Oakview Manor Care Home Care Home Service 41/43 Newark Drive Pollokshields Glasgow G41 4QA Telephone: 0141 423 8525 Type of inspection: Unannounced Inspection completed on: 27 October 2016 Service provided by: Oakminster Healthcare Ltd Service provider number: SP2003002359 Care service number: CS2003014530
About the service we inspected Oakview Manor is a care home for older people which is located in a residential area of Pollokshields, Glasgow. The service provider is Oakminster Healthcare Ltd. The service is registered to provide a care service to a maximum of 80 older people. A maximum of four places may be used for respite or short breaks. At the time of this inspection, there were 25 people using the service. Only one area of the building was in use with 33 bedrooms available, known as Caledonia unit. It is a four storey building. However, the top floor was not in use. There is a lift giving access to the upper floors. The ground floor has a newly refurbished dining room and café area. There is also a conservatory corridor with small seating areas and views over the main entrance driveway. A lounge is located to the rear of the ground floor. This is bright and pleasant. Bedrooms are located over three floors with the first floor having a lounge with small dining area. The second floor also has a small lounge but this facility was not used. Both floors have a small kitchen area that can be used for drinks and snacks. Most residents spend their day on the ground floor using the lounge and dining/conservatory areas. All of the bedrooms have en-suite toilet and bath or shower facilities. There are communal baths and showers available for those who require an adapted facility. The garden had a pleasant seating area which could be accessed using a ramp from the side of the building. Further work was planned to improve ease of access and use of the garden. The service states it aims to "enhance the quality of life of its residents." How we inspected the service This unannounced follow up inspection focused on progress made in meeting the requirements and recommendations set out in the inspection report of 11 April 2016. Taking the views of people using the service into account Three residents were consulted. All were satisfied with the service. Comments included: "The staff are good, I'm satisfied with the care, I have everything I need." "The staff are good but there's a lot of food I don't like. They could do with more staff at times. Some are better than others." "Quite contented, the food's OK, they come if I buzz." page 2 of 13
Taking carers' views into account Two visiting relatives of residents were consulted. One was extremely satisfied with the care and support being provided the other was still settling into the home and issues were being discussed. What the service has done to meet any requirements we made at or since the last inspection Previous requirements Requirement 1 The service provider must review and provide a comprehensive induction for new staff to ensure essential subjects are covered within the first weeks of commencing employment. For example, moving and assisting, adult support and protection and understanding restraint. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210). Regulation 9 Fitness of employees 9(2) The following persons are unfit to be employed in the provision of a care service: (b) a person who does not have the qualifications, skills and experience necessary for the work that the person is to perform. Regulation 15 15. A provider must, having regard to the size and nature of the care service, the statement of aims and objectives and the number and needs of service users (a) ensure that at all times suitably qualified and competent persons are working in the care service in such numbers as are appropriate for the health, welfare and safety of service users; and (b) ensure that persons employed in the provision of the care service receive (i) training appropriate to the work they are to perform; and (ii) suitable assistance, including time off work, for the purpose of obtaining further qualifications appropriate to such work. Timescale for meeting this requirement: by 30 June 2016. This requirement was made on 11 May 2016. Action taken on previous requirement Induction records were checked for four new staff. New records and practices had been introduced since the last inspection. This included the allocation of a mentor, more detailed recording of training and instructions given. page 3 of 13
