Inspection on 25/07/06 for Oak House

This inspection was carried out on 25th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 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

Oak House 24/09/07

Oak House 15/11/05

Oak House 08/03/05

Oak House 23/09/04

Oak House 30/03/04

Similar services:

Hunters Care Centre

Manor Lodge

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

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

CARE HOMES FOR OLDER PEOPLE Oak House [formerly Dove House] Chard Street Axminster Devon EX13 5EB Lead Inspector Teresa Anderson Key Unannounced Inspection 25th July 2006 10:00 X10015.doc Version 1.40 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 Oak House [formerly Dove House] DS0000057492.V298044.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 Older People. 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. Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oak House [formerly Dove House] Address Chard Street Axminster Devon EX13 5EB 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) 01297 33163 01297 33342 oakdash@aol.com Mrs Angela Martha Christina Baker Mrs Sarah Jane Mary Dennis, Mr Howard Norman Dennis, Mr David Malcolm Baker Mrs Angela Martha Christina Baker Care Home 17 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (17) of places Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. If it is proposed to amend the Partnership Agreement in such a way that Mr David Malcolm Baker or Mr Howard Norman Dennis become actively involved in carrying on the care home or in its day-today management the partners will advise the Commission for Social Care Inspection in writing without delay. 15th November 2005 Date of last inspection Brief Description of the Service: Oak House provides care and accommodation for up to 17 older people who have needs relating to old age and/or dementia. The house is a four-storey listed building, which has been converted for use as a care home. It is situated in the heart of Axminster, on the main road through Axminster and close to all amenities. A passenger lift and two staircases link all floors. The home has a large lounge divided into smaller seating areas together with a dining room on the ground floor. There is a further dining room in the lower ground floor, a part of which doubles as a staff seating and a smoking area. The home has a courtyard garden at the rear and limited parking at the front of the home. Information about this service, including CSCI reports, are available direct from the home. As at July 2006 the fees charged range from £270.00 to £500.00 per week. Additional charges apply for items and services such as transport, escort service for hospital services, newspapers and chiropody. Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 10.00 in the morning and 5.00 in the evening. During that time the inspector concentrated on looking at the care and services offered to three residents who are representative of the type of care offered at Oak House. The inspector spoke with these and other residents (although some have communication problems). She observed interactions between staff and residents and she spoke with staff and with visitors. The inspector also looked at records in relation to staff recruitment, training, fire safety and risk assessments. As part of the inspection the manager completed a Pre-Inspection Questionnaire. Surveys, asking for comments on this service, were sent to nine residents and one was returned; to thirteen staff and five were returned. Surveys were also sent to the local GP practice, district nurse and Community Psychiatric Nurse and three were returned. What the service does well: Oak House has a relaxed and informal atmosphere. Before admission all residents undergo comprehensive assessments to determine needs and establish if Oak House can meet these needs. From this and on-going assessments care plans are devised which take into account the residents preferences and wishes. Residents and their supporters say they have enough information about the home to make an informed choice. Health care needs are well met and health care professionals surveyed are satisfied with the care given in this home. Information obtained about residents includes information about their social interests which staff use to help residents remain active and occupied. The home employs an activities cocoordinator/occupational therapist who arranges activities and outings. Visitors are free to come and go (with residents’ permission) and visitors report they are kept up to date with information and are welcome in the home. The food at Oak House is enjoyed by residents who describe it as ‘lovely’ and ‘always good’. The home has two dining rooms and residents are offered support with eating if needed. Residents and visitors are encouraged to make comments or complaints as part of the improvement planning for the home. However, residents spoken with said they had no complaints to make. They also say they feel safe. Good recruitment procedures help to ensure that residents are protected. Staff receive comprehensive training including training in the protection of vulnerable adults. 75 of staff are trained to NVQ Level 2 and above. The home is clean and well managed. The managers and owners are well appreciated by staff and residents alike. Staff describe the management support they receive as ‘brilliant’, ‘creative’, ‘constructive’ and ‘very good’. Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 6 Residents’ monies are well managed and kept securely. Well established quality assurance procedures are in place. What has improved since the last inspection? What they could do better: 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. Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Assessments of service users are comprehensive ensuring that staff, as far as possible, understand each residents needs. Prospective residents have enough information to make a decision about where they live. EVIDENCE: Oak House has a Statement of Purpose and Guide to the home which details the services on offer and care provided. The owner reports that a copy of this is offered to prospective residents and a copy is kept in the hall. A ‘welcome pack’ is also being developed. One visitor spoken with did not remember seeing this but said that this was probably because they had moved into the home quite quickly. Although this family did not see the guide they had visited the home prior to moving in and had seen the bedroom being offered. The survey returned by a resident said that they had a contract. Terms and conditions of residency are contained within the guide to the home. The owner reports that when a new resident is admitted to the home a senior carer on duty is allocated to the resident to help them to settle in. Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. The care planning process and delivery of care ensures that, in general, good care is delivered although the quality of dementia care could be improved. Some improvements are required in the management of medications to ensure the safety of all residents. There are inconsistencies in the way personal support is offered meaning that some staff are not always promoting the privacy and dignity of residents. EVIDENCE: The assessments and care planning records of three residents were inspected. The system in use is easy to use and information is accessible to all staff. All plans have clear and ongoing assessments and are reviewed regularly. Information contained within care plans includes the person’s life history, their preferred routine and, to some extent, their likes and dislikes. There is evidence that healthcare needs are anticipated and well met. The majority of healthcare professionals who completed a survey are satisfied with the care given to residents, although one indicated that some staff are more skilled than others. Staff ensure that the risks to residents from falling are Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 10 minimised and yet there is evidence that they balance this with each resident’s need to walk around the home freely. The planning and delivery of care is, on the whole, person-centred. Discussions with staff demonstrate genuine caring and all staff have received training in care and in caring for people with dementia. However, some entries in the care plan of one resident demonstrate a possible lack of understanding of aggressive behaviour and the possible reasons for this behaviour. Although the owner reports that many strategies had been tried to help this resident these were not documented and are therefore unlikely to have been applied consistently by all staff. Some staff in their surveys indicated that they would like more support in this area of care. During the inspection, it was observed that two members of staff acted inappropriately when one resident made a mistake in judgement. This was discussed with the owners. On the whole residents’ medications are managed well with those residents able to self-medicate being supported to do so. However, one medication record sheet is confusing, potentially placing the resident at risk of receiving a medication that has been discontinued. Another medication sheet did not identify how much insulin a resident is to receive. In addition, the room in which medications are kept is very hot. The owners plan to measure the temperature in this room and to make alternative storage arrangements if needed. They also plan to carry out monthly audits to identify any issues and/or further training needs. During the inspection staff, on the whole, demonstrated respect for residents and could give examples of how they respect the residents’ privacy and dignity. The inspector observed that care is given in private, although one member of staff did leave a toilet door ajar when it was in use on two separate occasions. Healthcare staff report that they are able see residents in private. Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Links with the community and visitors are good. Opportunities to support and enrich residents’ social needs could be improved for those people with dementia. Support is, on the whole, offered in a way that promotes choice and flexibility. The meals offered provide choice, variety and meet nutritional needs although assistance is not always offered appropriately. EVIDENCE: Residents report, and the inspector saw, visitors coming and going throughout the inspection. Many residents went out with their visitors or entertained them in private in their bedrooms. Visitors say they are welcomed and often offered refreshments. One visitor said that she is always given updates and information about her relative and that staff are helpful. The home is situated close to the centre of Axminster and as such has easy access to all the amenities on offer there. There is a varied activities programme and the home employs an activities coordinator/occupational therapist who organises many different activities including card making, bingo and quizzes and some outings. Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 12 Oak House is also registered to care for people with dementia type illnesses. There was little evidence that the social needs of residents with these needs are being satisfactorily met. For example one care plan identified that the resident ‘enjoys being useful’. A plan to meet this need has not been devised. According to her care plan she has been involved in laying the table once, has chatted with other residents twice and has had her hair done since her admission three weeks ago. It is likely that she has been more involved and active than this. However, according to staff and the care plan, this resident has exhibited behaviour that significantly challenges the service, yet the care plan has not addressed the need for this resident to be useful which might help to overcome this type of behaviour. Residents who could speak with the inspector said that they choose how they spend their days and that staff are very helpful if they need help or want to do something. Care plans contain information about the residents preferred routine and some information regarding likes and dislikes, indicating that staff understand the need for residents to have control over their daily lives. The food at Oak House is described by residents as ‘lovely’, ‘always good’ and ‘very nice’. The home has a dedicated cook, a four-week varied menu and fresh fruit and hot and cold drinks are available. Those who need assistance with their meals are offered this although it was disappointing to see that the task of feeding one very needy resident was given to a College student undertaking work experience. Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a satisfactory complaints system with evidence that residents’ views are listened to and acted upon. Residents feel safe and well cared for and the staff’s knowledge of adult protection ensures that residents live in an environment where they are protected from abuse. EVIDENCE: Since the last inspection the Commission have received three complaints about this home. These have been referred to the owners for investigation and have been dealt with satisfactorily. One remains outstanding indicating that the home does always respond to complaints in a timely manner. The complaints procedure is contained within the guide to the home and no complaints have been received directly by the home. Residents and visitors said they could easily make their comments/complaints known, but that this had not been necessary. Staff have received training in the protection of vulnerable adults and demonstrated a good knowledge of abuse. They were clear about what to about suspicions or allegations and that abuse would not be tolerated. Residents showed signs of well being and those who could comment said they felt safe. Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The environment of this home provides residents with a homely, clean and safe place to live although some improvements in relation to infection control are needed. EVIDENCE: The home was found to be clean throughout. The resident who returned a survey stated that the home is usually clean and fresh. However, not all toilets had foot operated waste bins and one toilet did not have any paper towels for hand drying. Cleaning materials are stored safely. The home is homely throughout. Bedrooms, with the exception of one, are personalised and clearly marked to help the resident identify their own room. The latter has not been at the home for very long. This was discussed with the owners who will try to address this. Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 15 Since the last inspection new flooring has been laid in one bathroom and one toilet and a bath chair hoist has been purchased. Two bedrooms have been redecorated. Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The quality outcome in this area is good. This judgement has been made using available evidence including a site visit. Staff have, on the whole, the qualities and skills and receive appropriate and sufficient training to provide residents with the support and care they need. The recruitment procedures designed to protect residents are good. EVIDENCE: Staff training is given a very high priority at Oak House. At least 75 of care staff have successfully achieved NVQ Level 2 in care. Many of these have achieved Level 3 and some are working towards Level 4. All but one of the remaining staff are working towards gaining NVQ Level 2. One of the deputy managers has completed the Registered Manager’s Award (RMA) and the other is working towards achieving this. In addition it is reported that two of the relief staff also have NVQ Level 2. Examples of additional training that has been given are ‘stroke care’, ‘dementia’ and ‘bereavement care’. The resident who returned a survey states that they always receive the care and support they need and that staff always listen and act on what they say. Staff who returned surveys all said they know what to do if a resident is unwell. However, three out of five said that they are asked to care for people outside their area of expertise. One clearly stated this is in relation to the care of people with dementia. Three staff recruitment files were inspected and all had the information required to help protect residents. Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a site visit. The management systems in place help to ensure residents live in a wellmanaged and safe environment where they are protected. Resident’s safety and welfare is promoted through staff training and through the procedures in place. EVIDENCE: The manager of Oak House is also a co-owner. She has trained as a nurse (although this home is not a nursing home) and has successfully completed the Registered Managers Award (RMA). The home also has two deputy managers, one of who has completed the RMA and one of who is working towards achieving this. The manager/co-owner is often away from the home so has worked hard to empower and train the staff. She has however been asked to Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 18 monitor and keep under review the management arrangements in the light of her continued absences. The home also has an administrator. Staff who completed surveys said they felt well supported by the owners and managers and that the team work together for the benefit of residents. The management system is described as ‘brilliant’, ‘very good’ and ‘constructive’. Established quality assurance systems are in place that include staff meetings, residents meetings and quality assurance questionnaires. Monies held on behalf of residents are managed well and kept safely. Systems are clearly auditable. Three accounts were checked and found to be in order. The pre-inspection questionnaire indicated that all necessary policies, procedures and maintenance systems are in place. Staff receive mandatory training including fire safety, infection control, food hygiene and first aid. The fire log was checked and found to be in order. Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No 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 Standard OP9 Regulation 13 (2) Requirement You must make arrangements for the safe recording, handling, safekeeping, safe administration and disposal of medicines received into the home. (This relates to the need to ensure that records are clear and include all information, that amendments to medications are checked by two people and that medicines are stored at a temperature less than 25C). Timescale for action 31/08/06 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 OP7 Good Practice Recommendations You should ensure that all service user care plans set out in detail the actions which need to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service user are met (this relates to the needs of those residents with dementia). Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 21 2. OP10 3. 4. 5. OP12 OP15 OP26 6. OP31 You should ensure that the privacy and dignity of all residents if protected and promoted as far as possible. (This relates to the closing of toilet doors when being used by residents). You should ensure that the social needs of those residents with dementia are considered and met. You should ensure that only those with training and skill assist vulnerable residents to eat. You should ensure that good systems are in place to control the spread of infection. This includes that toilets and bathrooms have liquid soap, paper towels and foot operated pedal bins. You should review the management arrangements for the home, as the current manager is not usually in day-to-day control of the service. Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Oak House [formerly Dove House] DS0000057492.V298044.R01.S.doc Version 5.2 Page 23 - 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. 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