Inspection on 21/05/09 for Oxford House Nursing Home

This inspection was carried out on 21st May 2009.

CQC 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 CQC 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 30/10/08

Oxford House Nursing Home 02/06/08

Oxford House Nursing Home 21/02/07

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 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Oxford House Nursing Home 204 Stoke Road Slough Berkshire SL2 5AY Lead Inspector Julie Willis Key Unannounced Inspection 21st May 2009 06:30 DS0000011008.V375236.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Oxford House Nursing Home DS0000011008.V375236.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 (0) of places Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP). The maximum number of service users to be accommodated is 34. Date of last inspection 30th October 2008 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 £513 to £618.63 per week. Oxford House Nursing Home DS0000011008.V375236.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 that people who use this service experience adequate quality outcomes. This unannounced inspection took place on Thursday 21st May between 06.30 am and 2.30 pm. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that CSCI has received about the service since the last inspection. Prior to the visit a questionnaire was sent to the Manager along with survey and comment cards for residents and visiting professionals such as doctors and nurses. Any replies were used to help form judgements about the service. Consideration has also been given to other information that has been provided to the Commission since the last inspection. The inspector toured the building, examined records and met all of the residents. The inspector also spent time talking informally to staff and observing how care was being delivered to the residents. From the evidence seen by the inspector and comments received, the inspector considers that this service has a good awareness and understanding of equality and diversity issues and would be able to provide positive outcomes for residents in the areas of race, ethnicity, age, gender, sexuality, disability and belief. The inspector gave feedback about her findings to the homes Manager at the end of inspection. There were three requirements made as a result of this inspection. The Commission has received information about one anonymous complaint since the last inspection. This matter is the subject of safeguarding procedures. What the service does well: Residents say that they like living at the home, which is comfortable and clean. They have their own rooms which are decorated and furnished to their own tastes and liking. The activity programme is varied and interesting and includes trips out to local places of interest. Residents say that there is plenty to do and enjoy taking part Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 6 All of the residents told the inspector that they liked living at the home and that the service provided was good. Residents say that staff are caring and kind and there is enough staff on duty at the home to meet the needs of residents effectively. Records were well-kept and up-to-date and provided staff with the information they need to provide the right care. Staff are well trained and most have achieved professional qualifications in care to further enhance their skills and knowledge. Residents said that the food is good and is varied and nutritious. Resident’s visitors are warmly welcomed and may visit at anytime. They are encouraged to remain involved in the resident’s care and welfare and are consulted about issues that may affect them. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 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 Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information they need to choose a home that can effectively meet their needs. Residents are fully assessed prior to admission to ensure the home will be able to effectively meet their need. EVIDENCE: The homes Statement of Purpose and Service User Guide were examined and it is evident that both documents clearly set out the aims, objectives and philosophy of the home. Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 10 The information is clearly written in plain English and both documents provide sufficient information to enable prospective residents to know what is on offer at the home including any support, treatment and specialist services available. They give details of what a resident can expect of the service and give a clear account of the services provided including accommodation, qualifications and experience of staff, how to make a complaint and the outcome of recent CQC inspections. Both documents were reviewed and updated in September 2008. From examination of pre-admission documentation for two residents it is clear that people are only admitted if the service is satisfied that staff have the skills, knowledge and ability to meet the person’s needs. Both prospective residents were fully assessed at home or in hospital before they were admitted to the home regardless as to whether or not they had a care management assessment. The assessment was carried out by the homes Registered Manager. Information was sought from a range of health and social care professionals as well as the resident themselves and family members. This enabled the service to build up a picture of the residents needs and to plan fully for their admission. Where an assessment had previously been undertaken by the Care Management team at the Local