Care Home: High Oaks

What the care home does well The home continues to inform us about things that have happened since our last visit. Staff support the people living in the home and help them make decisions about their daily lives. Residents told us that the staff are supportive and made comments like "this home is great so are the staff and I would not change anything". The service continues to provide nutritional menus for the residents and takes into consideration those people who are on special diets. One person told us that they get choices every day and that they enjoyed the food. The provider and the manager have been keen to respond to recommendations made by the Commission. The service has a robust system in place for recruitment. What has improved since the last inspection? There have been some improvements in training since the last inspection and staff have received training in mental health awareness. More staff have now received training in all areas related to safeguarding vulnerable adults. More improvements have been made to the overall ambiance of the home and more refurbishment has taken place. There is a new system for support and care plans which are now more detailed and informative. Activities for the residents have improved as has the one to one support that each resident gets. There has been significant improvements in the way medicines are handled, administered, stored and recorded. There is now a more robust monitoring and oversight of the home. What the care home could do better: Ensure that all staff record all transactions for resident`s monies accurately. Ensure that the service continues to extend the system for monitoring the quality of the service it offers. Maintain the improvements that have already taken place and ensure continued compliance. Key inspection report Care homes for adults (18-65 years) Name: Address: High Oaks Rectory Road Gissing Diss Norfolk IP22 5UU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marilyn Fellingham     Date: 2 1 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 24 Information about the care home Name of care home: Address: High Oaks Rectory Road Gissing Diss Norfolk IP22 5UU 01379674456 01379677094 info@high-oaks.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): High Oaks Farm Limited Name of registered manager (if applicable) Mr Gary Colin Stear Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home High Oaks is a registered nursing home providing residential nursing care for up to eighteen residents of both sexes, who have mental health problems. The home also provides short-term care. The current proprietor took over in July 2003, and is using all rooms for single occupancy. Communal areas are in the main part of the home, with bedrooms in a converted single storey extension. The home is in a rural setting, and affords peace and tranquillity for residents. Access to local towns and facilities, requires use of the homes own transport as access to public transport is limited. Specialist support services required are accessed via G.P referrals. Fees range from £875 per week to £1600 Care Homes for Adults (18-65 years) Page 4 of 24 Over 65 0 18 1 7 1 2 2 0 0 9 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection that took place over six hours. The key inspection for this service has been carried out using information from previous inspections and from some residents and people who work in the home. The main method was case tracking. This involved selecting individual care plans and information available about people who live in the home and tracking their experience as a result of the support provided. During our visit a tour of the premises was undertaken and the residents records and staff files looked at. We also took the opportunity to speak with the consultant who has been advising the provider about improvements to the service. Care Homes for Adults (18-65 years) Page 5 of 24 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 on page 4. Care Homes for Adults (18-65 years) Page 6 of 24 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 Adults (18-65 years) Page 7 of 24 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. The Commission can be assured that the pre-admission assessments for new residents is thorough and informative. Evidence: The service has not admitted any new residents since our last inspection. The service has formatted a new process for admission purposes which allows for a thorough assessment of needs to take place and enable the home and the prospective resident to decide if the home is the right place for them. Care Homes for Adults (18-65 years) Page 9 of 24 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. The care planning process and support the residents get is thorough. The residents are supported to maximise their independence and their risk management is effective. Evidence: We looked at the records for three people living in the home; these were very informative and covered all aspects of the residents needs and care. The manager told us that they had further improved the support and care planning process and that it was working extremely well. These plans provided more information about the total needs of the person and were very detailed to ensure that the staff provided a consistent level of care and support. For example all three resident records we looked at had information about the support that was needed in relation to triggers of behaviour, support that was required for dealing with finances, support for taking medicines, support for maintaining personal hygiene and cleaning of own rooms. Plans were also in place in relation to some medicines that the residents Care Homes for Adults (18-65 years) Page 10 of 24 Evidence: were taking and the care that was needed in relation to these medicines. All three records we looked at had evidence of resident involvement in the support and care planning process and also had evidence of reviews of the plans and changes that had taken place as needs changed. We spoke with the three residents whose notes we looked at, all three stated that they felt that they were looked after well. One resident said I am getting better now whilst another told us things are more structured now and another told us I