Care Home: Oakwood

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• Chirnside House
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What the care home does well People were given information about the home and their needs were assessed before they moved in to Oakwood. This meant they knew their needs could be met. Prospective people who may choose to live at the home and relatives are encouraged to spend some time at the home, look round and ask questions about life in the home. All the people and relatives spoken to were pleased with the standard of care at the home. All eight people who returned surveys said they always received the care and support they needed. People looked well cared for and from observations made during the visits the staff were seen and heard to be kind and caring in their manner. Comments about the staff were, "They are a great team here, they look after us well," another person said, "I have been made to feel very comfortable here, they are good to me." Vsiting relatives were also happy with the staff, comments included; "the girls are great they are thoughtful and kind," another person said, "The staff here are happy, they make it homely and are friendly." Care plans in relation to wound management were well recorded. The home has an open visiting policy and relatives were seen to visit during the two visits. Relatives feel the manager will listen to them if they raise any concerns and they do their best to provide a good level of care. A choice of meal was available at each mealtime and people said they enjoyed the food provided. People who live at Oakwood have choice about their daily routines and they were seen to be supported in ways to promote their independence and dignity. The home did encourage the staff to attend study days and courses and staff spoken to said they found the courses interesting and relevant. Since the last inspection a number of staff have been on abuse awareness training and plans were in place to enable more staff to attend this. Health and safety checks were being carried out so that people`s safety was protected. What has improved since the last inspection? The home has appointed a staff member to be the training co-ordinator to assist with in-house training and the induction of new staff who is now developing this role. A new full time administrator has been appointed to do some of the paperwork to support the manager. The environment of the home had improved since the last inspection, this included replacing some windows, carpets and some areas of the home had been redecorated. The manager stated that a programme is in place to continue this, which is helping to create a pleasant living environment for the people accommodated. What the care home could do better: There were some improvements seen in the systems in place to manage medication although some further improvements could be made. The manager needs to make more checks to make sure that medication is being appropriately managed. The recordings on the medciation charts must be reviewed to ensure that staff record clearly the reason for someone refusing to take their medication. The manager stated she did plan to continue to make the care plans more person centred to involve the person`s individual needs and record more fully how they would like to be supported. The way that information is recorded about people`s social needs should be addressed to ensure people`s needs are met in full. The manager agreed that providing social activities was something that the service could improve upon. The outcomes for people using the service were good overall but recruitment needed to be reviewed so that people are safeguarded. A full audit of the staff files and the recruitment procedures must be carried out in order that people are protected. The manager needed to improve the recording of staff supervisions, appraisals and staff training to make sure these are carried out appropriately. The manager must ensure that she keeps us informed of any event within the home which affects the well being of people accommodated. Although the manager has stated this is due to be put forward, an application must be submitted to the Commission for the registration of the manager. Key inspection report Care homes for older people Name: Address: Oakwood Radcliffe Park Crescent Radcliffe Park Road Salford M6 7WQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Elizabeth Holt     Date: 2 3 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 29 Information about the care home Name of care home: Address: Oakwood Radcliffe Park Crescent Radcliffe Park Road Salford M6 7WQ 01617458119 01617458840 ann@raja.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr M.K. Raja care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Minimum staffing levels as specified in the notice issued in accordance with Section 25(3) of the Registered Homes Act 1894 on 20 May 1991 shall be maintained. One named service user is currently accommodated who is under 65 years of age. When this person leaves or reaches the age of 65, the category will revert to OP for people over 65 years of age. The service must employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief description of the care home Oakwood Hall Nursing Home is a care home providing nursing care for up to 30 older people. Oakwood is a large Victorian house situated in its own grounds at the end of a cul-desac within a quiet residential area of Salford. The home is close to Hope Hospital. Care Homes for Older People Page 4 of 29 Over 65 29 0 0 1 Brief description of the care home The accommodation is offered in a combination of double and single rooms over two floors. There is currently a programme in place to reduce the number of double bedrooms. The dining room is situated in the basement. A passenger lift allows access to all floors. The home is close to local facilities and it is close to the Motorways. There is adequate car parking space at the home. The weekly fees for accommodation and care at the home range from 380 pounds up to 500 pounds. Extra charges are made for hairdressing, chiropody, personal toiletries and magazines. People who are considering using the service can obtain information from the Service Users Guide, which tells people what they can expect from the service. Care Homes for Older People Page 5 of 29 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: This key unannounced inspection included a site visit. The manager and the staff at the home did not know that the visit was going to take place. The inspection was an opportunity to look at