Records showed that some subjects considered essential in the first weeks of commencing employment were covered. However, there was still some inconsistency in ensuring restraint training was covered. The induction records differed and some had this heading and others didn't. Overall the induction process had been reviewed and improved. Further improvements could be made - see recommendations. Met - within timescales Requirement 2 The service provider must ensure all staff understand the legal aspects of the use of physical restraint. Training on this subject must take place as soon as possible. This should reflect the guidance of the Mental Welfare Commission for Scotland - Rights, Risks and Limits to Freedom (2013). This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210). Regulation 4 Welfare of users 4(1) A provider must- (a) make proper provision for the health, welfare and safety of service users; (b) provide services in a manner which respects the privacy and dignity of service users; (c) ensure that no service user is subject to restraint, unless it is the only practicable means of securing the welfare and safety of that or any other service user and there are exceptional circumstances. Timescale for meeting this requirement: to be completed by 31 May 2016. This requirement was made on 11 May 2016. Action taken on previous requirement Understanding restraint training had taken place as a face-to-face session in May 2016 and was attended by 16 staff. An online training module was also available. Some staff had completed this but others had not. Two new staff had not had this training and it was not always included on the induction record. This needed to be clarified to ensure further improvements were made. Consideration could be given to the production of a restraint register. See recommendation 10. Overall, staff understanding on this subject had improved. Met - within timescales Requirement 3 The service provider must ensure staff can access current policies and procedures at all times in order to be able to refer to them and guide practice appropriately. This is in order to comply with: The Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 (SSI 2011/210). page 4 of 13
Regulation 3 Principles A provider of a care service shall provide the service in a manner which promotes quality and safety and respects the independence of service users, and affords them choice in the way in which the service is provided to them. This requirement also takes into account National Care Standards for Care Homes for Older People: Standard 5.1 - Management and Arrangements. Timescale for meeting this requirement: by 31 July 2016. This requirement was made on 11 May 2016. Action taken on previous requirement A new policy folder was now available for day staff and was soon to be made available for night staff. All staff could now access policies and procedures on-line. Staff training on the new "suite" of policies was planned. All daystaff spoken with were aware of the new policies being available. Night staff were not aware and this needs to be addressed. Overall, the progress meant staff with some more prompting and guidance will be able to access policies and procedures when needed. Met - outwith timescales What the service has done to meet any recommendations we made at or since the last inspection Previous recommendations Recommendation 1 The service provider should ensure that methods of gaining feedback from residents with dementia are developed and implemented. National Care Standards for Care Homes for Older People: Standard 11 - Expressing Your Views. This recommendation was made on 24 November 2015. A staff member had been given additional training to help obtain views of people with dementia using talking mats. However, this staff member had now left the service. A participation pack had been developed and this set out the importance of gaining feedback from people who use the service. The policy on participation was not included in the new policy manual. This needs to be added. Some staff were unclear about the availability and content of the participation packs. This remains an ongoing area for development. Overall, the recommendation is met. page 5 of 13
Recommendation 2 The service provider should continue to improve the care of people with dementia/learning disabilities and ensure staff interactions do not provoke but minimise any stress/distress reactions from residents. In order to do this, staff communication skills should be enhanced and interactions observed to promote good practice. National Care Standards for Care Homes for Older People: Standard 6 - Support Arrangements. Staff training in care of people with stress/distress was continuing to develop. There was no specific observational tool in use to record staff interactions and promote positive interventions. This could be developed. Overall, care plans and use of recording systems were developing. Staff interactions were observed to be positive. Recommendation 3 The service provider should ensure medication does not go out of stock, controlled drug patches are monitored more closely and disposed of correctly with records kept of returns to the pharmacy. National Care Standards for Care Homes for Older People: Standard 15.6 - Keeping Well - Medication. There were no issues of medication going out of stock which caused concern. Controlled drug patches were being monitored and used patches were stored in the controlled cupboard prior to return to the pharmacy. There was no record of this return. This was discussed with the manager and clarification needs to be sought to ensure appropriate records are maintained. Overall, the recommendation is met. Recommendation 4 The service provider should inform the Care Inspectorate of the proposed timescales for installation of the improved exit door alarms and the changes to the proposed dining room/cafe area. Interim dining arrangements should be confirmed prior to work being commenced. National Care Standards for Care Homes for Older People: Standard 4.14 - Your and Standard 9 - Feeling Safe and Secure. Exit door alarms were improved. Further changes were planned as refurbishment was completed. The new dining room has been established. Door security had been re-emphasised with staff and visitors following an incident. page 6 of 13