like being here and I feel I have moved on. One resident wrote in their survey to us that they had sympathetic and fair treatment. All three residents had risk assessments in their records and these gave an indication as to the level of risk attached to any activity and trips out and what triggered certain behaviour. There were good action plans in place to reduce the risks associated with known behaviours. There were very informative daily progress notes and we could see where care plans and support plans had been changed to accommodate some changes in behaviour that had occurred on a regular basis. It was evident from observation of care practices and discussions with residents and staff that people who lived in the home were supported to make decisions and choices in their daily lives. People who returned surveys all indicated that they made decisions about what they did every day. The AQAA (Annual Quality Assurance Assessment) tells us that the residents have a seminar (their choice of name), where they are involved in the running of the home and plan for the coming months; they also discuss issues about the home at their meetings which are held every morning. Care Homes for Adults (18-65 years) Page 11 of 24 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. Daily routines and the meals suit the people living in the home; their recreational and social needs are met. Evidence: Since our last visit to the home one of the support workers has been made the responsible person for arranging the activities for the residents: we spoke about what had been happening since our last Key Inspection and it all sounded very positive. All the activities are arranged with the residents who have input and decide either collectively or on an individual basis what they would like to do. We saw a programme for activities that had been arranged for the week of our visit, this was very varied and accommodated many requests from the residents. All activities that the residents have participated in are recorded in their notes. We noted that some are taken swimming, three ladies had been to the theatre to see an ABBA production and one of them told us how much they had enjoyed this. The home hires Care Homes for Adults (18-65 years) Page 12 of 24 Evidence: a room at the local village hall once a week where the residents meet up to discuss outings and plan for future activities. At the time of our visit some residents were involved in planning for a fete in August, we saw their plans for this and what they wanted to do: some of them were growing plants to sell at the fete, some wanted to make cakes to sell and it was obvious that the residents were very much involved in aspects of the arrangements. One resident told us that there was a lot going on now and another resident told us that they were hoping to go to a local riding school to help groom and muck out the horses. Another resident goes to woodwork lessons and we saw examples of their work. Whilst we were visiting the home we noted that there was a lot of activity, a fortnightly visit from the Music Man was taking place in the afternoon, we noted that this session was enjoyed by the residents who were much animated by this. Every Friday evening the residents choose a film they would like to watch on a DVD. The residents have also adopted a pony at a horse sanctuary and make visits to see it. We noted that staff were enabled to spend time with the residents and there were support plans in place for assisting people to socialise and for one to one activities. Independent living skills were being encouraged and people were being supported to take responsibility for tidying their own rooms; one resident told us that they liked helping out in the home and we noted them hanging some washing out on a line. We observed some good examples of staff putting core values into practice. There were locks on the residents bedroom doors and we noted staff knocking on doors before entering. We also observed a lot of staff-resident interaction and the promotion of dignity. A designated cook is employed at the home and prepares the main meals for the residents; a daily menu is posted in the dining room and we noted a number of choices that were available including those who are vegetarian and those who need special diets. The people living in the home like the meals and told us that they do get choices every day. We noted that there was a bowl of fresh fruit in the dining room that the residents had access to. Care Homes for Adults (18-65 years) Page 13 of 24 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. The health and personal care needs of the people using the service are met. The improvements in medicines management means that people receive their medication as it is prescribed. Evidence: The three residents records we looked at contained care plans for their hygiene needs, they also had information regarding the residents preferred routines. There was evidence in the care and support plans for prompts that were needed for the residents to carry out their own personal care. The residents had support plans in place for their medication and care plans for use of insulin and what interventions were needed. There were records in place when visits had been made to the GP and records for all consultations with other professionals who were involved with the residents care. We noted some significant changes in the way that medicines were managed. We noted medicines were stored securely and at the correct temperatures. There is now a safe system in place for ordering and disposing of medicines and better control of medicines held in stock. Care Homes for Adults (18-65 years) Page 14 of 24 Evidence: There were no unexplained gaps on the MAR charts which indicated that the residents had received their medicines as prescribed. We did a spot audit of those three residents whose care we were tracking and all tablets left in stock tallied with what had been given. All three residents had medicines that were prescribed as give when required, all three residents had care plans for this activity so that the continued use of these medicines could be justified. We looked at the policies and procedures for the management of medicines. Frequent auditing of medicines take place and