Care and Social Services Inspectorate Wales

Care and Social Services Inspectorate Wales Care Standards Act 2000 Inspection report Care homes for older people Oakdale Manor Rhiw Syr Dafydd Oakdale Blackwood NP12 0JJ Date of publication 14 July 2011 You may reproduce this Report in its entirety. You may not reproduce it in part or in any abridged form and may only quote from it with the consent in writing of Welsh Ministers

Care and Social Services Inspectorate Wales South East Wales 6th Floor Civic Centre Pontypool Torfaen NP4 6YB 01495 761200 01495 761239 Home: Oakdale Manor Contact telephone number: 01495 230900 Registered provider: Registered manager: Forest Gate Healthcare Limited Sandra Lloyd Number of places: 31 Category: Care Home - Older Adults Dates of this inspection episode from: 1 April 2011 to: 23 May 2011 Dates of other relevant contact since Unannounced inspection 23 May 2011 last report: Date of previous report publication: 14 April 2011 Inspected by: Julianna Biggs Page 1

Introduction Oakdale Manor residential home is a large two-storey detached building set in its own grounds, in the residential community of Oakdale. The home is registered with the CSSIW to provide accommodation and personal care for up to 31 older persons with dementia. The registered providers are Forest Gate Healthcare; the proprietors are Mr Richard Hutchinson and Mr Ian Hutchinson. The providers were not present during the inspection visit. Mrs Sandra Lloyd the registered manager of the home was present throughout the inspection and made every effort to comply with the inspection process. The purpose of the unannounced inspection was to focus on anonymous concerns raised with the inspectorate and to take the opportunity to seek feedback on action to meet good practice requirements made at the previously unannounced inspection in March 2011. The focus areas for attention in this inspection episode were: Partial tour of the premises. Staffing levels, response of staff to service users request for assistance and staff attitude. Relationships of staff with service users. Staff training, induction and supervision opportunities. Maintenance of records and communication systems including care assessment and planning processes. Food choice and quality. Feedback on progress on the part of the home since the last unannounced inspection. Summary of inspection findings On the day of the unannounced inspection to the home, service users were seen to be comfortable in their home environment. Relatives who spoke with the inspector responded favourably in respect of the care, food provision, laundry services, standard of cleanliness at the home and in general a homely environment. A visiting professional present gave overall positive feedback about the service provided. Staff who spoke with the inspector and returned questionnaires suggested team working was good but could be improved. The home had experienced a significant period of staff sickness and this was being managed within a performance management framework by the registered manager. An employment consultation was ongoing at the home in respect of terms and conditions. Interactions between service users and staff was observed to be relaxed, friendly and appropriate, response to service users requests for assistance appeared timely. Overall, the home appeared homely and comfortable and the service users seemed generally content. What does the service do well Page 2

Food appeared good and plentiful. Laundry appeared well managed. An ongoing effort to maintain the home and renew equipment was evidenced. Relationships of staff with visiting professionals and relatives appeared good and were confirmed as so by visiting relatives and a professional on the day of inspection. What has improved since the last inspection? Evidence of replacement of carpets and ongoing maintenance and renewal of decorating. What needs to be done to improve the service? a.) priorities No regulatory requirements were made at the time of this inspection activity. b.) other areas for improvement Ensure proposed arrangements for the activity co-ordinator hours are implemented. Ensure an audit of staff files and relevant training records is undertaken to identify staff training needs and reflect this in a training matrix. Prioritise training needs and arrange appropriate training. Update CSSIW of the above within two weeks of receipt of this report. Ensure meetings between new staff and their mentor when discussions around staff induction take place are appropriately recorded. Ensure it is highlighted to staff the importance of ensuring no gaps are evident in daily monitoring charts. Encourage service user representatives to sign agreement with service user plans in place, where service users are unable to do this themselves. Inspection methods Consideration of previous self assessment documentation and additional supplementary information previously sent to Care and Social Services Inspectorate of Wales (hereafter known as CSSIW). Consideration of the previous inspection report. Case tracking of 2 service users files and accompanying documentation and partial case tracking of 2 staff files. Partial tour of the premises. Discussion with 3 service users who wished to speak with the inspector. Discussion with 4 visiting relatives at different intervals. Discussion with 1 visiting professional. Discussion with the registered manager, deputy manager and senior staff member on duty. Discussion with 2 staff members on duty. Discussion with 3 ancillary staff present (cook, cleaner and laundry person).

