Care Home: High View Oast Nursing Home

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What the care home does well The home is welcoming to new residents and visitors, and residents are assured their needs can be met before they are offered a place. Residents individual wishes and preferences are respected and documented in the care plans. Residents are encouraged to maintain there independence, but receive the help they need. The health care needs of residents are understood and there are safe systems in place for dealing with medication. Residents find the lifestyle and activities at the home match their expectations. Residents said the meals are very good, and they have the choice of eating in the dining room or their own rooms, or the garden, good weather permitting. Residents feel listened to and confident that any complaint they may have would be taken seriously and dealt with. Residents said they enjoy the views, and the attractive garden. They also said they liked their own rooms and felt the home was well kept. Residents spoke highly of the staff and said they are caring and supportive. Staff receive the training they need to fulfill their roles The processes of running the home are inclusive and open. What has improved since the last inspection? Wound care documentation is now more clear with one form being used for each wound, so that evaluation is clearer. Consent to having photographs of wounds is now sought. Documentation is in place for checking residents at risk of falling or getting out of bed unsupervised. The home has had refurbishment completed to the kitchen, 8 en-suite bathrooms have been fitted. The lounge has been redecorated, and a shower room has been installed in place of one of the bathrooms. Medication charts are now checked and signed by 2 nurses if a printed sheet is not available. New staff must now provide a full employment history on thier application forms, this helps better protect residents. What the care home could do better: The daily record is kept separately from the care plans and therefore the record does not directly relate to the care plan, activities records are also kept separately, making the records disjointed. The laundry walls should be easily washable and a designated hand washing basin is needed. Key inspection report Care homes for older people Name: Address: High View Oast Nursing Home Poulton Lane Ash Canterbury Kent CT3 2HN     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: Justine Williams     Date: 0 3 0 8 2 0 0 9 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 Older People Page 2 of 23 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 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 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) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 23 Information about the care home Name of care home: Address: High View Oast Nursing Home Poulton Lane Ash Canterbury Kent CT3 2HN 01304813333 01304814700 highviewoast@new-meronden.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: New Century Care (Ash) Limited care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 33 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Physical disability - PD Date of last inspection Brief description of the care home High View Oast Nursing Home is a converted Oast house, which has retained many of the original features. The home is situated in an elevated position, and has panoramic views over the Kent countryside from many of the bedrooms and communal rooms. There is a local bus service from the village, which provides links to Canterbury, Sandwich and Deal, and there are rail links nearby. It is owned by New Century Care, who have a number of care homes in the South East region, as well as elsewhere in the country. The home is registered for 33 nursing beds, and so there is always a Care Homes for Older People Page 4 of 23 0 33 Over 65 33 0 Brief description of the care home registered nurse on duty. The bedrooms are situated on both ground floor and first floor, and consist of a mixture of single and double rooms. There is a passenger lift providing access between floors. The communal accommodation is situated on the ground floor and consists of two interlinking lounge areas and a dining room, a small quiet lounge, and a porch area. There is a stable staff team who work well together and interact well with residents. Fee levels currently range from £396.54 - £700.00, depending on the room available, and the nursing needs required. This information was provided at the time of the inspection. Care Homes for Older People Page 5 of 23 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: An unannounced inspection was carried out on 3rd August 2009 between 10am and 2.15pm. During that time the inspector spoke with residents, visitors to the home, staff members, and the registered manager. Feedback was given during and at the end of the inspection. Throughout the report those living at the home are referred to as residents as this was their preference. This report contains assessments made from observation, conversation and records, as well as case tracking. The manager returned the Annual Quality Assurance assessment AQAA, on time, and the information provided has been used in the report. As part of the inspection process surveys were sent to service users and to GPs, health care professionals, care managers and relatives of residents, information from the surveys was also used in the report. Care Homes for Older People Page 6 of 23 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. 