Inspection on 10/11/05 for Twin Oaks Nursing Home

This inspection was carried out on 10th November 2005.

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 Nursing Home 17/04/07

Twin Oaks Nursing Home 01/06/05

Twin Oaks Nursing Home 11/01/05

Twin Oaks Nursing Home 08/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Twin Oaks Nursing Home Hudson Way Chapel Break Bowthorpe Norfolk NR5 9NJ Lead Inspector Mrs Susan Golphin Announced Inspection 10th November 2005 09:30 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 Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 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 Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Twin Oaks Nursing Home Address Hudson Way Chapel Break Bowthorpe Norfolk NR5 9NJ 01603 743195 01603 748728 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) Mrs Ruby Jane Francis Karen Moore Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (49), Physical disability (49) of places Twin Oaks Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st June 2005 Brief Description of the Service: Twin Oaks Nursing Home is located in Bowthorpe, a suburb on the outskirts of Norwich. The home is purpose built and first registered in 1995. The nursing provision offers care with nursing for older people and for service users with a physical disability. Service user accommodation is on two floors divided into four wings with the building designed on different levels. There are 37 single rooms and 6 double rooms all en-suite. The reception and main services and facilities are sited on the ground floor. There is ample parking space to the front of the premises. The gardens to the rear of the premises are mainly laid to lawn with flowerbeds, and raised gardens and patio areas. Disabled access is at the front of the premises. Twin Oaks Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine announced inspection and took place between 09.30am and 4.30pm. The registered manager Karen Moore and one of the registered providers Susan Nolan were present throughout the day and have a good knowledge and understanding of the regulation and inspection process. They also use the event to review and reassess the development and progress of the service. The earlier part of the day was spent discussing and reviewing the care planning process and the changes to the format. Three residents were interviewed and three other patients were seen on the day and their care input by staff observed A short tour of the premises was undertaken during the discussions with staff. Corresponding documentation relating to their recruitment, employment and training were also seen. Two comment cards from healthcare professionals and five from relatives and five from residents were received by the CSCI. All the resident’s comments were positive and complimentary about the care service they receive with the exception of one minor item. Two of the comment cards from relatives /visitors said that they did not know about the homes’ complaints procedure. All the comments have been incorporated into the report except for issues which relate to individuals or their care, and these have been passed directly to the management for their attention. Feedback was given to Sue Nolan and Karen Moore at the end of the inspection. What the service does well: The home provides a consistently high standard of care to older people with nursing needs and younger adults with a physical disability. The stable staff group are well supported by senior staff and management. The staff are able to demonstrate a good knowledge and understanding of residents needs Residents were complimentary about the service they receive and gave examples of good input of care. The environment is well maintained to a high standard. Staff confirmed that they receive good support from the senior staff and management and have access to relevant training and supervision. Twin Oaks Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: There are no outstanding issues to address. The home have recently been the subject of a complaint, which involved other agencies and CSCI. The complaint was not upheld and no criticism made of the management or practice standards of the staff. The registered providers and senior staff have however, taken the opportunity to review relevant policies and procedures and to introduce tighter measures regarding both the informal and formal arrangements in place for meeting the care needs of residents and for sharing information with relatives. As part of their ongoing review of the services this year the registered providers will be carrying out the following-: • • • Review of meals, menus, and meal presentation to look at ways in which the process and style can be updated and improved. Ensuring that all service agreements are confirmed by letter with a clear description of the agreed service, how it will be met and a breakdown of the care and or specialist nursing needs. Review the activities and social stimulation offered for residents both from a group and individual basis with a separate assessment for those residents with a physical disability and within the younger age group. The review will involve discussions with the residents, relatives and encouraging regular involvement in promoting peoples interests. Developing communication meetings between trained staff and care staff to promote better contact and sharing of information or changes in residents care as they happen. • 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 Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 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 Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 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): 2,4,5 There are appropriate procedures in place to provide residents or their relatives with a clear assessment of need, information about the service and facilities and contractual arrangements prior to admission. EVIDENCE: All prospective residents are provided