Care Home: Oakwood Rest Home

What the care home does well Good information is collected about people`s care needs before they are admitted and this information is added to in the first few days. This information helps staff provide the right care for people. Medication is given as prescribed and there are good records in place, this helps to keep people well. Interactions between staff and people living in the home were seen to be good with staff intervening when any risky behaviour was observed. One person told us `my mum looks after me` and pointed to a member of staff. Another gave us the thumbs up sign. There are pets in the home so people have the ability to be involved with the care of a cat, a budgie or fish. People were dressed in the type of clothes that they wanted. Women had make up and jewellery on and had their fingernails painted if they wanted this helps them to preserve their self image. People have a choice of food available at meal times. Meals are well prepared and tasty. People are given other foods if this is more manageable for them. The home has an excellent rating for food hygiene. The home`s Annual Quality Assurance Assessment indicates that most staff have achieved a National Vocational Qualification level 2 in care which is the recognised qualification for care workers. There is a survey undertaken of relatives` and professionals` views of the service the home gives. We looked through the comments received and these were: `I`m very happy my father is always clean and tidy.` `We are very pleased, I nothing to fear because we know ( my relative) will be well looked after by staff who really care.` `Nothing is too much trouble I even have a meal.` `I enjoy my visits to Oakwood I feel at ease in the environment and it is welcoming and friendly.` `Very happy with the home they provide good care to my patients.` `Very good home.` The appropriate maintenance, servicing and inspection of electrical, gas, fire safety and lifting equipment has been undertaken. What has improved since the last inspection? The dining area has new flooring and the dining chairs have been recovered. The home`s AQAA indicated that they have increased the number of visits from the Dance/ exercise therapist. There is now a fulltime maintenance person on site and this helps to ensure that repairs can be completed quickly. What the care home could do better: People do not generally visit the home before they are admitted. It is useful to do this as it is an opportunity to see how the person copes in the building and with other people with dementia. Care plans and risk management plans needed to improve so information is available to staff about how to provide individual care to the person. There was not enough information on moving and handling, mental health, people that have care in their room, behaviour and activity plans. This can mean people are put at risk. Risk management plans were not reviewed in detail. There was not enough attention to how the home can work with people with dementia. The activities for example were not related to people`s past histories and interests. People that walk did not have enough activity to engage them and some items of interest such as soft toys were out of reach. Chairs tended to be set out around the outside of the wall preventing interactions between people. Risks were not clearly identified for example to people and from people that walk around the home at night, cluttered spaces and so on. Whilst complaints are logged not all the information is kept with the complaint record. Small concerns, dissatisfactions and compliments were not be recorded and this valuable information so the home can improve. Ways of getting people`s views about the service need to be explored. We have been told that the home has put a comment book in reception for visitors to the home to express their views since the inspection. Daily reports of people`s well being were poorly completed. The records of incidents between people living in the home and incidents where unexplained bruising to people had occurred were muddled adn therefore unclear. These incidents were not referred as required to other agencies under safeguarding procedures. These failures called into question the home`s procedures, training and management of safeguarding. Key inspection report Care homes for older people Name: Address: Oakwood Rest Home 78/82 Kingsbury Road Erdington Birmingham B24 8QJ     The quality rating for this care home is:   one star adequate 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: Jill Brown     Date: 2 5 0 2 2 0 1 0 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 32 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 32 Information about the care home Name of care home: Address: Oakwood Rest Home 78/82 Kingsbury Road Erdington Birmingham B24 8QJ 01213738476 01213829167 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Unityone Ltd care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 30. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia DE 30 Date of last inspection Brief description of the care home Oakwood Rest Home is a Residential Care Home providing residential care for up to thirty people with dementia. The home is situated on the Kingsbury Road, close to bus routes to Sutton Coldfield and Birmingham. It is a short bus journey from the shopping centre of Erdington, where there is a range of local facilities. Oakwood Rest Home was originally three adjoining properties, and provides accommodation on 3 floors, accessible by a shaft lift. The accommodation comprises of twenty single bedrooms, fourteen with en suite facilities and five double rooms, all with en suite. There are 2 lounges, and a dining room that is situated off the large main lounge. Bathing and toilet facilities are situated on all floors of the home. There is a car park at the front of the building, and at the rear, there is a large enclosed garden. The fees at the home are dependent on the type of room, there is a top up fee payable. Care Homes