Care Home: Oakmeadow Community Support Centre

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What the care home does well People who live at Oakmeadow or stay there for respite or rehabilitation speak highly of the standard of care provided. For example, one person who had stayed at the home for rehabilitation and was due to return to her own home to live independently said the standard of care is excellent. Care staff work with each person who stays at the home and their representatives, including health and social care professionals, so each person`s needs are met. The principles of privacy and dignity are promoted so people feel respected and valued. Their individual needs and personal preferences are recognised and addressed so care and support is provided in a way they prefer. The home is managed by an experienced manager so care staff receive the support, leadership and guidance they need to operate as an effective team. Staff are experienced, well trained and skilled so the people who live at the home know they are in safe hands and have confidence in the staff team`s abilities. The atmosphere in the home is welcoming and sociable and there is a range of activities on offer to keep people occupied. People who live at the home are able to entertain their guests in the privacy of their rooms and may offer them drinks and a meal if they choose so they can maintain good contact with family and friends. Almost all of the people returning questionnaires and all those spoken with said the food is always good. Special dietary needs are catered for and menus confirm that a varied and nutritious diet is on offer so that people continue to eat well when they stay at the home. The home is well maintained so people live in safe, comfortable and clean surroundings that suit their needs. What has improved since the last inspection? The assessment and care planning systems used at the home have improved so arrangements for health and personal care are based on the needs of the people who use the service and their needs are met in the way they prefer. The activities programme has been revised following consultation with the people who stay at the home so there is a range of appropriate activities on offer. The gardens have been improved and equipped with furniture and raised flowerbeds so all people who stay at the home can use and enjoy them. Some parts of the home have been redecorated and carpets in the corridors, which were stained, have been replaced so the home is fresh and clean. Detailed records of complaints and adult protection issues are kept up to date so the manager can show what has been done to deal with complaints and improve the service so people are safe and protected from harm. Effective quality assurance processes are in place so people are consulted about the way the home runs and a report has been published so the manager can show what has been done to deal with any problems and improve services provided. What the care home could do better: More work needs to be done to make sure that all risks are identified and reduced for people who stay at the home so they are safe and protected from possible harm and ill health. Appropriate records must be made of all medicines coming into the home, including stock records, to make sure that people who stay at the home receive the medicines as prescribed.People who are thinking about moving to the home for respite care or rehabilitation should always receive the information they need including the statement of purpose and service user`s guide so they can make an informed choice before moving in. They should also receive a statement of terms and conditions so they know their rights and responsibilities. Any limitation on a person`s freedom of movement or liberty to make decisions must be risk assessed, recorded and agreed with them or their representatives so their rights are promoted and met. Managers and senior staff should make sure that staff working on the dementia unit have the information and support they need to plan how to use their time to best affect to meet the social needs of the people staying in the unit as far as possible. All the people who use the service should receive a copy of the complaints procedure in a format that is suitable for their needs so they know how to make a complaint. CARE HOMES FOR OLDER PEOPLE Oakmeadow Community Support Centre Peelhouse Lane Widnes Cheshire WA8 6TJ Lead Inspector David Jones Unannounced Inspection 2, 5 and 7 November 2007 05:55 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 Oakmeadow Community Support Centre DS0000037125.V344497.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. Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakmeadow Community Support Centre Address Peelhouse Lane Widnes Cheshire WA8 6TJ 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) 0151 424 9185 0151 420 1993 dorothy.white@halton.gov.uk Halton Borough Council Dorothy White Care Home 32 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (3), Old age, not falling within any other of places category (32), Physical disability (2) Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 32 service users to include: * Up to 22 service users in the category of OP (old age not falling within any other category). (Hawthorns 7, Ashleigh 8 and Elms 7 = 22) * Up to 10 service users in the category DE(E) (dementia over the age of 65) may be accommodated. (Chestnut and Beeches). * Up to 3 service users in the category DE (dementia 55 years and over) may be accommodated. (Hawthorns1, Chestnuts and Beeches 2) * Up to 2 service users in the category PD (physical disability 55 years and over may be accommodated. (Hawthorns 2) * Up to 2 service users in the category OP (old age not falling within any other category) who are 60 years of age and over may be accommodated on Hawthorns and Elms areas of the home from time to time. The registered manager must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of service users at all times and shall comply with any guidelines that may be issued through the Commission for Social Care Inspection. The registered provider must ensure that Dorothy White achieves a qualification at NVQ level 4 in care by 11th November 2006. 