Inspection on 03/07/07 for High Oaks

This inspection was carried out on 3rd July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

High Oaks 22/12/09

High Oaks 17/12/09

High Oaks 26/10/09

High Oaks 13/08/09

High Oaks 05/12/06

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 High Oaks Rectory Road Gissing Diss Norfolk IP22 5UU Lead Inspector Mrs Marilyn Fellingham Unannounced Inspection 3rd July 2007 09:30 High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 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 High Oaks DS0000067173.V345419.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 Adults 18-65. 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. High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Oaks Address Rectory Road Gissing Diss Norfolk IP22 5UU 01379 674456 01379 674456 info@high-oaks.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) High Oaks Farm Limited Mr Gary Colin Stear Care Home 18 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (18) of places High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 The home is registered to accommodate up to eighteen (18) people of either sex, with mental disorder excluding learning disability or dementia. There must be a registered manager at the home, who shall be a first level Registered Mental Nurse. 5th December 2006 2 Date of last inspection Brief Description of the Service: High Oaks is a registered nursing home providing residential nursing care for up to eighteen residents of both sexes, who have mental health problems. The home also provides short-term care. The current proprietor took over in July 2003, and is using all rooms for single occupancy. Communal areas are in the main part of the home, with bedrooms in a converted single storey extension. The home is in a rural setting, and affords peace and tranquillity for residents. Access to local towns and facilities, requires use of the home’s own transport as access to public transport is limited. Specialist support services required are accessed via G.P referrals. High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over five and a half hours. Opportunity was taken to tour the home. Five service users were spoken with and three members of staff. The manager was present for the inspection process. Six service user comment cards were received and five from relatives prior to the inspection. Fees for the home arrange from £850 to £1,700 per week. What the service does well: What has improved since the last inspection? What they could do better: Continue to upgrade various areas of the home, such as the bathrooms and lavatories. High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 6 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. High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard 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 continues to ensure that people who enter the home and significant others have adequate information to make an informed decision about admission to the home. EVIDENCE: Two case notes of newly admitted service users were examined and these confirmed good practice. The case notes also confirmed that the service users needs were assessed over a period of time to allow the home to establish whether the needs of the prospective service users could be met: this also allows for the prospective service users to decide if they want to enter the home. Those two newly admitted service users stated that they felt that they had been given sufficient time and information to make an informed choice before admission to the home. The admission records also showed that an holistic approach had been taken in relation to assessing the needs. High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are encouraged to lead independent lifestyles and take responsible risks. The care plans indicate therapeutic care and the support given by staff. The service users are involved as much as possible decision making in the home. EVIDENCE: The Inspector examined four care plans; the initial assessment of needs and the ongoing assessment and information from other agencies had been used to formulate the prescribed care. These care plans were informative and contained guidelines for therapeutic intervention. It was noted that review of care was carried out on a regular basis and also altered according to the changing needs of the service users. High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 10 Risk assessments were in place and these contained information about encouragement given to service users to take responsible risks in relation to their move towards more independence. Those service users spoken to indicated in their conversations with the Inspector that they were well supported to take risks in their daily lives as part of their intervention for care. Meetings are held with the residents and they are given opportunities to participate in decisions about the home and information is exchanged by them and the staff. One resident is going to be part of the interview process for a new gardener as one of his interests is gardening. High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 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. Activities are managed very well. At the moment meals are managed well, however this area will be monitored closely. EVIDENCE: Although two comment cards received from relatives expressed that they felt there were not a lot of activities for the residents, this was not reflected in the conversations that the Inspector had with the service users. All activities are recorded on the daily progress notes and all those service users who spoke to the inspector said that they always felt that there was “loads to do”. On the day of inspection a number of the service users were attending a woodwork session and one service user told the Inspector about the number of items he had made, including a bench that is outside his room. Another service user was being taken out to spend time with a friend. The service users and staff meet every morning to discuss the day’s activities, these also include weekend High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 12 trips out. One service user said that they had the opportunity to go swimming, attend cooking sessions and gardening; they went on to say that they felt that they were given many opportunities to participate in activities that were concerned with their personal development. Another service user is often taken out for fish and chips because that is what they choose to do. All those service users spoken to said that they enjoyed the meals and that there were always choices. One service user said that they were vegetarian and that the kitchen catered for them very well. The home is about to embark on a new approach to nutrition, this has not been fully commenced yet as the staff need to discuss all aspects of the new regime with a community dietician: a meeting with her is planned for the forthcoming week. It was therefore difficult to assess the impact of this new approach and if the new diet will have an impact on the health and welfare of the service users. High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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. Service