for Older People Page 4 of 32 30 Over 65 0 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: one star adequate 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: We visited the home unannounced on a day in February 2010. We completed a key inspection which means we inspected the homes performance against the key National Minimum Standards. The last key inspection resulting in a report took place in May 2007. The home gave us information in an Annual Quality Assurance Assessment before the inspection. The AQAA shows how the home rates their performance in the areas set out in this report and what improvements to the service they intend to make. During the inspection we looked at two peoples care records fully. This means we looked at all the homes records about the person, their medication, any money held on their behalf and their bedrooms. We also looked at another 5 peoples care records in part. Care Homes for Older People Page 5 of 32 We spoke to six people living in the home and one relative. We also spent time in a communal area observing day to day practice of the home as this home is registered for people with dementia and some people cannot verbally communicate with us. We looked in a number of bedrooms, the communal areas and the laundry. In addition to peoples records we looked at records about the up keep of the building, complaints accidents and so on. We sent out surveys to the home to give to people and staff but received no responses. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 7 of 32 People do not generally visit the home before they are admitted. It is useful to do this as it is an opportunity to see how the person copes in the building and with other people with dementia. Care plans and risk management plans needed to improve so information is available to staff about how to provide individual care to the person. There was not enough information on moving and handling, mental health, people that have care in their room, behaviour and activity plans. This can mean people are put at risk. Risk management plans were not reviewed in detail. There was not enough attention to how the home can work with people with dementia. The activities for example were not related to peoples past histories and interests. People that walk did not have enough activity to engage them and some items of interest such as soft toys were out of reach. Chairs tended to be set out around the outside of the wall preventing interactions between people. Risks were not clearly identified for example to people and from people that walk around the home at night, cluttered spaces and so on. Whilst complaints are logged not all the information is kept with the complaint record. Small concerns, dissatisfactions and compliments were not be recorded and this valuable information so the home can improve. Ways of getting peoples views about the service need to be explored. We have been told that the home has put a comment book in reception for visitors to the home to express their views since the inspection. Daily reports of peoples well being were poorly completed. The records of incidents between people living in the home and incidents where unexplained bruising to people had occurred were muddled adn therefore unclear. These incidents were not referred as required to other agencies under safeguarding procedures. These failures called into question the homes procedures, training and management of safeguarding. 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 8 of 32 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 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to people and their representatives before they are admitted and this helps them decide if the home will suit them. People can be assured that enough information is collected about them to ensure that care can be given well. Evidence: We looked at the information collected for 2 people before they were admitted to the home. Information is collected about the person when they are visited by one of the management team and information is also received from social workers from the local authorities funding their stay. The information collected before people stay includes an assessment of how they manage daily living activities such as washing, dressing and eating. It includes some assessment of their understanding, their physical abilities and medical needs. However Care Homes for Older People Page 10 of 32 Evidence: it does not include peoples likes and dislikes, preferred lifestyle and history; this information is completed after they have been in the home a few days when a personal profile is completed. The records did not show that the latest two people had dementia and this is what the home is registered for or how the home planned to meet their needs. People do not often visit the home before coming to stay. This means the home loses an opportunity to assess how the person manages in the environment and interacts with other people with dementia. This information enables a decision whether the home can manage the persons care and identify any risks that need to be minimised. The homes Annual Quality Assurance Assessment (AQAA) stated that there is a Statement of Purpose and Service User guides available and that these are also available in large print, bold print and audio formats if needed. Our inspection in May 2007 found this to be case we did not look at these documents on this inspection. Care Homes for Older People Page 11 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The planning of peoples care and risk management is not good enough to always ensure peoples safety and wellbeing. People are helped to gain healthcare and have their medication administered well and this helps to keep people healthy. People are generally treated kindly and with respect and this helps their well being. Evidence: We looked at two peoples care records in full and looked at another five peoples records in part. We observed peoples well being, their interaction with each other and staff as we