Care Home: Oban House (42-46)

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What the care home does well What has improved since the last inspection? In October 2007 we issued 13 requirements and made no recommendations and so on this occasion the manager told us how these matters had been addressed. For example, we asked that care planning to be improved and we found on this occasion that care planning was well organised. We asked that bedroom doors have suitable locks fitted and this is underway; many doors now have a false letter box and door knocker as well as being painted different colours so as to give the impression of individual `front doors`. End of life care, including control of pain, is now incorporated into the care planning. We asked that carers respond promptly to the `nurse-call` system and in checking the automated records we see that most calls are being answered within two minutes. We also required that staff receive training in `customer care` so as to improve their attitude towards residents and on this occasion the expert by experience found, "Staff appear to be very caring" and as an example of residents` comments to her one said, "I am very happy here, it`s like being part of a family". In respect of diversity, the home provides care for residents from a range of backgrounds, although residents are mostly British. The home employs staff also from a range of backgrounds, although by checking the home`s own Annual Quality Assessment form (the AQAA) it appears few staff share the same ethnic background as the residents. There are number of male staff working in the home in order to be able to provide choice about gender. We were told that the home can, and does provided care for residents of various sexual orientations and of course the home is well adapted to cater for residents with physical disabilities. We are also advised that Oban has equipment such as a `loop system` to cater for those with hearing difficulties. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Oban House (42-46) Oban House 42-46 Bramley Hill South Croydon Surrey CR2 6NS Lead Inspector Michael Williams Key Unannounced Inspection 24th July 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oban House (42-46) Address Oban House 42-46 Bramley Hill South Croydon Surrey CR2 6NS 020 8649 8866 020 8649 8811 oban.house@schealthcare.co.uk www.southerncrosshealthcare.co.uk Apta Healthcare (UK) Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Manager post vacant Care Home 61 Category(ies) of Dementia (23), Old age, not falling within any registration, with number other category (38) of places Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (Maximum number of places: 38) 2. Dementia - Code DE (Maximum number of places: 23) The maximum number of service users who can be accommodated is: 61 Date of last inspection Brief Description of the Service: Oban House was trading as APTA Healthcare UK Limited, a subsidiary of Ashbourne Healthcare Ltd., but is now owned and managed by Southern Cross, a large company with homes across the country. Oban has kept the company name Ashbourne and continues to be called ‘Oban House’. The acting manager, who is not registered with the Commission confirmed that the details on the certificate are correct as outlined here and that there have not been any changes in the ownership, management or service registration details in the last 12 months – other than the appointment of the manager himself. Oban is a modern, purpose built care home. It first opened in 1997 for older people who require nursing care. The home admits residents both privately funded and through placement agreements with the local authorities. The home is arranged over three floors. Each bedroom has an en-suite toilet and shower and there are toilets and bathrooms located on each floor. Each floor also has its own communal living room, kitchenette and dining room. There is a main kitchen in the basement of the building and a laundry service is provided for the residents. We are advised that the fees are from £500 to £750 in 2008. Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means the people who use this service experience good quality outcomes. This inspection took place in the summer of 2008. The lead inspector, Mr Williams was accompanied by an Inspector with a nursing back ground and by an ‘expert by experience’ who made direct observation of the care provided and sought the opinions of various people who use the service, plus visitors and staff. People who use this service are referred to as residents and so this the term we also use in this report. In addition to this inspection visit, which latest approximately seven hours, a number of questionnaires were distributed to interested parties including residents, visitors and staff. We received three written replies but the expert by experience received several more that she incorporated into her own report notes. In compiling this inspection report the CSCI also noted information received into the commission including details of complaints, untoward incidents and general correspondence. We also took account of the home’s own, internal annual audit, the AQAA (Annual Quality Assurance Assessment). We also toured the premises and check documentation, including records, case files and staff records. The acting manager, Mr Anura Kalubowila, returned from holiday leave to assist in this announced inspection and we acknowledge his enthusiasm and contribution to the inspection process. What the service does well: This is a modern, purpose built home and the residents very much appreciate the facilities, particularly the spacious bedrooms with ensuite toilet and shower. The décor is very pleasing if a little tired after ten years. The use of linen tablecloths and napkins and the multitude of artificial flowers demonstrate an effort to provide an attractive and homely environment. The home therefore gives a very good first impression. The documentation, such as the statement of purpose, the resident guide and the residents’ case files and care plans are very detailed and are intended to ensure residents and staff have the information they need and that staff know about the care needs of the residents. The expert by experience concluded that, “I would say that most of the residents I had spoken to enjoyed living in Oban House, the staff appeared very caring”. She told us that it was the fifth care home that she had visited in this role and that it compared very favourably. The second inspector also thought this a good home and reported that a resident told her, “I can’t think of anything that would make it any better here”. Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The residents themselves had some suggestions, such as, “Air conditioning would be good” – reminding us this was one of the few very hot days in July 2008. One resident would like to have more of his own furniture in his room. The expert by experience found staff very busy, especially in the morning and in talking to staff concluded that more staff may be needed in the early mornings at the busiest time of the day; so we shall ask the home to review staff levels at peak times of the day. Observations we made include the need to expand, in the care plans, more detailed information about residents’ personal histories and past lives; this is especially important as residents become more forgetful. This will enable staff to more creative and reflect past interests in the activities and events residents can engage in during the day; as a simple example staff should know if any male (and perhaps some female) residents support a football team so the staff can help them keep in touch with their sporting interests each week. We found medication was still being administered at 11:30 in the morning – this Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 7 reflected a very busy part of the day and a rather late start for administering morning medication. We noted a rear fire exit was cluttered; although this was partially cleared by the end of the day. Some décor needs refreshing. Staff would benefit by further training in dementia care and in the care of residents with diabetes. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 3: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that detailed assessments will be undertaken prior to admission or at the time of admission so residents and placing authorities can assess ether or not their needs can be met. EVIDENCE: We checked a number of care plans in detail including nursing assessments and we spoke to staff, residents and some visitors to evaluate this standard. We found that care plans are well organised - although very bulky and seem, to be quite repetitive. We were impressed with the clear identification of and solutions to (medical and social) problems. We make one suggestion about care planning and that is they could include a more detailed picture of residents’ past lives – this will act as a prompt for those providing care and activities and also assist in the management of residents’ needs as their memory fails. Areas of strength include the standardised and complex documentation used to evaluate care needs; we make one suggestion to include a pen-picture of past life in those care plans. This section, about choice upon admission, is assessed as good. Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7 to 11: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. So that residents will know their needs have been assessed, and acted upon, this home uses standardised documentation to record all aspects of social and health care needs. EVIDENCE: Residents receive personal and healthcare support from staff who use individualised care plans. The home has as its underlying principles (promulgated in their statement of purpose) the values of rights of dignity, equality, fairness, autonomy and respect for residents. Personal healthcare needs and dietary requirements are clearly recorded in each plan which gives a comprehensive overview of their health needs and act as an indicator of change in health requirements – they are reviewed very regularly to check this. We note for example that in addition to annual reviews with care managers the plans are reviewed monthly by nursing staff and each week there is weekly evaluation or summary of progress; this means staff are occupied with rather a lot of recording but it does mean care needs are being monitored. We were advised by care managers (undertaking a recent investigation of care practices prior to our inspection visit) that nurses are not Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 11 always acting upon the information they record. The control of diabetes was cited as an example; where a nurse or nurses may not have acted promptly enough in responding to a high reading – so the home’s management team will follow this up to identify what remedial action is needed. Residents have the equipment they need and these are well maintained to support them and staff who assist them; this includes a well planned environment with wide doors and corridors and stairs with grab rails; hoists and lifting aids; specialist beds and mattress and a hearing loop system. Staff have access to training in health care matters and are encouraged and given time to attend seminars on specialist areas of work but we are making two suggestions in this area, the first is that they get extra training and advice on difficult to manage cases of diabetes and secondly more in-depth training on the care of people with dementia. The aims and objectives of the home reinforce the importance of treating individuals with respect and dignity. Medication records were checked by us are fully completed, they contain required entries, and are signed by appropriate staff. If individuals prefer, or where resident lack capacity, care staff manage medication on their behalf and this is the case in most instances in this home. The home provides safe facilities for keeping medication and other valuables in their bedrooms. The home has a good record of compliance with the receipt, administration, safekeeping, and disposal of controlled drugs and we identified no problems with the general administration of medication but two issues do need attention. The first is to ensure that medicines such as insulin is given in a timely manner and secondly that the times of administration of medication be discussed with the local doctors so as to ensure they are being administered at suitable times throughout the day – currently the medication round starts at 10am and is still being distributed at 11:30. We saw that the midday doses are given out after lunch and residents don’t get the evening dose until 10 pm. The home might wish to