Authority the home had received a copy of the assessment and care management care plan. It was clear that significant planning had been undertaken pre-admission to ensure that the resident’s transition to the home went smoothly. This included ensuring that the home had in place any specialist equipment needed by the individuals during their stay. The assessment documentation was well completed, holistic and comprehensive and gathered sufficient information to ensure that the home would be able to effectively meet the resident’s need. A range of clinical and nursing tools had been used to assess the resident’s nutritional needs, communication needs, continence needs, mental state, level of mobility and risk of falls. Both residents had been subject to manual handling risk assessments and safe systems of work were in place to reduce the likelihood of injury to both staff and residents during manual handling operations. From the outcome of six CQC surveys and discussion with four residents about their experiences at the home it was evident that residents felt relaxed and comfortable in the care of the staff. One of the residents that was being case tracked said “Everyone has been welcoming and friendly, we have everything Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 11 we need, and we haven’t any complaints”. Another said “yes it’s good here, staff try their best, the home is clean, food is good and I’m happy”. Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care practices at this home during the night fail to take account of people’s right to privacy, dignity and choice. Lack of accessible fluids and call bells pose a significant risk to residents. EVIDENCE: When the inspector arrived at the home at 6.30 am all of the bedroom doors were fully open. All but one of the residents was still in bed, most were asleep and a number of the residents were not fully covered by blankets, duvets or sheets which compromised their privacy and dignity. Seven of the residents had drinks that were inaccessible to them. They were often on bed tables that were over six feet away from the bed or left on dressing tables. Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 13 Five residents call bells were inaccessible which meant that the residents would be unable to summon help if needed. The call bells were either dangling from the wall, draped on the floor or were attached to bed rails out of the reach of the resident. Four people were fully dressed in bed at 6.30 am. The inspector was told by night staff that the residents had been washed and changed earlier in the morning and had been put back to bed. Three of the residents were fast asleep in bed fully dressed, another appeared quite agitated and confused and asked the inspector to do the buttons up on her cardigan. One resident was fully dressed and seated in their armchair. There was no call bell near to them and no drink available. They said “I was up at 5 am. They put you to bed early here, about 5pm, so I always wake up early”. It was not however, clear from their care plan, whether this was the resident’s personal choice of when to wake and retire. There is a need to review current practice. Residents should be consulted about the time they rise and retire. Call bells and fluids should always be within easy reach of the residents. The practice of fully dressing people early in the morning and putting them back to bed should cease unless it is at the residents specific request. Examination of the care plans for five residents evidenced that the resident’s health and personal care needs were well documented. Information was up-todate and sufficiently detailed. All care plans were in the process of being further developed to ensure that they are person-centred and individualised. The home has awareness and understanding of equality and diversity issues and residents individual needs in this respect is incorporated into peoples care plans. The home has an effective cross-gender care policy in situ and residents may express a preference in relation to the gender of staff tasked to carry out their intimate personal care. Documentation confirmed that the care plans were being reviewed at monthly intervals or more frequently when needed to ensure that they continued to reflect the needs of residents. It was not clear however, if the outcome of the review was shared with the resident and their family. The daily records were a clear account of actions and events that occurred to the resident over a twenty-four hour period. However, there completion was occasionally minimal and several entries were difficult to read. Any risks to residents had been fully assessed using a range of assessment tools. Detailed guidelines were in place to reduce the likelihood of occurrence. Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 14 This included manual handling, falls, continence, nutrition and likelihood of the resident developing pressure sores or tissue damage. Residents that were being case tracked who spoke to the inspector expressed little interest in the development and review of their care plans but felt that they could ask to see the records if they wished. One resident said, “I don’t know what you mean, all I know is that there are plenty of staff, they come when I call them and they look after me well, that’s all I need to know”. The Manager keeps a separate record (called a tissue tracker) of how people’s wounds and pressure sores are resolving. The homes ‘tissue tracker’ record was examined along with care and treatment plans. It was evident that there has been significant improvement in the treatment of wounds at the home. The involvement of specialist nurses was evident and fully documented. They have been providing support and guidance to staff to ensure the effective management of wounds. At the time of inspection all residents had the aids and equipment they needed to reduce the likelihood of pressure damage. People’s weights are accurately recorded on a regular basis (at least monthly). Records are kept of what action has been taken to highlight issues of significant weight loss and the outcome of any referral made to health professionals for their advice and support. Residents are provided with access to health and social care professionals for advice and support when necessary. General practitioners, community nurses, psycho-geriatricians, the community matron and other health professionals are regular visitors to the home and provide advice to the staff on all aspects of care. Accurate records were available on their advice and input. Residents confirmed that they regularly see their GP and are referred to hospital when necessary. Routine screening and preventative treatments are provided to all residents. The home has met the requirements of the pharmacy inspection which was carried out on 30th October 2008. The controlled drug cabinet has been securely fixed to a solid wall since the last inspection and there are effective systems in place to ensure that there are adequate supplies of medication for each resident. From examination of the medication administration system and discussion with senior staff it is clear that the home is now following best practice guidance when administering drugs. The home uses a local pharmacy to provide medication for the residents. All MAR (Medication Administration Records) are pre-printed for ease of use and to ensure accuracy. Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 15 The nurses have been reminded about their responsibilities in relation to the safe administration of medication and each has a copy of the NMC (Nursing & Midwifery Councils) guidelines. Storage systems at the home are effective and disposal systems are safe. The home uses the ‘Doom Box’ system for disposal of waste medicines including unused controlled drugs which are de-natured before disposal. Two signatures are required when administering any controlled drugs and these drugs are stored separately as legislation requires. The home has accessed the CQC professional website for guidance about the administration of creams and lotions. The home has put in place systems to record their administration to ensure the safety of residents. Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities is offered that provide opportunity for mental and physical stimulation. Residents are encouraged to maintain contact with their family and friends and are able to have visitors at any time. The home provides a varied and nutritious menu designed to meet the needs of its residents. EVIDENCE: People at the home are involved in meaningful activities of their own choice and according to their individual interests, diverse needs and capabilities. From discussion with staff and residents it was clear that activities are offered to residents at the home on a daily basis. The activity co-ordinator has drawn up a schedule which includes films, reading aloud, scrabble, soft ball games, Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 17 ludo, hoopla, bingo, snakes and ladders and craft activities. The activity organiser arranges one-to-ones with people who are bedfast including hand massage, manicures and reading aloud from books, papers or magazines. Outside entertainments from the ‘Troubadours’, local bell ringers and ‘Dave Mac’ are particular favourites with the residents as are visits from ‘Candy’ the PAT dog. At the time of inspection there was a relaxed and friendly atmosphere at the home. Several residents sat outside in the sunshine under sun umbrellas and two residents were offered their lunch in the garden. Use of the gardens by residents is common place in the clement weather and the patio area provides a pleasant area for residents to sit and chat together, read newspapers or listen to music. Visitors are made most welcome at any time and are offered appropriate hospitality during their visits. A number of social events are held throughout the year which promotes community involvement and which provide residents families with the opportunity to engage with the staff and residents on an informal and regular basis. Examination of the menu and discussion with catering staff confirmed that there is varied menu on offer at the home. People requiring special diets can be catered for and culturally appropriate meals are provided each mealtime for people with religious and cultural needs. There are always alternatives provided to the main menu. Lunch on the day of inspection was sausage and mash with carrots, cauliflower and cabbage followed by profiteroles or custard. Vegetable curry with ochre and chapatti was being offered to residents requiring a vegetarian diet. Special diets can be catered for including diabetic, vegetarian, low fat or pureed meals. Discussion with residents evidenced that the food was well cooked tasty and plentiful. A number of residents made comments such as “I’ve no complaints the food is always very good”, “lovely” and “there is always too much for me”. Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system. Residents feel their views are listened to and acted upon. Residents are protected from abuse and exploitation by staff that can demonstrate knowledge of the homes abuse of vulnerable adults and whistleblowing policies. EVIDENCE: Details of how to make a complaint are displayed in the home. The complaint policy meets the requirement of Standard and Regulation. It provides information on how to make a complaint and the formal stages in procedures. Examination of the complaint records indicated that there have been two complaints made to the home since 1st January 2009. One complaint was dealt with by the home to the satisfaction of the complainant and the second was subject to safeguarding procedures. Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 19 In addition an anonymous complainant made allegations about the quality of care at the home to the Local Authority which is being dealt with under safeguarding adult protocols. This matter is yet to be resolved fully. Residents spoken with at the time of inspection said that that they felt confident that they could approach staff with any concerns or complaints and these would be taken seriously and acted on without delay. There has been one allegation reported to the CSCI about the home since the last inspection. This as already mentioned is subject to safeguarding adult procedures. There are written policies covering safeguarding adults and whistle-blowing. These make clear the vulnerability of people in residential care and the duty of staff to report any concerns to a person in authority. There was evidence in staff files and from discussion with staff, that they receive training in ‘Safeguarding Adults’ as part of their formal induction to the home. This training is later refreshed and consolidated when staff undertake NVQ training in which it forms a core module. Residents confirmed that they feel safe and well cared for at the home. One resident said, “I have no complaints about the home, staff are kind and friendly”, “I’ve no regrets about coming here its what I expected everyone has done their best to make me feel that this is my home”. Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standards of décor and furnishings in this home offer residents a comfortable and homely place to live. Standards of hygiene are good throughout. EVIDENCE: The home has a well-maintained environment, which provides aids and equipment to meet the care needs of residents. Communal areas are attractively furnished and are decorated in a homely manor. Large conservatory windows overlook the gardens and residents say that they Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 21 particularly like to spend time in this area, which is used for activities and as a dining room. All bedrooms are personalised to the resident’s particular taste. Residents confirmed that they were able to bring with them small items of furniture and pictures and ornaments to personalise their own rooms. There is a choice of bathing and showering facilities both assisted and unassisted and there are sufficient toilets placed strategically around the home to meet the needs of residents. All bathrooms, toilets and sluices have a supply of liquid soap and hand towels to maintain satisfactory infection control standards. The laundry has appropriate facilities for the laundering of resident’s clothes and linens and there are appropriate infection control procedures in place to protect residents from harm. The home has a range of aids and equipment available to maintain resident’s independence and to promote safe care. Profiling beds are available for residents that need them and specialist mattresses are used to promote tissue viability. Berkshire East PCT recently undertook an infection control audit on 17th March 2009. The audit checked compliance with best practice, identified educational needs of the workforce and evaluated the effectiveness of infection control practices at the home. All recommendations made in the report have been fully acted upon by the home and as a result the home has reached full certification standard in the ‘Cleaner Safer Care Homes’ scheme. Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There were sufficient numbers of staff on duty at the time of inspection to meet the needs of residents effectively. The skill mix of the staff team was appropriate for the size, layout and purpose of the home. Recruitment policies and procedures at the home are robust and transparent and ensure the safety of residents. EVIDENCE: Examination of the recruitment files for the three most recent employees indicated that all necessary checks are undertaken on prospective staff to ensure the safety and protection of residents. Records were well kept and met the required standard. The staff records contained copies of induction training, job descriptions, application forms, two written references, training certificates, supervision and appraisal records. All staff have had a criminal records check before starting Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 23 work at the home. These were examined to evidence compliance with good practice. The day staff appeared to have a good understanding of how their individual role benefits the work of the team and a thorough knowledge of the key values that underpin their work with residents. Observation of their practice confirmed that staff were patient, kind and caring. They offered people personal care in a discrete manner which maintained their dignity, privacy, independence and choice. The same cannot be said of the night staff however, who need to be reminded of their responsibilities to respect these values at all times of day and night. Care Assistants are offered opportunities to gain qualifications to further enhance