seems to be my x main concern. To this end x is well supported and another relative told us the home provides a stable, secure environment for all its residents. Several residents rooms, communal rooms, two bathrooms, a shower room, the kitchen and laundry were viewed. All accommodation was pleasantly decorated, well maintained and clean with no odorous smells. The home had a programme of maintenance and decoration in place. The gardens were located to the rear of the home and were planted mainly to lawn and shrubs. The view from the small dining room and extension to the rear of the home provided a pleasant outlook for residents. Records viewed during the visit to the home confirmed that systems were in place to ensure the building complied with the requirements of the local fire and environmental health department. The home had stairs and a passenger lift to enable access to the first floor of the Care Homes for Older People Page 20 of 31 Evidence: premises. There were grab rails and aids in bathrooms and toilets to meet the mobility needs of residents. Call systems were provided throughout communal and individual rooms to enable residents and staff to call for assistance and records confirmed these were well maintained. A range of specialist pressure relief equipment was available to meet the needs of individual residents. Residents individual rooms were pleasantly decorated and furnished in keeping with the client group. Facilities were provided to meet the recommended standard (comfortable bed, curtains/blinds, chairs, mirror, wardrobe, overhead and bedside lighting etc.) However there were no door locks fitted and no lockable drawer for personal items or should they choose to self medicate. The home was clean with no malodorous smells evident. Systems were in place to ensure staff had personal protective clothing for use when providing personal care. However whilst there were disposable gloves available in the laundry, there were no hand washing facilities (liquid soap and paper towels) provided in the kitchen or residents rooms where personal care was being provided. This poses a risk of infection as staff needed to walk to the nearest bathroom to wash their hands and could touch door handles or other equipment en route. The laundry room was viewed and was seen to be domestic in size. There were two washing machines fitted and a drier. Both washing machines had sluice facilities (able to wash at 65 degrees centigrade for a minimum of 10 minutes) to minimise the risk of infection. Care Homes for Older People Page 21 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Oaklands can expect to be cared for by a team of staff who are robustly recruited and well trained. Evidence: There were twelve residents at the home including one resident who was in hospital. We were informed that in addition to the manager or senior care assistant staffing levels comprised two care staff during the day and two care staff during the night. An activities person also worked three days per week and a domestic/laundry assistant worked Monday to Friday. There was no cook employed and care staff were allocated on a daily basis to cook meals. The AQAA informed us that staff work well as a team and this was also confirmed from observation during the visit to the service. For example care staff assisted with some activities and the activities coordinator assisted with providing refreshments to residents. Staff also spoke of the manager assisting residents with their personal care needs. The duty rota was seen and confirmed the staffing levels were as discussed. During the visit to the home residents were observed to be well cared for indicating that staffing levels were appropriate for their needs. When asked are individuals health care needs met by the service? five relatives who completed surveys told us always. The AQAA informed us that the home employed nine care staff of which six had an Care Homes for Older People Page 22 of 31 Evidence: NVQ level 2 qualification. This exceeds the 50 needed to meet the recommended standard. In addition four staff were also undertaking NVQ level 3. We received the following comments from relatives who completed surveys: I feel that staff have good skills and are well trained and the staff are very caring and friendly. The recruitment files for two recently employed staff were viewed. Both files included evidence that the relevant checks (CRB, two satisfactory references, identification etc.) were undertaken prior to appointment. We were informed that a copy of the General Social Care Council (GSCC) Code of Practice was given to all new staff on appointment to ensure they were aware of their responsibilities as a care worker. This was also confirmed in discussion with staff. The files also included staff contract/terms and conditions detailing their legal rights of employment. The home had a training programme that included statutory training (health and safety, manual handling, fire safety, first aid etc). The same two staff records were viewed and confirmed that since appointment they had received training in manual handling, safeguarding adults, medication, fire safety, first aid and had completed the common induction standards. Observation of practice for medication had also been undertaken that ensured they were competent in their practice prior to administering medication. However there was no record of staff having undertaken recent infection control or food hygiene training and a recommendation had therefore been made in this report to that effect. A relative who completed a survey told us I feel that staff have good skills and are well trained and another relative told us I do feel the home has very good standards. Lolita and her staff are very good to all the patients. Care Homes for Older People Page 23 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Oaklands can expect to live in a well managed home that promotes the health and safety of residents and staff. Evidence: Discussion were held with the manager for the