Inspection on 17/03/09 for Twin Oaks

This inspection was carried out on 17th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Twin Oaks 15/10/09

Twin Oaks 16/03/07

Twin Oaks 22/03/06

Twin Oaks 20/09/05

Extracts from inspection reports are licensed from CQC, this page was updated on 21/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Twin Oaks Victoria Road Windermere Cumbria LA23 2DL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Margaret Drury     Date: 1 7 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Twin Oaks Victoria Road Windermere Cumbria LA23 2DL 01539448994 01539448994 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Heathwaite Care Homes Limited care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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) Date of last inspection Brief description of the care home 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 four single bedrooms and one registered as a double 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. Care Homes for Older People Page 4 of 24 Over 65 6 0 Brief description of the care home The fees for this service range from 495.00 605.00 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. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The visit to this service that forms part of the key inspection took place during one morning in March and we were in the home for over three hours. All the key standards were assessed during this time. Information about the home was gathered in different ways and this formed the basis for our inspection. The manager had completed an Annual Quality Assurance Assessment (AQAA) that was returned within the timescale allowed. It is a legal requirement that this document is completed annually by all regulated services. The AQAA outlined the facilities available within the service, what has been accomplished during the past year and what the manager hopes to achieve in the next 12 months. We spoke to staff residents and visitors and toured the building looking at the environmental standards. We received completed survey forms from residents and staff whose comments helped us to assess this service. Care Homes for Older People Page 6 of 24 We looked at the care planning system and examined the records for the administration of medicines. What the care home does well: 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 set out on page 4. 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. Care Homes for Older People Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 have their needs assessed before they move into Twin Oaks so they know their needs can be met. Evidence: The home has produced a limited statement of purpose and service user guide giving information about the home. This is given to all those people enquiring about accomodation at the home. When discussing this we did suggest that the fact that this service does not employ waking night staff should be included in the information made available to all prospective residents. The manager advised us that she always discusses this with those people who visit the home to look for accomodation. All residents are given a contract to sign and there is a copy kept on file for reference. The manager completes a full assessment of needs prior to offering a place to any prospective resident. This helps to ensure Twin Oaks will be able to provide the level of care required to meet those needs in an appropriate manner. All prospective residents and their families are invited and encouraged to visit the Care Homes for Older People Page 10 of 24 Evidence: home to meet the staff and other residents prior to accepting a place. Care Homes for Older People Page 11 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 living in Twin Oaks have access to healthcare professionals which helps to ensure their physical, emotional and health needs are met. Evidence: Each resident has a plan of care that is started on the day of admittance and based on the assessment of needs. The manager takes the responsibility for preparing and updating the care plans and every resident was re-assessed in January of this year. The care plans contain risk assessments that are updated as and when needs and dependency levels change. Healthcare needs are documented and details are kept of hospital and doctors appointments. All healthcare needs are met through good working relationships with the local doctors and district nursing service. Chiropody is provided by 2-weekly visits to the local health centre. Dental and optical services are available when necessary. The manager is well known to all extenal healthcare professionals and is able to access any equipment that may be required. Currently neither the residents or their families are involved in the care planning system but as the residents are well able to communicate with the manager and staff the manager did not see the need for involvement at this time. Care Homes for Older People Page 12 of 24 Evidence: Medication is received from the pharmacy in a normal dosage system, and advice must be sought to ensure all residents receive their medication in the safest possible way at all times. We made a requirement that, in future, all medication should be administered directly from the containers provided by the pharmacist. The manager should also provide a register for the receipt, administration and disposal of any controlled drugs that are prescribed as currently there is not one in place. Although the manager is responsible for the administration of all medication the other main carer has also completed training in safe handling of medication. During our visit we observed the interaction between the residents, manager and staff and found it to be warm, friendly and caring. Residents always wear their own clothes and are addressed in the way they wish to be. Although one of the bedrooms is registered for 2 people it is always used for single occupation, which means that no one will be asked to share a room unless they specifically request this. Care Homes for Older People Page 13 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 living in Twin Oaks receive the support they need to live their chosen lifestyle. Evidence: The routines in this home are as flexible as those living there wish. The manager has, in the past, suggested various leisure activities but those living at Twin Oaks prefer to do their own thing. One lady loves to sit in the window in the lounge and told us, I love sitting here and watching the world and looking at the lovely view. Some residents enjoy their newspaper and writing lettes and there was a