Care Home: Tall Oaks Nursing Home

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What the care home does well The newly registered manager is both enthusiastic and energetic and has brought about some positive changes including improvements to the quality of life for the people who live at the home. Management of the home is open and inclusive ensuring that the home is run in the best interests of the people who live there. Residents have a voice and any concerns or suggestions they have are taken seriously and acted upon.Staff moral is good and staff were seen to be caring and attentive to the needs of the residents. Individuals are treated with dignity and respect. The programme of activities and entertainment is good, social and therapeutic needs are met and daily life in the home, including meals are flexible and varied and adapted to meet individual needs. Individual healthcare needs are assessed and met on a continuous basis and treatment and advice from other healthcare professionals is actively sought when needed. Staff are carefully selected to work at the home, ensuring the safety of individuals, and are equipped with the skills to meet the assessed needs of the people who live there. Staff have an awareness and understanding of dementia care needs. This helps staff to meet the specific needs of residents with impaired mental abilities and challenging behaviour. Under each outcome extracts from the AQAA have been included to outline what the Providers of the home feel that they have done well. What has improved since the last inspection? What the care home could do better: CARE HOMES FOR OLDER PEOPLE Tall Oaks Nursing Home Charles Street Biddulph Stoke-on-trent Staffordshire ST8 6JD Lead Inspector Yvonne Allen Key Unannounced 5th February 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 Tall Oaks Nursing Home DS0000026969.V351192.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. Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tall Oaks Nursing Home Address Charles Street Biddulph Stoke-on-trent Staffordshire ST8 6JD 01782 518055 01782 511772 tall/oaks@craegmoor.co.uk 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) Speciality Care (REIT) Homes Ltd Beatriz Elvira Croft Care Home 55 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (55), of places Physical disability over 65 years of age (55) Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories. Old age not falling in any other category OP 55. Dementia over 65 years of age DE(E) 3. Physical Disability over 65 years of age PD (E) 55. The maximum number of service users to be accommodated is:55. Date of last inspection 28th June 2006 Brief Description of the Service: Tall Oaks is a care home providing personal care including nursing care for up to 55 elderly service users. This includes care for up to three service users with dementia and care for elderly service users with physical disabilities. A private company owns the home - Speciality Care (R.E.I.T. Homes) Limited Craegmoor Healthcare. The home is located on the outskirts of the town of Biddulph in the North Staffordshire district. Biddulph town centre is approximately a ten-minute walk away where there is a choice of shops, public houses, banks and churches. The home was purpose built several years ago and consists of two floors served by a passenger lift. There is ample carparking facility at the entrance car park. Gardens are accessible around the home to service users including wheelchair users. The accommodation provides for single bedrooms, none of which have en-suite facilities. There are six double bedrooms with en suite facilities. There is ample provision of communal and seating areas. The fees in this home range from £330.00 to £573.50. There are additional charges for hairdressing, chiropody (if private), newspapers and some of the outings. Tall Oaks Nursing Home DS0000026969.V351192.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 stars. This means that the people who use this service experience good quality outcomes. We, the commission, carried out this unannounced inspection visit over 5.5 hours with one inspector. Prior to the inspection visit the manager completed a self-assessment tool, which looked at all the standards and outcomes for older persons. This is called an Annual Quality Assurance Assessment (AQAA). In the AQAA the provider (owner) and manager of the home say how they believe that they meet the minimum standards and outcomes for the people who live at their home. Statements from this AQAA have been included in this report. We looked at all the Key standards during this inspection and made a judgement on how we assessed each of the outcomes for the people who live at the home. In order to make our judgements we gathered the following information – We We We We We We We We met and spoke with some of the people who live at this home. spoke with the manager and staff who work at the home. examined relevant documents and records. walked around the home. looked at how staff interact and care for the people who live at the home. spoke with a healthcare professional over the telephone. met and spoke with 2 relatives who were visiting the home. spoke with a Social Worker who was visiting the home. What the service does well: The newly registered manager is both enthusiastic and energetic and has brought about some positive changes including improvements to the quality of life for the people who live at the home. Management of the home is open and inclusive ensuring that the home is run in the best interests of the people who live there. Residents have a voice and any concerns or suggestions they have are taken seriously and acted upon. Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 6 Staff moral is good and staff were seen to be caring and attentive to the needs of the residents. Individuals are treated with dignity and respect. The programme of activities and entertainment is good, social and therapeutic needs are met and daily life in the home, including meals are flexible and varied and adapted to meet individual needs. Individual healthcare needs are assessed and met on a continuous basis and treatment and advice from other healthcare professionals is actively sought when needed. Staff are carefully selected to work at the home, ensuring the safety of individuals, and are equipped with the skills to meet the assessed needs of the people who live there. Staff have an awareness and understanding of dementia care needs. This helps staff to meet the specific needs of residents with impaired mental abilities and challenging behaviour. Under each outcome extracts from the AQAA have been included to outline what the Providers of the home feel that they have done well. What has improved since the last inspection? The programme of redecoration and refurbishment has commenced which has had a positive impact on the appearance of the home. The mural painted along the hall walls on the ground floor is attractive and stimulating and enjoyed by the residents who live in this area. The outside space has improved dramatically. With a great deal of hard work by the maintenance person and help from The Princes Trust volunteers, has resulted in a very pleasant garden and patio area for the residents to enjoy. Care plans are now more person centred and ensure that care is planned and delivered according to specific individual needs. We, the commission, have not received any complaints or concerns about the home since the last inspection. The manager deals with concerns and complaints effectively and the people who live at the home feel that she listeners to them. The following are statements from the AQAA outlining how the Provider feels that they have improved over the last 12 months – “Staff are more aware of the company policies,Pova training and the subjet now more open and undestand how essential is to report any issues no matter Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 7 how small they are. Staff training. 7 Care assistants have done the Palliative care course. No home pressure sores,Trained nurses are involving the distric nurses, tissue viability nurses and even GPs regarding pressure sores,prevention and healing. Community nurse a very useful rule for the care homes has been a great help when we need to find information. New statement of purpose,New service users guide with all the neccesary information for the service user and the relatives. staff information, accomodation, quality of service,complaints procedure. Service User Agreements are given on admission with terms and conditions and any Additional charges(private chiropodists)etc. More dementia orientated activities. Closer relations with the relatives working together towards the best for the resident. More trips out. More individualised activities. Staff participate in the activities as all are trained now for dementia care. Visits to the library. Coffee afternoons where we inviting the community. Children’s nurseries are coming to sing and visit the residents as they love children and the children love them too. Taken very seriously complaints, act straight away following company complaints procedure. Work in the garden has started now; re-decoration plan is in place and followed. Home is a lot friendlier looking as we have put plants outside and flowers according to the time of the year. An artist, expressing the 4 seasons, has now painted wall downstairs. Staff training is up to date. More dementia training, MUST(nutritional) by Community matron and Paliative care course for all staff given by the paliative nurse specialist. Chest infection protocol by the Community matron- Susan Pointon. Syringe driver, super-pubic cahetarisation(supervision by community matron), venepuncture. All qualified nurses can now give the subcutaneous fluids,to reduce the hospital admissions when unnecesary. Qualified staff for ear syringing in the home,without the need of transfering the clients to the surgery.” Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 8 What they could do better: The thematic painting of the ground floor corridors could developed through the remainder of the home. This is so that all the residents who live there are able to enjoy more stimulating surroundings. The programme of redecoration and refurbishment also needs to be continued through in order to update the home generally. The laundry room is very small for the size of the home even though only personal clothing is laundered here. Dirty and clean clothing are coming into close contact. It is therefore recommended that a larger facility be provided to help ensure that cross contamination does not occur. The Service User Guide must document the fees charged by the home. This is so that residents who are considering coming into the home are made aware of how much they will have to pay. The following are statement from the AQAA completed by the Provider, which outline what they feel that they could do better – “More training for the care assistants and qualified staff in Palliative care. Only 2 care assistants feel confident to administer medication to residential service users after training,further training will be given and supervisions to all the care staff again to build up confidence and a positive attitude,only trained nurses dispense medication in the home for residential and nursing patients. Much more information regarding death and dying in the care plans. More training for staff regarding death and dying even if they are not very kin with the issue. Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 9 Questionnaires to the relatives that decide not to bring their relatives to our home and if there is any reason regarding our service we will have to do something about. More activities,more variety. Much more activities to stimulate physical and spycological stimulation,individualising this activities according to the disability or condition. Much more choices. Time scales with complaints are hard to achieve due to getting in touch with people and organising meetings and hearings. The suspension under investigation, CSCI require a prompt suspension under any abuse issues and not always is agreed by the company.Unless there is strong evidence (bruising, marks) etc. but not for a complaint with no evidence. More training to be offered to staff not just the mandatory training, is very expensive and not always possible. We use the Staffordshire social care workforce partnership to offer our staff the variety of available courses(Risk assessments,tissue viability,paliative care,etc) We are currently awaiting for the Palliative care for the qualified given by the PCT to start as soon as possible.” 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. Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 10 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 Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are only offered a place at this home following an assessment of their needs and can be assured that, once in the home their needs will be monitored and met on a continuous basis. There is a need for the Provider to include the fees in the Service User Guide so that people are made aware of how much they will have to pay to stay at the home. EVIDENCE: Standards 1 3 and 4 were assessed. Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 12 Examination of the Service User Guide identified that the fees charged by the home are not included. There is a requirement to include the range of fees charged so that prospective residents are made aware of how much they will have to pay to live at the home. Discussions with the RM identified that individuals are assessed before being offered a place at the home. She also stated that emergency admissions are only accepted after an assessment of needs has been received from Social Services. Examination of 6 care plans chosen at random confirmed that the manager or her deputy prior to admission carries out a “pre-admission assessment of needs” on prospective residents. This is comprehensive and takes account of the categories of registration of the home. Discussions with two relatives who were visiting the home confirmed that they had been involved in the admission process when their relative was coming into the home and an assessment had been carried out. Examination of a random sample of 6 care plans identified that individual needs are evaluated regularly. Positive outcome areas were identified in this report for the people who live at this home and confirmed that individual assessed needs are met on a continuous basis. On the AQAA the Providers state that they do the following well – “Pre-admission assessments questionnaire is completed prior to any new admission we try to avoid emergency admissions but if there is any the preadmission assessment must be completed within 24hrs of emergency admission and the relevant risk assessment within 48 hors. The Moving and handling assessment before any member of staff start transferring the resident as a safety measure. Each room has got a statement of purpose that has just been updated.” Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care is planned, evaluated and delivered with dignity and respect. Healthcare needs are monitored and met by the nursing staff and access to healthcare professionals is promoted. EVIDENCE: Standards 7,8,9 and 10 were assessed. A total number of 6 care plans were examined at random. These included plans of people with varying degrees of needs – both personal and nursing care. All the plans were found to be comprehensive and had been based around an initial assessment of needs followed up with a more in depth needs Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 14 assessment. Individual risk assessments had been developed and short and long-term care plans put into place. There was evidence of personal choices and preferences being promoted in these care plans. These were recorded as “People who are important to me” “Things which are important to me” and “Family communication” forms. The Company had developed the care plans to be more person-centred since the last inspection. Discussions with four residents in the home confirmed that choices and preferences were upheld with one lady stating – “oh yes duck – I can do what I want when I want to”. There was evidence of the meeting of health care needs within care plans and specific monitoring of special nursing needs such as the prevention and treatment of pressure sores and the monitoring of diabetes and nutritional needs. There was also evidence of specialist professional input and advice – such as from the Community Matron. Discussions with the Registered Manager identified that the home was very much supported by her and that she came in to give talks and training for staff and “she is always available for support and advice”. A telephone discussion was held with the matron following the inspection and she confirmed her involvement with the home including training sessions. She did not have any concerns about the home and was pleased with how the care plans had developed and how the staff act on her advice. She is very supportive in respect of tissue viability training and advice in relation to pressure area care and the prevention and treatment of pressure sores. The Manager also confirmed that the home receives a good medical support from the GP practices. She