Inspection on 16/10/07 for The Uplands at Oxon

This inspection was carried out on 16th October 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

The Uplands at Oxon 21/07/08

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Uplands at Oxon Clayton Way Bicton Heath Shrewsbury Shropshire SY3 8HS Lead Inspector Pat Scott Key Unannounced Inspection 16th October 2007 09:15 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 The Uplands at Oxon DS0000070260.V348675.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. The Uplands at Oxon DS0000070260.V348675.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Uplands at Oxon Address Clayton Way Bicton Heath Shrewsbury Shropshire SY3 8HS 01743 282040 01743 282041 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) www.marchescare.co.uk Marches Care Limited Ms Denise Marshall Care Home 81 Category(ies) of Dementia (81), Old age, not falling within any registration, with number other category (81), Physical disability (81) of places The Uplands at Oxon DS0000070260.V348675.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide nursing care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Dementia (DE) 81 Physical Disability (PD) 81 Older People (OP) 81 The maximum number of service users accommodated is 81. 2. Date of last inspection New service Brief Description of the Service: The Uplands at Oxon is owned and operated by Marches Care Ltd, a family company. This home is the result of five years of planning to move the existing home from Dorrington to a new Shrewsbury based site. The result is a light, airy, modern, care home with four separate units of 20 single en-suite rooms. One of the units is specially designed with the needs of service users suffering from dementia. There are specially landscaped courtyard gardens for service users to enjoy including wheelchair height borders. The service offers palliative care to the Gold Standard Framework for palliative care. The service also has a life long learning facility with internet access for service users to use. Information in provided within a brochure pack which contains full details of the fee structure and possible funding arrangements. Fees are £690-£730. The service also has a website. The Uplands at Oxon DS0000070260.V348675.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider in the annual quality assurance assessment, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, planned quality assurance processes and observation of care experienced by people using the service. Marches Care Ltd is a family company, who, until the registration of this new purpose built home, owned and ran The Uplands at Dorrington, Shrewsbury. As this is the first key inspection of this service following registration and the home has only been operating at its new site since June 2007 a rating of “excellent” cannot be given as it is considered that the service needs to demonstrate this level of performance over more time. However, many of the outcomes for service users are indeed excellent and there seems no reason, given the systems and the enthusiastic approach of the proprietor, that this level of performance will not continue. What the service does well: Prospective service users and their families are treated as individuals and with dignity and respect for the decisions they need to make. The management respond to individual needs for information, reassurance and support. Staff listen to service users and take account of what is important to them and respond well to changing needs. The staff and residents appear to have a friendly relationship and the endeavours to provide activities for people with complex healthcare needs are to be commended. Staff are particularly skilled in providing end of life care and have forged strong links with the Hospice. The ethos of the home is that it welcomes complaints and suggestions about the service, uses these positively and learns from them. The service puts a high level of importance on training and staff report that they are supported through training to meet the individual needs of people using the service. The management communicates a clear sense of direction, is able to evidence a sound understanding and application of ‘best practice’ operational systems, particularly in relation to continuous improvement, customer satisfaction, and quality assurance. The Uplands at Oxon DS0000070260.V348675.R01.S.doc Version 5.2 Page 6 This is the first time the service has admitted service users with a primary diagnosis of dementia. The provider has researched this aspect of care thoroughly and has designed the environment and care strategy well. 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. The Uplands at Oxon DS0000070260.V348675.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 The Uplands at Oxon DS0000070260.V348675.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): Key Standard 3,6 National Minimum Standard 1 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Written records for the admission of new people to the service demonstrate that the process is personalised and that consideration has been given to all aspects of care. Significant time and effort is spent making admission to the home personal and well managed, so that prospective service users and their families are treated as individuals and with dignity and respect. EVIDENCE: The service provides prospective service users with a comprehensive brochure pack. This is specific to the service user group and contains photos and a condensed version of information within a ‘leaflet’. The same information is also on the website including the fee list which also provides comments/views The Uplands at Oxon DS0000070260.V348675.R01.S.doc Version 5.2 Page 9 from people who have used the service. The format and presentation of the information has significantly improved from the old version for the home at Dorrington. The service maintains pre-admission and admission records. One seen for a prospective admission is personalised and addresses physical health, mental health, social care and spiritual needs of the individual. The staff dealing with the admission see copies of the assessment summary and care plans of those carried out through care management arrangements. The service is highly efficient on obtaining these summaries as they are received on each unit via a dedicated fax facility. The service intends to improve further by seeking post-admission views of service users as to the quality of the improved admission process. The service is currently providing intermediate care for 5 service users. The service has a block contract with Shropshire County PCT which is shortly due for renewal. Individuals follow a structured rehabilitation programme which allows them to practice ‘being at home’ within a supported environment that encourages independence. The Uplands at Oxon DS0000070260.V348675.