Inspection on 25/02/09 for Lake House

This inspection was carried out on 25th February 2009.

CSCI 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

Lake House 14/09/06

Lake House 19/12/05

Lake House 28/06/05

Lake House 02/11/04

Lake House 21/07/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Lake House Lake Walk Adderbury Banbury Oxfordshire OX17 3NG     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: Marie Carvell     Date: 2 5 0 2 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 26 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 26 Information about the care home Name of care home: Address: Lake House Lake Walk Adderbury Banbury Oxfordshire OX17 3NG 01295811183 01295811260 manager.lakehouse@osjctoxon.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Orders Of St John Care Trust Name of registered manager (if applicable) Anna Hicks Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 43 The registered person may provide the following category of service only : Care home only (PC) to service users of the following gender: Either whose primary care needs on admisison to the home are within the following category : Dementia (DE) Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Lake House is a care home, which was purpose built in 1991. It is situated in the village of Adderbury, close to Banbury in Oxfordshire. Local shops and amenities are all within easy reach and the home is on a regular bus route between Banbury and Oxford. It is home to 43 older people and is managed by the Orders of St John Care Care Homes for Older People Page 4 of 26 0 0 43 Over 65 43 43 0 care home 43 Brief description of the care home Trust, a charitable organisation with a wealth of experience in providing residential care services. The local authority block purchases 22 of the 43 places in the home. The single storey accommodation provides individual rooms and service users are encouraged to decorate their own rooms with their personal possessions. The communal areas are pleasantly decorated and the lounge area accommodates a day centre for older people from the community, which service users may participate in if they wish. The home provides respite care but does not provide intermediate care. The building is divided into five wings and each wing has its own sitting and dining area. Each wing also has its own small kitchen area. The home is set in attractive grounds and there is a courtyard in the centre of the building. The fees for this service range from 562.00 pounds to 700.00 pounds per week. Items not covered by the fees include hairdressing, podiatry, newspapers, magazines, toiletries and Bingo. Care Homes for Older People Page 5 of 26 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: The last inspection of this service was completed in September 2006. This inspection of the service was an unannounced Key Inspection. We arrived at the service at 10.15am and was in the service until 6.25pm. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager, Anna Hicks in November 2008 and any other information that we have received about the service since the last inspection. Nine service users and one GP returned completed surveys. We looked at how well the service was meeting the standards set by the government and have in this report made judgements about the standards of the service. We toured the premises, examined a sample of records required to be kept in the home, including case tracking service user files and spent time talking to service users Care Homes for Older People Page 6 of 26 individually and in groups. We also spent time with the manager and staff on duty. In addition we observed how care was being delivered to service users and joined service users in one unit for the midday meal. At the last inspection two requirements were made these were to ensure that all care needs assessed are completed fully and monitor all care plans to ensure these contain all the goals required to meet service users health care needs. 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 8 of 26 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 9 of 26 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. Service users and their representatives are provided with sufficient information, to make an informed choice about moving into the home for a trial period. Service users are provided with a written contract/terms and conditions. All prospective service users are assessed prior to admission to ensure that the home can effectively meet their care needs. Evidence: All prospective service users are provided with information about the home, including the homes brochure, service user guide and a copy of the last inspection report. Oxfordshire County Council have a block contract with the home for twenty two of the forty three registered beds. Eight of the nine surveys completed by service users confirmed that they had received enough information about the home before moving Care Homes for Older People Page 10 of 26 Evidence: in. One survey stated that they had not received enough information about the home before moving in. Service users are provided with a contract/ terms and conditions and eight of the nine surveys completed by service users confirmed this. One survey stated that they had not received a contract/terms and conditions. A sample of contracts were examined and it was noted that a reference to medication stated All medication, whether under prescription or otherwise shall be kept under the control of the home manager, who will maintain contact with the service users GP. This was discussed with the manager and it is a recommendation of this report that this statement is removed. At the last inspection a requirement was made to ensure all care needs assessments are completed fully, this has been complied with. The manager undertakes a preadmission assessment of all prospective service users to ensure that the home is able to meet their needs. Service users and their representatives are encouraged to visit the home, stay for a while to meet other service users and the staff team. Time was spent with several service users who had recently moved into the home. Several said that being able visit the home and to spent time, talking to other service users and staff, allayed their anxieties and reassured them for what is a life changing decision. Care Homes for Older People Page 11 of 26 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. Care plans need to be in sufficient detail regarding lifestyle choices and the preferences of the service user with regard to how care is to be provided and when. Care plans need to be developed to include how emotional, psychological and social care needs of service users are identified and met. The healthcare needs of service users are fully met. Medication administration, recording and storage are maintained to a high standard. Service users feel that they are treated with