Inspection on 07/04/09 for Oaklands House Nursing Home

This is the latest available inspection report for this service, carried out on 7th April 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oaklands House Nursing Home Allington Lane West End Southampton Hampshire SO30 3HP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Beverley Rand     Date: 0 7 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 23 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Oaklands House Nursing Home Allington Lane West End Southampton Hampshire SO30 3HP 02380472581 02380471272 oaklands@lrh-homes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : London Residential Healthcare Ltd care home 54 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Additional conditions: 54 54 The maximum number of service users who can be accommodated is: 54 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia DE Mental Disorder, excluding learning disability or dementia - MD Date of last inspection Brief description of the care home Oaklands House Nursing Home is a registered care home providing personal and nursing care, with accommodation for 54 service users who may have dementia. The home is a large detached house, with a large garden and parking area at the front of the house. Accommodation is provided on two floors, which are accessed by stairs and a passenger lift. The home has 5 double bedrooms and 44 singles, all are en-suite with their own sink and lavatory, with bathrooms on each floor. There are two sitting rooms, a dining room and smoking room off the courtyard garden. Care Homes for Older People Page 4 of 23 Brief description of the care home The home is owned by LHR Homes and is situated in a semi rural location in West End, on the outskirts of Southampton and is easily accessible from the motorway. The current fees are between 600 and 800 pounds a week, depending on assessment. Care Homes for Older People Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before we visited the home we looked at the last inspection report, correspondence received by us since the last inspection and the Annual Quality Assurance Assessment which was detailed about improvements made and plans for the future. During the inspection we spoke with two visitors, a social care professional who was visiting, staff and the manager. We also looked at records such as recruitment files and care plans. Care Homes for Older People Page 6 of 23 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 23 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager ensures that service users do not move into the home without their needs being assessed. Evidence: The AQAA stated that the home invites potential service users and relatives to look around the home and to chat to staff. The manager undertakes assessments of prospective service users to ensure that the home can meet their needs. Professionals and relatives are involved with the assessment process where necessary. We saw needs assessments for the people whose care plans we looked at and found that they covered all areas. Care Homes for Older People Page 9 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health and personal care needs are met. Evidence: We looked at five care plans and found that they covered health and social care needs. Risk assessments were in place regarding falls, moving and handling, use of bed rails, use of footplates on wheelchairs and nutrition. Care plans were reviewed on a monthly basis, although the review paragraph often repeated the previous review. We discussed this with the manager who confirmed that the service users who this referred to had not experienced any change in their needs. Some care plans referred to service users as, resisting care or being, physically aggressive yet there were not any further guidelines or strategies. We spoke with the manager and staff about this and they explained the needs of the individual service users, which were not as great as could be suggested by the language used. An example was provided by the manager who said that the majority of people with advanced dementia were likely to be resistive to care at some time and that it would be a matter of them just waving staff away. Staff would go back later and try again. We spoke with staff who said that Care Homes for Older People Page 10 of 23 Evidence: they had read careplans and felt they were important regarding personal care needs. Care plans showed evidence of involvement of health care professionals. We saw examples such as staff noticing a service user was unstable following a particular medication and the doctor was called to review the medication. The home has good links with the psychogeriatrician who visits regularly and reviews medication as necessary. Only trained nurses administer medication. We looked at the storage for the medication which is stored on both floors of the home and found that it was stored securely. We looked at the medication administration records and there were not any gaps in the recording. There was medication which was to be administered, when required and this included medication for epilepsy and agitation. We asked nursing staff when they would give such medication and they were able to give answers but there were not any written care plans. We looked at the last two months medication administration records and saw that the particular medication had not been given during this time. We spoke to the manager about it and she confirmed that some service users had not used the medication and probably did not need it to be prescribed still. She undertook to ensure that care plans were put in place for medication prescribed as when needed. Throughout the inspection we saw evidence and spoke with people who confirmed that service users dignity was respected. Care Homes for Older People Page 11 of 23 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users enjoy the activities and have a choice of meals. Visitors are welcome. Evidence: Activities include a variety of singers and musicians who visit on a weekly basis, playing musical instruments, leading armchair exercises and trips out. The manager told us that service users had really enjoyed a company which visited, bringing animals such as snakes. Trips out are arranged as appropriate. The home employs an activities co-ordinator and on the day of the inspection we saw the staff member encouraging and supporting service users to play a board game. Other activities include hand massage, nail painting, gardening projects such as hanging baskets and growing runner beans and seasonal projects such as making Easter bonnets. Relatives are asked to complete a form about the service users personal interests and hobbies so that the activities can be tailored if possible to individual needs. Photographs are taken of service users enjoying activities and put into albums. During the inspection we saw that visitors were welcome at the home. We spoke with a visitor who visits most days and sometimes eats at the home, and they were positive about their relative living at the home. Care Homes for Older People Page 12 of 23 Evidence: We were told that when people moved into the home their food likes and dislikes were discussed. The manager said that there was not a set budget for food and that service users could choose what food they liked. The menus included a variety of meals and on the day of the inspection there was chilli or savoury mince. Other options were available such as omelettes. The home has themed menu days such as St Patricks day. Special diets are catered for and pureed food is provided where necessary. We received good feedback from visitors about the food and one commented that there was, good variety, the desserts are nice. Care Homes for Older People Page 13 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users feel able to complain. Staff have received training in safeguarding adults. Evidence: The home has a complaints procedure