Recommendation 5 The service provider should make an assessment of how residents who cannot operate a nurse call bell can be attended to quickly by staff if needed. Alternatives to the nurse call such as listening devices or a room change to a closer location to staff should be considered as options with appropriate assessment and agreement. National Care Standards for Care Homes for Older People: Standard 9.4 - Feeling Safe and Secure. Two residents were offered room changes to ensure closer contact with staff. There were no issues noted in relation to lack of staff attention. Recommendation 6 The service provider should consider how to enable residents to access the outdoors more regularly and easily. National Care Standards for Care Homes for Older People: Standard 4.1 - Your. A gardening group was set up throughout the summer. No changes have been made to improve ease of independent access to the gardens yet. Improvements are planned in the future. This will be monitored at future inspections. Recommendation 7 The service provider should consider the use of space if numbers of residents should rise. Alternative lounge space and revised dining arrangements would be necessary. Choices should be offered of where residents spend their day. Use of their own room during the day should be promoted if a rest from a chair is needed. National Care Standards for Care Homes for Older People: Standard 8.2 - Making Choices. The first floor lounge was now in use and provided a homely setting and alternative to residents who don't want to go downstairs to the larger lounge. Recommendation 8 The service provider should review the induction process with a view to checking practice at intervals throughout the probationary period. Allocation of a mentor and improved evidence of use of induction materials would be good practice. National Care Standards for Care Homes for Older People: Standard 5.3 - Management and Arrangements. page 7 of 13
The induction process had improved and included checks of progress at 4, 8 and 12 weeks. Staff spoke positively about the induction and support provided. This included allocation of a mentor and shadow shifts. The completion of the induction records were variable for example, in recording shadow shifts, inconsistent use of the online induction module and lack of clarity about the essential eight subjects to be completed. This meant the records could be further improved through more rigorous checking. In addition further development could be made to ensure difference in job roles are recognised during induction. For example, nurse, senior carer and care assistant roles all having distinction between them. Progress will be checked at the next inspection. Recommendation 9 The service provider should consider how to support and enhance the skills of night staff. The provider should ensure staff attend training sessions and are supported in supervision sessions by staff who have been working alongside them and can comment on their performance. Supervision should check staff have read and understood key policies and care plans to help support residents' care. National Care Standards for Care Homes for Older People: Standard 5.2 - Management and Arrangements. The recruitment to fill permanent night nurse posts has not been completed yet. This meant leadership on nights was carried out by bank or agency staff. Whilst on most occasions these staff were well known to the home there was an overall lack of leadership noted. Night staff spoken with were not aware of new policy availability. Supervisions of staff were being carried out by the bank nurses but completion of supervisions and training was not being checked and monitored thoroughly enough. Of the three night staff files examined one had no record of supervision for over two years and issues had arisen over the last year with non-completion of online training. The other staff had not had supervision for 7-8 months. Further work needs to be done to improve the quality of training and supervision of night staff. This recommendation is not met. Recommendation 10 The service provider should ensure paperwork is in place to give clarity to staff on the legal position for adults with incapacity, resuscitation decisions, covert medication and use of physical restraints such as bedrails, lap straps and tilt back chairs. Review dates should be monitored as a part of the quality assurance system. National Care Standards for Care Homes for Older People: Standard 5.4 & 5.11 - Management and Arrangements. An management document was seen which gave an overall record of legal status and resuscitation decisions. However, personal plan and handover sheets did not always include this clearly enough for day-to-day use by staff. An example of use of a lap strap was checked and no risk assessment was in place. page 8 of 13
