Inspection on 22/05/08 for Okecroft Nursing Home

This inspection was carried out on 22nd May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Okecroft Nursing Home Exeter Road Okehampton Devon EX20 1QF Lead Inspector Anita Sutcliffe Key Unannounced Inspection 22nd May 2008 08:10 Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 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 Okecroft Nursing Home DS0000071092.V363835.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 Adults 18-65. 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. Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Okecroft Nursing Home Address Exeter Road Okehampton Devon EX20 1QF 01837 52144 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) Guinness Care and Support Ltd Miss Constance Mary Flight Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 5. Date of last inspection Not applicable Brief Description of the Service: Okecroft is a care home registered for five people of either gender with learning disabilities who require nursing care. It has recently been re registered as the provider is now Guinness Care and Support Ltd. The home is an adapted bungalow, built in the 1940’s. It is set back from the road that leads into Okehampton, a rural town on the outskirts of Dartmoor National Park. Accommodation is provided on one floor and has access to the front and rear of the property by ramps and grab rails. Communal accommodation comprises: A lounge/dining room with small conservatory area leading to a garden. All bedrooms are for single occupancy and have a hand basin. There are no en suite facilities but all rooms are within close proximity to adapted bathing/toilet facilities. Staff are provided 24 hours a day with a trained nurse on duty through the day time. The manager states that fees are ……….. which includes private contributions, i.e. rent from benefits. Additional charges, as quoted in the home’s current guide to the service and statement of terms and conditions, are made for newspapers, the coin operated telephone, hairdressing, chiropody, toiletries, personal clothing and dry cleaning, share of the mini bus lease, insurance, petrol/diesel for trips out and activities and holidays. The home’s service users guide could be found in the entrance to the home and in service users folders. Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection was the first since the service was registered December 2007. It was to check the home’s compliance with the National Minimum Standards for Younger Adults by finding out what it is like to live at Okecroft through observation and survey information. We (the Commission) sent surveys to the family of people who use the service and staff. The home received two unannounced visits. Care records were examined and all people who use the service were met. We interviewed three staff and watched them interact with people. We looked in detail at the service two people receive. We also saw the home’s own quality survey results. All parts of the home were visited. Discussion was held with the manager. Some records and policies were examined. What the service does well: What has improved since the last inspection? This does not apply. As the first inspection since registration as a new service the home had no unmet requirements or recommendations to comply with. Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who move to Okecroft can be assured the home will be suitable for their needs, which will be fully assessed prior to admission. EVIDENCE: The people who live at Okecroft have done so for several years and there have been no recent admissions to the home. However, the needs of people who use the service are regularly reviewed. Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are well understood by an experienced staff who try hard to interpret people’s wishes and needs and support them to achieve. Risk is understood and managed in people’s best interest. EVIDENCE: People using the service were clearly relaxed and comfortable in their relationships with staff, who knew their needs very well. In survey four staff said they are always given up to date information about the people and one said they usually are. We looked at people’s care plans. They are required to be clear so that staff can look after people in the correct way, and as they wish, once their needs have been assessed. Records/plans showed a range of assessment tools and records, which were detailed and Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 10 would provide necessary information for staff to support people with activities of daily needs. People using the service have complex needs and their communication is very limited. However, there is detailed information for staff on how best to communicate with each person and staff are very experienced in this. The ability to have a choice or be consulted is dependant on how well the staff can interpret their needs. Members of staff were observed offering choices to people and using their experience to interpret the response. Risk, which mostly relates to health care, is well understood and managed. Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are disadvantaged by restricted access to outside activities and spaces. EVIDENCE: People who use the service are profoundly disabled and rely totally on others to provide for all of their needs. Staff said that there are yearly planning meetings to which family are invited and when goals and plans for each are reviewed. People at the home are of similar age, both male and female. Their rooms reflect them as individuals. Family, asked if the home helps people keep in touch, said: “My relative is not capable of keeping in touch but the care representatives always keep me informed of his health and well being”. Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 12 From staff surveys and discussion, plus observing that nobody left the home throughout the two inspection visits, we looked closely at how two of the five people spend their time, looking at their daily activity records. For the first we saw from records that they liked: ‘simple things; fresh air; walk in the woods’. However, we found that they left the home only four times for activities throughout the whole of May, three of those times for outdoor activities. They also went on a garden swing once and were visited twice by family. For the second person we found they left the home for activities only six times in May. We looked at other ways they could access fresh air and outdoor space and found the garden to be of limited use to them as it is not adapted for people with disability and contains little garden equipment or planting of interest. Although the home is newly registered little has changed to improve the garden since the previous registration. We were also told that, due to changes in banking arrangements for people, limits on the money they can access has meant holidays and summer outings have been temporarily restricted. People are having to spend almost all their time in the house regardless of any outside interests or the need/desire for fresh air. This is especially disappointing as they are more vulnerable to illness during the winter months. Members of staff said there are no restrictions on food provided at the home and staff ensure a healthy and balanced diet. We saw the kitchen was well stocked and the menu choices available. People need varying degrees of assistance with their eating; we saw this given as preferred and needed. Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The complex personal and health care needs of people who use the service are well understood and met in their best interest by an experienced staff. EVIDENCE: People’s needs, and how staff are to deliver care, was detailed in each person’s plan of care. We saw correspondence indicating that health care is also provided through outside agencies, such as dentist, physiotherapist and health care consultants. The manager described how decisions are made, as people using the service are unable to do this themselves. The home also looks at whether people will benefit from other therapies and have found benefit from herbalist therapy. Care plans are reviewed on a daily basis. Members of staff, and the manager, were able to describe people’s care needs in detail. Supplementary care plans are used where a short term concern needs to be dealt with, an example being an infection. Towards the rating of excellent we take into account the continuing standard of good health of the people who have very complex Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 14 physical needs and who, without a very high standard of care, would not continue in their good health. However, people do not currently receive well man and well woman health checks. The manager says she fully supports this is necessary and is trying to get this arranged. A family representative said about the care: “I believe the care provided and attention and consideration from members of the staff is outstanding”. Staff said: “We care very much about the residents” and “We provide high quality personal care and treat people as individuals with dignity and respect”. We looked at how medicines are managed in the home. None of the people using the service are able to look after their own so staff must do this for them. We saw staff administer medicines safely and properly record they had done so. We looked in each person’s plan of how medicines are to be administered and we discussed how the home uses emergency medicines. All was done in the person’s best interest. Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service are protected. EVIDENCE: Staff receive training in how to protect people from abuse and the strong family ethos of the home, and good leadership, also protects people. People who use the service have very limited ability to communicate and so rely heavily on the staff to interpret their needs. Staff were observed responding to these communication signs, such as a nod of the head or a smile, and said they could easily identify if a person was upset. The home has a complaints procedure, which is displayed in the entrance and is within the home’s written information. The manager says there have been no complaints and we have received no complaints about the service. Staff say they know what to do if somebody had concerns about the home and they described this to us. The home has a range of policies and procedures for staff use, which include ‘whistle blowing’ and protection from abuse. Family of a person who uses the service said they knew how to complain, adding: “I am confident that any concern I might have would be dealt with appropriately”. Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is safe, well maintained, clean, hygienic and homely but people are disadvantaged by the garden design. EVIDENCE: The rooms of people who use the service are personalised and contain equipment necessary to meet their health care needs. This promotes the safety and well being of people and the staff who assist them. There is a newly refurbished bathroom, clean and pleasant although containing specialist equipment. Staff have protective clothing to prevent the possibility of cross infection. We saw people using the lounge, dining area and conservatory, which looks over the garden. Communal spaces are nicely decorated with warm colours Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 17 and wall hangings. It is comfortable and homely in appearance and we are told that new insulation and roofing is keeping the home warmer. All areas of the home were clean and fresh. The laundry facility meets the needs of the home and staff receive training in Infection Control. We looked at the garden. It is quite large but of very limited use to people at the home. Staff have made efforts to overcome this, and are trying to find funding for improvements. We are aware that people have lived at the home for many years and in that time the garden should have been adapted to meet people’s needs, but very little has been done. People who use the service are disadvantaged regarding outside space available to them. (Also see standards 13 and 14). Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing numbers are not sufficient to fully meet people’s needs but staff ability is high. EVIDENCE: People who use the service appeared relaxed and comfortable in the presence of staff. The one survey reply from a family representative says the best way the home could improve is: “Recognition of the staff and the wonderful work they perform”. We spoke with three staff and the manager. One said that staffing is not an issue as it used to be. However, the five people who responded to surveys said there were often insufficient numbers of staff adding: • “Not enough staff at a time to do activities outside the home”. • “Whilst we currently have full staff cover the funding for staff is not enough for all individual needs”. Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 19 We found that people are not able to access enough activities. (See Standards 13 and 14). We therefore looked at the number of staff normally deployed in the home. We found that sometimes the housekeeper, who is also trained in care, is needed to cover care duties. Many times in the home there are only two care staff plus the trained nurse. This makes it impossible to provide outings for people and safe cover at the home for those who do not go out, so outings are infrequent and people’s lives adversely affected. Staff said they are being given training which is relevant to their role, helps them understand and meet the individual needs of people, and keeps them up to date with new ways of working. However, we found that staff had not received update training in epilepsy, recommended by the Joint Epilepsy Council to be every two years. This lapse has the potential to put people at risk should an emergency occur. Staff said through survey that all checks had been completed prior to their starting work at the home. This ensures staff are checked as safe to work with vulnerable adults. Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is very competently managed in people’s best interest but the provider does not always ensure needs can be met. EVIDENCE: The registered manager is very experienced and runs the home competently and with the best interest of people as the priority. One family representative said how very pleased they are with the service provided. Staff say they feel supported by the manager and understand why shortfalls, such as activities for people, occur. They also say the home is still settling down since the change of provider. Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 21 Staff confirmed that they have regular meetings and can contribute to the agenda, so they ‘have a voice’. They regularly review people’s care plans together discussing how they can improve the care they provide. There are no specific meetings for people who use the service but they share some of the staff meeting. Every year there is a formal review of people’s care, with family invited to attend. Although the standard of management within the home is high, we find that staffing is insufficient to meet all the needs of people at the home and the garden is of very limited benefit to them. The health and welfare of people are a high priority at the home. There are individual risk assessments, a good standard of health and safety training and equipment is properly maintained and serviced. We found no concerns relating to health and safety. Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 1 14 1 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 X 3 X X 3 X Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 23 N/A 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 YA13 YA14 Regulation 16(2)(m) 18(1) Requirement There must be arrangements in place for people to be able to leave the care home to engage in local, social and community activities of interest to them and which will enable them to have a full life within their capabilities. This must not be restricted through insufficient staff availability. There must be outdoor space within that available at the home, that is suitable for, and safe for use by, people who live there. This will give them the opportunity to enjoy the pleasures of a garden should they wish. Timescale for action 31/07/08 2. YA28 23(2)(0) 30/04/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Okecroft Nursing Home DS0000071092.V363835.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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