Issue of 10 staff questionnaires to both support and ancillary staff for. Observation of staff delivering care throughout the day. Examination of records relating to staff, service users and the home. Page 4

Choice of home Inspector`s findings: The registered manager advised the home had a statement of purpose and service user guide which was in the process of being updated. This is to be forwarded to CSSIW within one month of receipt of this report. Service user files examined contained an assessment and care plan prepared by the placing authority with a subsequent service user assessment and plan being developed by the home, (the content of which is discussed in the next section of the report). The registered manager confirmed no service users moved into the home without a preassessment and care plan in place from the Local Authority or an assessment by the home if the service user was self funding. This was evident in the files examined. The inspector examined training matrices prepared by a previous senior person who had now left the home. These demonstrated gaps in staff training, which the registered manager was aware of and confirmed arrangements were being made to ensure staff received appropriate mandatory training at timely intervals (the content of which shall be reported on later in this report). The staff team in place were diverse in age, skill and experience and appeared hardworking. Relationships demonstrated between support staff and service users appeared warm and caring. Requirements made since the last inspection report which have been met: Action required When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Timescale for Good practice recommendations: Ensure all staff files and staff training information is audited to produce up to date staff training prioritised according to need. Page 5

Planning for individual needs and preferences Inspector`s findings: Service user plans were evident in the two files examined. The quality of information in these plans was detailed enough to give account of how each service user wished to have their care delivered. Daily monitoring sheets such as bathing charts, nutritional intake, fluid, pressure relief/mobility encouragement and incontinence support needs supplemented each plan. The quality of recording on the service user daily records sampled evidenced gaps in some areas (nutritional intake records) and the manager acknowledged the importance of good monitoring being vital to ensure sound delivery of care. It was pleasing to note daily reports on the service users day included mood, behaviour and interaction and not wholly on clinical/custodial aspects. The registered manager confirmed staff would be reminded of the importance of ensuring all records are maintained up to date. Documents examined evidenced service users had risk assessments in place including: risk of pressure damage, risk of falls, moving and handling, fire, locked doors, call alarm assistance and their ability to use, nutritional risk, and use of bedrails had been undertaken as appropriate. All risk assessments were reviewed on a monthly basis unless the service user s condition changed and then more regular review was necessary. Evidence of referrals to relevant professionals for assistance in delivering appropriate care was observed. Care files and documentation was observed by the inspector to be stored securely within locked cupboards within a main office at the home. Page 6

Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Timescale for Good practice recommendations: Ensure it is highlighted to staff the importance of ensuring no gaps are evident in daily monitoring charts. Encourage service user representatives to sign agreement with service user plans in place, where service users are unable to do this themselves. Page 7

Quality of life Inspector`s findings: On the day of the inspection the inspector observed service users with access to three communal lounges, two with televisions and reading materials were available. Rotas examined evidenced an activity co-ordinator should work twenty hours a week but at the time of inspection it was their rostered day off. Changes to the activity worker had recently taken place due to change of staff personnel and staff roles. Later in the day the care staff appeared to be taking a more visible role in chatting to service users. Main activities generally took place in the afternoons. Relatives visiting the home relayed to the inspector activities that often took place at weekends including birthday parties put on by the home and a recent party held to celebrate the royal wedding. The manager advised organised activities are frequently held at the home. A relative relayed details where arrangements had been made for their relative to visit a local pub for a meal and was aware of arrangements forthcoming for service users to have a day out to Porthcawl. Information on advocacy services was made available within the home and an Age Concern advocate was visiting a specific service user during the inspector s visit. Service users could receive visitors in private if they wished or in vacant lounges. There were no restrictions on visiting times within the home and this was observed by the inspector during the visit to the home. A visitor s book was available in the foyer. Relatives who spoke with the inspector advised staff attitudes towards their relatives was observed to be of a warm, friendly and caring nature. Staff were observed to interact with service users in a kind, pleasant and appropriate manner during the inspector s visit. This was also confirmed by the visiting professional the inspector spoke with. All service users, relatives and a visiting professional who spoke with the inspector spoke highly of the quality and quantity of food observed to be on offer. Food on offer at lunch time appeared to be plentiful and looked appetising. Two main meal choices were available along with a fresh fruit pudding or choice of fruit. Kitchen staff who spoke with the inspector reported stock to be available and adequate. Some minor issues had previously been experienced with regard ordering particular fresh ingredients but this had been rectified. The kitchen staff member was very busy due to being short one member of staff, due to sickness, the deputy on duty assisted with serving on this occasion. One staff member commented about own label brands being used due to budget, as opposed more expensive. This was not in keeping with the positive comments received in respect of quality from others spoken with or that observed by the inspector. Homemade cakes were offered with afternoon teas. Service users weights were monitored, where detailed as an assessed need. Gaps in recorded nutritional intake have previously been referred to, which the registered manager agreed to address. Page 8