with a written contract on admission to the home. A full assessment of need is completed either by the placing agency or the manager prior to admission or before the placement is agreed. The information received is always checked and reviewed to ensure it is accurate and still reflects individual wishes and choices. It is the registered providers intention to make sure that all placements are confirmed in writing setting out how resident’s needs will be met within the service. The confirmation will form part of the contract and care plan. (see recommendation) Residents spoken to on the day of the inspection confirmed that they had visited the home prior to admission and those that had not had been happy for a representative to do so on their behalf. Twin Oaks Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 9 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): 7,8,10,11 There is a clear care planning process in place, which provides staff with the information they need to meet resident’s healthcare needs. Personal support in the home is offered in such a way as to promote resident’s privacy and dignity, including end of life care and supporting relatives. EVIDENCE: The care planning process has been the subject of a major review and the outcome has provided a much easier to use document. The process is being introduced over the coming months and will be completed by March 2006. The current plans offer appropriate information about residents and how their care is met. Residents spoken to on the day said that they are happy with the service they receive; one resident said that they have a good relationship with the staff and management and can discuss problems openly with them. Examples of good care practice were given which confirmed that resident’s rights are respected. Staff were also observed appropriately meeting the specialist nursing needs of patients who are not able to express a view about their care. Twin Oaks Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 10 The staff have a wide range of experience in dealing with death and bereavement, and through supervision they have also developed supportive and positive approach to end of life care. Twin Oaks Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 11 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 The dietary needs of the residents are well catered for with balanced varied selection of meals. Residents are able to socialise with others as they choose and maintain contact with family and friends. Residents are encouraged and expected to be involved in the process of daily living and decisions about their lifestyle. EVIDENCE: Group activities take place each week and include music appreciation and craft and art pastimes. One resident attends day services each week and others are encouraged to maintain contact with their families and friends. The management are reviewing the social activities in the home and will be looking at ways in which resident’s individual interests and social stimulation can be promoted. (see recommendation) Residents are asked for their views and opinions about their care and encouraged to remain part of the planning process and decision-making about what they wish to do. Examples were given, where one resident has come up with ideas about changing the layout of their room. The changes will help them to continue to remain independent, access their clothes easily, and have the telephone within easy reach. The management have happily complied with all Twin Oaks Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 12 the changes requested and have also adapted pieces of furniture as part of the plan. Residents said that the meals and choice of food is good and gave examples of some of the dishes and favourite meals. Menus are displayed and the staff also remind residents about the menu and the options available on a daily basis. Staff were observed assisting people to eat and drink in a discreet and sensitive way. The registered providers are to review the meals service and the way in which meals are presented. Residents are to be asked to be involved in the review and will be seeking ways in which the whole process can be more creative and interesting. (see recommendation) Twin Oaks Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 13 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): 16,18 There is a good complaints process in place, which promotes an open style relationship with residents and their representatives. The policies and procedures in place protect residents from abuse. EVIDENCE: Three of the comment cards received as part of the inspection process said that some relatives and representatives are not aware of the complaints procedure in the home. The information and details relating to complaints procedure are available on site and invite contact and access with senior staff and management in the event of any issues. The home have received one complaint this year that also involved other agencies and CSCI. The complaint investigation is complete and was not upheld. There has been no criticism of the management, staff or care practice. However the management have responded to the investigation in a proactive and positive way and will be reviewing some of the procedures in place regarding the documentation relating to care contracts and also to the way in which the contact and the relationships with residents relatives is managed. External training sessions about protecting vulnerable people have been attended by all the staff. The sessions have included the use of videos, workbooks and group discussion. Sessions on adult abuse awareness have also been covered during the induction training and NVQ training. Twin Oaks Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 14 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): 19,22,26 The standard of environment in this home is high and provides the residents with a comfortable and homely place to live. Specialist equipment to aid and promote