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Inspection on 17/11/09 for Oak House

Also see our care home review for Oak House for more information

This inspection was carried out on 17th November 2009.

CQC found this care home to be providing an Poor 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has improved the quality of care provided to residents of the home since the last inspection. Observation of practise confirmed that care was being provided in a discreet and sensitive manner which respected residents right to dignity, privacy, independence and choice. All residents have an up to date and detailed care plan which is underpinned by effective risk assessment and risk management guidelines. The care plans for six people were examined and were found to be comprehensive and detailed. They contained sufficient information to enable staff to meet peoples needs effectively. Both computer held records and paper documents were up to date and accurate and contained sufficient information for staff to be able to provide the appropriate level of care. The risk assessments were accurately documented and mechanisms and guidelines were in place to reduce the risk identified. Staff commented that the `Saturn` computer system had become more reliable since it had been overhauled and they had more confidence in using the system. They commented that `it breaks down less often which has reduced the stress` and that they felt that the care plans were `well written and accurate`. The provision of the midday meal was observed on all three floors as part of this inspection. The atmosphere during lunch was relaxed and unhurried on each unit. Residents confirmed that the food was to their liking and was tasty and nutritious. From observation of practise it was evident that residents were being supported to eat their meals discreetly by seated staff. Gentle and appropriate persuasion and assistance were offered to those residents that required supervision and support. At the last key inspection in August there were shortfalls identified in relation to the quality and content of the pre admission assessments carried out by staff of the home. Subsequently several individuals who had been subject to safeguarding adult protocols were moved to other establishments which could more effectively meet their need. As a result of these shortfalls a requirement was made that assessments should be fully completed by competent and qualified individuals. Although it was identified during thissite visit that there have been no new admissions to the home since the last key inspection, examination of documentation relating to those people who had been admitted to hospital and then readmitted to the home, indicated, that each resident had been fully reassessed prior to their return. The home had been mindful to ensure that residents met the admission criteria for the home and were only admitted when the home had sufficient information about the residents needs and was satisfied that the home could meet those needs effectively. Information in the pre admission documentation had been gathered from a variety of sources including the prospective resident, their relatives, advocates and relevant health and social care professionals. The pre admission assessment was thorough and holistic and included information about the residents health and personal care needs along with information about the residents dietary needs, communication needs, mobility needs, history of falls, continence, medication regime and mental state. All the information had been collated and a new care plan developed. There have been a large number of complaints made about the quality of care provided by the home and a number of referrals have been been made and investigated under joint adult protection protocols. A requirement of the last key inspection was for staff to understand how to protect adults from abuse and to understand what constitutes neglect, abuse and exploitation. In response to this requirement the home has provided staff with additional training. Examination of the training matrix indicates that 56 staff have received safeguarding training since February 2009 and 43 staff have received training in customer care. 49 staff have received training in equality and diversity. The home has plans to ensure that all staff have further refresher training which includes training in the Mental Capacity Act and Deprivation of Liberty. The home is now checking that staff have understood what they have learnt during their training using on line questioning and certification. Staff spoken with had a good understanding and awareness of what constitutes abuse and understood their need to whistle blow if they observe poor practise. Staff seemed well motivated and said that they had enjoyed participating in training sessions. They appeared enthusiastic about their work role and were keen to provide quality care. Staff have also received refresher training in manual handling, safeguarding and customer care. Additional training opportunities are on offer to aid their knowledge and skills and improve care practise. Staff have been provided with one to one supervision sessions to enhance communication and to develop staff in their work role and to help management to monitor performance. Since the last key inspection there have been a number of changes in management of the home to aid continuity for residents and staff and to improve the homes overall performance. In the last week, the Registered Manager Wendy Marsh has returned to the home after a period of sick leave. She is being supported in her daily management tasks by the Operations Manager and Regional Director from Care UK who are based at the home along with a team of Senior Managers from other Care UK establishments that are working alongside staff in a hands on capacity. There is recognition that the home has lacked effective communication and management monitoring systems and since the last inspection new systems have been put in place to generally improve the outcome for service users. Meetings are held with hotel services, catering and nursing staff on a weekly basis. A programme of supervision and performance monitoring has been developed for staff. Meetings with residents and relatives are regularly convened to exchange information and to gain quality assurance feedback. Deficits in the quality of service provision are being dealt with daily as they are bought to managements attention.The home is currently in the process of recruiting to its many vacant posts including a Clinical Lead for the home and various Unit Managers, nurses and care staff. This will aid continuity for residents and reduce the homes dependency on agency workers. The home is being monitored on a daily