all the core standards of the National Minimum Standards (NMS) and was made to make a judgement on the quality of the service provided by the home. Prior to the inspection the provider completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment and a dataset that is filled in once a year. It is one of the main ways the Care Quality Commission obtains information from providers about how they are meeting outcomes for people using their service. The manager was advised to read the guidance so that she can provide more specific information about what they could do better, and their evidence to show what they do well. The Commission sent out surveys to people who use the service and staff so they could tell us what they thought about the service. A total of eight pepople who use the service and five staff returned their surveys. Comments from these surveys are used in Care Homes for Older People Page 6 of 29 the report where possible. The visits took place over the course of nine hours on Tuesday 21st July 2009 and Thursday 23rd July 2009. During the course of the visits time was spent sitting and chatting with people who use the service, the staff including the manager and visitors to the home. Records were looked at in relation to the running of the home and health and safety and a partial tour of the premises was made. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: There were some improvements seen in the systems in place to manage medication although some further improvements could be made. The manager needs to make more checks to make sure that medication is being appropriately managed. The recordings on the medciation charts must be reviewed to ensure that staff record clearly the reason for someone refusing to take their medication. The manager stated she did plan to continue to make the care plans more person centred to involve the persons individual needs and record more fully how they would like to be supported. Care Homes for Older People Page 8 of 29 The way that information is recorded about peoples social needs should be addressed to ensure peoples needs are met in full. The manager agreed that providing social activities was something that the service could improve upon. The outcomes for people using the service were good overall but recruitment needed to be reviewed so that people are safeguarded. A full audit of the staff files and the recruitment procedures must be carried out in order that people are protected. The manager needed to improve the recording of staff supervisions, appraisals and staff training to make sure these are carried out appropriately. The manager must ensure that she keeps us informed of any event within the home which affects the well being of people accommodated. Although the manager has stated this is due to be put forward, an application must be submitted to the Commission for the registration of the manager. 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 on page 4. 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 29 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 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information and have their needs assessed before moving into the home, so they know that their needs can be met. Evidence: People who use the service are given information about the home where possible before they move in. Copies of the homes recently updated service user guide and the statement of purpose were available in peoples bedrooms and in the entrance hallway of the home. Six of the eight people who returned surveys said they had received enough information about the home before they moved in so they could decide if it was the right place for them. Three pre admission assessments were looked at for people who had moved into Oakwood since the last inspection. The assessments were detailed and gave staff some initial information about the persons needs for them to develop the care plan from. One person said, Oh it was lovely of the manager to come and see me in the hospital before I came here and look at the pleasant room I have been given. Care Homes for Older People Page 11 of 29 Evidence: In the AQAA the manager stated that, We discuss at length what we can offer and actively encourage them to visit us as many times as they wish. The pre admission assessment will tell us that we as a home will be able to meet their needs fully. People who were admitted under care management arrangements had copies of the assessments held within their care plans. The home does not provide intermediate care. Care Homes for Older People Page 12 of 29 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. Peoples health and personal care needs were met in the way they preferred and their privacy and dignity was respected. Evidence: The care plans were looked at for three people. These gave details of the persons assessed needs for the staff to carry out the care identified in the way the person wanted. Care plans included a record of the progress of the person and their condition. There was evidence to show that where possible care plans had been drawn up with the involvement of the person themselves or their next of kin. Care plans included notes of visits from other professionals, for example one care plan had details of the advice from the podiatrist and another had information from the dietician. The care plans included risk assessments and evidence that peoples health needs were being monitored. Examples included risk assessments for nutrition, pressure monitoring and falls. The manager told us that three people had wounds, two of these were acquired before they came to live at Oakwood and action had been taken to address the cause of the other persons by ordering a new chair for them. Care plans showed the wounds were well managed and progressing well. Records included Care Homes for Older People Page 13 of 29 Evidence: information about the pressure relieving equipment in place. The eight people who filled in a survey said that they always received the care and support they needed, the staff always listen and acted on what they said, the staff always or usually was available when they need them and they always receive the medical support they need. One person added, They help me and care for me and they make me laugh. A discussion with the manager highlighted that she did plan to continue to make the care plans more person centred to involve the persons individual needs and record more fully how they would like to be supported. From observations made throughout the visit and from conversations with staff, relatives and people living