Inspection on 08/07/05 for Oaken Holt House Nursing & Residential Home

This inspection was carried out on 8th July 2005.

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

The inspector 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 &... 02/02/06

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 Eynsham Road Farmoor Oxford OX2 9NL Lead Inspector Delia Styles Lilian Mackay Unannounced 8th July 2005 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 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 H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Oaken Holt Address Eynsham Road Farmoor Oxford OX2 9NL 01865 863710 01865 865252 01865 864831 www.oakenholt.co.uk Oaken Holt Care Ltd Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Alison Valentine, Nursing Manager Mandy Vettraino, Residential Manager Care Home (CRH) 80 Category(ies) of Dementia - over 65 years of age (DE(E)) 14 registration, with number Old age, not falling into any other category (OP) of places 80 Physical disability (PD) 1 Oaken Holt H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: !: On admission persons should be aged 60 years and over. 2: Maximum of 30 persons with nursing needs. 3: The total number of persons accommodated at any time must not exceed 80 Date of last inspection 14th February 2005 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 acommodation 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 acommodation 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 H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 9.50 am finishing at 3 pm. Two inspectors undertook the inspection, one visiting the residential accommodation in Oaken Holt House and Coach House, and the other the nursing wing. A partial tour of the premises took place, and a sample of care records were inspected. The inspectors spoke to 12 residents, the nursing and residential care managers, 3 staff, a co-director/owner and a visitor. The inspectors discussed their findings and recommendations with managers and a company director at the conclusion of the inspection. What the service does well: What has improved since the last inspection? The decoration and furnishings are of a good standard, and re-decoration and replacement of any worn or old soft furnishings and furniture is ongoing. The windows of the Coach House were in the process of replacement at the time of this inspection. A vacancy for an activities co-ordinator has been filled, and the new staff member is working hard to get to know residents’ preferences for individual and group activities and entertainments. The nursing wing has created a ‘Snoezelan’ room, where special lighting effects, music and aromatherapy are used to create a soothing and relaxing area for individual residents. Oaken Holt H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 Page 6 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. Oaken Holt H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Oaken Holt H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 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 standard(s) 3 The home has a comprehensive admission procedure that includes proper assessment of people’s needs prior to them moving into the home, so that the prospective residents are assured of their care needs being met. EVIDENCE: The inspectors looked at the care plans for 6 residents. There was detailed information about the needs of residents from assessments undertaken by the home’s managers and information from professional health and social care staff and family members. The home’s guidelines show that a full assessment based on a new resident’s abilities and needs is required to be completed within one week of admission. Oaken Holt H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 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 standard(s) 7&8 The health needs of residents are well met with evidence of good links with medical and social care professionals. 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. EVIDENCE: The inspectors looked at a number of the care plans for residents. The care records contained extensive admission details and there was evidence of regular visits from doctors and other social and health care professionals, depending on the need to the individual residents. Several care plans seen included a short history or social record, completed by a relative of the resident. This is particularly helpful to staff where the resident has memory problems, because it helps staff to be aware of the person’s former lifestyle and interests before they came to the home. The records are regularly updated and if changes are made the resident, their relative or advocate sign to show their agreement to the care plan. Some care plans seen on the nursing wing were not sufficiently detailed or had not been updated to show, for example, the progress of a resident’s wound Oaken Holt H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 Page 10 healing, or management of diabetes. This is important so that all staff have precise information about the care they need to give, and to accurately assess the effectiveness of that treatment. Staff assess residents’ nutritional needs on admission and weigh them regularly. However, the care plans did not include specific detail about what action staff should take if someone was at risk of malnutrition or the effectiveness of food supplements, if needed. The home should contact the community dieticians for more information about the use of a recommended way of assessing nutritional needs that is being introduced throughout Oxfordshire. The use of this particular method of assessment and taking the suggested actions to help improve residents’ diet if they are considered ‘at risk’, has been shown to be effective and easy to put into action. A physiotherapist visits the home three times a week and provides assessment and treatment to residents who need it. Physiotherapy is included in the homes fees. Oaken Holt H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14 & 15 The home places emphasis on the range of activities and opportunities provided for residents to be involved in social and recreational interests that meet their individual needs. There was evidence that residents were able to live as independent a life as possible and that their views were sought and acted on by the home’s proprietors and managers. The meals in this home are good, offering a choice and variety and catering for special dietary needs. The dining rooms are attractive and provide residents with a choice of environment and companions with whom to share a leisurely meal and conversation. EVIDENCE: The nursing wing had a programme of activities advertised. This is usually coordinated by a member of the nursing team who is a registered mental nurse and has considerable experience in caring for older people with memory problems. At the time of the inspection the staff member was on leave and staff planned to organise some activities with residents during the afternoon. A ‘Snoezelan’ sensory room has been set up in the nursing wing. This uses different lighting effects and music to provide a relaxing and calming environment that is particularly helpful to some residents who have periods of restlessness and anxiety. Oaken Holt H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 Page 12 A new activities worker has been appointed to work in the home and was in the process of getting to know individual residents and asking what sort of activities and entertainments they would like. She will try to incorporate activities across the whole site. The home provides a wide range of activities and has a minibus that is used to transport residents on outings and trips to Oxford and