30 June 2006 2. 3. 4. Date of last inspection Brief Description of the Service: Oak Meadow is a local authority community support centre that incorporates a day centre and a care home. The day centre is not subject to inspection. The care home provides personal care on a permanent or short term/respite basis for up to 32 older people. It includes an intermediate care unit The Hawthorns and a dementia care unit The Beeches and Chestnuts for ten residents. It is owned and managed by Halton Borough Council. Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 5 The home is purpose built and designed to meet the needs of older people. There are three floors with first, second and mezzanine floors. Access to the second floor is provided by stairways and a passenger lift. Accommodation is set out in a number of group living areas, each equipped with lounge/dining room with kitchenette, and bathroom and toilet facilities. Kitchen and laundry facilities are on the mezzanine floor, which are only accessible from the lift inside the building. The home is in a residential area of Widnes with access to public transport and local amenities Information about Oakmeadow, including copies of the most recent inspection report, is made available to each resident and can be acquired by contacting the home on the telephone number given above. Information provided confirms that fees charged depend on levels of supervision required. There are no additional charges other than hairdresser, toiletries, newspapers and other sundry items charged at cost. Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection of Oakmeadow Community Support Centre was unannounced. It included a visit to the home that took place over three days taking 9hours and 45 minutes in total. The visit was just one part of the inspection. Before the visit, the manager was asked to complete a questionnaire to provide detailed information about the home and how it is meeting the needs of the people who use the service. CSCI questionnaires were also made available for the people who stay at the home, their families and health and social care professionals, such as nurses and social workers. Their views have been taken into account. Other information received since the last key inspection was also reviewed. During the visit, various records were looked at and a tour of the home was carried out. Observations were made of the well being of people on the dementia care unit and how staff interacted with and provided support and care for them. A number of people who live at the home were spoken with. They gave their views and these have been included in this report. What the service does well: People who live at Oakmeadow or stay there for respite or rehabilitation speak highly of the standard of care provided. For example, one person who had stayed at the home for rehabilitation and was due to return to her own home to live independently said the standard of care is excellent. Care staff work with each person who stays at the home and their representatives, including health and social care professionals, so each person’s needs are met. The principles of privacy and dignity are promoted so people feel respected and valued. Their individual needs and personal preferences are recognised and addressed so care and support is provided in a way they prefer. The home is managed by an experienced manager so care staff receive the support, leadership and guidance they need to operate as an effective team. Staff are experienced, well trained and skilled so the people who live at the home know they are in safe hands and have confidence in the staff team’s abilities. The atmosphere in the home is welcoming and sociable and there is a range of activities on offer to keep people occupied. People who live at the home are Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 7 able to entertain their guests in the privacy of their rooms and may offer them drinks and a meal if they choose so they can maintain good contact with family and friends. Almost all of the people returning questionnaires and all those spoken with said the food is always good. Special dietary needs are catered for and menus confirm that a varied and nutritious diet is on offer so that people continue to eat well when they stay at the home. The home is well maintained so people live in safe, comfortable and clean surroundings that suit their needs. What has improved since the last inspection? What they could do better: More work needs to be done to make sure that all risks are identified and reduced for people who stay at the home so they are safe and protected from possible harm and ill health. Appropriate records must be made of all medicines coming into the home, including stock records, to make sure that people who stay at the home receive the medicines as prescribed. Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 8 People who are thinking about moving to the home for respite care or rehabilitation should always receive the information they need including the statement of purpose and service users guide so they can make an informed choice before moving in. They should also receive a statement of terms and conditions so they know their rights and responsibilities. Any limitation on a person’s freedom of movement or liberty to make decisions must be risk assessed, recorded and agreed with them or their representatives so their rights are promoted and met. Managers and senior staff should make sure that staff working on the dementia unit have the information and support they need to plan how to use their time to best affect to meet the social needs of the people staying in the unit as far as possible. All the people who use the service should receive a copy of the complaints procedure in a format that is suitable for their needs so they know how to make a complaint. 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. Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who are interested in moving to Oakmeadow have their needs assessed and information about the care, facilities and services provided so they know how their needs can be met at the home before deciding to move in. EVIDENCE: There is a statement of purpose and service users guide, which are available in a range of formats and languages, so all people who in the local community have access to the information they need. Managers and senior care staff have made a concerted effort to make sure that people thinking of moving in to Oakmeadow are provided with the information they need to help them decide whether the accommodation, care and services provided are suitable to meet their needs. However only half of the people who responded to the CSCI survey said they received sufficient information before they moved in. This means that more needs to be done to make sure Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 11 all have the information they need to help them with their decision making before they move in. People who use the intermediate care and respite services provided at Oakmeadow do not routinely receive a statement of the terms and conditions that relates to their stay at the home. They need this information so they know about their rights and responsibilities in relation to the services they are to receive; without it they are disadvantaged when making decisions about the home. Assessment and admissions procedures are well established so people wishing to move to the home have their needs assessed before they make any decisions about moving in. The care records of three people living at the home were read during the visit. These contained assessments based on the person’s abilities and needs in coping with everyday living, and plans of care for any needs identified during the assessment so people moving in know how their needs are to be met. People who are in Oakmeadow for intermediate care confirmed they are encouraged and supported to become as independent as possible so they are able to return home. One person who was shortly to move back to their own home after a period of rehabilitation was very complimentary about the staff and the standard of care provided. They said they were “very happy with the home and the standard of care provided - it is excellent - they all do their jobs and work very hard”. Health and social care professionals including a GP and three community care workers were equally complimentary about Oakmeadow and the standard of care provided. Managers and staff work in partnership with health and social care professionals to ensure that people admitted for intermediate care and rehabilitation receive the care and support they need. Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to the service. Arrangements for health and personal care are based on the needs of the people who use the service and the principles of respect; dignity and privacy are put into practice. However, some gaps in risk assessments means that some of the people who live at the home have remained at risk of developing pressure sores. EVIDENCE: A key principle of the home is that people using the service maintain control of their lives and that they are involved in development of their care plans so they receive the care, support and rehabilitation they need in the way they prefer. This is reflected in comments made by the people who use the service and their representatives, including relatives and health and social care professionals. Most of the people responding to the survey said that staff listen and their needs are always or usually met. Visiting relatives also made positive comments about the standard of care received. For example, one said: “When my husband has respite the staff treat him with great respect. Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 13 They could not do more if it was their own family they were caring for”. Another relative said: “My mother has been at Oakmeadow for six weeks or so and I feel she has been cared for well. The staff are very efficient including agency workers, friendly and responsive. Information is forthcoming when requested”. Staff were knowledgeable about the health and social care needs of each person living in the home and they were seen to interact with the people who use the service with sensitivity and care. They appeared to work as an effective team with the benefit of good communication and shared aims and objectives. They work in partnership with the many health and social care professionals to ensure that each person’s health and social care needs are met. For example, a visiting GP stated that managers and care staff at Oakmeadow “respect the individual, communicate with health service to provide a safe, respectful and caring environment for the people” who use the service. This is confirmed in the home’s care planning and record systems. The care planning system used at the home has been improved to make sure that care staff have the information they need to provide the right care and support for each individual. Care planning processes have been improved for people with dementia who use the respite care service provided at Oakmeadow. Care plans generally cover each individual’s needs for stimulation and motivation although one person’s care plan did not deal with these issues and another’s had not been updated when her hearing aid had broken which meant that her ability to engage in conversation and watch TV was impaired. Care staff need this information so they can plan how they are to work with people with dementia to make the best use of resources and ensure that people receive the support they need to enjoy a fulfilling lifestyle. Each person’s care plan normally includes a range of detailed risk assessments that are linked to risk management plans wherever hazards and risks are identified. However these were not in place for one of the people who regularly used the respite care services provided by the dementia care unit. It is important that any hazards associated with this individuals’ stay at the home and any restrictions on their freedom of movement or power to make decisions are risk assessed, agreed and recorded so they are safe and their rights are respected. Assessments for two of the people who used the service indicated that they had been assessed as being “at risk” of developing pressure sores. However risk management plans