Quality of care and treatment Inspector`s findings: At the time of the inspector s visit there were 30 service users accommodated in the home. The home is registered to accommodate up to 31 older persons with dementia, requiring personal care. The registered manager advised all service users within the home had some degree of dementia. Staff received dementia training to assist them with service users needs. The home had referral mechanisms in place to ensure that service users received appropriate access to specialist medical, nursing, psychological and clinical services and this was evidenced on the records examined. The registered manager advised good relationships were established with all visiting professionals and General Practitioner surgeries locally. This was confirmed by visiting professional the inspector was able to speak with. The home had a medication policy in place regarding the ordering, receipt, administration and return of medicines within the home. Senior staff administered medication and confirmed with the inspector they had received medication training. Medication was noted to be stored securely and medication administration sheets examined appeared to have been completed accurately. The registered manager advised no service user self medicated at this time within the home. Risk assessments were available in the records examined indicating that assessments for risk of pressure damage, risk of falls, moving and handling, fire, locked doors, call alarm assistance and ability to use, nutritional risk, and use of bedrails as appropriate had been undertaken. Care plans had been put in place to guide staff in caring for individuals health needs. These detailed interventions and equipment required. The registered manager advised all service users with moving and handling needs had a profile bed. Equipment would be obtained prior to admission for those service users with identified moving and handling needs. Service users wore their own clothing and washing and drying facilities supported the laundering of personal items of clothing and bed linen to a good standard. Feed back from relatives and staff questionnaires supported this. The registered manager advised a full fire risk assessment was in place and that staff receive regular updates regarding fire training, as well as during their initial induction training. Fire as a risk to service users was observed to be included as part of the risk management process at the home. Page 10

Staffing Inspector`s findings: The registered manager confirmed the number of care staff was appropriate to the assessed needs of the service users, the size, layout and purpose of the home. At present and according to the service users assessed needs five staff worked in the morning with a senior or deputy manager. In the afternoon four staff worked with a senior or deputy carer. The registered manager confirmed she worked a minimum of 20 hours supernummary per week. Staff rotas examined demonstrated four staff were on long term sick and during a particular week the home had experienced significant levels of absence. The registered manager advised that she and her deputy, as well as the staff team, filled in during such occasions as well as times of annual leave and training requirements. The registered manager confirmed that absence was monitored during staff supervision within a performance management framework. Staff were observed to respond in a timely manner to service users requests for assistance. There were sufficient hours of ancillary staff employed within the home to maintain cleanliness, laundry and catering services. The home also benefitted from the services of a handyman. Training matrices examined demonstrated gaps in some mandatory training areas, namely, first aid and food hygiene. The Deputy at the home was in the process of retrieving up to date information from staff files by conducting an audit to ascertain which staff had what training and prioritise accordingly. Relevant information was going to be reflected on the front of staff files for ease of reference when discussing staff training needs during staff supervision. The manager agreed to give this area priority and provide CSSIW with a written update within two weeks of receipt of this report and provide an up to date training matrix and details of courses arranged for staff to attend. Staff who spoke with the inspector confirmed staff received service user specific training such as challenging behaviour, diabetes, fundamentals in care, Parkinson s disease, dementia awareness and deprivation of liberties training. The inspector examined two staff files partially at the time of the visit and noted recruitment information included relevant checks. However, gaps in employment history were not recorded as explored at interview on both staff files, one of which related to a new staff member. The registered manager agreed to ensure this information was obtained at interview if not apparent on received application forms and clarify with the current individual. The registered manager confirmed newly appointed staff received induction that was cross referenced with the Care Council for Wales Social Care Induction Framework. The new staff file examined did not evidence this. However the new staff member confirmed meetings with their mentor had taken place. The deputy manager agreed to ensure such meetings, in particular when they included discussion of the staff member s induction, were appropriately recorded and demonstrate the regular contact received. The registered manager confirmed it was the aim of the home for staff to receive formal supervision, every two months along with an annual appraisal. Senior staff that spoke with the inspector confirmed they had received training to conduct regular staff supervision. Annual appraisals were confirmed to be conducted by the registered Page 12