What the care home could do better:

The training opportunities for staff should continue. All staff including ancillary staff should receive customer care and safeguarding adult procedures training to enhance their knowledge and skills.

Random inspection report Care homes for older people Name: Address: Oak House Oak House Wexham Road Slough Berkshire SL2 4HF zero star poor service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Julie Willis Date: 1 7 1 1 2 0 0 9 Information about the care home Name of care home: Address: Oak House Oak House Wexham Road Slough Berkshire SL2 4HF 01753528419 01753572463 manager.oakhouse@careuk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Amanda Wendy Jane Marsh Type of registration: Number of places registered: Conditions of registration: Category(ies) : Care UK Community Partnerships Ltd care home 120 Number of places (if applicable): Under 65 Over 65 0 120 dementia old age, not falling within any other category Conditions of registration: 120 0 (1) 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 need on admission to the home are within the following categories Old age, not falling within any other category- (OP) Dementia - (DE) (2) The maximum number of service users to be accommodated is 120. Date of last inspection Care Homes for Older People Page 2 of 9 Brief description of the care home Oak House is operated by Care UK. It has 120 beds divided into eight, 15 bedded units. It provides residential, nursing and continuing care to older people, some who may be suffering from dementia. The cost of the service varies between 750 and 900 pounds per week. Care Homes for Older People Page 3 of 9 What we found: This random unannounced inspection visit was undertaken by two inspectors Julie Willis Regulation Inspector & Tim Inkson Local Area Manager on Tuesday 17th November between 10:30 and 14:30. The inspection was focused on checking compliance with requirements from the last key inspection which took place on the 17th & 18th August 2009. The outcome of the last key inspection was that the home was zero rated as it was deemed to be providing POOR outcomes for its service users. Since the last inspection the home has received a number of complaints that have been investigated by the Police and Local Authority under safeguarding adult procedures. As an outcome of the last inspection the home was required to complete an improvement plan for the Commission which has been drawn up to address requirements of the last inspection and to address deficits in the quality of services provided by the home. These requirements have been fully met. What the care home does well: The home has improved the quality of care provided to residents of the home since the last inspection. Observation of practise confirmed that care was being provided in a discreet and sensitive manner which respected residents right to dignity, privacy, independence and choice. All residents have an up to date and detailed care plan which is underpinned by effective risk assessment and risk management guidelines. The care plans for six people were examined and were found to be comprehensive and detailed. They contained sufficient information to enable staff to meet peoples needs effectively. Both computer held records and paper documents were up to date and accurate and contained sufficient information for staff to be able to provide the appropriate level of care. The risk assessments were accurately documented and mechanisms and guidelines were in place to reduce the risk identified. Staff commented that the Saturn computer system had become more reliable since it had been overhauled and they had more confidence in using the system. They commented that it breaks down less often which has reduced the stress and that they felt that the care plans were well written and accurate. The provision of the midday meal was observed on all three floors as part of this inspection. The atmosphere during lunch was relaxed and unhurried on each unit. Residents confirmed that the food was to their liking and was tasty and nutritious. From observation of practise it was evident that residents were being supported to eat their meals discreetly by seated staff. Gentle and appropriate persuasion and assistance were offered to those residents that required supervision and support. At the last key inspection in August there were shortfalls identified in relation to the quality and content of the pre admission assessments carried out by staff of the home. Subsequently several individuals who had been subject to safeguarding adult protocols were moved to other establishments which could more effectively meet their need. As a result of these shortfalls a requirement was made that assessments should be fully completed by competent and qualified individuals. Although it was identified during this Care Homes for Older People Page 4 of 9 site visit that there have been no new admissions to the home since the last key inspection, examination of documentation relating to those people who had been admitted to hospital and then readmitted to the home, indicated, that each resident had been fully reassessed prior