sat in the lounge looking at these records. We found that care plans covered almost all areas but that some of the plans were about what the service aims to do rather than how to care for the person. The individualised planning of care got lost in this other information. We were told that when staff wanted the up to date information on a person they would look in the Care Homes for Older People Page 12 of 32 Evidence: handover book rather than in the care plan which suggests that this is not the working tool it needs to be. We looked at personal care people needed and found that the difficulties people had washing and dressing were explained, as well as what they liked to wear and whether they could make a choice. It was good to see that information that reaffirmed the persons gender identity, view of self and individual choice such as likes to wear make up and jewellery, prefers trousers and jumpers. When we checked the person was dressed in this way on the day of the inspection. We found a plan that had been up dated to say that a person needed their food cut up but this was not dated, dating records helps to confirm when peoples needs change. We found that people that have care in their rooms did not have sufficient plans in place and monitoring tools to ensure they have regular checks. Although one person had monitoring tools in respect of their food and drink intake which were completed. Another person had behaviour associated with eating and there were not enough measures in place to manage this effectively. There were significant gaps in risk management plans. For example although move and handling risk assessments were completed these did not result in a safe system of work to explain to staff how a person was to be moved from place to place. Although we observed good moving techniques from staff these need to written to support new or agency staff. We looked at the risk management plans for a person with a mental health condition that resulted in them being aggressive or expressing suicidal thoughts. We found that these plans did not indicate what staff were to do if the person became aggressive or suicidal. The review of the risks were signed but did not indicate if there have been any issues since the last review or if the measures in place are working. People had appointments made to see health professionals shortly after admission to the home such as GPs, dentists, opticians and so on and this ensures that peoples health can be assessed. We found where issues were of concern such as peoples weight, increase in aggression, refusals to be assisted with personal care or mental health concerns appointments with health professionals were made and or discussions had with family members. However we also found that daily records were poorly completed and it was sometimes difficult to see the reasons for these referrals. The home had information recorded separately to be sent with people if they went to hospital. The information contained important details of the persons health conditions Care Homes for Older People Page 13 of 32 Evidence: and gave the hospital contact details of the home. The medication administration was administered well and this helps to keep people well. Medication was stored securely in a locked medication room. Copies of the current prescription were kept and this helps to ensure that the medication dispensed from the chemist is as prescribed. In front of the medication administration records (MAR) there was a photograph of the person and this is an extra check to ensure the right medication is given to the right person. Information was also kept on any allergies the person may have and a copy of an agreement from the GP for suitable homely remedies such as pain relief. This checks that homely medications can be safely given if not prescribed. The amount of medication found in the home tallied with the MAR of medication received and given out. We did not find any stockpiled medications. One person had some medicines available in their room and was assisted by a relative with these. There were inadequate safeguards for this. Staff were observed to treat people appropriately and well. Most staff spoken to had had some training in dementia care the staff training matrix confirmed this. We observed a member of staff manage a persons shouting out behaviour intervening before this caused undue annoyance to other people in the lounge. Another person had gained an object that may be harmful to them and a member of staff traded this for another item that the person needed. A member of staff intervened when a person got upset by another person putting a mug in an unsafe place. Showing the mug to the person saying its ok Ive got it now, its safe. We spoke to a number of people about the care they received. One gave us a thumbs up sign. Another said my mum looks after me and pointed to a member of staff. Another said the care was good. People were generally dressed appropriately, women had their fingernails attended to and painted where they wanted. Some mens nails were long and not well kept. One person was irritated by the state of his nails and showed us how uneven one of his nails was. Care Homes for Older People Page 14 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities for people in the home were not varied enough and did not reflect their past experiences and interests. This may mean that they are not meaningful to them. The arrangements for visitors and for meals were good and these aspects enhance peoples lives. Evidence: The homes AQAA told us that the priest visits once a week and the service has an outside entertainer that visits once a week to do a singing and dance session. We observed during the day the activities and interactions between staff and people living in the home. We observed games of bingo involving six people in the morning. We were told by one person they have jigsaws and Bingo and that there was evidence of a large snakes and ladders game. One relative told us they had been there were the