we saw all records for this. Care Homes for Adults (18-65 years) Page 15 of 24 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. The complaints procedure ensures that formal complaints will be investigated and acted upon. Training has taken place to ensure that people using the service are protected from abuse. Evidence: We noted that there was a complaints procedure displayed in the home, a copy of which is given to all residents as they move into the home. The records in the home showed us that there had not been any complaints received and the Commission has not received any complaints either since our last visit to the home. We spoke with five residents who were aware of the procedure for making a complaint and told us that they knew who to go to if they had any concerns. We looked at the staff training records these confirmed that all staff were up to date with training relating to safeguarding issues and those staff members we spoke with were aware of all issues relating to abuse and the manager was also aware of the procedures to follow in case of abuse. Care Homes for Adults (18-65 years) 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. The service provides a clean, homely and safe environment for the people who live there. Evidence: Many changes continue to take place that have overall enhanced the environment. The smoking room remains well furnished and pleasant and smoke was not detected permeating from this room. The premises were clean and tidy and during our visit a number of residents were enjoying sitting in the garden which was looking very tidy and pretty. There are a number of seating areas around the garden for the residents to use and we noted some plants that were being nurtured by the residents for their fete. The corridors are all being re painted and were looking much brighter. Care Homes for Adults (18-65 years) Page 17 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Staff are able to effectively support the people who live in the home. The service has a robust system in place for recruitment to ensure that all new employees are safe to work with vulnerable adults. Evidence: Since the last Key Inspection a new manager has been appointed and some changes made to the staff team. We looked at the duty rosters for the week we were visiting, these showed that staffing levels were adequate and allowed for extra staff to be on duty for trips out and one to one responsibilities. The residents that had completed surveys indicated that staff were available when they needed them. We noted that there were better training records in place and that staff were receiving training that was appropriate to the work that they were carrying out. Some training has taken place since our last visit in December 2009 and all staff members have received training in relation to safeguarding and some have attended courses for Conflict, Resolution and Breakaway: all staff have had fire training and we saw records for this. We saw the records for the new recruits that had been employed since our last visit, all appropriate checks were in place and this indicated that there is a robust system in place for recruitment. The service has introduced a new system for formal supervision, we saw records for this. Three members of staff told us that they had, had supervision Care Homes for Adults (18-65 years) Page 18 of 24 Evidence: sessions and told us that they found them to be most useful. One member of staff confirmed that they had received supervision and that they had also carried out some supervision for other members of staff. We saw records that evidenced that supervision had been carried out. The staff who we spoke with told us that they were very clear about their roles within the home and that they felt more supported. One commented that there was a different atmosphere in the home and that they felt the team was more cohesive and organised. The staff also told us that they now have regular staff meetings where they discuss the new support plans and the way forward for the future. Care Homes for Adults (18-65 years) Page 19 of 24 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. The overall management and administration systems are effective and ensures that the home is run in the best interests of the people living there. Evidence: Since the last Key Inspection a new manager has been appointed, she has the appropriate experience and qualifications to take on the role. The manager discussed with us some of the improvements that have taken place since her arrival and acknowledged that there is still more work to be done. We talked with some staff members about the changes that had taken place since the last Key Inspection; one staff member told us that things had improved since the managers arrival, she is approachable and gets things done. Another staff member said that things are more structured now whilst another said I like working here now. We looked at health and safety related information, records showed that there were service arrangements in place for all equipment and the fire system had been updated. We carried out a random check for three residents monies held by the home, out of Care Homes for Adults (18-65 years) Page 20 of 24 Evidence: the three residents one residents money did not tally with what was held by the home, there was two pounds and fifty pence too much. Although the home has put in place a more robust system for accounting of residents monies the staff must be more careful in their record keeping. The service is in the process of developing a Quality Assurance system for measuring the quality of the service it offers; we saw results from some of the surveys that had been sent out to staff, residents and relatives and other professionals. These results were very positive about the support given by the service. Care Homes for Adults (18-65 years) 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 Adults (18-65 years) 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 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 1 37 For staff to maintain accurate records for transaction of residents monies. Care Homes for Adults (18-65 years) Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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