and each service user has a copy in their room. There is also a copy in the reception area. We looked at the complaints logbook and saw that there was one complaint which had been responded to and resolved within four days. We spoke with two visitors who both said they would feel able to complain if necessary. We also spoke to a social care professional who said they had never needed to make a complaint. The AQAA states under the section, what we could do better, that the manager will, consider how to address assumptions that if we have no complaints that everything is working well. Staff have received training in safeguarding adults and were able to tell us what they would do if they suspected that a service user was being abused. Care Homes for Older People Page 14 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a clean and homely environment. Evidence: We walked around the home, looking at the communal areas and some of the bedrooms. The main lounge is large and is divided, by the use of furniture, into smaller sitting areas. One area of the lounge is used for activities such as board games. There is an additional, smaller lounge which is used by service users who prefer a quiet environment and this lounge can also be used for events such as birthday parties. The kitchen and laundry areas are separate to the communal areas and service users cannot access these for their own safety. We were shown a certificate issued by the Environmental Health Authority in January which showed that the home was awarded an excellent rating for food preparation procedures. We looked at the bathrooms which were functional with specialist bathing facilities. The upstairs bathroom has a new assisted bath. We saw that this bathroom was also used to store linen baskets and various pieces of equipment. The manager told us that this equipment is removed before anyone has a bath. There is also a downstairs bathroom which has an assisted bath. Care Homes for Older People Page 15 of 23 Evidence: The AQAA told us that service users have a choice about whether they move into a single or shared room and we spoke to the manager about this during the inspection. She said the decision was made depending on individual preferences, assessed needs and family views. She also said that prospective service users were made aware as to whether the vacancy was single or shared and that the fees charged were irrespective of whether the room was single or shared. The home employs a full time maintenance person. The manager told us that she speaks with the maintenance person on a daily basis and prioritises the work as necessary. The house stands in large grounds and there is a courtyard garden which is only accessible through the buildings surrounding it, which means it is safe and secure. The home employs cleaning and laundry staff. We spoke with visitors who said the home was kept clean. One said that the housekeeper did a, wonderful job. Another visitor said that the cleaning had improved over the years and that the carpets were cleaned weekly. Comments made on a recent quality assurance surveys included, the cleaning staff have worked hard to keep the home smelling clean and fresh; the home is always very clean, no unpleasant odours and, the home is bright and airy. Care Homes for Older People Page 16 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by well trained and qualified staff. Robust recruitment procedures protect service users. Evidence: We looked at the rotas and discussed staffing levels with the manager. The manager told us that the staffing ratio was generally three registered nurses, but with a minimum of one nurse for each floor and between eight and ten care staff. Nursing and care staff are supported by cooks, kitchen assistants, cleaning staff, laundry staff, a maintenance person and an administrator. Visitors told us that the staff were, very caring and that, the nursing care was always good. A visitor felt that staff were, diligent about health and let me know if (my relative) is unwell. They also said that, it feels like more staff interact well with residents in between doing tasks. The social care professional told us that the staff, know the service users inside out and that they could visit at, any time time of day and talk to anyone, they can update me on any of my clients. They are such a good staff team and are supportive of family. Recent quality assurance surveys included comments such as, I find the care excellent and consistent. Staff are very helpful, outstanding care and efficiency and, the Care Homes for Older People Page 17 of 23 Evidence: home, staff and manager are excellent. The manager told us in the AQAA that all new staff had had pre-employment checks completed before they started work. We looked at the files for three new staff and found that all files contained two references and a Criminal Records Bureau check. However, we did see that the references were dated when they were written but not when they were received. The manager told us that the head office completed the recruitment checks and would not have started new staff until the references had been received. We advised the manager that the records should show what date the references were received. New staff undergo an in-house induction and a formal induction which meets national minimum standards in care. We were provided with a copy of the training matrix which showed that staff were up to date with training such as moving and handling, fire safety, safeguarding adults, infection control, food hygiene and health and safety. Other training provided to nursing staff includes phlebotomy, tissue viability and catheterisation. Most staff have completed training in dementia awareness and this included ancilliary staff. Staff confirmed that they had, loads of training. The home plans to provide training in challenging behaviour and communication. Some service users have been diagnosed with mental health issues other than dementia. The manager said either she or the trained nurses find out relevant information about conditions and ensure it is available to other staff. The home has achieved an Investors in People award for the way it works with staff. Out of twenty five care staff, five have achieved a National Vocational Qualification in care, (NVQ) level 2. Seven staff are working towards the qualification and one is working towards NVQ3. Some care staff have qualified as nurses abroad and are studying for NVQ4. Care Homes for Older People Page 18 of 23 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in the best interests of the service users. Evidence: The manager is a Registered General Nurse and has nearly twenty years experience in nurse management. She was working towards a management qualification and completed four out of six modules at university but the course was discontinued before students could complete it. The manager updates relevant training and has undertaken courses including, Yesterday, Today, Tomorrow which is about dementia, pressure care, challenging behaviour, moving and handling, safeguarding and Mental Capacity Act. The home has a quality assurance system in place and we looked at completed surveys as detailed elsewhere in this report. The organisation ensures that the monthly unannounced visits are made to the home and a report is given to the manager. We looked at the most recent reports and found them to be detailed. Care Homes for Older People Page 19 of 23 Evidence: The manager told us that the home does not look after any money on behalf of service users. There are systems in place to ensure that regular maintenance tasks are completed, such as checking the hoists and other equipment. We looked at a sample of maintenance certificates which showed that equipment is well maintained which ensures the safety of service users. Care Homes for Older People Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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