local places of interest. The residents and staff were looking forward to a 1940’s theme fancy dress competition. The choice of menus at mealtimes is impressive, with an ‘a la carte’ menu. The daily menu offers two dishes from each of the three courses available at lunch and dinner. Additionally, salads, sandwiches and omelettes are available. The chefs meet and discuss the menus with residents, to ensure that individual personal tastes and preferences in food are met. Oaken Holt H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 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 standard(s) 16 The home has a satisfactory complaints system and there was evidence that residents feel that their views are listened to and acted upon. EVIDENCE: The inspector discussed a complaint that had been received by the home, about a resident whose needs could no longer be met in Oakenholt. The manager of the nursing unit acknowledged that documentation about the person’s increasing care needs was incomplete and earlier discussion with his/her relatives about the issues would have been advisable. However, the actions taken by the manager to arrange specialist medical and nursing assessment of the resident and involving a relative and care manager in this process had been appropriate. Oaken Holt H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 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 standard(s) 19, 20, 23 & 26 The standard of the environment within and outside this home is very good, providing residents with a very attractive and homely place to live. Regular maintenance and an on-going programme of improvements and refurbishment ensure the safety and well being of residents, whilst keeping the character and individuality of the buildings and residents’ own rooms. EVIDENCE: The inspectors toured the buildings and spoke to individual residents in their rooms. The standard of cleanliness throughout was very high. Individual resident’s rooms were highly personalised with their own belongings and small items of furniture. Residents and staff ensure that there are fresh flower arrangements throughout the home. Outside, the flowerbeds, containers and hanging baskets provided a colourful and attractive outlook for residents. Oaken Holt H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 Page 15 The grounds are well maintained and residents spoken to were very appreciative of the beautiful environment and views over the surrounding countryside and Farmoor reservoir. There is an on-going programme of planned maintenance and refurbishment. The Coach House apartment window frames were being replaced. A new suite of furniture for the Main House lounge is planned. CCTV cameras provide security viewing of the car parks and entrances to the home. The nursing wing doors have key code locking devices to provide additional safety for residents. Residents in the nursing wing have a small courtyard garden with a fishpond, seating and flowerbeds. Because the site is on a hillside, the garden is steeply sloped and this restricts its use for elderly frail residents. In the last report it was recommended that the proprietors look at ways to enlarge the amount of level garden area that could be used safely for residents in the nursing wing. The conservatory room provides a bright and warm area, and additional dining space, opening onto the courtyard garden, for the nursing wing. Residents in the Coach House apartments each have a small patio area with seating and planting areas, facing over the valley and drive access to the grounds. Residents are encouraged to maintain and choose the planting for the gardens if they wish. Oaken Holt H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 The numbers and skills of staff meet the needs of the residents. Overall, staff have a good understanding of residents’ care needs and this was evident from discussion with residents and observation of staff at work. Managers ensure that all staff have the opportunity to attend training and updating in care, health and safety topics, so that they are competent to do their jobs. EVIDENCE: Staff spoken with had received training in a range of health and safety topics including fire safety, food hygiene and service, moving and handling and first aid. Training and updating in wound care and care planning was planned for nurses in the nursing unit. The nursing unit manager said that there were vacancies for 2 care assistants but that staff were being recruited. The use of agency staff was minimal, but where necessary to fill staff absences, the same agency and staff were used to make sure that residents’ usual care routines were not affected. Managers and staff spoken with have a good understanding of residents’ support needs. Residents were appreciative of the care staff and their kindness and patience. One resident told an inspector that they had some difficulty with communicating with some care staff recruited from overseas, because of their understanding of the English language. Oaken Holt H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32 & 38 The proprietors and managers are very experienced in their roles, communicate well together and provide clear leadership throughout the home. The systems for maintenance and ensuring the safety and welfare of residents through staff training and risk assessment EVIDENCE: Both registered managers have achieved the Registered Managers Award, a formal qualification for their role, as recommended by the Commission. The company directors and managers all have considerable experience in caring for older people in residential settings. The management team are available to residents on a daily basis and meet together regularly to discuss the way the home is run and any development plans. The home has purchased stair chairs and ‘ski pads’ for fire evacuation use and training for staff in use of this equipment has been arranged. Oaken Holt H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 Page 18 Risk assessments were in place in the care records of residents who would need full assistance in the event of a fire or need for emergency evacuation of the building. The inspector observed two care staff in the nursing unit use an ‘under-arm’ lifting method when transferring a resident from a wheelchair to an armchair. This method of transferring someone is incorrect and should not be used, because it increases the risk of injury to the resident’s shoulder joints, and may cause injury to the staff if the resident is unable take their own weight. Staff should always use the safe and recommended moving and handling methods, including any equipment, as they are taught. Oaken Holt H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION 4 3 x x 3 x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 x x x x x 3 Oaken Holt H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 Page 20 NA Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 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 7.2 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, diabetic monitoring, and residents leisure and recreational activities. Access the training and information about the M.U.S.T (Malnutrition Universal Screening Tool) and use this nutritional assessment tool Create/extend a safe outdoor area with improved levelled access for residents in the nursing wing. Ensure that all staff use appropriate and safe moving and handling techniques to reduce the risk of injury to residents and themselves. 2. 3. 4. 8.9 20.3 38.2 Oaken Holt H57_H08_S27166_Oaken Holt_V234294_080705_Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Burgner House 4630 Kingsgate 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. 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