at the home, they were treated with respect and dignity. During the visit one staff member was seen encouraging a person to carry out some hand exercises following a stroke which this person said, This will help me to keep my hand going. A sample of medication administration charts were looked at. We found that most records about medicine administration were clear and most medicines could be accounted for although some shortfalls were noted. The medication policy was dated August 2005 however the self assessment showed this had been reviewed. A recommendation was made for the manager to record the date that policies have been updated on the form themselves. We were unable to carry out a full audit of medications because some were in bottles and others were in blister packs. These two systems made it difficult to track medication and show that it had been given properly. For one person there were three tablets which had not been administered and the record did not show clearly why these had not been given. Staff must record clearly the reason why a person does not take thier prescribed medication. The manager was confident she would address these shortfalls immediately. A recommendation was made to hold an up to date copy of the British National Formulary (BNF) in the office so that staff can access up to date information about any medication. The manager needs to set up a robust system to check and audit medications regulalry so that she can monitor medicines management. An infection control audit had recently been carried out and recommendations had been which the manager was addressing. Care Homes for Older People Page 14 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social, cultural and recreational activities generally meet the expectations of people living at the home. Evidence: From the sample of care plans looked at some had information about peoples social history while for others there was little information about their past employment, family and social background. In the AQAA the manager stated that, We feel we could improve the transition for the prospective service user by finding out more life history information prior to admission. The manager agreed there were some gaps in information about peoples social needs that could be addressed. At the time of the visit the role of the activities organiser was being covered by the care staff as a short term arrangement. A plan of activities was in place however the staff stated how people do vary in their wishes and capacity to be involved in the activities. Some of the activities recorded included singing, arts and crafts, bingo and quizzes. Of the eight people who completed a survey, five people said there are always activities they could take part in if they wanted and three people said, sometimes. In the AQAA the manager said that providing social activities was something that the service could improve upon. During the visit staff were seen sitting and chatting with people on a one to one basis and clearly knew the people well. Visitors were seen to call Care Homes for Older People Page 15 of 29 Evidence: throughout the day. People spoken to said they had enjoyed entertainment recently with another local home and they were looking forward to a social evening on the night of this visit. The home had an open visiting policy and relatives spoken to were very positive about the way they were encouraged to visit the home, one person said, I come anytime I fancy and have never once been made to feel uncomfortable. The staff are very welcoming. We saw there was a choice of meal at lunchtime. The menu is varied and nutritious. The staff clearly knew the likes and dislikes of the individual people and were seen to support those that needed assistance during mealtimes in a sensitive way. Seven out of eight people who returned surveys stated that they, Always liked the meals at the home. One person said, The food is good here, they give me generally what I enjoy. The manager stated that following the recommendation made at the last visit to encourage people to make use of the dining room, the staff did try to do this however people preferred generally to eat in the lounge areas or in their own bedrooms. Care Homes for Older People Page 16 of 29 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 were confident that the manager and staff would listen to their concerns and some staff had received training in the protection of vulnerable adults to ensure people were safeguarded from abuse. Evidence: The complaints procedure was available on display and information on how to make a complaint was included in the Service User Guide to the home. Responses in the surveys showed that all eight people who returned them knew how to make a complaint about the service and stated there was someone they felt they could speak to informally if they were not happy. One person living at the home stated they would, Talk to Sue the manager or one of the staff if I was worried about anything, they are easy enough to talk to. Visitors spoken to during the visit stated they would have no hesitation in bringing any concerns to the manager and they felt confident their concerns would be listened to and acted upon. The records showed there have been no formal complaints received by the service since the last visit by the Commission. We saw that some staff had attended training Safeguarding Vulnerable Adults. Four staff spoken to during the visit were aware of the course of action they would take in the event of an allegation of abuse and a recording system was in place for staff to sign they had read the the homes policy and the local procedures. A recommendation was made for the programme of safeguarding training to be carried out for all staff at the home and for this to be clearly recorded on the training matrix. (See staffing). Since the last key inspection one referral has been made to Salford Councils Care Homes for Older People Page 17 of 29 Evidence: safeguarding team in relation to an allegation of poor handling. This was not upheld and the home followed their own internal disciplinary procedures. Care Homes for Older People Page 18 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefited from a warm, clean, safe environment which had an ongoing programme of improvement. Evidence: In the AQAA the manager stated that the home is well maintained, safe, warm and pleasing to the eye. The manager stated in the AQAA that they are in the process of losing the three remaining double occupancy rooms in favour of single bedrooms. Rooms have been redecorated and most have been