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): Key Standards 7,8,9,10 National Minimum Standard 11 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users’ care needs and risk assessments are set out in their individual plans of care which ensures that all care needs have been addressed and will be fully met. The service is particularly skilled in palliative care so that service users requiring specialist end of life care can die with dignity. The service understands the need to comply with safe medication systems and staff practice ensures that the home’s procedures are complied with and that service users health matters are safely addressed. The actions of staff and their approach to care ensures that service users are treated with respect and their right to privacy is upheld. The Uplands at Oxon DS0000070260.V348675.R01.S.doc Version 5.2 Page 11 EVIDENCE: Records seen showed that individual care is planned well and reviewed monthly or sooner if changes occur. Health screening takes place so that early intervention can be established. Risk assessments are in place regarding manual handling, use of bed rails and any relating to individual behaviour. From records seen, the staff group is balanced to enable choice of male, female and age related preferences when delivering personal care. The service participates in a recognised palliative care programme and have purchased specialist equipment to manage symptom control. The service has established links with a GP specialist in palliative care and has taken part in a training and information video for end of life care. A guest room is available as accommodation for the relatives of service users who wish to stay overnight. The dementia registration category for the service is new. However, staff have always cared very well for service users who require nursing care but have gone on to develop dementia over time. All service users now have single rooms with en-suite showers so that care can be conducted in private. Service users are well groomed with their hair, nails and clothes looking clean. No issues were identified in discussions regarding approach of staff or being assisted with intimate tasks. Staff observed going about their work have a cheerful and professional attitude. Staff spoken with are very knowledgeable about clinical issues and how care is to be structured to address these. NVQ qualifications are above the required 50 . The service accepts responsibility for administering medication to service users. The service has suitable storage facilities for all types of medicines. Written records for receipt and disposal are maintained and the medication reviews regularly take place. The management has developed a medication management audit tool to ensure that practice complies with procedures. Service users spoken with said that staff are “kind and professional”, and ‘really lovely’. Another said ‘they actually ask me my preference and don’t just do things to me’. The Uplands at Oxon DS0000070260.V348675.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): Key Standards 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are provided with social activity and can keep in contact with family and friends. Social, cultural and recreational activities meet service user’s expectations through assessment, consultation and choice. Service users receive a healthy diet according to their assessed requirement and preference. EVIDENCE: Social support is tailored to individual needs given their level of ability to participate. The service has made links with the local church and other community groups who will be able to take a more active part in the social aspect of the home. The local library delivers books and tapes and the home has a quiet room which has daily newspapers and periodicals for service users to read. The home has a cinema and a life long learning room for service users where they can watch films with surround sound or use personal computers with The Uplands at Oxon DS0000070260.V348675.R01.S.doc Version 5.2 Page 13 broad band internet access to keep in touch with family and friends. The PCs have extra large keyboards for ease of use. All bedrooms have digital televisions with free-view channels. Families and friends visiting stated that they are encouraged to visit and have use of the kitchenettes for refreshments. Service users who are able, can make drinks for their visitors. The home only provides single en-suite bedrooms so that each persons right to a private life is respected. Staff were seen to knock and wait for an answer before entering service user’s private space. The service provides rummage and reminiscence boxes for service users on the dementia unit. It is the stated intention of the service to provide more equipment for sports and activities on this unit as the service develops and more people are admitted. It is also the intention to employ more activity coordinators and increase the amount of holistic therapy offered. The home provides two hair and beauty salons. Records show that menu choices are offered daily and there is a choice for service users as to where they eat; in their own room, one of the day rooms or within the café. Specialist diets are catered for and service user care plans show that nutritional assessments are conducted and liaison with the chefs maintained. The choice and availability of meals has improved from that provided at the home in Dorrington. The catering manager holds NVQ 3 in catering. The Uplands at Oxon DS0000070260.V348675.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): Key Standards 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure which is accessible so that people who use the service have information of how to make complaints about the home. Training is provided so that service users are protected from abuse and have their legal rights protected. EVIDENCE: Service users surveys stated they know whom to approach if they have a problem as most of the staff have transferred from the previous home. All expressed confidence that issues would be dealt with. There is a high level of accessibility to the management at this home which ensures that concerns can be dealt with very quickly. Staff files seen showed that adult protection training has been provided. polices and procedures are in place that uphold equal opportunities, antidiscrimination practice, whistle blowing, gifts and wills etc. The complaint log details all concerns received whether written/verbal or ‘minor’ comments. None have been received since the registration of the home. The Uplands at Oxon DS0000070260.V348675.