to meet their pressure area care needs were not in place. The health records showed that each person had experienced problems with pressure areas. In each case care staff had referred the individual to the district nurse for treatment of the pressure area when it appeared. However, effective care planning would have ensured that appropriate arrangements for care and any necessary equipment would have been put in place before pressures sores develop. Managers and staff recognised their oversight in Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 14 respect of pressure area care and revised the home’s care planning procedures to ensure that effective arrangements for care are put in place and are consistently reviewed whenever an individual is assessed as being at risk of developing pressure sores. Appropriate arrangements are in place for the administration and safe storage of medicines with the exception that stock records of all medicines entering the home were not made so it would be difficult or almost impossible to make appropriate medicine checks without this information. Senior care staff said that medicines audits are carried out as a matter of routine but the audit is not recorded for the benefit of analysis and review. Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Choice based on the personal preferences of the people who use the service is promoted so their lifestyle in the home reflects their expectations. EVIDENCE: There is a strong commitment to enabling the people who use the service to develop their skills, including social, and independent living skills. Most of the health and social care professionals returning the CSCI survey identified this as one of the home’s major strengths. All the people who used the intermediate care and rehabilitation services spoke highly of the standards of care and support they had received to help them develop their abilities and return to their own homes. One of the people who was staying on the intermediate care unit stated: “I am very happy with progress I have made so far on intermediate care” and another who was due to return home after a period of rehabilitation said the service had met her needs well. Of the ten people returning CSCI survey questionnaires eight said activities are always or usually available, one said they are available sometimes and another said suitable activities are never available. Information provided by the Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 16 manager indicates that the quality of activities has improved because of increased knowledge and feedback from the people who use the service and professionals. The quality assurance processes for the home will ensure that all people using the service are able to express their views so the activities provided reflect personal preferences and meet their needs. The assessment and care planning processes used at the home identify each person’s social needs. This includes religious needs and there are links with local churches and faith organisations so each person’s needs are met as far as possible. The activity programme includes group and individual work. Activities include arts, crafts, board games, drama group, themed activities relating to the seasons and local outings. These are open to all people who use the service including people staying on the intermediate care and rehabilitation unit. An observation of the well being of the people who were living on the dementia unit was conducted over a one and a half hour period. This confirmed that people benefit from attentive, courteous and professional care provided by trained and experienced staff. However, it was clear that more focused planning would have improved opportunities for engagement for some of the people. For example, one person was sitting next to a fellow resident who had four visitors and on the other side of them other residents were engaged in a game of dominoes with their backs to this person. This meant that the person had little opportunity to engage with people or occupy themselves with anything. When visitors and staff did engage with them they took full advantage of the situation but there were times when they appeared disengaged and bored. Another person sat in front of the TV; they were trying to listen to the news and another current affairs programme but could not hear the TV because their hearing aid was broken. The person had some insight into their condition and was able to enjoy other people’s company but became disengaged from time to time and was bored because of lack of stimulation and opportunities to engage or take part in an activity. The two care staff in the unit were busy all the time and were actively responding to the needs of all five people but most of their time was spent with one person who made the most demands on their time. Staff always reacted positively to all people and their interventions were effective and courteous. Overall a high quality of care was provided but effective planning of the evening may have meant that all could have been offered opportunities to engage in something interesting and fulfilling. Planning for how staff are to make the best use of available resources will be particularly important when the dementia care unit is operating at full capacity with ten people living on the unit and staffing ratios will be lower. Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 17 There are no rules on visiting. People who live at the home may entertain their guests in their own bedrooms or one of the lounges. There is also a quiet room, which is open to all people who use and visit the service. Visiting relatives and friends indicate satisfaction with standard of care, facilities and services provided. All stated that the home meets the differing needs of the people who use the service and they are encouraged to live the life they choose. Many made positive comments. For example, one said: “The home provides a caring service, they show great respect and consideration for everyone. The staff are pleasant, helpful and always offer the care and support needed.” Most people who responded to the CSCI survey stated the food is good and all those spoken with during the inspection confirmed this. Special dietary needs are catered for and menus confirm that a varied and nutritious diet is on offer. Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a thorough complaints procedure and effective adult safeguarding procedures so people’s concerns are listened to and people who use the home are protected from possible abuse. EVIDENCE: The complaints procedure for the home provides appropriate guidance and information on how to make a complaint. However only 50 of the people responding to the survey said they knew how to make a complaint to the home. People need this information so they know their rights and have the information they need to make a complaint should they need to. Information provided indicated that eight complaints had been received since the last inspection. A record is maintained in the home of all complaints received including a record of the action taken or what feedback was given to the complainant where appropriate. Reading of these records and discussion with the manager confirms that people are listened to. Their complaints are taken seriously and are acted upon so their concerns are addressed and their needs met. Robust procedures for responding to suspicion or evidence of abuse or neglect are in place including whistle blowing in accordance with the Public Interest Disclosure Act 1998. There have been 22 adult protection referrals since the Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 19 date of the last inspection. All were handled effectively and were reported in accordance with the local procedures. Information provided indicates the majority of staff have had adult protection “alerter” training and all receive refresher training via a video twice a year. The records on adult safeguarding kept at the home have been improved as they are kept in chronological order and provide information on related investigations plus any follow up action that may have been required. Reading of these records and discussion with the manager confirms adult safeguarding issues are acted upon and where appropriate action is taken to make sure that the people who use the service are protected from abuse and neglect. Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises provide spacious accommodation that is designed to help the people who use the service to maintain. It is well maintained so that people live in safe, comfortable and clean surroundings. EVIDENCE: The home is in a residential area of Widnes with easy access to public transport and local amenities. Accommodation is set out in a number of group living areas, each equipped with lounge/dining room with kitchenette, and bathroom and toilet facilities. The gardens have been sub-divided to provide two separate areas. Both internal gardens have been improved with chairs tables and equipment including raised flower beds so all people can use and enjoy them. Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 21 A tour of the premises was carried out. All areas of the home were fresh and clean. Carpets in corridors have been replaced, some bedrooms have been redecorated and new floor coverings provided. All people using the service said that the home is fresh and clean. Some of the corridors need redecorating but this included in the home’s rolling programme of redecoration, maintenance and repair. Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care staff are trained, skilled and employed in sufficient numbers to make sure that the needs of people who use the service are met. EVIDENCE: The people who live at the home, their relatives and visiting health and social care professionals speak highly of the staff team, indicating satisfaction with the overall standard of care. One person who lives at the home said staff are lovely and another said they are hard working and do their jobs well. Six of the seven relatives who responded to the CSCI survey stated that staff always have the right skills, so the people who use the service always receive the care and support they need. A number of relatives made other positive comments including one who said, “overall they do a very good job, I feel safe knowing my relative is in good hands. It’s a home well worth keeping open”. Another state,: “I am very pleased with the home. It provides a caring service to residents. They show great respect and consideration to everyone. The staff are pleasant, helpful and always offer carers support if needed”. The staff team were seen to work as an effective team with good communication and shared aims and objectives. Two agency staff were on duty at the time of the visit. Both had worked at the home on a number of occasions and were familiar with the needs of the people who use the service. Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 23 Information provided by visiting health and social care professionals, including a GP, a social worker and three community care workers indicates that staff routinely seek and act on advice from them. The staff work in partnership with health and social care professionals so the health and social care needs of the people who use the service are met. Rotas show there are enough staff on duty to meet the needs of the people who use the service. Information provided by the manager indicates that staffing levels have improved throughout the service with a ratio of one staff member to five people using the service aimed for. This ratio was met and exceeded at the time of the inspection. Seven staff were on duty including two senior care staff and four care assistants to the twenty-three people living at Oakmeadow at the time of the visit. Staff recruitment records were not checked during this visit. However information provided by the manager confirmed that Halton Borough Council has reviewed and revised staff recruitment procedures to make sure that the requirements of the National Minimum Standards and the regulations are met so vulnerable people are safeguarded from potential abuse or poor practice. Managers encourage staff members to undertake nationally recognised qualifications beyond the basic requirements, and recognise the benefits of a skilled and trained