users are well supported by the staff. The health care needs of the service users are well attended to. Improvements have been made to ensure that the handling and administration of medication is managed well. High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 14 EVIDENCE: All the service users spoken to felt that they were well supported by the staff, one service user said that they found the home a real help and that they were well supported by one particular member of staff who also has skills in counselling. One service user makes regular respite visits to the home because they feel that the home facilitates their move towards more independence. Another resident shared with the Inspector that they felt that their mental health status had improved greatly since being at the home. The Inspector observed much interaction between the staff and the residents and it appeared a happy atmosphere in the home. One resident was requiring one to one care, this was being carried out in a sympathetic manner and allowing the resident some freedom of movement in a safe and caring way. Discussion with the service users led the Inspector to believe that their health and emotional needs were met and the care plans certainly reflected this notion. The Inspector examined medication in stock and the records to see if these related to the prescribed care and medication that had been administered; there were found to be no discrepancies. Weekly and monthly medicine audits are carried out and these were examined by the Inspector. The policy and procedure for ensuring that medication was appropriately handled for those residents going on leave was found to be satisfactory. No one was selfmedicating at the time of the inspection. High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 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. Service users are listened to and are aware of the complaints procedure. Staff have the knowledge to recognise all areas relating to safeguarding adults. EVIDENCE: The general consensus from the residents was that they felt that they were listened to and that those whom the Inspector spoke with knew who to go to with their concerns and complaints. The training records confirmed that the staff members had had suitable training in relation to Safeguarding adults. It is recommended that the new cook is given the opportunity to also attend training in this area. Those staff spoken to were all aware of those issues in relation to safeguarding adults. The Inspector examined the records for complaints, these were not significant in their nature and the Commission has not received any complaints. High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 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. Whilst enhancement of the environment has started to take place there are areas that are not suitable to meet the client’s needs. EVIDENCE: A thorough tour of the home took place, the home was found to lack the necessary level of cleanliness in all areas. Apparently the person who does the cleaning is on sick leave; no attempt had been made to ensure that the home was still cleaned during the cleaner’s absence. It was also noted that the cleaner also does the maintenance and some gardening so no designated cleaner is employed. All bathrooms and lavatories are most unacceptable and are in need of total refurbishment. High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 17 Some areas and bedrooms have been re decorated as new residents move in and a new stair carpet has been obtained. Part of the roofing of the house has been replaced. A new washing machine with a sluice facility has been installed and a hand basin has been put into the clinic room. There are plans in hand to refurbish the kitchen and add a dishwasher. The garden has been tidied up and a vegetable garden has been made; one of the residents has been helping in the garden. High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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. Service users are supported by a cohesive and effective staff team. There is a robust system in place for recruitment. High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 19 EVIDENCE: Examination of duty rosters and discussion with staff members confirmed that the home is staffed appropriately to meet the needs of the service users; the manager adjusts the amount of staff on duty to reflect the number of service users in residence and their assessed needs. Records for newly appointed staff were examined, these contained appropriate proof of staff identity and the acquisition of two references and CRB and POVA checks before employment. The staff spoken to felt that they had the skills to do their job; a training programme is in place and this was seen by the Inspector. Discussion with some of the service users led the Inspector to believe that they were well supported by the staff and the staff themselves felt that they were more cohesive and worked well as a team. The skill mix of the staff has improved and it would appear that there are less incidents that service users are involved with. Those staff spoken with confirmed that the staff team was much more cohesive and there did not appear a conflict of interests amongst the staff any more. High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 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. Service users benefit from the ethos and leadership in the home. The cleanliness of the home could be better managed. The home has provided a good system for monitoring the quality of the services it provides. High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 21 EVIDENCE: Discussion with the residents and the staff led the Inspector to form the opinion that the home is well run, although some improvement is needed in managing the cleanliness of the home, thus ensuring that the health and welfare of the service users is promoted and protected. The staff and service users feel that they are well managed and supported and that the manager encourages an open transparent environment. One member of staff said that both the manager and the provider responds to requests for further learning and opportunities for development and that they are very approachable. The home has carried out a formal system for monitoring the services offered and the results of this was seen and the action taken by the home to address some of the issues highlighted by the quality report. High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 x 4 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 x x x 3 x High Oaks DS0000067173.V345419.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? 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 2 Standard YA24 YA24 Regulation 23 (2) (b) 23 (2) (d) Requirement The premises must be kept in a good state of repair externally and internally. All parts of the home must be kept clean. Timescale for action 15/09/07 03/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA24 Good Practice Recommendations The back garden should be kept in reasonably good order and acceptable in appearance. 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