Inspection on 21/02/07 for Oxford House Nursing Home

This inspection was carried out on 21st February 2007.

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

Oxford House Nursing Home 21/05/09

Oxford House Nursing Home 30/10/08

Oxford House Nursing Home 02/06/08

Oxford House Nursing Home 01/02/06

Oxford House Nursing Home 31/08/05

Oxford House Nursing Home 24/01/05

Oxford House Nursing Home 04/05/04

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 Oxford House Nursing Home 204 Stoke Road Slough Berkshire SL2 5AY Lead Inspector Philippa MacMahon Unannounced Inspection 09:15 21 February 2007 st 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 Oxford House Nursing Home DS0000011008.V321656.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. Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oxford House Nursing Home Address 204 Stoke Road Slough Berkshire SL2 5AY 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) 01753 536842 01753 539262 info@oxfordhousenursinghome.co.uk Mr Edward Millar Johnston Mrs Abina Teresa Johnston Angela Cole Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st February 2006 Brief Description of the Service: Oxford House Nursing Home was opened in 1980 and is owned by independent proprietors Mr and Mrs Johnston. It has the facilities for 34 service users (OP) who require Nursing and Care needs and is situated in a quiet residential close on the northern outskirts of Slough. The home offers views over adjoining school playing fields and residential properties. The establishment was originally an Edwardian family home and has many original features and décor. The fees for this service range from £490 to £560 per week. Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 09:15 houra and was in the service for 6 hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner or manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. Two of the commission’s comments cards were received from GP’s, and two from Relatives/Visitors. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. The registered provider and registered manager were in the home at the time of the inspection and met with the inspector. The inspector examined care plans and followed this up by meeting with the individual residents to see if their identified care needs were being met. The medication systems were examined, and the homes complaints procedure. The Social and Recreational activities programme was discussed with the coordinator, residents and staff. A tour of the building took place. Staff rosters and the homes recruitment procedures were examined, and the training and development programme for all staff discussed with the manager. The inspector met with the homes Administrator and examined records required by regulation. The inspector would like to take this opportunity to thank everyone who assisted in this inspection in any way. What the service does well: The home offers a clean, comfortable, homely, and friendly place for the residents who live there. The residents are well cared for and very appreciative of the care provided. The staff are well qualified to meet the needs of the residents. The present group of staff have worked together for some time and there is no use of agency staff in the home. Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 Page 6 The activities programme is very flexible and designed to meet the needs of the residents living at the home. Visitors and relatives are always made to feel very welcome in the home. The home has just won a Safe Food Award from Slough Borough Council. The meals are much appreciated. The home is very well managed. 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. The summary of this inspection report can be made available in other formats on request. Oxford House Nursing Home DS0000011008.V321656.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 Oxford House Nursing Home DS0000011008.V321656.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Every resident has a comprehensive assessment of their care needs prior to admission to the home and know that the home can meet those needs. The home does not provide an intermediate care service. EVIDENCE: The inspector examined a sample of care plans and found in each that a comprehensive pre-admission assessment had been carried out and that this formed the basis for care planning. Inofrmation had been obtained from other health care providers who had been involved in the individuals care. All preadmission assessments are carried out by the registered manager with another senior member of staff. Wherever possible the persons family or representative are included in the discussions, and encouraged to visit the home before any admission takes place. The home also offer resipite care and Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 Page 9 this is a useful opportunity to for anybody considering long term care to experience the service provided. Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Every resident has a care plan in which their assessed care needs are identified and the action required to meet those needs. The medication system is overall in good order. The residents are treated with dignity and respect. The residents wishes regarding care at the end of their lives is acted on. EVIDENCE: A sample of care plans were examined and this was followed through by meeting with the person to see if the identified care plan and actions meet the needs of the resident. Overall the care plans are clear, working documents that give a good picture of the individuals care needs and how these will be met. The inspector noted that in one care plan for a person who regularly comes into the home for respite care that the original assessment of care needs was carried out in 2004. It is a requirement that any assessment of care needs needs to be kept under review, and revised at any time when necessary to do so having regard to any change of circumstances, and particularly when an individual is readmitted to the home for respite care. Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 Page 11 Evidence of good wound care was found but this was not supported by scientific measurement or photographic evidence of progress or deterioration in the healing process. It is recommended that a review of wound care and the development of protocals should take place involving imput from the community specialist nurses. The residents all have good access to local GPs , and other health care professionals. The inspector noted very detailed information about the residents personal preferences, with regard to how they were dressed, and the best way to communicate with them. This is commendable and shows the level of commitment that the home has to caring for individual needs. Two of the visiting GPs had responded to the Commissions comment cards and had written positive coments as follows. “Overall very well run home, professional staff, very caring, good atmosphere.” And “I am happy with the care my patients receive.”` The medication system was examined and found to be overall in good order, and supported by a regular visit from the supplying pharmacist. However the inspector noted a number of omission in the medication administration record with no code to show the reason. It is a requirement that the recording of the administration of medication must be in accordance with the Nursing and Midwifery Council and Royal Pharmaceutical Societies guidelines on the administration of medicines. The inspector also noted that eye preparations in current use had not been dated on opening. These preparations have a short life once opened and it is good practice to note the date on the opening. It is recommended that any eye medication should be dated on opening the container. The inspector noted that the staff have a good understanding of issues of privacy and dignity by always addressing residents by their preferred term of address, and knocking on doors before entering a persons private room. The residents appearance and attention to detail of their likes and dislikes of how they prefer to be dressed was apparent. Information about residents wishes around the time of their death was seen in the care plans, and the home is involved with the national End of Life Project that ensures that peoples wishes are carried out and the best possible care provided at the end of their lives. A number of residents have an Advanced Care plan in place, and this is commendable. Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home make every effort to ensure that the home offers lifestyle experiences that match the residents own lifestyle. There is good opportunity for residents to take part in social and recreational activities of their choice. Meals are of a good standard but the ambience of the shared mealtime could be improved. From the evidence seen it is apparent that the home is able to provide a service that meets the needs of individuals of various religions, race and culture. EVIDENCE: The inspector met with the activities co-ordinator who is free lance and is employed to work Monday to Friday 9am to 12 md. This home is her preferred place of work and the reasons for this are that she feels part of the care team, valued, there are no agency staff employed and the staff team is very settled. An extensive programme of social and recreational activties is provided but it is not written in tablets of stone. Quite a lot of work is on a 1-1 basis, and particularly when a new person is admitted to the home. One of the residents has recently comleted a book with assistance from the activities co-ordinator and the administrator of the home. There is good contact with the community Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 Page 13 and local churches, and visits to the library are periodically undertaken. The home participates in the Pat Dog scheme and a visiting dog comes every 2 months. The co-ordinator often meets with relatives if appropriate to find out more about the residents preferred lifestyle. Records are kept of the residents participation in any of the activities offered. Meals and mealtimes are considered to be an important part of the residents day and the inspector joined the residents in the front lounge for lunch. There is no separate dining room and meals are taken on individual chair tables. This makes for a rather crowded room as a number of resident require assistance with eating and the staff need to sit with them. It also meant that the whole mealtime experience was rather mechanistic and not allowing for much social interraction. There are is no dining table, or tablecloths and napkins. It is recommended that a review of the dining facillities should take place to look at ways of improving the meal time experience for the residents. The meal served looked appealing and wholesome and those residents spoken to said that the food is always good. Snacks and drinks are readily available at other times of the day and night. The cook is able to cater to individual dietry requirements both medical and cultural. Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an accessible complaints procedure in place. Staff are aware of issues around the protection of vulnerable adults. EVIDENCE: The home has an accessible complaints procedure in place and copies were seen within the homes service user guide in each of the residents rooms. The Commission has not received any information concerning a complaint made to the service since the last inspeciton. Staff are aware of issues around the protection of vulnerable adults and this is included in the induction and ongoing training for all staff. Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable, clean and well maintained environment for the residents. EVIDENCE: The inspector toured all areas of the premisies, and over all found that the home is cleaned and maintained to a high standard. The quality of the decorating and furnishings are of a good standard. Since the last inspection there has been some changes made to the grounds. The frontage has been landscaped to allow more parking spaces and a gate and pathway have been added to improve the security of the home. One of the ground floor bathrooms has flooring that is badly stained and does not look very appealing. It is recommended that consideration should be made to replacing the stained flooring in the ground floor bathroom. One of the residents rooms has two oxygen cylinders that were not secured in a stand or to a wall to prevent them falling over and causing damage. This was immediately dealt with by the registered manager as there was a stand already in the home. It is Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 Page 16 recommended that all staff