entertainer had been present. The home has televisions and music centres available. On day of the inspection a television and a music centre was on in the same area which can be confusing. There were soft toys in the area but these were on top of a cupboard. The records of peoples involvement in activities are in the daily reports and these were poorly completed. The environment is not set up for people to find things to do easily. Care Homes for Older People Page 15 of 32 Evidence: Peoples care plans indicate what their interests were latterly but there are no life history books or records that may give information about what has interested people in their early life so that can provide activities that are meaningful to them. This is important for people with dementia. There are pets within the home. One person talked to us about the cat and another spoke about the fish tanks both were happy that these animals were within the home. We sent surveys to the home but have received no replies. We spoke to a relative who was at the home that day and they told us that staff are kind, helpful and spoke of the efforts made to try and reverse the day time sleep pattern their relative had. Some people sat for long periods of time, others moved about. Generally, there was no attempt to stop people moving around if they wished. This is good as this assists people with sleeping at night, helps bodily functions and prevents pressure areas. People were given breakfast as they came downstairs to the lounge in the morning. Others had meals in the room. People were offered a choice of food at all times. Drinks were available in the lounges and people were offered drinks. One person said of the breakfast best Ive ever known. We sampled the lunch choices for people which were either roast chicken drumsticks or cottage pie with green beans and roast potatoes. We found the meal was well cooked with all food provided easy to chew. The food was tasty with the cook using herbs and spices to flavour food so that the salt content could be reduced. There was apple pie and custard for pudding. People seemed to enjoy the meal. One person observed had egg sandwiches instead. One persons medication records indicated that they had food supplements and these were given as prescribed. Another person was not eating meals and this had been raised with the GP. Care Homes for Older People Page 16 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be assured that the service has systems to measure dissatisfactions with the service and this makes it difficult to improve. People cannot be assured that systems are always robust enough to identify when they are at risk and to refer appropriately. Evidence: We have received no complaints about this service in the last year. The homes AQAA told us they had not had any complaints. We asked for the complaint log and found one complaint that had been received recently the full details were not kept with the complaint log and this could make it difficult to spot themes of dissatisfaction. The complaint procedure is displayed. Many people in the home would find it difficult to make a formal complaint and be involved in meetings because of their memory difficulties. More quality assessment audits need to be devised and ways of capturing peoples comments explored so the service can assess its performance. We looked at the homes accident, incident, handover and daily records and found that these records did not tally. Staff did not have a clear view of how these records were to be used. This in part led to issues of aggression between people living in the home and unexplained bruising not being referred to the appropriate agencies. We are aware that investigations into this are taking place. Care Homes for Older People Page 17 of 32 Evidence: There was one person on a recliner chair at the time of inspection. We looked at their care records there were no risk assessments or plans of care to support its use. In addition the chair had a table over one end making it impossible for the person to independently get off the chair and this is a restraint. The staff training matrix staff files and staff spoken indicated that staff receive the appropriate level of training however the service was not demonstrating that this training is being implemented. Care Homes for Older People Page 18 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the environment is clean and homely people cannot be assured that it always meets their specialist needs. Evidence: We looked around the home looking at the communal areas, bathrooms, the laundry and some of the bedrooms.There is a large enclosed lawned garden at the rear of the home that some people went out in during the inspection to smoke. There was some garden furniture available for people to sit on. We found that the home was generally clean and well presented. However there were some individual bedrooms where odours prevailed. There was evidence of maintenance work being carried out and we met the recently appointed maintenance operative. The manager stated they working at how the home could become more appropriate for people with dementia. The homes AQAA indicated that the dining room chairs had been upholstered and the dining room flooring had been changed. The home has areas for people to sit, a large lounge area with a smaller lounge area and dining area leading off it and a conservatory at the front of the building. We found the large lounge area had chairs around the walls. Many of the chairs had the same Care Homes for Older People Page 19 of 32 Evidence: seating height, although there was a settee. The small lounge was cluttered and people using the lounge were in danger of trips and falls. There was a small room that was labelled as a sensory room. The room was not large enough and didnt have sensory equipment so was not fit for that purpose. The conservatory was a pleasant room but out of the main area and not used independently by people living in the home. All bedroom doors were painted green and all bathroom