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 7 of 23 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 8 of 23 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. Residents have their needs fully assessed before moving in and are assured their needs can be met before being offered a place. Evidence: The records for 4 residents were seen, one of these residents had moved into the home recently. The records contained a detailed pre admission assessment, covering all aspects of need and included cultural and diversity needs. The assessments are carried out by the manager or senior nursing staff, and no resident is offered a place at High View Oast unless the staff are certain the home can meet their needs. The new resident said that his family had visited the home on his behalf, as he had been unable to visit himself. He received the service users guide before he moved in and found the information useful. Although the home does not provide intermediate care the staff are working with 1 resident to help him return to supported living accommodation, and this resident continues to make progress with mobility, and self care with the support from the Care Homes for Older People Page 9 of 23 Evidence: staff. The resident hopes to move out of the home within the next 6 months. Care Homes for Older People Page 10 of 23 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. The health and personal care needs of residents are well managed. Residents are treated with respect. Evidence: The records for 4 residents were seen, each contained a very detailed care plan which included all the actions staff should take to meet the needs of the resident. All the plans contained risk assessments with respect to falls, risk of developing pressure sores, nutritional vulnerability, individual risk assessments are also drawn up for every resident. The care plans are reviewed and updated monthly and more frequently if necessary. There is a document in the care plans to indicate that residents have been involved in the drawing up of their care plans but these had not been completed for every resident. The home documents residents health care needs in the care plan. A health care professional commented staff are very aware of patients needs or the possibility of deterioration and regularly make contact for advice Residents who have wounds or pressure sores have each documented separately since the recommendation made at the last inspection, so that a clearer evaluation can be made. The home has purchased equipment to relieve pressure sores. Opportunities for Care Homes for Older People Page 11 of 23 Evidence: physical exercise are given through the activity programme. All residents are weighed and screened for nutritional vulnerability. Residents are assisted to attend medical appointments, and are escorted by staff from the home if their family cant attend. The home has a medication policy, and residents who wish to and are able to may self medicate. Each room has lockable storage space should they wish to self medicate. Records are kept of all medication entering and leaving the home. All staff receive training in the medication system (Boots MDS) used at the home and only the registered nurses administer medicines. Since the last inspection the manager ensures that hand written entries on MAR charts are signed by 2 nurses. Residents spoke very positively about how they are treated by the staff, and they said they felt their privacy and dignity was respected at all times. A relative commented they give my mum the care and respect she deserves. Residents are called by their preferred name and have access to a telephone for use privately. Screening is provided in shared rooms. Care Homes for Older People Page 12 of 23 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. Residents find the routines and lifestyle experienced at the home matches their expectations. Residents enjoy a wholesome and appealing diet. Evidence: The home employs an activity coordinator from 10am to 3pm Monday to Friday. The coordinator arranges in house activities including arts and crafts, knitting, puzzles, exercises and external entertainers also visit the home. For those residents who are either unable or unwilling to take part in activities the coordinator visits them in their room, for either a chat, reading poetry or novels, etc. The activity coordinator keeps a record of residents social interests, and up to date information about activities is displayed. Residents may have visitors at any time and private space is available if they prefer to see visitors away from their own rooms or the communal areas. Visitors to the home are made to feel welcome. One visitor said they are always really friendly to visitors. The home is conducted to promote independence but to provide the care needed. Residents are encouraged to bring in possessions including furniture from home if they wish. Many bedrooms contained pictures, items of furniture, and other personal possessions, which residents spoken with said made it feel more like home. Residents spoken with said they really enjoyed the quality of the meals and that there Care Homes for Older People Page 13 of 23 Evidence: is always plenty of choice, the menu for lunch that day was omelette with any filling, or sausage and mash. The cooks prepare and cook all the meals. The home has a cold water drinks dispenser and fresh fruit is available. The home buys fresh fruit and vegetables and fresh meat locally. Hot drinks and snacks are available throughout the day. Special diets are catered for, these currently include pureed diet, and diabetic diets. Care Homes for Older People Page 14 of 23 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. Residents are confident any complaint they had would be dealt with appropriate. There are robust policies in place and regular training for staff to enable them to protect the residents from abuse. Evidence: The complaints procedure is displayed in the entrance, in bedrooms and is included in the service users guide. The procedure is clear and includes timescales for responding to complaints. Residents spoken with were aware of who they could complaint to and felt confident that any complaint they