confirmed that individuals are able to keep their own GP if they are in agreement. There was evidence of visits by GPs and discussions with residents confirmed that they see their GP whenever they need to. There was evidence of other healthcare professionals being involved with the home including the dietician, the optician, the community psychiatric nurse, the chiropodist and, when needed, the dentist. At the time of the visit a Social Worker was carrying out a review of a resident at the home. We were able to talk to her and identified that she was also happy with the care provided to her clients by the staff at the home. She commented that the individual who she had been to see today was doing “very well” at the home. The procedures relating to the receipts, storage, administration and disposal of medication was examined and this was all found to be in order and was in accordance with the home’s policies and procedures and the NMC guidelines. Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 15 We were told that there were no individuals who were in control of their own medication (self-medicating) at the time of the inspection. However, there was a policy in place for this and individuals would be able to do this following a suitable risk assessment. At the time of the visit staff were heard and observed to be polite and respectful toward residents. Those residents who were spoken to confirmed that staff treated them with dignity and respect. The AQAA states that the Providers do the following well and was evidenced at the time of the inspection visit – “Each service user is cared as individual according to the different needs.Staff at Tall Oaks are very commited.Care assistants, and Senior care assistant deliver the care according to the care plan that has been developed after an admission assessment by the Manager or the Deputy manager.Each enquiry taken is followed by a complete assessment,visiting the residents /home/hospital/another care home.Introducing ourself to the resident and having a complete picture of their needs by looking at care plans, chatting to the resident, observing and talking to the person is in charge of the care at the time.The staff knows very well each resident , likes dislikes,residents wishes are priority and respected. Dying and Death is a very important part of care. We liaise with GP’s. District Nurses, McMillan Nurses and 7 of our care and senior carers have done the Palliative care course. We follow clinically the Liverpool pathway. Comfort, respect, dignity are achieved at all the time. Each service user has got a personal centre care plan, individualised and information is kept in the different areas of the plan. These are reviewed each month or when needed. Each resident has got a named nurse and a Key worker. The resident is involved when possible and the next of kin are given the opportunity to get involved with the care plan. Mental health needs are well specified and reviewed. Any Health care issues are dealt with to promote and maintain good health. The dignity of doing as much as possible for ones self is encouraged. Trained nurses and care assistants will observe any signs of deterioration or changes in condition and report it straight away. Pressure areas are daily checked and turning charts are followed and signed each shift by the nurses. All staff are aware of the prevention and the company policy regarding pressure sores. Manager/Deputy manager sees pressure sores at least once a week. Tissue viability nurses /district nurses are involved when necessary. Nutrition, skin condition, weight changes are taken into consideration. Staff are well aware of the prevention of pressure sores and identify any signs. We have a self medicating service user assessment prior to admission this is done and if the resident wishes are to be self medicated and the physical and mental capability are fine we carry out a risk assessment. Assistance and Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 16 supervision to the resident are given and a monthly review is carried out. A locked cabinet is provided in the residents room for the safe storage of the medication. We follow all the NMC and company policies for the administration and the discarding of medication and all the staff are aware of it. Regular competence assessments are done by myself (Manager). Medication is reviewed on a regular basis by the GP and any changes or adjustments needed that the nurses have noticed will be reported to GP straight away. Privacy and dignity is given at all the time, Personal centre plan has got all the information needed like how the residents like to be called, being assisted by a male or a female, when the GP come to see them, must be seen in a private room, bathing, showering preferences etc. Medication policy is in place and staff have access to it, we follow the NMC administration of medication guide. There is a daily medication audit between the nurses and the medication given is signed and the right number of tablets left is correct. Internal Medication audits have very good scores and the action plans are completed.” Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at the home are encouraged to exercise choice and control over their daily lives ensuring that autonomy is promoted. The meals served are varied and nutritious and individual nutritional needs are assessed and met. EVIDENCE: We looked at all of the standards for this outcome. There was a structured programme of activities and entertainment in place at the home. This programme was displayed around the home together with photographs of residents participating in activities and trips out. Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 18 There is a dedicated activity co-ordinator employed who has worked at the home for several years. Discussions were held with her during which she explained how she includes all the residents in the home including one to one sessions with individuals who are confined to bed. There was evidence documented in care plans that individuals are encouraged to participate in organised activities on a regular basis. At the time of the visit (pancake day) some of the residents were visiting the local town hall to enjoy pancakes. For the people who were not able or did not want to do this – the Cook stated that he was making pancakes for tea. There was evidence contained in care plans of individuals continuing with hobbies and interests, which they had enjoyed before coming into the home. Their personal preferences in respect of all activities of daily life were documented, and, wherever possible, upheld. Spiritual needs were also recognised and catered for with visits from the local churches and clergy. Links are maintained with the community – with some residents visiting the local shops and amenities regularly. Schools visit from time to time and coffee mornings and fetes are held in the home. Visitors were observed coming and going throughout the visit and those spoken to confirmed that they are able to visit at any time. The individuals who were spoken to stated “the food here is very good” and when asked about choices they confirmed that if they did not like what was on the menu then they could choose something else. They also confirmed that they were offered regular drinks throughout the day and could have a drink and a snack if they wanted one in the night. At the time of the visit there was 2 main dishes being served for lunch. Staff were observed assisting individuals who needed help to eat their meal. The Cook confirmed that special diets are catered for including diets for diabetics, vegetarians, soft diets and any other needs. Menus were examined and meals found to be varied and nutritious. Individual nutritional needs are assessed and this is documented in care plans. Any problems are identified and action taken to meet needs. Individuals are regularly weighed and advice from the dietician sought when required. Some individuals were also prescribed nutritional supplements. Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 19 The following was documented in the Provider’s AQAA and was demonstrated at the time of the visit – “Introduce the service users with similar capacities, interests to each other to spend time enjoying theirs hobbies, talking, chatting, walking etc. A selection of activities some daily some weekly, some monthly are offered, an Activities coordinator is daily in the home, stimulation, enjoyment, keeping the faculties left after a stroke or other condition for as long as possible, homely feeling etc are targets. We encourage the residents to maintain regular contact with family and friends, involving local community as much as possible. Residents are taken to trips out with special transport safe for disabled and going to restaurants where they can cater for the different diets. Weekly bingo for the residents all the family and friends are welcome, entertainment, and organ that one of the relatives plays for the residents as often as she comes and they all love the sound. Residents’ capacity to exercise, individual autonomy and choice. Bingo evenings for residents, staff, relatives and friends as often as possible when the staff come to help even if they are not working to make money for the residents funds, staff cooks ,we had a curry night when the staff from Pakistan cooked delicious curry, cakes cooked by staff or donated presents for the raffle. We have made some money to get residents umbrellas for the outside garden when is finished, flat screen TV for the main lounge, stereos for the different communal areas. Videos, bubble machine, interactive activities for the activity coordinator to use with the residents. The chef knows very well all the service users dietary needs; staff have to communicate with the chef when there is a new admission. Relatives are always welcome to stay and join the resident at meal times; chef will prepare an extra meal for the relative or friend. At Christmas time we had a few relatives joining the residents in their rooms for privacy if that was their choice 0r in the main lounge. Service users have the choice to vote according to theirs mental capacity. Service users will handle their own personal affairs if capable or the person appointed does so. Personal records are kept safe in accordance with the Data protection 1998. We have a regular internal financial audit and service users at our home are well protected from financial abuse. Residents meetings to listen to the residents’ opinions, suggestions, Your voice meetings with relatives too. Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 20 Once a year relatives questionnaires. Complaints procedure and comments books are always welcome.” Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at this home can be assured that the systems in place will help to keep them safe from harm. Any concerns that individuals have will be listened to and taken seriously. EVIDENCE: We looked at standards 16 and 18. There was a clear complaints procedure displayed in the home. This contained the local CSCI details but will need to be amended to include the new address and telephone number. The CSCI had received no complaints directly since the last inspection and there had been 1 safeguarding referral, which had not been upheld. The manager maintains a log of concerns and complaints, which also includes action taken and investigation findings. This document also demonstrated that the manager is effective in addressing concerns early so that they do not develop into complaints. Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 22 The residents and visitors spoken to confirmed that the manager is approachable and accessible and that in the past she has dealt with concerns effectively when they arose. The 2 nurses spoken to confirmed that they were aware of their responsibilities in respect of safeguarding issues and the procedures for the reporting of abuse. Examination of the training files of 4 staff members confirmed that they had received training and instruction in Protection Of Vulnerable Adults (POVA). Examination of these staff files also confirmed that the recruitment procedure is very thorough and that staff are only offered employment following Criminal Record Bureau (CRB) and POVA checks. On their AQAA the Providers state “We do take every complaint very seriously,so reasured residents and families if there is any concern, no matter how small seems to be,we are investigating and follow the proper chanels.Time scales to repond to the complaints are targeted.Working closely with residents, relatives and staff. Legal service users rights are protected and if the resident isnt capable the next of kin or access to solicitors is provided. Protection from abuse is a priority. All the staff has been trained for POVA and the company policies are available for everyone to read.Handling money company policies are in place, staff aware of them.Administrator and Manager are the only ones to handle the money 2 signatures always neccesary. Residents and relatives are well familiarised and understand how to make a complaint and they are fully aware of what to expect afterwards regarding response time. Monthly complaints are recordered and followed the outcome. Service users are registered on the electoral roll. All staff have completed the POVA course. Whistle blowing procedure and complaints procedure are located at the front door Verbal complaints are taken as serious as written and we have got a monthly record of complaints. The is a very good communication in between residents relatives and staff.” Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 23 Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a safe, comfortable environment, which has been adapted to meet the needs of individuals. The people who live at the home benefit from the communal areas and attractive outdoor space. The small size of the laundry room raises some concerns about the ability of staff to maintain infection control. A larger room is recommended for this purposes in order to ensure the safety of the people who live there. EVIDENCE: We looked at standards 19 and 26. Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 25 We toured the home inspecting all the communal areas and a selection of bedrooms. There had been some redecoration since the last inspection. This had included addressing the previous requirement to make good the flooring opposite room 22. The kitchen ceiling had been painted and the Company had purchased a new fridge and new boiler since the last inspection. Room 3 and a further 2 bedrooms had had new carpets. The manager stated that the Company was in the process of replacing beds and mattresses and currently had 21 electric beds and 22 divans. The home was clean and well presented throughout. Domestic staff, including the housekeeper were observed cleaning all areas of the home. Bedrooms had been personalised and adapted to meet the individual needs of the residents. The ground floor corridor walls had been decorated with a mural, which was attractive and interesting for the people who live there. The manager explained that she hopes to carry this theme through to the other areas of the home. We were given a copy of the planned redecoration programme, which identified the areas in need of redecoration as well as those already done. As the home is looking very tired in many areas it is recommended that this redecoration and refurbishment programme be carried on throughout the home. There had been a lot of work carried out on the garden and patio area surrounding the home since the last inspection and this had greatly improved this area. The manager showed us some before and after photographs, which demonstrated the changes and improvements. The manager commented that they had obtained a grant for this work and young people from The Prince’s Trust had painted the fencing. Positive comments were received from the residents, especially those who had lived at the home for some time. One of them stated – “It will be lovely to sit out in the summer, I am looking forward to it.” The laundry was visited where the laundry assistant was busy with washing personal clothing. The Company continues to contract out general laundry to a laundry company. This laundry room has been raised by CSCI as an area of concern previously due to its very small size. On a previous inspection we requested a visit from the infection control nurse specialist. She also raised concerns about the small size in relation to the close proximity of clean washed clothes next to dirty clothes. The laundry assistant Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 26 was doing what she could to keep dirty and clean clothes away from each other but this were not an ideal situation. It continues to be a recommendation of CSCI for the Company to provide a larger laundry room. The residents were observed enjoying all the communal areas throughout the home. The AQAA states – “The home was looking tired , the walls have now been painted and is looking cleaner and more tasteful. We have purchased new bedding to match, different colours for men and women. In one of the Your Voice meetings was mentioned the necessity of changing the blinds in the conservatory and now blinds have been replaced. We are replacing the beds for more secure beds like low care beds slowly due to