personalised by families. This commitment to improving the environment for people living at the home was seen during this visit. One person said, I didnt really want to give up my own home but this room is so lovely that I wouldnt want to complain. A recommendation made at the last inspection to ensure the temperature of the home is run at an ambient temperature had been addressed as the home felt comfortable. One person stated that, It feels just right here, I am never too hot or too cold. Some of the carpets had been replaced since the last inspection and the manager had advised that further carpets on the corridors had been replaced since this visit from the Commission. Seven out of eight people who replied in surveys stated that the home was Always fresh and clean. A partial tour of the premises showed that the ground floor lounge was in need of redecoration and some of the bathrooms are in need of updating. A discussion was held in relation to the ground floor bathroom where there was no handwashing sink, Care Homes for Older People Page 19 of 29 Evidence: the hoist was unclean and the light pull cord needed replacing. A discussion with the manager highlighted that a full audit of the environment should be carried out to ensure that people live in a safe, comfortable, well maintained environment. A programme of maintenance is kept and the maintenance man was following a programme to improve the environment. The manager stated that plans were in place to redecorate bedrooms and corridors that had not been updated and the AQAA confirmed there were plans to make the environment for people who lived at Oakwood better. Care Homes for Older People Page 20 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from support provided by experienced and committed staff whom they trust. Some areas of staff recruitment procedures are not robust enough to protect people which was recognised by the manager. Evidence: On the day of the visit there were ten people accommodated on the first floor and ten people on the ground floor in receipt of nursing care. The staff on duty clearly knew the care needs of the people needing support well and there were enough staff to support the needs of the people accommodated. Two people spoken to said they did not have to wait long when they needed attention and one person added, The staff come to me quite quickly when I buzz for attention, they never leave me any length of time. In the surveys, all eight people who returned them said the staff always or usuallyare available when you need them and they listened and acted on what we said. Staff were observed encouraging and coaxing people in a supportive way to carry out tasks for themselves to promote their independence. We assessed the recruitment practices of the home by looking at the staff files for four people. Criminal Records Bureau (CRB) checks were being carried out for each staff member. A recommendation was made for the manager to record details of interview notes, including discussions held with prospective employees to highlight any information disclosed by them during interview. There were some shortfalls noted in Care Homes for Older People Page 21 of 29 Evidence: staff recruitment practices. The sample of files looked at did not include photographs, there were not two written references on files for the three people looked at. For one person there were no notes to show that the employment gap for a number of years had been explored at interview. A recommendation was made that if requests for references have been chased, copies of the letters sent should be held on the persons file. For another person the health decalration and immunistaion history was not recorded. The information in the staff files was not found to be well organised and a recommendation was made to index these and make them more organised. The manager stated they had been through a difficult period in relation to record keeping following the loss of the administrator whose role has since been replaced by another person. Staff at the home do follow an induction and the records for the homes own programme were not always well completed. A discussion with the manager highlighted that the staff do follow the Skills for Care induction which she stated allows her to feel confident that all areas for initial training have been covered. We discussed the need to have an up to date training matrix to show clearly the staff training that has been carried out and when training is due. We looked at the records for fire safety training. The records showed the manager had not received fire training since 4/9/07 and there was no record to show she had done an update since. The manager stated she had done this however the records were not accessible at this visit due to some problems with the computer which was being addressed. One staff member stated she had recently attended dementia care training and since the last inspection two staff had become trainers in Moving and Handling. The home employed 19 care workers with 14 members of staff who have successfully completed National Vocational Qualifications level 2, 3 or 4 in care or health and social Care. From discussions with staff members and from observations made during the visit, the staff were meeting the needs of people living at the home. One staff member said, I enjoy the training because it supports me to be better at my job. In the AQAA the manager stated that some training courses had been cancelled due to unforseen circumstances and these were in the process of being rescheduled. We discussed staff supervisions, although some staff spoken to felt they did receive this and the manager stated there is a system in place for staff supervisions, there were no records available at the time of this inspection to support this. Comments from people who use the service, responses in the surveys and letters of thanks showed they were happy with the way staff supported them. One persons relative said, The staff are great here, they look after my Mum really well, she never complains to me. One of the cards stated, You are all caring and considerate people Care Homes for Older People Page 22 of 29 Evidence: and I thank you from the bottom of my heart. Thank you for all your care and kindness shown to our mother. Whilst another person wrote, My father and I really do appreciate all that you have done to make my mother feel so welcome. In the AQAA, the manager said that the plans for improvement in the next twelve months were, Fire Safety training for all staff and to improve the staff training records. The senior care