very relaxed atmosphere in the main lounge. One lady is currently being cared for in her room, which is her own choice. Ministers of religion visit the home to give Communion to those who wish to take it. Visitors are welcome at any time although the manager does request that consideration be given not to visit during mealtimes. One resident attends a day centre and enjoys this very much. Residents handle their own personal finances for as long as they wish after which there is family involvement. Meals and refreshements are served at set times. Both the manager and staff told us that this was what the residents preferred. One gentleman told us he knew exactly what time his morning coffee was coming so it helped him to plan his day and spend Care Homes for Older People Page 14 of 24 Evidence: time reading his newspaper. There is no choice at mealtimes mainly because the manager knows the residents, their likes and dislikes very well. All those living in the home told us they really enjoyed their meals but could not always remember what was on the menu. meals are home cooked and prepared by the manager. If a resident decides they dont want the main meal an alternative would be offered. Care Homes for Older People Page 15 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 living in Twin Oaks know any complaints or concerns will be listened to and acted upon. They are safeguarded at all times. Evidence: There is a complaints process that is discussed with prospective residents and their families when they visit the home looking for accomodation. There is also a copy in each of the residents rooms. There have been no complaints to record and we (CSCI) have not received any. We have not been notified of any via Social Services either. The manager has completed the train the trainers course in protection of vulnerable adults and has passed on the necessary information to her member of staff. This was also covered when the carer completed her National Vocational Qualification at levels 2 and 3. Both the manager and carer knew what process to follow should such an incident come to light. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Twin Oaks provides a safe and comfortable home that is well maintained, well decorated and furnished to a high standard. Evidence: Twin Oaks is a large detached property situated not too far away from the centre of Windermere. It is an extremely well kept building with both the internal and external features maintained to a very high standard. The owners partner is responsible for the maintenance programme and upkeep of the well appointed gardens. The building has been adapted for its present use as a care home. There is plenty of communal space for up to 6 people in a large lounge, dining room and well maintained outside space. There are four single bedrooms and one room registered as a double. This is currently used for single occupation and will remain so unless there is a request for shared accomodation. Accomodation for residents is on the first floor, which is accessed by two stair lifts. The residents rooms are well decorated and personal to the individual as those living in the home are encouraged to bring in items from home. They all have ensuite shower facilities. Communal bathing and toilet facilites are suitable for any resident that may have a physical disability and there are aids around the home to assist with movement throughout the building. The manager is aware of the need for hygiene and the control of infection and there are systems in place to avoid cross infection. The home was extremely clean, warm Care Homes for Older People Page 17 of 24 Evidence: and comfortable on the day of our visit. Care Homes for Older People Page 18 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 living in Twin Oaks receive care and support from staff who have the skills to support them correctly. Evidence: We discussed the staffing arrangements with the manager who confirmed that she currently has one member of staff. who assists her in providing care and support to the residents. Her partner supports the residents in other ways such as rides out in the car or taking residents out for walks. Since the last inspection the carer has completed her National Vocational Qualification in social care at both levels 2 and 3. The week prior to our visit she attended a study day on The Deprivation of Liberty which she said she found very interesting. The manager ensures that everyone that is concerned with the running of the home has an enhanced Criminal Bureau Check in place as an added safeguard for those living in the home. She told us that she would only employ people who were experienced and suitable to care for vulnerable adults. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Twin Oaks is run in the best interests of people who live there and their welfare is promoted whever possible. Evidence: The registered manager is a qualified nurse with a wealth of experience in the care of vulnerable, older people. She is responsible for the day to day running of the home with the support of her partner and one member of staff. She knows the people who live in Twin Oaks very well and has a clear understanding of their needs. She runs the home in the best interests of those living there and those who we spoke to said,Adele does all she can for us and Adele is wonderful and I wouldnt be as well as I am today were it not for her care. The atmosphere in the home was warm and relaxed on the day of our visit and the residents told is they liked Twin Oaks because it was small and just like living at home. There is no formal quality assurance syatem but the manager speaks to residents daily and family members often to ask their opinion of the service and is always looking for ways to improve the good level of care already provided. Care Homes for Older People Page 20 of 24 Evidence: Residents are responsible, as far as they are able, for controlling their own finances but if this is not possible family members assist. Health and safety procedures are in place and the manager is aware of the need to avoid cross infection. Fire safety equipment is in place and serviced annually and all other equipment in the home is serviced under annual service level agreements. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 To ensure prscribed medication is administered from the dispensers provided by the pharmacy. To ensure all prescribed medication is administered safely in accordance with the Care Home regualtions 13 (2) 06/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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