the high cost. The home is very clean the Domestic staff work very hard and all of them are very conscious over the cleanness of the home. Our Regulation 26 visits shown that home is clean and free of smells. Relatives have commented how clean is and there is not even one complaint over smells. Not many points in the environmental health visit and all are now completed. Staff room has now been renovated with new floor and new table and chairs all done with staffs money. No outbreaks and Im sure is because staff are very aware now of the infection control policy. Hand washing posters in all the toilets and in the nurses’ room. Washing machines have the very hot wash for the red bags, with the body fluids or patients with MRSA or other infection that needs barrier-nursing care. All policies for cross infection are in staff room for everyone to read and sign. Sluices doors are now operated in a way that they cannot be left open; they will shut straight away to avoid any smells in the corridors and residents rooms next to it. The maintenance man is constantly following a re-decoration plan in corridors and rooms. Specialist equipment is available where appropriate as well as serviced regularly by the company suppliers as well as repaired when necessary.” Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 27 Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 28 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people in this home are cared for by a skilled staff team who have been carefully selected and are able to meet their needs. EVIDENCE: We looked at all the standards for this outcome. At the time of the inspection visit there were 47 residents accommodated in the home, 23 of which were in receipt of nursing care and the remainder personal care. The Registered Manager works supernumery and there was 2 nurses on duty all day from 8am until 8pm. There is a deputy manager employed, who was on duty at the time of the visit. There were 7 care assistants working with the nurses during the busy morning shift then 6 care staff from 2pm until 8pm. On night duty there was 1 nurse and 4 care assistants. The feedback received from residents and visitors was that the staff were “kind” and “very caring”. Observation of the interaction of staff with residents was good and staff were observed to be attentive to needs. Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 29 There was an adequate supply of ancillary staff – 1 housekeeper and several domestic assistants. There was a laundry assistant on duty daily. There was a head Cook, a second Cook and several kitchen assistants. There is a full time maintenance person and administrator employed. An activities person is employed part time. Examination of 4 staff files identified that staff had been carefully selected to work at the home. Written references had been obtained, CRB and POVA checks carried out. There was evidence of staff induction training and 2 staff members spoken to confirmed that they had received induction training as a new starter. There was a structured staff training and development programme in place and documentation of various training sessions for staff. Staff spoken to confirmed that their training needs were identified and supported. Mandatory training sessions were held on a regular basis – examples of this were health and safety, fire safety, moving and handling, infection control, food safety and first aid. Staff had also received training in Dementia Awareness and management of Violence and Aggression. This is applicable as the home is registered for Dementia needs (3 persons) and staff will have the knowledge and skills to be able to manage challenging behaviour needs. NVQ (care) training was on going for care staff and over 50 were trained to levels 2 and above. The AQAA states – “We dont use agency as we always have got the necessary permanent staff to cover the shift. Off duty done well in advance and staff have time to cover the shifts available over the holiday period. We have got bank staff that work on a regular basis when hours are available. Service users are used to the staff and know them well. 95 of the Care assistants have got the NVQ 2 and undertaking the level 3. Service users needs are met by the numbers and skill mix of staff. Number of staff on the floors is the right for the assessed needs of service users. All new staff undergo the Induction and foundation training.” Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 30 Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 31 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and is run in the best interests of the people who live there. EVIDENCE: We looked at standards 31,32,33,35,36 and 38. The manager was on duty at the time of the visit and discussions were held with her. Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 32 She explained how she had almost completed the Registered Manager’s Award and had undertaken several other study days since the last inspection in order to keep herself clinically updated. The manager had become “Registered” with CSCI since the last inspection. Discussions with staff members and residents identified that the manager is approachable. She has an open and inclusive management approach. It was observed that the manager’s interactions with the residents confirmed that she knew them well and has regular contact with them. There was a good rapport between manager and staff and manager and residents. There is an effective Quality Assurance programme in place at the home. The manager has to complete a monthly quality assurance tool – “Clinical Governance Quality Assurance Data”. This audits the health and welfare of all the residents in the home including individual weight loss, pressure sores and accidents. The manger also audits other