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): 19,26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home ensures that service users live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: The Uplands at Oxon is a new, purpose built care home. Access is through automated doors and the home is protected by external CCTV on all external doors. The home offers 81 single en-suite bedrooms all fitted with a direct dial private telephone, digital television, a specialist nursing bed and nurse call system. One service user on the dementia unit was keen to show off her room and could identify its location. The management have provided assisted bathrooms based on research of best practice for the service user groups accommodated. There are a number of day rooms in which service users were seen to be relaxing, that enjoy views over The Uplands at Oxon DS0000070260.V348675.R01.S.doc Version 5.2 Page 16 surrounding countryside. There are courtyard gardens (one exclusively for the dementia unit) with wheelchair accessible beds for anyone with an interest in gardening. Signage in the home is excellent throughout. The dementia unit has signage appropriate for the service users on bathroom doors and their individual bedroom doors. Rooms are easily accessible for those with a visual impairment as signage has the addition of Braille. Internet access is available in bedrooms as well as the communal facility. Nurses stations are situated on each unit but are sited in a way that does not impinge on the homely feel of the place. The laundry is external to the home and is well organised and infection control polices in place. Staff were seen to wash their hands after dealing with service user care. Gloves and aprons are used by staff when providing personal care. Sluice rooms are provided on each unit with modern equipment to ensure infection is minimised. The Uplands at Oxon DS0000070260.V348675.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): Key Standards 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. Staff in the home are trained and are in sufficient numbers to fill the aims of the home and meet the changing needs of service users. The service is proactive rather than reactive in its staffing, recruitment and training so that they plan for the potential needs of people who may use their service in the future. EVIDENCE: The home is not fully occupied but sight of staffing rotas on the units being used showed that an appropriate number and skill mix is on duty at all times. The rota showed, and staff confirmed that trained nurses are often on duty to back up the lead nurse on each unit so a higher proportion of nurses are on duty. Staffing for a full compliment of service users has been forecast and planned for with additional roles having being created, e.g. unit orderlies who support the care team and kitchen team. Many staff have transferred from the home in Dorrington and new recruitment has also taken place. Five new recruit files were examined. All checks required by Regulation were in place. Induction programmes have been implemented for new staff. The The Uplands at Oxon DS0000070260.V348675.R01.S.doc Version 5.2 Page 18 management input is supernumerary to care staff numbers although the manager does directly supervise staff during their shift-work. Staffing rotas are in place and NVQ training is provided and the minimum ratio of 50 trained staff being at level 2 has been exceeded. The deputy manager and two senior qualified staff all hold the registered managers award and NVQ 4 in care. The service trains catering and domestic staff to NVQ level. Staff meetings take place that are minuted so staff have forum to air their views. Training provision is high on the management agenda. Records show that health and safety, manual handling, infection control, basic care techniques, nutrition and skin care are all regular on-going topics. A talk on the Mental Capacity Act is scheduled for the afternoon of 16/10/07. Research for best practice in dementia care has taken place. Staff have access to the service’s ‘intranet’ at each nurses station so up to date knowledge and information is integral to daily practice. The service’s policy on reflective practice is still in place and staff have the opportunity to discuss what works well and what they could better for service users. Thus, the staff team support each other and share skills and knowledge with colleagues. Service users were very complimentary about staff and feel they are very well cared for. Service users in the home recognised staff by sight and name. A new personnel manager has been appointed which will improve the system of appraisals. Staff spoken with stated that they have time to talk to service users about their care plans and their conditions. They are very knowledgeable of the policies of admission and ensure that service users are treated as individuals. The Uplands at Oxon DS0000070260.V348675.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): Key Standards 31,33,35,38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect and with effective quality assurance systems in place, service users are assured that the overall conduct of the home is being excellently managed. EVIDENCE: There is a clear management structure in the home. The director, Mandy Thorn, is very involved on a day to day basis. The registered manager, Denise Marshall, is supernumerary and provides support to the unit managers and lead nurses. Administrative support has been improved so that answering telephones and the door etc does not take staff away from delivering care. Through discussion, the Director demonstrates she is highly confident in sound business systems and financial management with additional support from The Uplands at Oxon DS0000070260.V348675.R01.S.doc Version 5.2 Page 20 newly appointed personnel and finance managers. These persons will support the registered manager in recruitment and staff support. A new quality assurance system will be implemented on an on-going basis. This format will provide an audit trail of quality assurance within the home. It is user friendly and uncomplicated and asks some direct questions for views about all aspects of the service. The service employs a full time health and safety maintenance person who provides full and clearly written recording of all safety checks and maintenance. The Uplands at Oxon DS0000070260.V348675.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 4 X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 4 The Uplands at Oxon DS0000070260.V348675.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Uplands at Oxon DS0000070260.V348675.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 The Uplands at Oxon DS0000070260.V348675.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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