Care Home: Oakleigh

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What the care home does well Residents benefit from a thorough admission process, which not only ensures their needs can be met but makes the transition of moving into a care home as pleasant as possible. The health needs of residents are well managed. Residents may self medicate but for those who are unable or do not wish to, the home has robust policies and practices to ensure medication is appropriately handled stored etc. Residents are treated with respect and with their privacy and dignity assured. Residents say their visitors are welcome and many of the resident enjoy the type of activities going on at the home. Residents enjoy the quality, presentation and variety of the meals at Oakleigh and enjoy having input into what is on the menu. The home listens to its residents and acts on any complaints and dissatisfaction and residents feel confident in the home putting any problems right.The home is decorated and furnished to a high standard, which is being well maintained. The residents and staff benefit from strong leadership and an open and inclusive management style, and the homes well established quality assurance systems. What has improved since the last inspection? The service users guide has been reviewed and amended to make the information about fee`s clearer. The new care planning and assessment documentation is very thorough and holistic, enabling staff to identify all areas of resident`s need as well as their strengths. Risk assessments now pay particular attention to falls in line with good practice guidance. What the care home could do better: Ensuring the daily events or daily evaluation is completed for all residents will evidence that care has been delivered to residents and give a picture of how residents spent their day. A review of the frequency and type of activities provided for residents with dementia should be undertaken, to ensure the activities on offer are appropriate to their abilities and to ensure residents are engaged in meaningful activity at times and frequencies which are suitable to them. Residents will benefit from outings being arranged once the home has organised hiring a minibus periodically. CARE HOMES FOR OLDER PEOPLE Oakleigh Evelyn Gardens Godstone Surrey RH9 8BD Lead Inspector Justine Williams Unannounced Inspection 14th November 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oakleigh DS0000028523.V350071.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. Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakleigh Address Evelyn Gardens Godstone Surrey RH9 8BD 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) 01883 731000 susan.eades@anchor.org.uk sharon.blackwell@anchor.org Anchor Trust Mrs Susan Eades Care Home 50 Category(ies) of Dementia - over 65 years of age (20), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (19), Physical disability (5), Physical disability over 65 years of age (5), Sensory impairment (5) Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. For those residents within the category PD, age range is 18-64 years, for all others the age range is over 65 years. 11th September 2006 Date of last inspection Brief Description of the Service: Oakleigh is registered with the CSCI (commission for social care inspection) to provide accommodation and care to fifty older people. In addition the home is registered to provide care for 20 residents with dementia. The property is located in a residential area in Godstone, Surrey and close to local shops, pubs, parks and other public amenities. The home is close to the M25 and A25, and therefore enjoys good road links, the home is close to a bus route but the service is infrequent and the nearest railway station is some 4 miles away. Accommodation is on three floors which is divided into five self contained units comprising of a lounge, dining room, kitchen, bathroom, shower room, toilets and bedrooms have en-suite facilities. The home has a lift to ensure the accommodation is accessible to service users. The ground floor and 2nd floor are for elderly people and the middle floor has 2 units for residents with dementia, staff allocated to this area have all undergone some dementia training and regularly work with these residents. The home has a garden which is well maintained, accessible and secure. Private parking is available. The fees charged by the home range from £457.52 to 701.43 per week, depending on the complexity of residents needs, additional charges are made for hair dressing, chiropody, newspapers etc. Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced key inspection was carried out on 14th November 2007 between 10.00 am and 14.30 pm by regulatory inspector Justine Williams. During that time residents, staff and the deputy manager agreed to speak with the inspector both in public and privately, the manager was unavailable that day. This report contains assessments made from observations, conversations and records, case tracking and a tour of the premises. Feedback was given during and at the end of the inspection. As part of the inspection process surveys were sent to service users, GP’s, health care professionals, care managers and relatives of residents. Some specific comments made included; “I cannot fault the care and attention my (relative) gets, staff are always pleasant and helpful to visitors” “Oakleigh is a very good home providing a very good standard of care to its residents” “we are so pleased to have such peace of mind about (relatives) care and welfare” “reducing the degree to which residents are institutionalised, spending most of their days asleep or watching TV would improve residents lives” What the service does well: Residents benefit from a thorough admission process, which not only ensures their needs can be met but makes the transition of moving into a care home as pleasant as possible. The health needs of residents are well managed. Residents may self medicate but for those who are unable or do not wish to, the home has robust policies and practices to ensure medication is appropriately handled stored etc. Residents are treated with respect and with their privacy and dignity assured. Residents say their visitors are welcome and many of the resident enjoy the type of activities going on at the home. Residents enjoy the quality, presentation and variety of the meals at Oakleigh and enjoy having input into what is on the menu. The home listens to its residents and acts on any complaints and dissatisfaction and residents feel confident in the home putting any problems right. Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 6 The home is decorated and furnished to a high standard, which is being well maintained. The residents and staff benefit from strong leadership and an open and inclusive management style, and the homes well established quality assurance systems. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 7 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 Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 8 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): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have confidence that the home is right for them through the homes robust admission processes. EVIDENCE: The homes service users guide has been reviewed and altered to make the information about what is covered by the fee’s clearer. The statement of purpose and service users guide are regularly reviewed and updated and both contain all the relevant information. New residents find the information supplied by the home useful when making the decision to either stay for respite or to move in permanently. New residents have their needs fully assessed prior to moving in, and the home now makes arrangements for prospective residents to come in for a trial day rather than a more brief visit to them in their own home or in hospital. The deputy manager said this allows the staff to carry out a better, more thorough Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 9 assessment particularly for those residents with dementia. Residents said it provided more opportunity to “test drive” the home and meet the staff and other residents. The home does not provide intermediate care. Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care and health needs of residents are met and will be better evidenced when a daily record is kept for each individual. Residents are treated with respect. EVIDENCE: The home has recently changed the care planning documentation to a more comprehensive model. The new documentation, includes a thorough assessment of needs, a pen portrait which includes personal and social history, interests, hobbies etc, a detailed and holistic care plan, as well as various screening tools in line with good practice, including waterlow for pressure area risk, nutritional screening, moving and handling etc. Personal risk assessments are also undertaken, including falls risk assessments. These documents are signed by residents, and are reviewed regularly. The home has not been completing daily records for residents, this provides evidence that residents have had the care delivered and also should Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 11 indicate how residents spent their days. Whilst some of the documentation completed, evidences that parts of the care are delivered i.e. the medication administration record evidences medicines have been given, no additional information is recorded, like the effectiveness of the medication. Other aspects of the care plan would not be evidenced at all. The deputy said that she and the manager were aware of these issues and plan to reinstate the daily records. The home completes records of health care professionals visits and these indicate that residents health needs are well managed, again when daily records are reinstated further evidence of this will be recorded. Residents said they could access their GP at any time and also that the home arrange any other visits for them such as optician and dentists. The home does not have much of its own pressure relieving equipment but is provided with the equipment needed through the district nursing service. The home has recently been provided with an updated medication policy from the company it is owned by. The deputy and manager are in the process of reviewing the policy to ensure it is suitable and applicable to the home. The policy is very comprehensive. The home has a medication store on each floor and stores medicine appropriately. One member of staff is responsible for ordering and checking medicines entering and leaving the home and regular audits are conducted. Only staff who have received competency based training administer medicines. Residents said the staff were “very good”, “absolute gems” and “do anything for you”. Residents said staff attend to their personal care needs sensitively and with proper regard for their privacy and dignity. Staff were observed knocking on bedroom doors and waiting to be invited in before entering. None of the bedrooms are shared. One professional commented on a survey card that the staff had dealt sensitively with a friendship and romance between 2 service users. Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The majority of residents have a relaxed comfortable lifestyle with opportunities to occupy themselves with a range of interests. The range, and frequency of activities on the dementia unit may not be adequate. EVIDENCE: The home does not employ designated staff to run and plan activities, however a local charity group run activities daily from Monday to Friday, for a couple of hours in the mornings. On the day of the site visit residents were enjoying a sing along in one of the ground floor lounges. The group running activities alternate which lounge they use, and residents from all units are encouraged to attend. Despite this only a finite number can participate due to the number of residents and space in each unit. Whilst residents spoken with from the ground and 2nd floor units said the activities suited them, a review of the type and frequency of activities on the dementia units should be conducted, using specialist dementia guidelines and expertise. Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 13 The home has recently lost use of its minibus, but the deputy said there are plans to hire a minibus for trips in the future. In addition to the charity groups activities the home also books external entertainers. Residents have recently enjoyed a Halloween party and Guy Fawkes party, involving fire works, a bonfire and “lily Fawkes”! Some surveys returned indicated that relatives were not happy with the activities, in that outings are rare, the sitting rooms are dominated by overloud televisions and the failure to recruit designated activity staff has been the residents loss. Residents said their visitors are made very welcome and they may have visitors any time. Residents said that they would enjoy outings being reinstated. Residents are encouraged to look after their own finances for as long as they are able, and residents are encouraged to bring in personal items and furniture as they wish. Residents said the food was very good, a cooked breakfast is available every morning, the main meal is served at lunch time and a choice of main meal and pudding is available, breakfast is at 08.30, lunch at 12.30, and tea at 5 pm, a snack is available with the evening drink at 7.30 pm fresh fruit is always available. Residents may help themselves to drinks if they are able as each unit has a kitchen, food is prepared in the main kitchen and brought onto the units by heated trolley. One comment from a survey form was that the food is not always very hot, the deputy said she would look into this. Special diets are catered for including soft, and diabetic diets, vegetarians options are made available when needed and other diets would be catered for should the need arise. Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to people who listen to any concerns and who will take action to ensure they are protected from abuse. EVIDENCE: The home has a complaints policy which is displayed in each unit, the main policy contains timescales for acknowledging and responding to complaints but the documents in the units do not. The home has received no complaints since 2005. The home has a compliments book and has received lots of cards and notes from relatives and residents thanking the staff. Residents said they would feel comfortable to make a complaint, and said they were sure that staff would listen to them and act on their concerns. The homes training programme includes adult protection, and staff receive information about adult protection at induction. Staff spoken with demonstrated sound knowledge of what constitutes abuse and what their actions must be, should abuse be reported to them. The home has an adult protection policy in place and also has a copy of the Surrey Social Services adult protection protocols. The home has not received any adult protection alerts recently. Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 15 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): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a homely, well maintained and comfortable environment in which to live. EVIDENCE: The home was purpose built in 2002, it is arranged into 5 units 2 on the ground floor, 2 on the 1st floor and 1 on the 2nd floor, each unit has its own kitchen, lounge and dining room, and is self contained. The communal areas and private bedrooms and bathrooms are decorated and furnished to a high standard and the home has been well maintained. The grounds are safe and attractive, and are easily accessible for the residents living on the ground floor, the residents on the other floors may be reliant on staff to accompany them depending on their ability, and for those on the 1st floor the extent of their Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 16 dementia. The deputy confirmed that the building complies with requirements of the fire department and environmental health department. The premises are clean and with the exception of 1 area, from offensive odours, however the carpet was being cleaned in this area. The laundry was clean and well organised with hand washing facilities. Foul laundry is washed appropriately, staff have good knowledge of infection control procedures and potential hazards. Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for and supported by properly recruited and trained staff. The low staffing numbers at night may compromise care particularly on the dementia units. EVIDENCE: The home is staffed with 2 care staff on each unit throughout the day, and the manager or deputy as well as ancillary staff. At night however the home as 3 care staff one for each floor on duty. The staffing levels on the dementia units particularly at night should be regularly reviewed, staff spoken with said that nights could be very busy. Staff said that when on a break a member of staff from another floor would answer their buzzers. This could leave the dementia unit without any staff at times. Given the unpredictable behaviours of residents dementia, and that many may find it difficult to use a buzzer if they needed assistance the current staffing levels at night may not be adequate. The home has attained around 70 of staff with NVQ’s at level 2 or 3, and staff are supported and encouraged to undertake NVQ. The home does not use agency staff, but has its own bank of casual staff and its regular staff which are asked to work additional shifts as needed. Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 18 The home has robust recruitment practices and works to its own policies. New staff complete an application form and provide 2 references, files contain application forms, a brief transcript of the interview, 2 written references, proof of identity, CRB and POVA checks. The home has a training matrix to enable the manager and deputy to track when staff training updates are due, and what training each staff member has had. Staff are up to date with core training and receive additional training relevant to their roles. Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 19 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe and well-managed home. EVIDENCE: The home has a registered manager who has the RMA (registered manager award) qualification and provides management stability. The manager has been in post for some time and is supported by a deputy who assisted with the inspection site visit. Staff said the manager communicates a clear sense of direction and leadership, and staff feel included in the decision making processes at the home. Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 20 The home has robust quality assurance processes and systems in place, many of which are conducted by member of the company who are independent of the home, thus giving an unbiased view. The home uses surveys to residents, relatives and stake holders, audits both internal and external, regular staff meeting, residents meetings and relatives meetings, a development plan could easily be produced from the existing quality assurance systems, should it be required from the Commission. The manager returned the completed Annual Quality Assurance Assessment as required by the Commission, the document had been completed appropriately and concisely. Residents are encouraged to manage their own finances for as long as they are able, and each resident has lockable storage space. The home manages small amounts of money on resident’s behalf and although money is not kept separately, each resident has an individual balance sheet and they or a relative is asked to check and sign it periodically, receipts are also kept. The home asks that resident keep only a small amount of money with them and to keep the rest in a bank account so that residents are not disadvantaged from not earning any interest. The manager ensures safe working practices and environment through the home’s policies, and regular supervision, the training programme. The health and safety of resident’s staff and visitors to the home is ensured through regular servicing and checks of equipment and systems. The manager is fully aware of her responsibilities to comply with relevant legislation, and carries out risk assessments for safe working regularly. Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 21 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 3 X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 4 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 Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 22 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. 1 Standard OP27 Regulation 18 (1)(a) Requirement The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users in thata review of the numbers of staff employed at night be conducted especially for the 1st floor where residents have dementia. Timescale for action 15/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 23 1 OP7 2 OP12 It is strongly recommended that the daily record be reestablished to document what care has been given to residents, and to provide a record of how residents have spent their day and to provide a daily evaluation. It is strongly recommended that a review using best practice guidelines of the type and frequency of activities for the residents with dementia be undertaken. Oakleigh DS0000028523.V350071.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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. 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