had would be taken seriously and acted upon. One resdient said I dont need to make complaints if theres something Im not happy with I tell the Matron and she sorts it straight out A detailed records of complaints made is kept and also a log which enables the manager to easily track any patterns or trends in complaints made. the records kept include details of investigations and correspondence. The home has received 4 complaints since the last inspection in August 2007, all of which have been resolved. The home has not received any adult protection alerts or had to raise any since the last inspection. There is a comprehensive policy in place for staff to follow in the event of an adult protection alert being raised, and the manager and staff receive regular training updates. The manager is aware of her responsibilities in the event of an adult protection alert. The manager and staff have received training in deprivation of liberty and the Mental Capacity Act. Care Homes for Older People Page 15 of 23 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. The residents have a clean, homely and comfortable environment in which to live Evidence: The home is located in a rural area, surrounded by fields near a small village. Residents enjoy the views from every aspect of the home. The home is a converted oast house, it is comfortable, clean and decorated to a very good standard, the home was odour free and visitors and residents spoken with said it is always clean, and odour free. The garden has attractive seating area, and ramps from the lounge for wheelchair access and for those who have difficulty with steps. Since the last inspection further refurbishment has been completed, including the provision of 8 en suite bathrooms, free standing wardrobes have been put in replacing built in cupboards which restricted space in some of the bedrooms. The lounge has been decorated, a bathroom has been converted to a shower room, and the kitchen has new units, which was a recommendation form the Environmental Health Inspection. All areas of the home were toured and throughout it was clean and hygienic. The laundry floor is impermeable but the wall paint was flaking in areas making the walls more difficult to wash down. There is no hand basin in the laundry for hand washing, staff use the bathroom next door for hand washing. The manager agreed to discuss this with the infection control nurses. Foul laundry is washed at the appropriate high temperatures and the home has procedures for infection control. Care Homes for Older People Page 16 of 23 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. The residents are cared for by a trained and safely recruited staff team. Evidence: The current staffing levels meet the needs of the residents. The staff measure the dependency levels of the residents on a regular basis, and this information is used when assessing the needs of prospective residents, adjustments to the staffing levels are made when necessary. The staff rota shows what staff are on duty and what their role is, and includes the manager so staff can see when she is available. The home employs kitchen assistants and cooks, laundry staff, housekeepers, maintenance and gardening staff, some of these staff have dual roles and can work in other areas when needed. This provides flexibility of staffing and ensures care staff are free to care rather than have their time taken up with other roles. There is a low turnover of staff at the home and there has been no use of agency staff for some time, the home has a bank of staff who prefer casual work who provide cover for sickness and annual leave. 14 of the 17 care staff have attained NVQ at level 2 or above, and some of the ancillary staff also have NVQs. New staff have a detailed and thorough induction to Skills for Care level. The home has a thorough and robust recruitment policy which it works to, which is based on equal opportunities. Staff records contained application forms, 2 written references, evidence of CRB and POVA checks, and proof of identity. Evidence of training was also on file. Care Homes for Older People Page 17 of 23 Evidence: The manager keeps a training matrix and core training for staff is kept up to date. Additional training in dementia, palliative care, and other areas of interest are also sought for staff. Care Homes for Older People Page 18 of 23 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. The home is well managed and run in the best interest of the residents. Evidence: The manager is a registered nurse, and is currently studying for the Registered Managers Award. The manager does regular training to keep up to date, and there are clear lines of accountability within the home. There are a number of quality monitoring systems in place which form the quality assurance system, these include, staff meetings, residents meetings, auditing of documentation, annual surveys and newsletters. The home looks after small amounts of money for residents who are unwilling or unable to look after it themselves. The money is kept securely and separate balance sheets are kept. The manager does not act as appointee for any service users. The AQAA states that the maintenance and servicing of equipment is up to date, and there are policies and regular training to ensure safe working practices, this is monitored through staff supervision. Risk assessments are carried out with respect to the environment and other safe practice topics. Accidents and illnesses are monitored, Care Homes for Older People Page 19 of 23 Evidence: recorded and reported to the appropriate agencies. Care Homes for Older People Page 20 of 23 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 21 of 23 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 Care Homes for Older People Page 22 of 23 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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