Inspection on 16/03/07 for Twin Oaks

This inspection was carried out on 16th March 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

Twin Oaks 15/10/09

Twin Oaks 17/03/09

Twin Oaks 22/03/06

Twin Oaks 20/09/05

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

CARE HOMES FOR OLDER PEOPLE Twin Oaks Victoria Road Windermere Cumbria LA23 2DL Lead Inspector Liz Kelley Unannounced Inspection 10:00 16 March 2007 th 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 Twin Oaks DS0000064043.V295599.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. Twin Oaks DS0000064043.V295599.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Twin Oaks Address Victoria Road Windermere Cumbria LA23 2DL 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) 015394 48994 015394 48994 Heathwaite Care Homes Limited Miss Margaret Palling Care Home 6 Category(ies) of Old age, not falling within any other category registration, with number (6) of places Twin Oaks DS0000064043.V295599.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 6 service users to include: up to 6 service users in the category of OP (Older People not falling within any other category) 22nd March 2006 Date of last inspection Brief Description of the Service: Twin Oaks is a domestic style property which has been equipped to provide accommodation and care for up to six older people. The home is furnished and decorated to a good standard, and provides a very comfortable and pleasant environment for the people who live there. The accommodation is on two floors, on the ground floor there is a spacious lounge, dining room, bathroom, toilet and kitchen, and on the first floor there are six bedrooms each with an en-suite shower and toilet. There is a small car park, and gardens with level access and seating. The home is situated in the town of Windermere, close to all of the usual amenities. The current scale for charging is £485 per week, with additional charges for hairdressing, chiropody and newspapers. A brochure is available for prospective residents, and a summary of the latest Commission for Social Care Inspection report is made available on request. Twin Oaks DS0000064043.V295599.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the main inspection of the year and all the key standards were examined. The inspection took place over a one month period, and included a visit to the home. Surveys and interviews were carried out of residents, relatives and health professionals. The visit to the home was carried out over a half a day. Time was spent with residents individually and collectively. The manager and staff member were interviewed and observed carrying out their duties. Documents examined included care plans, daily notes and safety and maintenance records. What the service does well: What has improved since the last inspection? Training has been given a higher profile and both the manager and staff member have attended courses to add to their skills and expertise of running a home and caring for older people. For example the manager is due to attend a course to help assist in how best to keep adults safe and to understand the local procedures for working with social services. Paperwork and care planning has improved and these are now up-to-date and contain a good amount of detail to assist in caring for each person in a way that best suits their needs. Twin Oaks DS0000064043.V295599.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Twin Oaks DS0000064043.V295599.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 Twin Oaks DS0000064043.V295599.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home has robust procedures in place to introduce new residents and this results in a high number of successful placements. EVIDENCE: Files contain relevant paperwork, including social work assessments and reports from health care professionals prior to a person choosing to stay at the home. Admissions are not made to the home until full needs assessment has been undertaken. The manager also carries out an assessment which includes visits to see the person in their own home or while in hospital. All those wishing to move in are invited and encouraged to visit the home to meet the staff and other residents and to enjoy a meal and spend some time in the Home. One resident described the introduction, which included a series of visits to the home prior to making a decision. Each resident is provided with a statement of terms and conditions prior to moving to the home. This sets out Twin Oaks DS0000064043.V295599.R01.S.doc Version 5.2 Page 9 in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the resident. These measures ensure that admissions to the home only take place if the manager is confident they have the skills and ability and qualifications to meet the assessed needs of the prospective resident. This results in placements to the home being appropriate and successful. A residents feedback card stated “ We received a well illustrated brochure and were shown round by the owner”. The home does not offer intermediate care referred to in point 6 above. Twin Oaks DS0000064043.V295599.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a care planning system that ensures all health and social care needs are met. EVIDENCE: Each resident has a plan of care that is prepared by the manager on admission to the home. The plan is agreed with the resident and their family members (with the resident’s agreement) and reviewed on a regular basis. The plans were found to be very informative, with details of the care needs, healthcare visits and appointments. Reviews were up to date with the family members being involved wherever possible. The manager includes a pen picture and a typical daily routine for each person to ensure that care is tailor made to the individual. A residents feedback card commented “ I can have a bath when I want one, and help is always available if I need it”. The care plan is a working document being reviewed regularly with appropriate amendments. This includes risk assessments with the emphasis on addressing safety issues whilst also promoting a better quality of life. Twin Oaks DS0000064043.V295599.R01.S.doc Version 5.2 Page 11 Medication is received from the pharmacy and is checked in by the manager who is also responsible for any medication that has to be returned. The inspector checked the records and found them to be correctly completed. All the residents said they were able to see their doctor when they wished and when necessary had visits from district nurses. Residents have agreed to, and have signed to say the home can take care of medications on their behalf. Discussions with the manager and residents confirmed that residents are always treated with respect and their dignity is preserved at all times. A socialworker commented that residents “feel they have been able to thrive whilst at Twin Oaks, with increased mobility and a complete reduction in falls”. And a District Nurse commented on residents “self caring increasing leading to increased dignity”. Twin Oaks DS0000064043.V295599.