dignity and respect. Evidence: Care plans are drawn up from the pre-admission assessment, agreed and signed by the service user and representative, as appropriate. Care plans are reviewed on a regular basis and any changes recorded. Information regarding health and personal care is well documented. However, care plans do not evidence how the service users Care Homes for Older People Page 12 of 26 Evidence: emotional, psychological or social care needs are identified and met. Care plans are not in sufficient detail regarding lifestyle choices or the preferences of the service user with regard to when care is to be provided and when. The Trust is currently in the process of redesigning all care planning documentation. Six surveys completed by service users confirmed that they always received the care and support needed and three surveys stated that they usually received the care and support needed. At the last inspection a requirement was made that care plans must be monitored to ensure these contain all the goals required to meet service users health care needs. This has been complied with. The healthcare needs of service users are met by seven GP practices and a range of healthcare professionals, including district nurses, visit the home as required. From discussion with service users, staff on duty and examination of service user records, the healthcare needs of service users are fully met. Eight surveys completed by service users confirmed that they always received the medical support needed, one survey stated usually. Comments made on a survey completed by a GP confirmed that the home always seek advice and act upon it to manage and improve individuals health care needs. Comments made in relation to what the home does well included The homes attention to particular requests for our services and implementation of instructions given, The friendly environment of the home, The apparent continuity of care between the team. Medication is administered by care staff who have completed appropriate medication training from a pharmacist. One care leader has overall responsibility for medication issues in the home, this she does well. Recording of medication administered, including controlled drugs and when required medication were seen to be well maintained with no obvious gaps in recording. Storage was well organised as was stock control. Medication such as eye drops, clearly stated the date when opened. Guidelines for when required medication is in place as well as risk assessments for service users, who are responsible for their own medication. Regular medication audits take place. Time was spent with service users in private and in communal areas. Service users expressed their satisfaction of living in the home and the care received. All service users spoken to expressed the view that they felt well cared for, and that all staff were helpful and friendly. Staff were observed to interact with service users in a respectful and appropriate manner. Staff addressed service users by their preferred name and in discussion with staff on duty, they were clear about the need to respect service users privacy and dignity. As in many other care homes, there is a wide range of racial, ethnic and faith Care Homes for Older People Page 13 of 26 Evidence: backgrounds represented within the staff team compared with the current service users. One survey completed by a service user raised this as a concern. From discussion with the manager, Anna Hicks, we consider that the home is able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. However, there are indications that service users sometimes find that some staff cannot communicate satisfactorily because English is not their first language. Care Homes for Older People Page 14 of 26 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 are encouraged to make choices and to remain as independent for as long as possible. There is a wide range of activities arranged to meet the social needs of service users. Service users are provided with a varied, wholesome and nutritious diet. Evidence: There are two activities organisers in post, once has specific responsibility for service users attending the day centre. A wide variety of activities are offered and information is displayed on notice boards in the home. Activities range from one to one, small group to large group activities and outings. Although a wide range of activities take place, this is not evidenced in service user care plans or daily records. This should be addressed following the redesigning of the care planning documentation. The home has a hairdressing room, shop and a bar. Assistance is given to service users wishing to visit local clubs and societies. Surveys completed by service users indicated that seven felt that there were always activities arranged by the home that they could take part in, one survey stated that usually activities are arranged that they could Care Homes for Older People Page 15 of 26 Evidence: take part in and one survey stated sometimes activities are arranged that they could take part in. Service user meetings take place, these are chaired by the activity organiser. The manager attends these meetings occasionally and we discussed other means of seeking service users views and opinions, such as joining service users at coffee time or for a meal. Many service users have friends and family who visit regularly. Service users are encouraged to maintain links with the community. Service users said that their friends and family are always made welcome and are offered refreshments. Religious minsters visit the home on a regular basis and regular services are held. Arrangements can be made for service users to attend local places of worship, if requested. Service users confirmed that the routines are flexible and they are able to spend their time as they choose. We joined service users in one unit for the midday meal. The days menu was displayed and service users expressed their satisfaction of the high standard of catering in the home and the choice of meals offered. Menus demonstrated that service users are offered a varied, wholesome and nutritious diet. The meal was delicious, hot and attractively served. The chef visited the unit during the meal to ask if everything was to the service users satisfaction. Service users confirmed that this is routine. Staff were observed to be attentive and to assist service users in a discreet and dignified manner. Surveys completed by service users indicated that four service users felt that they always liked the meals in the home and five felt that usually they liked the meals in the home. Comments made on one survey included they are very tasty and nutritious. Care Homes for Older People Page 16 of 26 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 are confident that any concerns or complaints would be taken seriously, listened to and acted upon. Policies and procedures are in