home who stated that she had completed NVQ level 4 in Care and Management and was also a registered mental health nurse (confirmed from her personal file). Since the previous key inspection she had also undertaken distance learning courses in dementia awareness, occupational health and safety and first aid and had undertaken updated medication training, safeguarding adults, manual handling and deprivation of liberty training. The manager had owned and managed the home for eight years and was therefore experienced in caring for older people. During the visit to the home it was clear that she was well known to all the residents. Comments from staff and relatives confirmed they were confident in her as a manager. One relative told us if I have any problems I always speak to the management and it is then sorted out. Care Homes for Older People Page 24 of 31 Evidence: The manager explained the homes quality assurance policy. Questionnaires were forwarded to residents and their representatives two months following admission to obtain their views and establish any areas for improvement. Surveys were distributed annually to residents, their representatives and to health and social care professionals. The manager said that action was taken to address any issues from the surveys. However there was no report produced from which an annual plan could be developed and no audits were available as evidence to show standards were monitored. The AQAA informed us that the home had a comprehensive range of policies and procedures in place for staff guidance. However many of these had not been reviewed for a number of years to ensure they met with up to date legislation and best practice guidance. The AQAA lacked detail, was inaccurate in part (stating some procedures/risk assessments were not in place when found during the visit to the home) and was not specific in the comments made throughout. There is therefore a need for action to be taken to develop the AQQA to provide more specific detail of the service provided and the systems in place for auditing and monitoring the service. This will provide evidence to the Commission that the home aims to meet the needs of residents and staff by promoting their health and safety and ensuring the development of best practice in the care of the older people who live there. The arrangements for handling residents monies were discussed with the manager. One resident managed their own financial affairs. All other residents had a relative or representative to manage their finances on their behalf. Personal allowances were held in secure facilities on their behalf. The personal allowances and records were inspected for two residents. Both amounts of money were present and correct with records of transactions made and receipts held as evidence. The manager said that supervision was undertaken for all staff at two monthly intervals to discuss care practice and performance. Handover was provided between shifts to ensure staff were aware of residents changing needs. Ongoing supervision was undertaken daily as the manager also provided personal care and was therefore easily able to observe staff practice. Appraisals were provided annually to discuss performance and training needs with a six month review also held. The records for one staff member were viewed and confirmed these arrangements were in operation. The home had a health and safety policy and procedures in place for staff guidance that had been reviewed during 2008. The records confirmed that staff had attended health and safety training following appointment. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g.checks on fire equipment, fire alarms and emergency lighting Care Homes for Older People Page 25 of 31 Evidence: etc.). Care Homes for Older People Page 26 of 31 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 27 of 31 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 1 4 The statement of purpose 31/07/2009 must be reviewed to include all information set out in the regulation and in Schedule 1. This will ensure that prospective residents have full information about the home to enable them to make a decision about moving in. 2 9 13 The temperature of refrigerator temperatures must be recorded to ensure they remain within safe limits. Medicines not stored appropriately may deteriorate and affect the well being of residents who receive them. 31/07/2009 3 9 13 Omissions should be followed up and the reason recorded. 31/07/2009 Care Homes for Older People Page 28 of 31 Residents who do not receive their medication as prescribed may become ill. 4 26 13 Liquid soap, paper towels 31/07/2009 and foot operated pedal bins must be provided for staff hand washing in all areas where personal care is provided. This also applies to the laundry and kitchen. Without appropriate hand washing facilities the risk of infection cannot be minimised. 5 38 18 All staff who handle food must attend food hygiene training. This will ensure that staff are aware of safe practice and residents health and safety is protected. 30/09/2009 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 1 2 3 4 5 9 12 13 14 24 CD records should record the name and address on disposal/discharge. More stimulating and varied activities should be provided to enhance residents lives. The visiting arrangements should be reviewed to accurately reflect the flexibility of visiting times. Residents should be enabled a choice of time in getting undressed and going to bed. Door locks and lockable drawers should be provided in individual residents rooms to promote their privacy and independence. Care Homes for Older People Page 29 of 31 6 7 30 32 Staff should receive updated training in infection control. The AQAA should be completed accurately and in full, providing more specific detail of the service provided at the home. The quality assurance systems should be developed to provide an annual plan for the home. 8 32 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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