There was no restraint register in place to show clearly that physical restraints such as bedrails, lap-straps and tilt back chairs had been agreed with clear review dates in place. This recommendation is partly met but further work needs to be done to ensure systems are established and used effectively. This will be reviewed at the next inspection. Recommendation 11 The manager needs to demonstrate that appropriate cleaning measure and infection measures to control the spread of on infection is implemented and monitored. Practice should be in line with evidence based good practice and National Guidance for Scotland for prevention and control. National Care Standards for care Homes for older people, standard 4.3:your environment This recommendation was made on 13 May 2016. Infection control training was ongoing with staff. No issues of poor practice were noted. Recommendation met. Recommendation 12 The manager needs to ensure that staff supports the known wishes and choices of the resident or their family. This recommendation was made on 13 May 2016. Residents' personal plans were being used to record needs and preferences. No issues of choices not being supported were noted. Recommendation met. Recommendation 13 The manager needs to demonstrate that the deployment of staff on shift ensures adequate supervision of all residents, in all areas of the home, at all times. Levels need to take account of the lay out of the building. National Care Standards for Care homes for older people standard 4.2 Your environment and standard 5.7 Management and staffing This recommendation was made on 13 May 2016. Deployment of staff had improved with staff covering each of the floors at all times. Recommendation 14 Managers need to Recruit Permanent or regular bank staff promptly to provide residents with workers who know them their families and their needs. National Care Standards: Care Homes for older People Standard 5 : management and This recommendation was made on 13 May 2016. page 9 of 13
Staff consistency was improving with a reduction in the use of agency staff noted. Complaints Please see Care Inspectorate website (www.careinspectorate.com) for details of complaints about the service which have been upheld. Enforcement No enforcement action has been taken against this care service since the last inspection. Inspection and grading history Date Type Gradings 3 Nov 2016 Re-grade Care and support Management and leadership 11 Apr 2016 Unannounced Care and support Management and leadership 24 Nov 2015 Unannounced Care and support Management and leadership 24 Apr 2015 Unannounced Care and support Management and leadership page 10 of 13
Date Type Gradings 18 Dec 2014 Unannounced Care and support Management and leadership 10 Jul 2014 Unannounced Care and support Management and leadership 26 May 2014 Unannounced Care and support 1 - Unsatisfactory 1 - Unsatisfactory Management and leadership 1 - Unsatisfactory 28 Feb 2014 Unannounced Care and support 1 - Unsatisfactory 1 - Unsatisfactory Management and leadership 1 - Unsatisfactory 29 Aug 2013 Unannounced Care and support 1 - Unsatisfactory 1 - Unsatisfactory Management and leadership 29 Mar 2013 Unannounced Care and support Management and leadership 24 Aug 2012 Unannounced Care and support Management and leadership 20 Feb 2012 Unannounced Care and support Management and leadership page 11 of 13
Date Type Gradings 29 Jul 2011 Unannounced Care and support Management and leadership 29 Sep 2010 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 29 Apr 2010 Announced Care and support 5 - Very good 5 - Very good Management and leadership 27 Oct 2009 Unannounced Care and support 5 - Very good 5 - Very good Management and leadership 17 Apr 2009 Announced Care and support 5 - Very good 5 - Very good Management and leadership 5 - Very good 8 Oct 2008 Unannounced Care and support Management and leadership 8 Jun 2008 Announced Care and support Management and leadership page 12 of 13
To find out more This inspection report is published by the Care Inspectorate. You can download this report and others from our website. Care services in Scotland cannot operate unless they are registered with the Care Inspectorate. We inspect, award grades and help services to improve. We also investigate complaints about care services and can take action when things aren't good enough. Please get in touch with us if you would like more information or have any concerns about a care service. You can also read more about our work online at www.careinspectorate.com Contact us Care Inspectorate Compass House 11 Riverside Drive Dundee DD1 4NY enquiries@careinspectorate.com 0345 600 9527 Find us on Facebook Twitter: @careinspect Other languages and formats This report is available in other languages and formats on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas. page 13 of 13