to their return. The home had been mindful to ensure that residents met the admission criteria for the home and were only admitted when the home had sufficient information about the residents needs and was satisfied that the home could meet those needs effectively. Information in the pre admission documentation had been gathered from a variety of sources including the prospective resident, their relatives, advocates and relevant health and social care professionals. The pre admission assessment was thorough and holistic and included information about the residents health and personal care needs along with information about the residents dietary needs, communication needs, mobility needs, history of falls, continence, medication regime and mental state. All the information had been collated and a new care plan developed. There have been a large number of complaints made about the quality of care provided by the home and a number of referrals have been been made and investigated under joint adult protection protocols. A requirement of the last key inspection was for staff to understand how to protect adults from abuse and to understand what constitutes neglect, abuse and exploitation. In response to this requirement the home has provided staff with additional training. Examination of the training matrix indicates that 56 staff have received safeguarding training since February 2009 and 43 staff have received training in customer care. 49 staff have received training in equality and diversity. The home has plans to ensure that all staff have further refresher training which includes training in the Mental Capacity Act and Deprivation of Liberty. The home is now checking that staff have understood what they have learnt during their training using on line questioning and certification. Staff spoken with had a good understanding and awareness of what constitutes abuse and understood their need to whistle blow if they observe poor practise. Staff seemed well motivated and said that they had enjoyed participating in training sessions. They appeared enthusiastic about their work role and were keen to provide quality care. Staff have also received refresher training in manual handling, safeguarding and customer care. Additional training opportunities are on offer to aid their knowledge and skills and improve care practise. Staff have been provided with one to one supervision sessions to enhance communication and to develop staff in their work role and to help management to monitor performance. Since the last key inspection there have been a number of changes in management of the home to aid continuity for residents and staff and to improve the homes overall performance. In the last week, the Registered Manager Wendy Marsh has returned to the home after a period of sick leave. She is being supported in her daily management tasks by the Operations Manager and Regional Director from Care UK who are based at the home along with a team of Senior Managers from other Care UK establishments that are working alongside staff in a hands on capacity. There is recognition that the home has lacked effective communication and management monitoring systems and since the last inspection new systems have been put in place to generally improve the outcome for service users. Meetings are held with hotel services, catering and nursing staff on a weekly basis. A programme of supervision and performance monitoring has been developed for staff. Meetings with residents and relatives are regularly convened to exchange information and to gain quality assurance feedback. Deficits in the quality of service provision are being dealt with daily as they are bought to managements attention. Care Homes for Older People Page 5 of 9 The home is currently in the process of recruiting to its many vacant posts including a Clinical Lead for the home and various Unit Managers, nurses and care staff. This will aid continuity for residents and reduce the homes dependency on agency workers. The home is being monitored on a daily basis by the Senior Management team from Care UK and representatives of the Local Authority who have provided specialist input, training and support. All staff have received refresher training in moving and handling and have been assessed to ensure their competency. Only one incident of poor practise was observed during the inspection which involved an agency worker who was putting themselves at risk. The matter was addressed by Senior management at the time of the incident. Staff are also being offered additional training opportunities in Huntingtons Disease training, medication training, PEG feeding and nutrition, diabetes, infection control, first aid, community care practise and the law. 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 2. Care Homes for Older People Page 6 of 9 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 9 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, 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 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 9 of 9 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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