areas on a regular basis such as medication, cleanliness, infection control and meals. The views of residents are sought in the way of residents’ surveys – for individuals and/or their families to complete. Also regular residents’ meetings are held where individual views and opinions are welcomed. This is entitled – “Your Voice”. We were given a copy of the January 2008 issue, which demonstrated what individuals had asked for including ideas for activities and entertainment. The AQAA states that the home has done the following as a result of listening to the people who live there – “We have purchased some light weight cups, some were found to be a bit heavy for the more fragile service users. Menus are displayed in the lounge area. Garden suitability, being adapted, for the residents to look or walk about. Lovely garden pond will be filled with water plants and fish. More variety in menus. Services users are always ask for what they want to eat and they get it. The menus are amended to incorporate the preferences of the residents. Menus are kept under regualr review. If they ask we make every effort to provide, but our chef meets directly with all new residents on admission.” The Company also carry out an internal audit report annually. The manager pointed out that last year the home had scored 3 out of 5 stars and this year they have scored 5 out of 5. The maintenance of individual personal allowances was examined with the administrator. There is no one at the home who acts as agent or appointee for Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 33 individuals. Residents are encouraged to handle their own monies and affairs wherever possible. If not then it is usually family members who do this. If individuals do not have any family members then the manager will seek an advocate for them, with their agreement. Examination of staff records and discussions with staff members identified that staff receive regular formal supervision. Records relating to health and safety were examined. These had been well maintained by the maintenance person and were clear to follow. There was evidence of the servicing and maintenance of equipment as well as the many tests and checks, which the maintenance person carries out on a regular basis. The AQAA states – “Five stars in the internal financial/administration audit. As a Manager Im doing the Managers award in social care. Health and safety course has been completed. I have got an open door policy, my office is always open to anyone who wants to discussed any issues or ask any questions. I listen to everyone’s opinions and if I cant help I ask for help, working close with my area manager and other managers within the company. Regular staff meetings to discuss any issues regarding the home, service users, relatives and staff. Monthly relatives and residents meetings “your voice. We comply with all the internal audits expected by the company that follows all the CSCI requirements. At the moment the main target is adjust the environment for the dementia service user to been able to have the highest quality of life within the home. The home has got a homely, friendly, caring, positive atmosphere. Every single member of staff demonstrates commitment towards the wellbeing of each service user. Staff are aware of the Company policies and procedures and demonstrate every day in the quality of work and the relation with each service user to cover their needs as individuals, identifying any changes and reported immediately to the appropriate person. Training is completed and we followed a training plan. Care staff have 2 monthly reviews that we are just about to completed due to the large amount of staff at this home. The administration department and the manager deal with the financial interests of the service users following all the company procedures .A previous 4 star out of 5 internal financial report has just been exceeded by a 5 star audit. The action plan was put in place straight away from the previous one Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 34 and results were rewarded Safekeeping is in place, with all the relevant documentation and 2 signatures for each entrance. Records and received are kept. Service users are involved in the care they are receiving and any changes are explained and report to them, when the service user is not capable to give consent or get involve in their own care the next of kin is the key first contact for any matters to deal with the service user. Health and safety home manual is up to date and I had the Health and safety for managers course in February. Staff are aware of how important is the safe working environment and the safety of the service users”. Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 35 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 x 3 Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 36 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 OP1 Regulation 5(1)(b) Requirement The Service User Guide must contain the “amount and method of payment of fees”. This is to ensure that people are made aware of how much they will need to pay in order to stay at the home. Timescale for action 10/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP26 Good Practice Recommendations The Providers should consider providing a larger facility for use as a laundry room in order to help prevent the spread of infection. The redecoration and refurbishment programme should be continued throughout the home in order to improve the environment for the people who live there. This would include developing the themed corridors. OP19 Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Tall Oaks Nursing Home DS0000026969.V351192.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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