worker who was taking a lead in some of the staff training and the manager said they were committed to improving the staff training and staff recruitment records. Care Homes for Older People Page 23 of 29 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 and their relatives were confident the manager ran the home in the best interests of the people who live there and she was aware of areas that can improve the services provided to promote their health, safety and welfare. Evidence: The home continues to be run by the same manager who has worked at Oakwood now for four years. She has not yet registered with the Commission but plans to submit her completed application forms within the next few weeks. During the visits the manager showed insight into improving the service for people living at Oakwood. The office manager and the training co-ordinator are working alongside the manager to provide some support. Discussions with the manager highlighted that she did recognise the following areas where shortfalls were identified. The auditing of medication practices, recruitment, staff training and staff supervision and she was keen to improve these. As raised in the last inspection report the manager needs to audit the medication system to make sure the staff are following the policies and procedures inplace. It was clear the manager creates an open and positive Care Homes for Older People Page 24 of 29 Evidence: atmosphere within the home and that staff, people who use the service and relatives find her approachable. Staff and visitors to the home confirmed the manager did make herself available to speak to them to discuss any issues. In the AQAA the manager stated that the changes in the administrative support over the last twelve months had contributed to the above areas not being addressed as fully as they should be. She did state, that now the new administrator was more familiar with her role that this enabled her to spend more time monitoring and assessing the staff and the care procedures at the home. The home has a system in place to obtain the views of people who live at the home, relatives and visiting professionals. Responses from these are used to identify improvements for people who live at Oakwood. In the AQAA the manager said that, We are hoping to set up a relatives group, we have recently spoken to some of our new service users families who seem very interested. This should be considered as a way to include peoples views in future plans. Some of the services maintenance records and fire safety records were looked at. Fire safety checks were up to date and a fire risk assessment was in place to protect people from the risk of fire. A record was available of a recent fire drill with a list of staff who had attended this. Maintenance records were up to date for the passenger lift and the call bell system, water temperature checks were carried out on a regular basis. Accidents and incidents that occurred in the home were recorded appropriately and the manager was auditing and monitoring these to check if there were any patterns and to minimise the risk of any further incidents. The manager must make sure that the Commission are notified of accidents, incidents in the home which affect the well being of the people accommodated. The manager and the administrator talked about the arrangements for the management of money belonging to people who use the service. They explained that if people needed toiletries for example buying for them, the family or person themselves would give the manager some money and then the purchase could be made on their behalf. In the statement of purpose a comment is made that a charge is made for toiletries. Where possible people manage their own money, six peoples monies are paid directly from the Local Authority. For some peoples accounts looked at, there were outstanding balances. The administrator explained that she was not always given sufficient information from head office for her to be able to close the transaction down on her spread sheet. A recommendation was made for this information to be forwarded from head office so the records could be updated and for the persons money to be held in interest bearing accounts. Care Homes for Older People Page 25 of 29 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 26 of 29 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 29 19 The manager must ensure 30/10/2009 that a full audit of all staff files be carried out to ensure these include the requirements made in the Care Homes regulations 2001. This must include a detailed employment history, gaps discussed and appropriate written references. This is necessary to make sure that people who use the service are supported by staff who are appropriately screened before they are employed to protect the people accommodated. 2 38 37 The manager must ensure 10/08/2009 the Commission are informed of any event within the home which affects the well being of people accommodated. Care Homes for Older People Page 27 of 29 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 So we can make a decision that peoples health, safety and well being are being managed appropriately. 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 9 It is recommended that the date that policies have been updated is recorded on the form themselves to show the date when this has been reviewed. It is recommended that all records about medicines are clear and accurate to make sure that all medicines can be accounted for and show clearly that people are given medicines as prescribed. It is recommended the manager finds out more information about peoples social needs and records this in the care plan to ensure peoles needs are met in full. It is recommended that the programme of redecoration and refurbishment is continued to make the environment pleasant for the people who live at Oakwood. A recommendation was made that if requests for references have been chased, copies of the letters sent should be held on the persons file. The staff files should be organised so that information is readily available. A recommendation was made for peoples financial information to be forwarded from head office so the records could be updated to close any records down and for the persons money to be held in interest bearing accounts. A recommendation was made for an appropriate recording system to be put in place for formal staff supervisions. 2 9 3 12 4 26 5 29 6 35 7 36 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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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