workforce. Information provided indicates that 54 of care staff team have an NVQ level 2 or above in care. Each member of staff has a personal development training plan. There is a comprehensive staff-training programme that incorporates “Skills For Care” staff training standards. There is a rolling programme of training that covers: Safer Handling, Risk Assessment, Medication, Fire Awareness, and training in conjunction with other identified training needs. Staff training records confirm that staff receive regular updates, although it was noted that one staff member had not received training in medication since 25/05/2004. Information provided indicates that staff have received training on equality and diversity and most are familiar with the concepts, but none of the staff said they were aware of the handbook circulated to all care homes on equality and diversity by CSCI. The manager advised that this booklet had not been received at Oakmeadow. Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 24 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, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is based on openness and respect. Quality assurance systems are in place so the home can develop in a way that reflects the views, changing needs and expectations of the people who use the service. EVIDENCE: The manager is a qualified and experienced practitioner in the field of social care with many years of experience caring for older people. Since the last inspection she has completed an NVQ level 4 in health and social care and intends to enrol for the registered managers award in the near future. Senior care staff and care staff speak highly of the manager. They appreciate her leadership and guidance and find her approachable and supportive. Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 25 The manager was on annual leave at the time of the inspection, and the management of the home was in the hands of the senior care assistants. They were seen to operate as an effective team. Communication was good and they managed the home with competence and skill so the needs of the people who use the service were met. Effective quality assurances processes are in place. The people who use the service are consulted about quality of services provided during their review meetings, at residents meetings and via annual quality assurance questionnaires. The quality assurance systems used in the home include consultation of other stakeholders such as relatives and health and social care professionals. An annual report on quality issues is produced and is available to CSCI and all interested parties. Halton Borough Council seeks to ensure the health and safety of all employees and residents. Risk assessment and risk management is central to the conduct of the home. The manager ensures that risk assessments are carried out for all safe working practices and significant findings are recorded and reviewed. Where hazards to health and safety are identified, risk management plans are developed, agreed and recorded so the people who use the service and staff are safe. Deficiencies in risk assessment relating to the management of pressure area care identified during this inspection were dealt with by the manager so risk management and care plans are put into place without delay and all people receive the care and support they need. Information provided indicates that fire precautions are in place and routine maintenance checks of gas and electrical systems, hoist, electrical appliances, lift, fire alarms, extinguishers and emergency lighting systems are undertaken and are up to date. All staff spoken with during the inspection confirmed that they have regular one-one supervision by their line manager. Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 26 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 2 3 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 13 (4) (c) Timescale for action Any unnecessary risks to health 31/12/07 and safety of the people who use the service, including their risk of developing pressure sores, must be identified and as far as possible eliminated so they are safe and protected from possible harm and ill health. Appropriate records must be 31/12/07 made of all medicines entering the home as part of the audit trail to show that people are receiving their medicines as prescribed. Requirement 2 OP9 13 (2) Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations All people who are thinking about moving to the home for respite care or rehabilitation should be given the information they need including the statement of purpose and service users guide so they can make an informed choice about moving there. Each person who uses the service should receive a statement of terms and conditions at the point of moving in to the home so they know their rights and responsibilities. Care plans to ensure that dementia care needs are identified and planned for should be developed so staff can plan their work to ensure the social care needs of all people with dementia are met and the best use of available resources is made. A record should be made of any limitation on a person’s freedom of movement or liberty to make decisions to show that this has been risk assessed, recorded and agreed with them or their representatives so their rights are promoted, met and the requirements of the regulation are met. Records should show the date on which medication audits take place so managers know when further audits are due. Staff working on the dementia unit should receive the support they may need from senior staff to help them plan how to use resources to best affect so they meet the needs of all the people staying on the dementia unit and make the best use of resources. People who use the service and their representatives should be given a copy of the complaints procedure in a format that is suitable for their needs so they know how to make a complaint if they so choose. 2 OP2 3 OP7 4 OP7 5 6 OP9 OP12 7 OP16 Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oakmeadow Community Support Centre DS0000037125.V344497.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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