doors were blue and this helps people with dementia know the purpose of each room. We were told that they were looking to change the colour of the corridors to assist peoples orientation around the building. There are two doors that have fastening bolts on. One door is situated leading from the small lounge to a corridor where bedrooms and toilets are situated. We were told by a person that they had been locked in the corridor because another person had secured the bolt. Although there was another route out of the corridor the bolt should be removed in order to make the area safe and prevent people feeling lost or isolated. The other bolt is on the laundry and a more appropriate fastening is required as the bolt will not prevent some people gaining access. The laundry has a lot of equipment and substances that may be a hazard to people living in the home. Off the main lounge there is a suite of toilets, although this means there is ready access to toilets it is not homely. There were no signs on the door to indicate if they are in use. Some of bathrooms were small which may prove difficult for people with mobility problems to access baths. Some bedrooms have low beds in relation to the height of the people accommodated in them and this may pose a risk for those people that independently walk. From conversations with staff, a relative and records we know that some people walk at night and the home is over three floors. There is no assistive technology to inform staff when people are up at night despite knowing this is a known risk for some people. The manager has told us since the inspection they have ordered equipment. The kitchen had recently been assessed by the health and Safety food safety department and received an excellent rating for cleanliness. Care Homes for Older People Page 20 of 32 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 living in the home can expect to have enough trained staff to assist them. However peoples safety is not always their first consideration. Evidence: During the inspection there were enough staff on duty to provide care to people. There were care staff, a cook, housekeepers, the maintenance operative and the manager on duty. As reported in the Health and personal care section generally incidents between people that may happen are deflected by staff. Staff told us that although busy at times there were enough staff. Observations showed that staff interacted well with people and the homes surveys indicated that relatives thought the staff were kind and helpful. The homes AQAA told us that 90 percent have staff have a National Vocational Qualification level 2 in care or above. This is the recognised training that care staff need to undertake and this is above the required standard of 50 We looked at the recruitment records of 2 new members of staff and found that people had the appropriate checks needed before they were employed. We asked the manager to check the documentation on one person as this was slightly different format than we had previously seen. Care Homes for Older People Page 21 of 32 Evidence: We were provided with a training matrix, we looked at staff files and we talked to three staff about training. We found training certificates on staff files, the matrix showed that training was undertaken there were some gaps but training was seen as ongoing by staff and part of the job. We had concerns that staff did not understand the reporting requirements of unexplained bruising and aggressive incidents between people living in the home. ( Please see Complaints and Protection.) Care Homes for Older People Page 22 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although home tries to run in the best interests of people, the lack of good systems and recording have meant there have been shortfalls in the service for some people. Evidence: The registered manager has worked in the home for a number of years and undertaken the Registered Managers Award training the recognised qualification for managers of care services. Although not on the training matrix we were told that she had undertaken Mental Capacity training in January 2010 indicating that her own training is continuing. People living in the home went up to the manager during the inspection one said Good to see you back. One person went up to the manager and gave her a hug. This showed that people look at the manager in a positive light. When we told the manager of our concerns she was very receptive and gave a commitment to put matters right. She has since contacted us about some of these matters leting us know what the action is being taken. We note that the home has only a dementia registration so all new admissions must have dementia to remain Care Homes for Older People Page 23 of 32 Evidence: within their registration or they must apply to vary their registration. There is a quality assurance system based on contact with relatives and professionals involved in peoples care. This had yet to be completed and analysed. We recorded the comments the home already received. Im very happy, my father is always clean and tidy. We are very pleased that I nothing to fear because we know ( my relative) will be well looked after by staff who really care. Nothing is too much trouble I even have a meal. I enjoy my visits to Oakwood I feel at ease in the environment and it is welcoming and friendly. Very happy with the home they provide good care to my patients. Very good home. There has been a resident and relative meeting in September 2009 but the home found that people living in the home found it difficult to communicate their views in this way. Other systems need to be looked at to try and gain peoples views. We looked at a sample of money that was held on behalf of people living in the home. The home does not hold money individually for people in the home but holds a portion of that money and puts the rest in a bank account. When a person needs money it is taken out of the portion held in the home. The records then show the amount spent, the receipt