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. The routines of the home are planned around the residents’ needs and wishes and are flexible enough to meet the changing needs of the individual. EVIDENCE: Discussions with the residents during the visit evidenced that any routines in the home are flexible and ensure those living in the home make their own choices about how they spend their time. This was observed by the various choices residents were making for breakfast, each person had an individual tray made up with their food preferences, delivered at different times and with a choice of newspapers. Residents also said that this could be changed whenever they liked and from day-to-day. A feedback card commented “ I am happy to have breakfast served in my room, and enjoy having lunch around the dining room table with other residents. We have supper together on our laps in the lounge”. The same degree of choice was offered to activities and each person has a range of day services, outings and hobbies that they chose to follow, all of Twin Oaks DS0000064043.V295599.R01.S.doc Version 5.2 Page 13 which were enabled by the support offered by the home. This includes arrangements to attend a church of the individual’s choosing. In discussion with residents they all agreed they like living at Twin Oaks because the home was small and personal and they could choose how to spend their day. One resident told the inspector that she had previously spent a short time in another home but found it too large and noisy and loves her present home as it is “a home from home”. The meals are varied and the manager is able to cook what the residents like and so the menus are prepared on a daily basis. There is always a choice and the meals where judged to be of a high quality with ample fresh fruit and vegetables, and home baking. Twin Oaks DS0000064043.V295599.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel confident that any issue they raise will be dealt with promptly and they are safeguarded by the home’s adult protection policies. EVIDENCE: Twin Oaks has a clear complaints procedure which is given to new residents when they move in to the home. A copy of the complaints procure is displayed in the home and is given to residents’ families. The atmosphere in the home is open and friendly and residents know they can raise any complaints and appropriate action will be taken to resolve their concerns. Residents comment cards stated that they knew how and who to make complaints to. The policies and procedures regarding protection of residents are satisfactory and are regularly reviewed and updated in line with regulations and other external guidance. The home has the latest guidance on the local multidisciplinary procedures for reporting abuse, and the manager has reserved a place on the next training for Safeguarding Adults aimed at care home managers. Twin Oaks DS0000064043.V295599.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,23,24,25 and 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The standard of the environment both externally and internally in this home is excellent, providing residents with an attractive, warm and comfortable place in which to live. EVIDENCE: This home provides a very high standard of accommodation for those living there. There is an ongoing programme of redecoration that ensures the residents live in a warm, comfortable and attractive environment. All the bedrooms have en-suite toilet facilities and there is a bathroom that is suitable for any resident that may have a physical disability. The bedrooms are sufficiently large to enable the residents to bring favourite items of furniture from their own homes. Domestic arrangements in the home ensure the residents live in clean and hygienic surroundings. Twin Oaks DS0000064043.V295599.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a small staff team that is able to provide a high standard of care and support. EVIDENCE: Both the manager and her partner support residents to have active lives of their own choosing. In addition the home employs one carer every morning and she also carries out domestic duties. Residents described the managers partner as being very helpful in taking them out for drives and walks, and they speak very highly of the care that they receive from the staff member and manager. One residents said “They always make time to talk to me and to listen also”. All involved in the care of residents have Criminal Reference checks providing protection for the residents. The manager has introduced training courses for herself and the other member of staff. The carer is currently enrolled on an NVQ in Care and the manager is undertaking a management course. Details of these and other courses would benefit from being held in individual training files, along with supervision notes, to determine any gaps and development needs. Twin Oaks DS0000064043.V295599.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Twin Oaks is well managed and residents’ interests, safety and welfare are protected. EVIDENCE: The proprietor, who has a nursing qualification is responsible for the day-today running of the home, and has enrolled on a management course to help her in this role. The manager has a very clear understanding of the needs of older people, as she had been a District Nurse for a number of years. She ensures the best interests of the residents are served and provides exactly the level of care they want and need. The home has a very relaxed atmosphere as was evidenced by comments such as “I like living here as it is like being in my own home”. Twin Oaks DS0000064043.V295599.R01.S.doc Version 5.2 Page 18 The manager ensures that service users control their own money wherever possible, and if not then relatives assist with these tasks. The home does not act as appointee for anyone living in the home. Secure facilities are provided for the safe-keeping of money and valuables both in service users own rooms. The manager is responsible for health and safety and all fire safety procedures are in place. She ensures that fire drills and fire safety equipment are tested on a regular basis. All risk assessments are in place and reviewed on a regular basis. The equipment in the home is serviced under annual contracts with documentation in place on file and available for inspection. The tests and checks of the fire safety equipment and procedures were being completed and recorded in the fire log book. Information was available relating to the storage of substances hazardous to health. Risk assessments were completed to safeguard residents when using the stairs. There are some systems in place to check the quality of the services and care provided, and the proprietor will be developing these systems in future months. Although the staff member is supervised in her daily work, the manager was recommended to carry out more formal supervision sessions with the one staff member to ensure a framework for training and personal development. Twin Oaks DS0000064043.V295599.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x 4 x 4 4 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 x 3 Twin Oaks DS0000064043.V295599.R01.S.doc Version 5.2 Page 20 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. 1 2 Refer to Standard OP36 OP30 Good Practice Recommendations The manager should formally supervise staff and record these sessions A training plan should be developed for the home including the manager and staff member Twin Oaks DS0000064043.V295599.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Twin Oaks DS0000064043.V295599.R01.S.doc Version 5.2 Page 22 - 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!