place to protect service users from possible abuse. Evidence: The homes complaints procedure is displayed in the entrance hall of the home and is included in the service user guide. Since the last inspection two complaints have been received by the home. Recording of the complaints were clear and detailed, stating action taken and outcomes. The manager views complaints as a valuable monitoring tool. All surveys completed by service users confirmed that they know how to make a complaint. Service users and staff spoken to were clear about the complaints procedure in the home. Comments included Id speak to any of the carers, they would know what to do next, Ive never needed to complain about anything, All staff are always helpful and ready to help in anyway. Since the last inspection we have not received any information regarding complaints about this service. All staff receive training in the homes policies and procedures in protecting service users from possible abuse, including whistle blowing procedures. This was confirmed Care Homes for Older People Page 17 of 26 Evidence: by staff on duty and evidenced in training records. No safeguarding adult referrals or safeguarding adult investigations have taken place since the last inspection. No referrals have been made for inclusion on the Protection of Vulnerable Adults list (POVA). The home has a copy of the Oxfordshire safeguarding adults procedures and staff were familiar with the process for reporting safeguarding concerns. Care Homes for Older People Page 18 of 26 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. The home provides safe, well maintained and comfortable accommodation. The layout and local of the building is suitable for its stated purpose. Service users expressed their satisfaction of the premises, facilities, garden and access to community resource. Evidence: The location and layout of the building is suitable for its stated purpose. Service users expressed their satisfaction of the premises, facilities, garden and access to community resources. The home is well maintained and there is an ongoing plan of redecoration and maintenance. At the time of our visit, bedrooms and communal areas were being redecorated and new carpets being fitted. The housekeeping staff work hard to ensure that the home is clean, pleasant and free from unpleasant odours. The home is welcoming, comfortable and has a homely feel. Care Homes for Older People Page 19 of 26 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. Staffing levels appear to be adequate to meet the needs of the service users. Some aspects of the recruitment process need to be more robust to protect service users from possible harm. Staff are well trained and are able to carry out their roles with confidence. Evidence: From discussion with the manager, staff on duty, examination of rosters and observation, staffing levels appear to be adequate to meet the needs of the service users. At the last inspection a good practice recommendation was made to ensure that at least 50 per cent of care staff are trained to NVQ level II or above, this figure has been exceeded. Members of staff are encouraged to undertake National Vocational Qualification (NVQ) training. The five care leaders have all completed NVQ at level III and one is working towards level IV. Currently twenty two of the thirty nine care staff have completed NVQ level II. All kitchen staff have completed NVQ at level II or III and all housekeeping staff have applied to undertake the training. Care Homes for Older People Page 20 of 26 Evidence: A sample of staff personnel files were examined, it was noted that from the sample seen a full employment history was not recorded, although this is requested on the application form. Following the inspection we received an action plan from the manager confirming action to be taken to ensure that this information is recorded. The manager asked that we accept that this is not a widespread problem within staff files. All staff have an formal interview conducted by two senior staff and written references and police checks are carried out, before the member of staff begins working in the home. Following the inspection we received an action plan, detailing more robust measures to be introduced to ensure that information recorded on references corresponds with information recorded on the application form. The home has a training and development programme in place. All staff undertake induction training, appropriate to their role once in post, complete mandatory training and specialist training as appropriate. Staff spoken to expressed their satisfaction of the training provided by the Trust and the opportunities for career advancement. Care Homes for Older People Page 21 of 26 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. Service users benefit from a well managed home. Evidence: The home is run by an experienced and well qualified manager, who has recently completed a Diploma in Management in addition to already achieving the Registered Managers Award and NVQ level Iv in Management. She is supported by a full time, experienced administrator and five care leaders. In discussion with staff on duty and service users all expressed the view that the home was being run in the best interests of the service users. Comments made by members of staff included Anna has high standards, She is fair as long as staff do their job properly, Approachable and supportive. Procedures are in place for dealing with service users monies and valuables held in safekeeping on their behalf. Records are well maintained. Care Homes for Older People Page 22 of 26 Evidence: All staff with supervisory responsibility have completed supervision training. All staff receive formal planned supervision at least six times per year. This is recorded, agreed and signed by both the supervisor and supervisee. Staff meetings are held regularly and are recorded. Policies and procedures are in place and are reviewed on a yearly basis or more frequently if needed. Reports by a senior member of the Trust or the responsible individual are completed following a visit to the home each month, these were available for examination. Quality assurance systems are in place and the manager undertakes regular audits. Evidence was seen to demonstrate that the views of the service users are obtained to measure the homes success in meeting the aims, objectives and statement of purpose. At the last inspection a good practice recommendation was made that the frequency of the gas installation maintenance be checked. This has been complied with. A sample of records relating to health, safety, fire and service users welfare were seen to be well organised and up to date. Care Homes for Older People Page 23 of 26 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 24 of 26 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 25 of 26 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!