should be made aware of the guidelines for safe storage and use of oxygen in a care home setting. Two of the shower rooms were cluttered with wheelchairs and footrest from wheelchairs. It is recommended that an alternative storage of wheelchairs should be found rather than using the residents shower room. Two of the bedrooms examined had an offensive odour. The maintainance person was busy with the installation of a new call bell system that was nearing ocmpletion and had not been able to shampoo the two rooms as a consequence. The registered manager assured the inspector that this would be given a priority as it was one thing that the hpme really prided itself on that there are no offensive odours. In one residents rooms a bowl containing a number of tubes of tooth cleansing tablets was observed, close to the door. This in the inspectors view is not good practice as the tablets could be mistaken for sweets, and would cause harm if swollowed. It is a requirement that any tooth cleaning tablets must be kept locked away. The grounds are most attractrive and the rear enclosed garden is much appreciated by all. A sample of hot water outlet temperatures was taken an in each case was found to be within the recommended safe levels. Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers and skill mix of staff on duty at all times. The homes recruitment procedures are robust, and training and development is high on the agenda for all staff. EVIDENCE: The inspector examined copies of the staff rosters and found that there were sufficient numbers and skill mix of staff on each shift to meet the care needs of the residents. There is a very stable staff team who have worked together for some time and cover for each other at times of sickness, or leave. Agency staff are not employed. Regular staff meetings take place and the manager has an open door style of management with clear communication systems. A sample of staff records were examined and found to have all the necessary checks in place to ensure the protection of the residents. Staff training and development is seen by the manager as being of great importance and the inspector was shown a matrix of individual staffs training undertaken and pending. The percentage of care staff who are qualified to level 2 of the national vocational qualification is 88 which is commendable. The home is also involved in a pilot for fast tracking staff through the training called the Experienced Employee Route. This is proveing to be very successful and less stressfull for staff who are very experienced but have no Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 Page 18 formal qualification. The induction training package used at the home is an approved Skills for Care Council tool. Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and there are clear lines of accountability. The health, safety, and welfare of the residents and staff are promoted and protected. EVIDENCE: The registered manager is a qualified nurse with a wealth of experience in the care home industry. She is working towards the national vocational qualification , registered managers award, and hopes to complete this in the near future. There is very good sense of teamwork and clear lines of acountability and responsibility. The quality assurance systems in the home are developing. The proprietors monthly visit is well documented and covers all the necessary check required Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 Page 20 to monitor the service. This visit also includes a questionnaire for one of the residents to complete to obtain their view of life in the home. An annual questionnaire is also carried out and another is due to be undertaken shortly. The home do not manage any residents financial affairs and any incidental expenditure on the residents behalf is billed to them or their representative. All staff receive ongoing mandatory training in fire safety, moving and handling and food hygienne. Additional training in infection control is also provided. The induction training for all staff includes these topics Supporting policies and procedures are in place and accessible to the staff as working documents. Records required by regulation where examined and found to be in good order. Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 Page 21 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 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 4 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 Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 14(2)(b) Requirement It is a requirement that any assessment of care needs needs to be kept under review, and revised at any time when necessary to do so having regard to any change of circumstances, and particularly when an individual is readmitted to the home for respite care. It is a requirement that the recording of the administration of medication must be in accordance with the Nursing and Midwifery Council and Royal Pharmaceutical Societies guidelines on the administration of medicines. It is a requirement that any tooth cleaning tablets must be kept locked away. Timescale for action 12/03/07 2 OP9 13(2) 12/03/07 3 OP38 13(4)(c) 12/03/07 Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 Page 23 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 2 3 4 5 6 Refer to Standard OP8 OP9 OP15 OP26 OP38 OP22 Good Practice Recommendations It is recommended that a review of wound care and the development of protocals should take place involving imput from the community specialist nurses. It is recommended that any eye medication should be dated on opening the container. It is recommended that a review of the dining facillities should take place to look at ways of improving the meal time experience for the residents. It is recommended that consideration should be made to replacing the stained flooring in the ground floor bathroom. It is recommended that all staff should be made aware of the guidelines for safe storage and use of oxygen in a care home setting. It is recommended that an alternative storage of wheelchairs should be found rather than using the residents shower room. Oxford House Nursing Home DS0000011008.V321656.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Oxford House Nursing Home DS0000011008.V321656.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. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!