their knowledge and skills such as National Vocational Qualifications at level 2 & 3. Twenty of the 23 current care staff have achieved the award or are shortly to complete it. Examination of the training records indicated that all staff are provided with refresher training at regular intervals, in core skills such as fire safety awareness, health & safety including COSHH, first aid, manual handling, care planning, nutrition, pressure area care, food hygiene, safeguarding adults, dementia awareness and infection control to ensure resident safety. From records and discussion with staff it was clear that all permanent staff have been properly inducted and have completed a period of shadowing more experienced staff to ensure that they are confident and competent to carry out the tasks of the job. Staff confirmed that they had undertaken an in-house induction and foundation training to Skills for Care specification. There is a need however, to consider extending the scope of and recording the training provided to agency and bank staff to ensure the safety of residents and staff. Examination of the supervision records evidenced that staff are supported at regular intervals at least six times a year. Residents were complimentary about the qualities of the staff they made the following comments “they are kind”, “always come when I need them” and “they are always polite”. Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 24 Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The resident’s benefit from living in a well managed home, where there is evidence that there health, welfare and safety is of primary importance. The registered person is qualified and experienced to run the home for the benefit of residents. EVIDENCE: The staff team confirm that the Homes Registered Manager – Angela Cole demonstrates effective leadership skills and is always accessible and Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 26 supportive. They say that Angela is caring, efficient and is always keen to support individual members of staff’s personal and professional development. The Manager is supported by a competent Administrative Assistant who frequently deputises in her absence and carries out regular home audits to ensure standards are being maintained. The formal role of deputy is currently vacant with senior nurses managing the home in the absence of the manager. Consideration should be given to reinstating the ‘deputy’ role to ensure that continuity and standards are maintained at all times. The staff say they are kept well informed and up-to-date and that they have the opportunity to express their opinions openly in staff meetings, supervision sessions and staff handovers. They say that they are provided with plenty of opportunity to express concerns, share information and to feel included and involved in the way the service is delivered. The night staff to day staff handover was observed as part of this inspection. Sufficient information was exchanged during the meeting to enable and facilitate the effective care of residents. The Proprietors visit the home regularly and carry out a regular audit of services. A Regulation 26 report is written each month, which elicits the views of residents and other visitors to the home and measures the homes achievements and outcomes since the previous visit. Management meetings are held weekly and have been used to closely monitor the homes progress towards the goals identified in its current action plan. The home carried out a satisfaction survey in November 2008 to measure its success in meeting its objectives. The surveys were produced in a user-friendly format to aid clarity and understanding for the residents. The results indicate a high level of satisfaction with the quality of the service offered by the home. Some questionnaires were also sent to relatives, care managers and other stakeholders. The outcome of questionnaires was collated to identify trends and to help identify where improvements could be made to services. A number of health and safety records were examined including fire records and hot water records. These checks evidenced that essential servicing and maintenance of equipment is undertaken routinely to safeguard the health and welfare of residents. Servicing and safety certificates were available on file. Unnecessary risks to the residents are identified using comprehensive risk assessments that are reviewed at regular intervals. So far as possible risks are reduced or eliminated. There is a need to ensure that senior staff are aware of how many residents are in the home as night staff said that there were 29 residents in situ when there was actually 28. This could pose a serious risk in the event of fire. Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 27 Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 3 3 x x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x 3 x 2 Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 13 (4) c Requirement Ensure that staff are aware of how many residents are in the home at all times to ensure residents, staff and others are protected from risk of harm. Ensure that residents have access to fluids at all times Ensure that residents have access to call bells to enable them to summon assistance at all times Timescale for action 01/07/09 2 3 OP15 OP22 16 (4) 12(1) 01/07/09 01/07/09 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 Oxford House Nursing Home DS0000011008.V375236.R01.S.doc Version 5.2 Page 30 Care Quality Commission Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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