manager. The home had over 50% of staff who either had or were working towards a relevant National Vocational Qualification. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Timescale for Good practice recommendations: Ensure an audit of staff files and relevant training records is undertaken to identify staff training needs and reflect this in a training matrix. Prioritise training needs and arrange appropriate training. Update CSSIW of the above within two weeks of receipt of this report. Page 13

Conduct and management of the home Inspector`s findings: The registered manager had the necessary qualifications and experience to manage the home. The registered manager had worked at the home for many years and displayed a good knowledge of all aspects of the home s management and a good understanding of service user needs. Communication between the registered manager senior staff and staff team was observed to be open, and this was confirmed by staff who spoke with the inspector and in returned CSSIW staff questionnaires. The inspector was informed that there was an open door policy in place. The registered manager was keen to ensure staff aired any concerns about the home they might have and was disappointed that anonymous concerns had been raised with CSSIW rather than directly through the organisation. However, the registered manager was keen to co-operate with regulatory process and rectify any concerns raised. In discussion with the inspector the registered manager advised she would ensure the report from the unannounced inspection would be shared with all staff for consideration. Ten staff questionnaires were left at the home on the day of the inspection, three of which were returned. All returned questionnaires reflected the individual staff members had no concerns about the home. Two questionnaires stated staff worked well as a team and one stating good with the additional comment there is always room for improvement wherever you go. All commented highly on standards of cleanliness in the home. Thoughts on the way in which the personal laundry service was managed at the home, all commented very good. All three questionnaires commented that the standard of food for service users was very good. All questionnaires confirmed they were well supported and had adequate equipment to do their job appropriately. Comments for improvements included additional lockers for staff and more staff. Comments were shared with the registered manager for consideration. The inspector spoke with several ancillary and care staff members on duty throughout the day. A staff consultation was ongoing at the home in respect of ancillary and care staffing levels and contract terms and conditions. Concerns were raised with the inspector in respect of employment terms and conditions. These staff were encouraged to seek appropriate employment advice from relevant services. The registered manager advised staff were being kept informed as part of the process and any likely outcome of such a review. The inspector spoke with three different relatives during the inspection visit all were complimentary about the home in terms of standards of care, approachability of the management, quality of food, standards of cleanliness and laundry service. The registered manager advised that the area manager Mrs Peters visited the home a minimum of every 3 months, (Regulation 27 visit, a visit by the provider or their representative to monitor the quality of the service offered by the home). A report had been previously made available during the last inspection in March. Therefore, this area was not examined. An appropriate insurance certificate was displayed within the home. Page 14

A visitor s book was in evidence within the home to monitor the number of people within the building. The financial status of the home was not discussed during this inspection visit. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Timescale for Good practice recommendations: None Page 15

Concerns, complaints and protection Inspector`s findings: The registered manager advised a complaint policy and procedure was in place and that no complaints had been received at the home since the last inspection in March 2011. Relatives who spoke with the inspector advised they were aware of the complaints procedure and who to contact in the event they had any concerns or issues. Comments received suggested that Sandra [the manager] is very approachable. A book kept alongside the visitor s book in the foyer of the home was available to enable visitors to make comments about the home and its practices. The inspector noted several pleasant comments recorded. The inspector also viewed a particularly favourable response in the form of a returned relative satisfaction survey. Previous inspection self assessment information indicated the home had policies and procedures in place regarding Protection of Vulnerable Adults (POVA). Training matrices indicated two staff without the above training. Arrangements were in place to ensure staff received this as a priority. The registered manager advised there had been no POVA issues since the last inspection. During the previous inspection in March 2011 the inspector had been advised that staff had received deprivation of liberty (DOLS) training and this would be ongoing for new staff. The registered manager advised there remained no deprivation of liberty safeguard authorisations in operation at the home. The purpose of the unannounced inspection was to focus on anonymous concerns raised with the inspectorate. No regulatory requirements were made in respect to the concerns based on the findings of the inspector at the time of the visit made. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for New requirements from this inspection: Timescale for Good practice recommendations: None Page 16