independence and mobility is in place and accessible to residents. There is a well-defined infection policy in place with clear clinical advice and guidance for staff to follow. EVIDENCE: The external and internal areas of this home are well maintained to a high standard. Resident’s rooms are equipped and furnished to meet their needs. A small sample of rooms were seen during the day and reflected resident’s personal choices and styles. Although the premises are of a good standard the registered providers have an ongoing maintenance and refurbishment programme which forms part of their overall business plan each year. This year one wing of the home will have all the carpets replaced which will include 27 bedrooms; access corridors; two Twin Oaks Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 15 sitting rooms; and two dining rooms. Redecoration will also take place during the refurbishment, which will be phased to minimise disruption. The infection control and MRSA policy for the home is reviewed on a regular basis and updated to include any changes in practice and new initiatives. Recently the management have sent letters to all the staff reminding them to maintain the policy, follow good practice and clinical guidelines. On the day of the inspection the standard of cleanliness and maintenance was exemplary. Twin Oaks Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 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): 27,29 There is a well-established staff group with the expertise and skills to meet the healthcare needs of the residents. The recruitment and selection process for the home supports and protects residents. Arrangements are in place to offer relevant training and clinical guidance to all staff. EVIDENCE: There are adequate numbers of staff employed throughout the day and night. The management have reviewed some of the care practices and routines to promote prompt responses to call bells especially at the busiest times of the day. Some initial changes have been made and these are being monitored to see how effective they are. The management are aware of the pressures on staff at crucial times of the day, and are also using the review, and seeking the views of the residents to look at the way care is being delivered. Four staff were spoken to on the day and all said that they felt well supported by the management and confident about the way they work and care they provide. A small sample of staff files were seen all contained appropriate references, CRB, confirmation of identity and copies of the terms and conditions of employment. The records related to the staff group seen on the day were well maintained and stored securely. NVQ training is being promoted and 6 staff have qualified this year. The percentage of staff with NVQ has increased from 15 to 30 this year. Twin Oaks Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 17 Mandatory training is in place and takes place on a regular basis. Staff confirmed that they have completed first aid (26 staff attended) Fire training health and safety and moving and handling is carried out by the homes’ own trainer on site. Specialist training in catheter care, wound care including tissue viability and pressure area assessments have also been provided. Twin Oaks Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 18 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): 31,36,38 The home is well managed with positive leadership from the registered providers. The open style of management promotes the residents interest at all times. Staff supervision is in place but does not formally record all clinical and practice supervision. Good arrangements are in place to monitor the safety and maintenance of the premises and facilities and ensure compliance with other agencies. EVIDENCE: The home is well managed with evidence that resident’s and relative’s views are sought about the service and service delivery. The management and maintenance of the premises and equipment and general facilities is the responsibility of Richard Nolan. The standard of record keeping and the safety checks in place for both equipment and services is well maintained to a high Twin Oaks Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 19 standard. Recent inspections confirm that the home complies with other agency legislation and have carried out appropriate risk assessments. Formal staff supervision is in place but not all the sessions carried out are recorded. Some practical supervision is carried out on an observational basis and the management acknowledge not all the events or agreed action with regard to professional development has been recorded. (see requirement) Twin Oaks Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 20 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 x 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x 3 x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x 2 x 4 Twin Oaks Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 21 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 OP36 Regulation 18 Requirement The registered providers are required to maintain a written record of all supervision sessions with staff to ensure development, practice, and training needs are acknowledged and form part of the annual appraisal process. Timescale for action 31/03/06 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 Refer to Standard OP4 Good Practice Recommendations It is recommended that the registered providers continue with the review of this standard and implement the plan to revise the way in which confirmation of placements and needs assessments are made. It is recommended that the registered providers complete their revision of the care planning process and bring into use by March 31st 2006. 2 OP7 Twin Oaks Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Nursing Home DS0000015695.V255066.R01.S.doc Version 5.0 Page 23 - 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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