for the spending and what the person has left. In this system it is not possible for us to sample fully a single persons account. Receipts were kept for any service or goods that the home purchased on behalf of people. The bank account statements were not kept on site and so it was not possible for us to check if all of the money held matched the records kept. The manager was unable to tell us if the bank account was interest bearing and if so how was this given to people. The home was acting as agent for two people and we did not think that there were enough safeguards in place to protect the person and the home. We asked them to contact social services to ensure that a better system was in place. We have had contact from a social worker and know this has been done in one case. There were no people living in the home that were subject to a deprivation of liberty authorisation at the time of the inspection. The home has yet to revisit their admission procedure to ensure that they have considered peoples rights in relation to the Mental Capacity Act. This is to ensure that people that do not have the ability to make decisions have appropriate safeguards put in place. We looked at a number of health and safety records for gas, fire, water and lifting equipment safety and found that these services were maintained and inspected as Care Homes for Older People Page 24 of 32 Evidence: required. Care Homes for Older People Page 25 of 32 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 32 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 4 14 People must not be admitted 31/03/2010 outside the homes category of registration. This is to ensure that the home effectively manage peoples needs. 2 7 15 (1),12 (1)(a) Where people have a diagnosed mental or physical health condition a plan of care should be in place. Remedial action must be taken to ensure this. This is to ensure that people get the care they need and so staff are aware of the persons difficulties. 30/04/2010 3 8 15 (2) 12(1)(a) Reviews of care 15/04/2010 and risk management plans should be robust enough to show any changes in peoples condition and action taken. Care Homes for Older People Page 27 of 32 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 This is to ensure that the care people receive changes as their need changes. 4 8 13 (4)(c) 12 (1)(a) Where risks have been identified to a person due to behaviour, food intake, moving and handling and so on. A risk management plan must be in place. This is to ensure that risks to the person and other people are minimised. 5 18 13 (6)The home must ensure that staff understand and are competent following training. This is to ensure that issues of concern are referred appropriately. 6 18 13 (7) People must be assessed 31/03/2010 before the use of reclining chairs. This is to ensure that they can get out of them. Or that they are only being used in a therapeutic manner and that they are not being unduly restrained. 7 18 12 (1)(a) 13(6) You must ensure that when bruising is found that this is linked to the cause. Or where this is 31/03/2010 31/03/2010 31/03/2010 Care Homes for Older People Page 28 of 32 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 not possible refer to the appropriate agencies. This is to ensure that measures can be taken to reduce the reduce the risk of recurrence and where necessary safeguard the person. 8 18 17 (1)(2) Schedule 3(3)(j)(o) 31/03/2010 Schedule 4 (16) You must ensure that there are clear policies, procedures and systems in place when there are accidents and incidents. This is to ensure that concerns raised from accidents or incidents can be appropriately acted upon. 9 19 13 4(a) Communal areas must have clear walkways. This is to ensure that people are not in danger of slips, trips and falls. 10 22 23 (2)(n) 13(4)(a)Assessments must be completed for the aids and adaptations people need and arrangements made for their provision. This is to ensure that the people living in the home have the help and support they need to ensure their safety and comfort. 21/05/2010 31/03/2010 Care Homes for Older People Page 29 of 32 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 11 37 17 (1)(2)Measures must be put in place to improve the record keeping in the home. This is to ensure that the service people receive is monitored and that changes in need or condition can be acted upon 16/04/2010 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 5 People should visit the home before admission so the home can determine how the person manages within the envionment and with other people living in the home. Appropriate levels of records should be kept to evidence that people are reeiving the care as planned. Where peoples relatives are involved in the application of medicinal creams or homely medications a risk assessment and monitoring tools must be in place. Information about peoples life histories and interests needs to be collected and collated so that a personal activity plan can be devised. This is to enable people to have some occupation that is relevant to them. The home should develop ways of collecting peoples comments and views of the service in a routine way to improve their service. There should be a review of bolts used in the home to ensure that people cannot feel locked in or have access to areas that are unsafe. Consideration needs to be given to how communal areas should be organised to ensure that people have quiet areas and areas of interest and activity. Investigations must be made and measures taken to Page 30 of 32 2 3 8 9 4 12 5 16 6 19 7 22 8 26 Care Homes for Older People 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 irradicate odours found in some bedrooms. 9 35 Systems of assisting people with their money should be reviewed if this includes holding a bank card and a pin number. The admission policy must be reviewed to include considerations of the Mental Capacity Act. 10 37 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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