The physical environment Inspector`s findings: Oakdale Manor is a large detached two-storey building set in its own ground, in the residential community of Oakdale. The home is close to local amenities. The home is registered for a maximum of 31 service users, though to ensure all rooms were single occupancy there were 30 service users accommodated at the home on the day of the inspection visit. The focus for this inspection was issues raised in an anonymous concern forwarded to the inspectorate. Concerns raised did not focus on the environment therefore this area of the home was not inspected, in any depth. A partial tour of the home was conducted. The environment appeared clean homely and comfortable. The home had implemented a cycle of maintenance and renewal of soft furnishing and decoration of communal areas, to maintain a homely environment. The handy person was observed to be decorating whilst the inspector was visiting. The stairs had recently been painted, brightening this area up considerably. Maintenance and repairs were ongoing, carpets and decoration of communal areas had taken place. A service user invited the inspector to view their bedroom and decoration. Cleanliness and décor was of a good standard. There had been opportunity for the user to personalise their bedroom. The registered manager advised technical checklist information previously supplied as part of the self assessment information completed by the manager on behalf of the home for the former inspection in March remained up to date and no major structural issues were of concern. Requirements made since the last inspection report which have been met: When completed Requirements which remain outstanding: (previous outstanding requirements) Original timescale for Regulation number New requirements from this inspection: Timescale for Good practice recommendations: None Page 17

A note on CSSIW s inspection and report process This report has been compiled following an inspection of the service undertaken by Care and Social Services Inspectorate for Wales (CSSIW) under the provisions of the Care Standards Act 2000 and associated Regulations. The primary focus of the report is to comment on the quality of life and quality of care experienced by service users. The report contains information on how we inspect and what we find. It is divided into distinct parts mirroring the broad areas of the National Minimum Standards. CSSIW`s inspectors are authorised to enter and inspect regulated services at any time. Inspection enables CSSIW to satisfy itself that continued registration is justified. It also ensures compliance with: Care Standards Act 2000 and associated Regulations whilst taking into account the National Minimum Standards. The service`s own statement of purpose. At each inspection episode or period there are visit/s to the service during which CSSIW may adopt a range of different methods in its attempt to capture service users` and their relatives`/representatives` experiences. Such methods may for example include selfassessment, discussion groups, and the use of questionnaires. At any other time throughout the year visits may also be made to the service to investigate complaints and to respond to any changes in the service. Readers must be aware that a CSSIW report is intended to reflect the findings of the inspector at a specific period in time. Readers should not conclude that the circumstances of the service will be the same at all times. The registered person(s) is responsible for ensuring that the service operates in a way which complies with the regulations. CSSIW will comment in the general text of the inspection report on their compliance. Those Regulations which CSSIW believes to be key in bringing about change in the particular service will be separately and clearly identified in the requirement section. As well as listing these key requirements from the current inspection, requirements made by CSSIW during the year, since the last inspection, which have been met and those which remain outstanding are included in this report. The reader should note that requirements made in last year`s report which are not listed as outstanding have been appropriately complied with. Where key requirements have been identified, the provider is required under Regulation 25B (Compliance Notification) to advise CSSIW of the of any action that they have been required to take in order to remedy a breach of the regulations. The regulated service is also responsible for having in place a clear, effective and fair complaints procedure which promotes local resolution between the parties in a swift and satisfactory manner, wherever possible. The annual inspection report will include a summary of the numbers of complaints dealt with locally and their outcome. Page 18

CSSIW may also be involved in the investigation of a complaint. Where this is the case CSSIW makes publicly available a summary of that complaint. CSSIW will also include within the annual inspection report a summary of any matters it has been involved in together with any action taken by CSSIW. Should you have concerns about anything arising from the inspector`s findings, you may discuss these with CSSIW or with the registered person. Care and Social Services Inspectorate Wales is required to make reports on regulated services available to the public. The reports are public documents and will be available on the CSSIW web site: www.cssiw.org.uk Page 19

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