consider 8am, 12, 4pm, 8pm (and 10pm for night sedation) as being more typical and better for residents and possibly better for staff to be able to administer medicines. Care plans are individual to each resident although inevitably there is much repetition since residents often have similar needs but each does contain clear information about the individual’s wishes, choices and decisions as their health deteriorates. So far as we were able to ascertain by speaking to staff and checking care plans staff work to a good standard and constantly monitor pain, distress and other symptoms to ensure individuals receive the care they need. We understand that when residents die family and friends can help with the arrangements if this is what the resident had agreed to. Staff support both the family and the home’s other residents during the bereavement process and staff understand and are sensitive to the particular religious or cultural needs of the individual or their family – since staff represent various ethnic and religious belief systems the knowledge base within the team is very good. Areas of strength include assessment and recording whilst matters requiring improvement are training in control of unstable diabetes. This section, about care is assessed as good. Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12 to 15: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. This home is providing a comfortable setting and with some opportunities for activities and so within the constraints of their own frailty and staff time residents can enjoy the lifestyle they choose. EVIDENCE: To assess this aspect of the service we spoke to as many of the residents as possible; we spoke to visitors including relatives and professionals such as a Chiropodist and we spoke to staff including the ‘activity coordinator’ - who told us about the use of the garden for recreation on the day we visited. As this was a very hot day the front entrance provided a pleasant sheltered spot for residents to enjoy the landscaped gardens. Individuals are supported to identify their goals, and work to achieve them; so for example, one resident told us that they had an appointment to meet with their key worker to discuss their care plans and their personal goals and wishes. Residents have the opportunity to develop and maintain important personal and family relationships. We discussed with the manager how the home would support a couple, be they male/female or same-sex, if they wanted to spend time alone together. We understand that no couple have actually requested any special arrangements to meet their partner but the manager seemed open to any such approaches and so the service appears to respect the human rights of people using the service with fairness, equality, Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 13 dignity, respect and autonomy underpinning the care and support being provided. Residents can be involved in meaningful daytime activities if they chose and are able – so for example the home provides entertainers during the month and employs a member of staff to coordinate activities. On the day we visited residents were enjoying time in the garden, with suitable staff support, shade and drinks in place. However, we also note the use of the television, left switched on but unnoticed for long periods, is not a very positive approach to ‘providing a programme of activities….and providing facilities for recreation’ as the regulations [16(2)n] requires for residents The expert by experience met with lots of the residents and as an example of residents’ opinion she reports that one said to her, “He enjoyed the home, the food and the activities and was visited by his daughters”. He had several photographs of his family on the window ledge. And so it seems that the daily lives of residents is organised according to their individual interests, diverse needs and capabilities. However it was also evident that staff are very busy and their time is taken up with matters of general care rather than individual attention to the social life of any particular resident. We saw for example that once residents had been supported to make their way into the communal lounges they often sat without staff actually in the room whilst a nurse, “keeps an eye on them from the nurse station” as one nurse said. We checked the general arrangements for catering in this service by speaking to people living and working there; by checking to kitchen and kitchenettes; by the checking menus and the food records and the nutritional assessments. The first impression is very good indeed; tables are laid with linen tables and napkins and there are flowers on each table. The dining areas are very well presented and the small kitchenette in each dining room gives staff the equipment and layout to serve meals in a well-planned way. Menus are decoratively displayed on each table – although they may be in too small a print for some residents to read. The menus are not only well planned but they are checked for nutritional value by an expert so that residents have a well balanced meals each week. Residents told us they enjoy the food in this home and relatives said residents often compliment home for the nice food they get. Menus include a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. We saw as we observed the midday meal that care staff are sensitive to the needs of those residents who find it difficult to eat and give assistance with feeding. They are aware of the importance of feeding at the pace of the resident, making them feel comfortable and unhurried. Areas of strength include the residents’ feedback given to the expert by experience which summarises the general impression. A resident said, “I like listening to the radio”. She also told us she, “Loved exercise, did not like the television but loved the activities”. A resident also said, “She was looking forward to her lunch”. No requirements for improvement are made in this section about daily life and it is assessed as good. Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 and 18: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has in place procedures for dealing with complaints and for safeguarding residents so residents can be assured they will be listened to. EVIDENCE: The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment knowing that they will be listened to; so for example, several residents and visitors confirmed that they not only knew how to complaint but had done so successfully in the past. They were happy with the outcome when they raised their concerns. Some have never had cause to complain they told us whilst others said, “It has all been sorted”. The service has a complaints procedure that is clearly written and easy to understand. It could be made available on request in a number of formats such as large print to help anyone living at, or involved with, the service to complain or make suggestions for improvement. The complaints procedure is supplied to everyone living at the home in their own copy of the Resident’s Guide and is displayed in a number of areas within the service such as the entrance lobby. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. We checked this to this was the case. Unless there are exceptional circumstances the service can respond within a short timescale, usually 28 days. The home learns from complaints, and we understand that it is rare that a complaint about the same issue is made twice. The policies and procedures for safeguarding adults are available and give Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 15 clear specific guidance to those using them. Staff working at the service know when incidents need external input and who to refer the incident to. There is a clear system for staff to report concerns about colleagues and managers. Staff know that if they ‘blow the whistle’ (report) on bad practice they will bee supported by the company (Southern Cross). The home understands the procedures for safeguarding adults and have attended strategy meetings to provide information to external agencies such as Social Services when requested – as they have been on several occasions in 2007/8. A number of referrals have made to the local Social Service Department [SSD] which the home has been involved in, indicating that the home’s senior staff are clear about the procedures. The company has taken a positive approach to such matters in order to resolve allegations of poor practice if and when they have arisen. Whilst it is disappointing that complaints about care practices arise at all the company has taken a positive approach and tried to correct deficiencies where they have been identified. A very recent example involves the support of resident with diabetes – the SSD Care Management team formed the view that further training was needed so that staff could better manage cases of unstable diabetes and the manager has given an undertaking to put such training in place. Training of staff in safeguarding is regularly arranged by the Home and the home’s training schedule confirms this. Other ad hoc training, for example dealing with physical and verbal aggression, can made available to staff as needed. All staff understand what restraint is and alternatives to its use in any form are always looked for. Equipment that may be used to restrain individuals such as bed rails, keypads, recliner chairs and wheelchair belts are only used when necessary and risk assessments are in place for this. People are involved in the decision making process about any limitations to their choice in this area. Individual assessments are always completed which involve the individual where possible, their representatives and any other professionals such as the care manager or GP. Areas of strength include the positive approach taken by the staff and managers in listening to concerns and complaints and we know from recent experience that the service cooperates fully in dealing with allegations of poor care practice and abuse. Whilst acknowledging that concerns have arisen about care, the procedures for addressing those concerns are in place and so this section, about complaints and protection is assessed as good. Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS: 19 and 26: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The presentation of this purpose built home is excellent and is kept clean and tidy so that residents can expect a high standard of accommodation. EVIDENCE: The layout of the home and the manner in which it is being maintained means that this is a safe, comfortable and suitable environment for the residents. The style of décor makes Oban House look homely and very well presented. There were however a number of matters requiring attention and they are outlined here; wallpaper is beginning to suffer wear and tear, for example over radiators the walls are still blackened; some walls have been damaged by chairs and now look a bit unsightly and this has occurred in various locations around the home including some bedrooms and lounges. Some bedroom doors now have (false) letter boxes fitted and a door knocker and each bedroom door is painted a different colour, this gives the impression of personal front doors. However, not all bedrooms have suitable door locks as advised in the national minimum standards. Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 17 The call bell system (nurse call) was inadequate in so far as there is no central sounder or panel to indicate who needs assistance – but we are advised on this visit that a new radio linked system is to be installed. Nor is there a readily available, portable system for residents sitting in the lounge or dining area unsupervised; if there is it did not appear to be in use for those residents we saw sitting in these communal areas. Meanwhile we checked that the current call bell system is working for residents by checking the read-out, this gives the time of a call and response to it; it was usually the case the calls are being answered within two minutes. The premises are being kept clean, hygienic and free from offensive odours and systems are in place to control the spread of infection. Residents and relatives commented how clean the home is, so domestic staff are to be commended. We checked the temperature of lounges on the hot summer’s day and found an average temperature of about 26oC – which is warm but not intolerably hot for mid-morning. A visiting chiropodist noted that this, and many other similar care homes, tend to be rather hot and soporific and not surprisingly residents often seem quite sleepy even in the middle of the day. We were told that it was difficult to ventilate the lounge on the ground floor since it was unsafe to open the patio doors. Residents suggested air conditions and whilst portable units were in place a more powerful and fitted system each these rooms might be considered. The laundry-room is in the basement as is the kitchen and matters of concern arose for these facilities. Areas of strength include the general high quality of the premises and the matters requiring improvement include improvements to the nurse call system, bedroom door-locks and the wear and tear noted throughout the building. This section, about the environment, is assessed as good - with the potential to be excellent. Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27 to 30: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are trained but further training is indicated and residents need extra staff time in the morning and so at present we assess that residents can expect their staff will not always be able to meet their needs and fully as they might expect. EVIDENCE: Although our overall assessment of this section is judged to be adequate and not good there are many good aspects to staffing in this care home. The many residents our expert by experience spoke to referred to the, “kindness of the care workers” and we saw for ourselves how attentive and caring staff were. However all three people inspecting this home took note of the very lengthy start to the residents’ day. Medication was still being administered at 11:30 am and some residents were still being supported to be washed, dressed and have nursing care (wound care for example). This meant, inevitably that some residents were sitting in the lounges unaccompanied by any staff – with a nurse, “keeping an eye on them”, as one nurse said, from the nurse station just outside the lounge areas. With little to occupy them it was not surprising to observe many residents quietly dozing in their armchair at mid-morning. As a visiting chiropodist noted, the room was very warm and soporific. Because staff were not in attendance the patio doors could not be opened to improve ventilation we were told. The use of the television, left switched on but unnoticed for long periods whilst staff are busy engaged elsewhere, is not a positive approach to daily activity and engagement by staff with residents. We noted that upon our arrival at about 10:00 am the Manager was on leave and the Deputy was working on one of the floors in addition to her role, actingOban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 19 up as person in charge. In such a large service we found this unacceptable since in effect no-one was acting as Manager whilst the Deputy dispensed medication. This matter was quickly addressed by the Deputy when we advised her to deal with the situation; a replacement Nurse was brought in to cover the to provide nursing cover for the floor and deputy then took up her role as person in charge of the home. In addition the acting manager returned form his leave to assist. We were concerned that without our unscheduled visit and timely intervention the home would have been short of a senior member of staff free to manage the service. However, we conclude that residents are generally satisfied that the care they receive meets their needs, although there are times when they may need to wait for staff to give support and attention especially in the mornings - but we checked the record of responses to calls bells and found response times are usually quite quick. It is quite clear that the company, as represented by the new (acting) manager recognises the importance of training, and tries to deliver a programme that meets standards but there are gaps in the delivery of training. The manager is aware of these staff training needs and plans to deal with this. Two specific areas include support for residents with complex diabetic needs and training in respect of residents with dementia. The staff we spoke to were clear about their various roles, nurse, carer, cleaner, cook and so on, and knew what is expected of them – we noted how well the staff team worked together so that the domestic staff were as kind and thoughtful towards the residents as any of the care staff. For the most part residents told us that staff working with them know what they are meant to do, and that they meet their individual needs in a way that they are satisfied with – although one small point suggested that staff are not always as attentive to residents’ wishes as they might be – a residents wanting a napkin (the home uses linen ones) had it taken away with no replacement offered – the expert by experience was on hand to offer a paper tissue. It is a small point but very noticeable to any resident experiencing even the smallest slight. We checked a sample of Oban’s staff records to confirm that the home has a recruitment procedure that meets statutory requirements and standards. The procedure is followed in practice and there is accurate recording at all stages of the process and the home is commended for having detailed and well managed staff files that are properly indexed. The manager confirmed that all Nurses have an ‘active’ PIN (Personal Identification) number and of the sample that we saw this appeared to be the case. Similarly were advised that all staff have had a police [CRB] check specific to Oban and again we checked a sample of files to confirm this was the case. Areas of strength include the residents’ opinion that staff are kind and caring towards them; that staff training is detailed and wide ranging; recruitment is thorough in order to protect residents; whilst matters requiring attention include the need to review the deployment of staff at busy times of the day and for specialised training in some areas. We assess this section about staffing as adequate. Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 33, 35, 37 and 38: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The recently appointed manager has yet to be checked and registered by the Commission so we cannot assure residents that he has is fit to be in charge and that he posses the necessary skills to manage this care home. In other respects residents can be assured this is a well organised service. EVIDENCE: It is commendable that the new (acting) manager returned to Oban from his short holiday break several hundred miles away in order to assist in the inspection. It demonstrated a commitment to the service and we appreciated his professional approach to our unannounced visit. We note that this is the third manager to be appointed to run this care home in since 2006. The manager, with the full support of the owners Southern Cross, trains and develops the staff team - who are generally competent and knowledgeable to care for the people who use the service. But there have been a number of lapses in the delivery of care. A number of incidents of potentially poor care Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 21 have been investigated by care managers from the local Social Service Department. Most recently it was identified that staff needed further training in the support of residents with complex diabetes and perhaps further guidance in managing residents who resist support and so put their own wellbeing at risk. It is acknowledged that a balance is to be drawn between a resident’s right to refuse support and the carers’ ‘duty of care’. A better appreciation of the new Mental Capacity Act may assist. Following various Social Service Department [SSD] investigations the service has responded positively and offered further training and, where appropriate, disciplinary procedures have been followed where staff have failed to work to professional standards and safeguard residents. It is the responsibility of the manager to ensure residents are safe and well cared and it is for senior managers, through their monthly unannounced visits and other auditing arrangements, to ensure policies, procedures and practice remain safe and this has not been the case in Oban House in 2007. Judged by this and other visits to this service the Commission is of the opinion that the managers of Oban are intent on providing a safe and good quality care service and have been open and straightforward in their dealings with the Commission. The service is planned to be user focused, to take account of equality and diversity issues, and generally works in partnership with families of people who use the service and professionals but despite complex documentation families do not always feel listened to. The home has a Statement of Purpose that sets out the aims and objectives of the service but again residents have said that the service the home advertising in its Guide does not always match their experience. For example, the timing of meals and the accessibility to staff when they need assistance. Checks were made regarding the home’s arrangements for assisting residents with their personal allowances (‘pocket money’) and the system appears sound. Residents can access their funds and auditable accounts are kept. Systems are in place to ensure that the property and money of residents (held by the home) can be held securely and is safeguarded. Provision is also made for residents to control their own money if they wish to do so. The service provider takes responsibility for the home’s accounts and business development. The home has insurance cover in place. Checks show that records are generally well maintained, up to date and accurate. Also a range of records were reviewed during this visit include the visitors’ book, accidents, incidents, complaints, care plans, staff files, kitchen records, and so forth. Whether or not staff have enough time to undertake their duties is again a recurring theme and suggests the need to review staffing levels perhaps of the busier times of the day and a requirement to review staffing deployment is made at the end of this report. Such a review may need to take account of administration – what is the burden of paper-work expected of staff and is this reducing the time they have to work directly with residents. A number of safety issues arose - in addition to the recent incident alluded to earlier in this report and which required a resident to return hospital – a ground floor fire escape was partially blocked with numerous items; whilst Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 22 some of this material was removed during the course of the day some remained and could compromise evacuation, and if flammable would reduce its effectiveness as a ‘protected fire escape route’. Areas of strength include the generally well managed service, the residents’ appreciation of a good care home with kind staff; well managed record keeping documentation; good staff support and so forth. Matters requiring improvement include the need to register a manager and to address safety issues. This section, about management and administration, is assessed as adequate. Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME: Good Standard No Score 1 2 3 4 5 6 ENVIRONMENT: Good Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE: Good Standard No Score: 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES: Good Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION: Good Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING: adequate Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION: Good Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 OP30 Regulation 12(3) Requirement Timescale for action 30/09/08 2 OP8 12(3) 3 OP27 18 Health Care: the home must ensure all nursing staff receive additional training in the management of complex diabetes. Health Care: the home must 30/09/08 ensure all nursing staff receive additional training in the support of residents unable or unwilling to maintain an agreed programme of care and medication. Staff numbers: The home must 30/09/08 review the deployment of staff at different times of the day (for example mornings) so as to assure residents they will not have to wait for an unreasonable time to be supported. Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Care Plans; We recommend that the care plans are broadened to include greater detail about each resident’s personal history, particularly where residents have increasingly failing memory of their own; this is so residents can be supported more effectively. Décor: It is recommend that the programme of redecoration is continued paying particular attention to areas where walls are marred by radiator heat. Registration of manager: We recommend that the owners submit an application for the registration of a manager for Oban House without unreasonable delay. 2 3 OP19 OP31 Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oban House (42-46) DS0000019035.V364825.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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