Inspection on 02/02/06 for Oaken Holt House Nursing & Residential Home

This inspection was carried out on 2nd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Oaken Holt House Nursing &... 30/10/06

Oaken Holt House Nursing &... 08/07/05

Oaken Holt House Nursing &... 14/02/05

Oaken Holt House Nursing &... 13/05/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Oaken Holt House Nursing & Residential Home Eynsham Road Farmoor Oxfordshire OX2 9NL Lead Inspector Delia Styles Unannounced Inspection 2nd February 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 Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 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. Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Oaken Holt House Nursing & Residential Home Address Eynsham Road Farmoor Oxfordshire OX2 9NL 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) 01865 863710 01865 864831 D.k.hwoakenholt.co.uk Oaken Holt Care Limited Mrs Mandy Vettraino and Alison Valentine Care Home 80 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (80), of places Physical disability (1) Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. On admission persons should be aged 60 years and over. Maximum of 30 persons with nursing needs. The total number of persons that may be accommodated at any one time must not exceed 80 8th July 2005 Date of last inspection Brief Description of the Service: Oaken Holt House is owned and managed by Oaken Holt Care Ltd, and is situated in 23 acres of landscaped grounds in a secluded elevated position 3 miles from the city of Oxford. The home is registered to provide nursing and residential care for up to 80 residents aged over 60. The main building is a substantial Victorian house and provides nursing and residential accommodation over three floors, serviced by lifts. Accommodation in the residential area of the main house is provided in a variety of rooms, from single rooms to large self-contained apartments with en-suite facilities or separate facilities. The Coach House is a separate building and also provides residential accommodation for less dependent residents. The nursing wing is an extension arranged over two floors, with accommodation provided in single en-suite rooms. The communal rooms are spacious and well furnished. The residents can use the terraces and well-tended gardens. The responsible person, Ms Jane Kennedy-Hill, is in day-to-day charge of the home, with a co-director/proprietor, Mr S Murray. There are two registered managers, one for the nursing wing and one for residential, supported by a team of nurses, care assistants, housekeeping, maintenance, gardening and contract catering staff. Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection (that is, the home was not aware that an inspection was to be done beforehand) and focussed on the key standards not inspected at the announced inspection done in July 2005. Two additional comment cards received in August 2005 from a resident and their relative were positive about the standards of care and facilities in the home. A third relatives/visitors comment card was positive about the standard of catering and cleanliness but was less satisfied with staffing levels, access to the home for disabled residents and the activities/stimulus provided for residents who are less able to get ‘out and about’ in the home. During the inspection, the registered managers, Ms Valentine and Ms Vettraino, and co-director, Ms Kennedy-Hill, were available and discussed the observations and recommendations with the inspector at the end of the visit. A partial tour of the home was undertaken. The home procedures for the storage and administration of medicines, records of medicine administration, a sample of care records in the nursing wing and a sample of staff recruitment records was examined. What the service does well: The staff team achieve a high standard of care for residents. Residents’ accommodation is of a very good standard and the home’s setting, in its own well maintained, extensive grounds provide a very attractive environment which residents enjoy. The quality of cleanliness, catering and décor are of an excellent standard. The managers and proprietors are very experienced in their roles and work well together. They are readily available to residents and visitors on a day-today basis, so that there is a sense of staff having a personal interest in maintaining a high standard of care for residents in this home. The home uses a quality assurance system to carry out regular checks on the standard of services and facilities to make sure they are consistently high. Residents and families are involved in providing feedback about standards using questionnaires. Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Overall, the standard of care plans and records about residents’ care was good. In the nursing wing some improvement should be made to the detail written about care of wounds, residents’ nutritional needs, and the effect of the nursing care given. Old care plans and nursing notes should be stored safely, so that only the up to date care plans are in daily use, making the records less bulky. The assessment of people’s nutritional needs – whether they are at risk of being undernourished, for example – could be improved by using the assessment method recommended by dieticians that is being introduced throughout Oxfordshire. The procedures for the storage and administration of medicines to residents are satisfactory but some improvements are recommended to be made to the medicine administration records, especially where staff are asked by the doctor to make handwritten changes to residents’ prescribed medicines, or where staff have to list the medicines brought into the home by residents when first admitted. The records of staff recruited to work in the home could be better organised to show that the home has a systematic and thorough system of vetting prospective employees to make sure that they are suitable to work with vulnerable adults. Residents could have a regular opportunity to discuss their care and any changes that are needed at a planned individual review meeting, perhaps annually, with key care and nursing staff, and their doctor. Where residents are privately funded and do not have a representative from local authority social services, a regular formal review meeting with each resident would help the residents and homes’ staff to be confident that the home continues to meet each individual resident’s assessed needs. Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 7 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. Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 8 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 Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 9 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): Standards not assessed on this occasion. EVIDENCE: Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 10 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, 9 & 10 Overall, the care planning system is of a good standard. The care plans show that residents, their relatives or other significant person are involved in drawing up care plans and agreeing any alterations that need to be made if the resident’s care needs change. The procedures for the safe storage, administration and disposal of residents’ medicines are good. Personal support in the home is offered in a way that promotes and protects residents’ privacy, dignity and independence. EVIDENCE: The care plans for two residents in the nursing care wing of the home were looked at (care plans for residents in the main house and Coach House were not reviewed on this occasion). There were some missing assessments and evidence of recent updating for, example about the wound care for a resident and no record of the action taken in relation to their nutritional needs, although assessed as ‘at risk’. Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 11 There was some evidence to show that the home is beginning to partially use the nutritional risk assessment method (Malnutrition Universal Screening Tool – M.U.S.T) recommended by the NHS community dieticians, as it is a nationally recognised and validated method. The MUST tool information should be fully used because it does provide useful and consistent ways to estimate residents’ body mass index (BMI) even if it is not possible to weigh residents, and has care plans to use, so that residents’ nutritional status can be monitored and improved through the suggested interventions. The residents’ care record files (especially for residents who have been in the home for some time) are bulky with old care plans for ‘resolved’ problems still held in the current folders. It is recommended that old care records are put in a separate section in the file or removed for archiving, so that it is clear which are the current care instructions for staff to follow. The systems for the storage, administration and recording of medicines in the home are well organised overall. However, there were instances in both the nursing and residential wing where handwritten alterations to the medication administration records (MAR) sheets had been made by nursing or care staff on the instructions of the doctor. It is recommended that the prescribing doctor checks and signs any changes to the MAR sheets as soon as possible. If nurses or care staff must make changes, they should be clearly and accurately copied and checked and countersigned by a second care or nursing staff member, to reduce the risk of errors being made in the medication given to residents. Where residents have prescribed skin creams or lotions applied by care staff, reference should be made to this on the MAR sheet, so that a record is kept showing that the product has been applied correctly and with the frequency prescribed, and so that the effectiveness of the residents treatment can be assessed. In the residential parts of the home, residents’ medications are held in individual named cassette boxes, prepared by the pharmacist. Some of the cassette boxes did not have the printed information card about the tablets on the reverse: Ms Vettraino is aware of this and is arranging for the pharmacy to amend this, so that staff can check that the description and number of tablets in each cassette compartment is correct. The nursing wing has the correct equipment for the safe storage of any unwanted or unused medications, prior to collection by a specialist waste company, to comply with the recent changes in legislation about disposal of medicines from care homes with nursing. Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 12 There is evidence that the homes policies and practice support and encourage residents to remain as independent as possible and that staff provide help in a courteous and respectful way. The managers and proprietor have demonstrated sensitivity and skill in the way in which they have ensured that the privacy and dignity of residents with specific care needs have been considered and addressed in situations where the individual residents cannot express their own needs or values because of the deterioration in their mental health. Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 13 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 The home has a varied programme of activities and social events, and plans these in response to residents’ suggestions and preferences. EVIDENCE: There was evidence to show that the programme of activities for residents has developed further since the last inspection: at that time a new activities organiser had recently come into post, and one of the nurse’s on the nursing wing was on leave. The member of the nursing team who is a registered mental nurse has considerable experience in caring for older people with memory problems. S/he has increased the opportunities for suitable activities with residents in the nursing wing, and is working with the activities organiser and other staff to provide a regular daily programme of events. The home managers felt that the comments received by the inspector from a relative about the need for more stimulus for residents, had been made at the time when there had been less organised activities on offer, and that this has now been addressed. Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 14 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): 18 The home has a staff training programme and procedures in place to ensure that residents are protected from abuse. EVIDENCE: There is evidence that staff are alert to report suspected abuse and that appropriate and prompt action is taken by managers to investigate and address any such allegations. All staff attend mandatory training in adult protection issues during their induction and have regular updates. Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 15 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): Standards not assessed on this occasion. EVIDENCE: Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 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 & 29 The numbers and skill mix of staff provide a consistent standard of care to meet the needs of residents. The home procedures for the vetting and recruitment of staff protect residents from the employment of potentially unsuitable people in the home. EVIDENCE: The home rarely uses agency staff, as there are sufficient numbers of their own employees to meet residents’ care needs and who can work additional hours to cover for colleagues’ absences if necessary. This means that staff have a good understanding of residents’ support needs and residents are confident in the staff members’ ability to care for them in the way they wish. A sample of staff records was examined. There were some omissions – for example, two files did not have a second reference and one had no photograph. Managers were confidant that second references had been requested and that a satisfactory verbal reference had been received whilst the written reference was awaited but this was not clear from the individual files seen. It is recommended that the home use a more systematic record to show the dates on which police checks and references were requested and when satisfactory clearances and references were received, and by whom. Where a verbal reference is taken, the manager or responsible member of staff should record the outcome. Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 17 There was evidence of regular staff appraisals on staff files, showing that their work performance is assessed and any problems are discussed with the employees’ managers and with additional training or actions to be taken recorded. Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 18 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, & 35 The home managers are both experienced in their roles and, together with the home proprietors, provide clear leadership throughout the home and maintain a high standard of care. There is evidence that the home regularly reviews aspects of its performance through self-review and consultation with residents, relatives and staff. The financial and accounting systems in the home safeguard the financial interests of residents. EVIDENCE: Both the residential and nursing unit managers have considerable experience in their roles and in care of older people in a residential setting. The managers work well with Mr Murray and Ms Kennedy-Hill, co-directors of the company who own the home, and senior catering, maintenance and domestic staff, to ensure that there is a consistently high standard of care and environment for residents. Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 19 The home uses the Registered Nursing Homes Association (RNHA) quality assurance system to assess the standard of care and facilities in the home. The home managers are readily available to residents and their families to discuss any day-to-day queries or concerns. However, the home does not hold regular formal reviews of care with individual residents to discuss any changes in care or suggestions that residents and their families may have. Consideration should be given to providing the opportunity for a formal review of care annually with residents and key staff. The proprietors confirmed that all residents have a family member or appointee to assist them with their personal finances, if they are no longer to manage their own financial affairs. The home does not deal with residents’ personal monies. Any small purchases made for residents by staff at residents’ request are receipted and ‘double-signed’ by staff and the resident. Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 20 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X X Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 21 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. Standard Regulation Requirement Timescale for action 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 * Ensure that care plans are sufficiently detailed to show the action that needs to be taken to ensure that all the health care needs of the residents are met. In particular, evaluation of nursing interventions should be documented in relation to wound care and nutritional needs. * ‘Resolved’ care needs/problem care plans should be removed from the current care plan files and archived, to reduce the bulk of the folders and ensure only current care plans are in use to improve the ‘readability’ and access to information for staff (and residents). Access the training and information about the M.U.S.T (Malnutrition Universal Screening Tool) and use this nutritional assessment tool * If staff have to make handwritten alterations to the Medicine Administration Record (MAR) sheets on the verbal instructions of a doctor, the doctor should check and countersign these in person as soon as possible. If DS0000027166.V282243.R01.S.doc Version 5.1 Page 22 2. 3. OP8 OP9 Oaken Holt House Nursing & Residential Home the doctor is not available, the staff member who made the amendment should have a second staff member check and countersign the MAR sheet. * There should be a record of any prescribed skin creams/lotions applied by care staff: this should be crossreferenced on the MAR sheet, so that there is evidence that the prescribed treatment has been given as ordered. * The home should have copies of a recent British National Formulary (BNF) for staff to refer to. 4. OP29 Use a check list /tracking tool to ensure that all the required checks and references are in place, together with the signature of the staff member(s) who requested and received information, the dates requested and received and the outcome of the references. Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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 Oaken Holt House Nursing & Residential Home DS0000027166.V282243.R01.S.doc Version 5.1 Page 24 - 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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