Care Home: Mile Oak Rest Home

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What the care home does well The home provides a warm and welcoming environment which is well maintained and continued improvement in decoration and refurbishment since the new ownership of the home. One individual told us "it`s just like home". Staff are clearly committed to provide care which is supportive and individuals we spoke with spoke of staff as being "helpful in every way" "put themselves out". One individual told us "it`s very pleasant to live here, staff are very good, exceptional". A strength of the home is the real effort made to provide a range of activities including cookery, gardening club, yoga, arts and crafts. One individual told us "there`s a good choice of things to do if you want to" and "I enjoy the activities here". The quality of food and menu is an area of improvement since the new ownership of the home and this was the view of individuals we spoke with and Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 staff. "Meals are always good with a choice being offered every day that`s good" "I enjoy the meals and food here". Staff told us that since the new ownership they have felt "more valued" and spoke positively of the management of the home. What has improved since the last inspection? This inspection was undertaken as a result of change of ownership of the home and to make a judgement of the effect of this change of ownership and any impact on the quality of care provided. What the care home could do better: This inspection did not identify any areas of practice which warranted requirements being made to address shortfalls. However it was discussed with the manager that in our view staff would benefit from training relating to specific conditions associated with old age and mental health in old age. Staff should also undertake Mental Capacity Act training to inform their practice and have greater understanding of the issues around mental capacity. We also discussed the need to continue to review staffing levels in the home using a dependency tool so that the home can ensure that with changing needs of individuals there continue to be the necessary staff to meet those needs. Key inspection report CARE HOMES FOR OLDER PEOPLE Mile Oak Rest Home 2 The Acorns Wimborne Road West Wimborne Dorset BH21 2EU Lead Inspector Jon Clarke Unannounced Inspection 22nd April 2009 10:00 09 DS0000073096.V375152.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 2 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 Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mile Oak Rest Home Address 2 The Acorns Wimborne Road West Wimborne Dorset BH21 2EU 01202 885225 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) Leeson Care Homes Limited Miss Lisa Joanne Sutton Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 20 Date of last inspection Brief Description of the Service: Mile Oak Rest Home is an older property adapted to provide care to up 20 older people. The home is situated one mile from the town centre of Wimborne. All of the personal accommodation have en-suite facilities (two with en-suite bath) with each room fitted with call bell system, telephone sockets. Some rooms on the ground floor have direct access to the garden and patio area. The home has two lounges, a sun lounge and dining room with extensive level access garden. There is a lift to the first floor and two assisted baths. The home aims to: Provide comfortable accommodation and a warm and friendly atmosphere for our residents in which they feel at home and in control of their own lives. To treat each of our residents as individuals and ensure that our committed and caring staff are able to provide sensitive care and support for our residents that preserves their privacy and dignity. (From the home’s Statement of Purpose) Fees £535-565 Dependant on care needs. Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced visit to the home as part of our inspection. This inspection was prompted by the change of ownership of the home. We looked at a number of records and documents relating to the care provided in the home. These included pre-admission assessments, care plans, medication administering records and staff records relating to recruitment and training. We also looked at health and safety practice in the home. There was an opportunity to speak with a number of individuals who live in the home about their experience and the quality of care they receive. We also spoke with a group of staff about working in the home and what they thought about the care provided. As part of this inspection the manager completed a Annual Quality Assurance Assessment (AQAA) which set out the areas of practice based around the National Minimum Standards summarising what the home does well, the evidence for this, what they could do better and how they have improved in the last 12 months. The information from the AQAA has been used to help make a judgement about the quality of care provided in the home. What the service does well: The home provides a warm and welcoming environment which is well maintained and continued improvement in decoration and refurbishment since the new ownership of the home. One individual told us “it’s just like home”. Staff are clearly committed to provide care which is supportive and individuals we spoke with spoke of staff as being “helpful in every way” “put themselves out”. One individual told us “it’s very pleasant to live here, staff are very good, exceptional”. A strength of the home is the real effort made to provide a range of activities including cookery, gardening club, yoga, arts and crafts. One individual told us “there’s a good choice of things to do if you want to” and “I enjoy the activities here”. The quality of food and menu is an area of improvement since the new ownership of the home and this was the view of individuals we spoke with and Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 6 staff. “Meals are always good with a choice being offered every day that’s good” “I enjoy the meals and food here”. Staff told us that since the new ownership they have felt “more valued” and spoke positively of the management of the home. 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. Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 People using the 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’s Statement of Purpose provides the required information about the home, the facilities, staffing arrangements, admission procedure and aims and objectives of the home so that individuals can make an informed choice about the suitability of the home. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs. EVIDENCE: Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 9 We looked at the home’s Statement of Purpose it provided clear information about the service provided by the home including facilities (number of rooms and sizes not included), admission arrangements and fees including any additional costs. Also included was activities and example of menu, complaints procedure including timescales for responding to any complaint and information about CQC. The home is hoping to improve the information available and has a website which provides information about the home including activities that have taken place in past month and fees. We looked at a number of pre-admission assessments they provided good information about the health and social care needs of the individual. Included was information about physical health and detailed medical history and personal history. The home has changed the assessment to include a statement as to whether the home can meet identified care needs and the room to be offered. Where individuals are known to the local social services a copy of their assessment and care plan is obtained as part of the pre-admission information and assessment. Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care Planning and arrangements for meeting health care is generally good providing staff with the necessary information so that the health and social care needs of residents are met. Arrangements for managing resident’s medication make sure that resident’s health needs are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. EVIDENCE: We looked at a number of care plans and they set out the tasks needed to meet care needs. Moving and Handling assessments had been completed as had risk assessments. Pressure sore risk is identified however there is no specific tool to assess nutritional needs but we were told a member of staff has Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 11 received training and the MUST tool is to be introduced. Care plans had been reviewed on a regular basis and care plans had been signed by the individual. It was noted that the home uses a Falls Screening checklist and this is good practice. There was in-consistent practice about the regular weighing of individuals in one instance the care plan stated that weight was “recorded in notes monthly” however there was no record of this taking place. Records showed that the people who live in the home have access to health services such as dentist, chiropody and community nurses. One individual told us that they only “have to ask and I can see my doctor”. A comment received by the home from a doctor said “an excellent care home, I often recommend it” and another doctor commented “overall a good residential home with competent and helpful staff”. We looked at the arrangements for the management and storage of medication and they were satisfactory with good systems in place to manage stock, secure storage and controlled drug cupboard. Administering records for a period of 4 weeks and these were completed accurately with no gaps in recording, changes signed by two staff members. Controlled drugs were records on MARS record with two signatures but not in Controlled Drug register. One individual takes responsibility for their medication and a risk assessment had been completed. Where “homely remedies” had been used these had been recorded on MARS record as required. Returned medication is recorded and signed by pharmacist representative. We spoke with a number of individuals about the approach of staff they told us that “staff treat us well”, “staff very good, exceptional staff”. When asked if they felt they were treated with respect individuals told us “always” “they (staff) respect you”. We also observed staff throughout our visit talking and assisting individuals in a supportive and sensitive manner. Individuals also told us that they felt their privacy was respected “staff always knock on my door”. Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the 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 arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. EVIDENCE: We spoke with individuals about the activities in the home and they told us that there “was enough” “could be better”. The home has recruited an activities organiser to work one day a week. Activities arranged for the month of April included: exercise, cookery, yoga, arts and crafts. This is area that the home has identified as needing to improve “developing a more varied Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 13 programme of activities and events” by “asking residents for their suggestions…..gather more information from residents about their life history.” Individuals told us that their visitors “always made to feel welcome” that there are no restrictions around having visitors. One individual told us that they felt “staff were always welcoming and friendly”. We spoke with individuals about their ability to choose how they spend their day and choices in daily routines such as getting up and going to bed. One individual told us “its really up to me what I do there’s no real routines here”. Another told us “I can get up when I want it’s my choice”. Staff told us that they want to make Mile Oak “a real home” and “give choice” to people. We asked what they would do if an individual who needed assistance to go to bed said they didn’t want to “not a problem” “we would go back later when they wanted to go to bed”. We spoke with individuals about the meals provided in the home and they all were very positive about the quality and choice available: “very good, usually give you a good choice”. Menus showed a variety of meals being provided and any particular diets are catered for. Staff and people who live in the home all said that they felt the meals had improved. Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the 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 has clear procedures in place and this enables individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to all staff in this area. EVIDENCE: The home has a complaints procedure in place and this is made available in the home’s Service Users Guide. We spoke with a number of individuals about what they would do if they were unhappy about the service they were receiving or had other worries. They told us they would “talk to the staff they would do something” “the manager will sort it out if anything worries me”. Individuals were aware of the home’s complaint procedure “if I want to but don’t everything all right for me”. The home has received one complaint since the last inspection and this was responded to professional with written response and the home is attempting to address the issue raised about an individual living in the home. We have not been contacted by any individuals about the service provided at Mile Oak. Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 15 The home has Safeguarding Adults policies and procedures in place and training records showed that staff have received training in Adult Abuse and Protecting Vulnerable Adults. Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 People using the 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 provides a safe and hygienic environment for people who live in the home and staff. People who live and work in the home benefit from a warm, welcoming and well-maintained environment. EVIDENCE: In walking around the home it was evident that there is a good standard of decoration and maintenance. Over the past twelve months three bedrooms have been decorated and two have been re-carpeted. Others areas which are being planned for re-decoration are the lounge, dining room and hallway. New furniture has been purchased for communal areas of the home making them attractive and homely in their appearance. Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 17 Individuals we spoke with all said how the home “is always nice and clean” “its well looked after”. There are infection control procedures in place and staff are provided with protective clothing where this is necessary. Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements in the home are generally satisfactory so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. EVIDENCE: We were provided with staff worked rotas for period of 2 weeks which showed that there is generally 2/3 care staff on duty am, 2 pm and waking night staff. There is currently no domestic staff at weekends however we were told that the home is attempting to recruit for this post. We spoke with individuals and they told us that “staff very good, will help you if you need it” and “staff always there if we want help”. Another individual when asked about the response of staff when they use the call bell said “when bell rings they are there”. Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 19 We looked at recruitment records for four members of staff. All of the applicants had completed full and detailed application forms, two references had been obtained and criminal record bureau checks. Training records showed staff had completed the “mandatory” areas of training: moving and handling, first aid, fire, food hygiene. Where staff have responsibilities relating to the management or administering of medication appropriate training has been undertaken. Staff are due to undertake Safeguarding training in May. Currently there are 8 members of staff who have completed NVQ professional qualification (from AQAA) Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good opportunities for individuals who live in the home and others to express their views about the service they receive. The practices of the home help to make sure that the health, safety and welfare of residents and staff is protected. EVIDENCE: The manager of the home has worked in the care setting for over 15 years, she has the Registered Manager award. Individuals we spoke with said she was Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 21 someone “we can talk too” “she’s there if we want her”. Staff described her as “approachable”. The home undertakes quality assurance questionnaires and recently completed a survey about the food in the home which showed that individuals were “all very satisfied or satisfied” with the quality of meals provided in the home. Comments from individuals who responded to a questionnaire have been included in this report. Other comments received: “I find Mile Oak delightful…….more like a small hotel then a rest home, all staff very welcoming and always smiling” “we very much appreciate your patience, concern and kindness”. We looked at records relating to health and safety practice in the home. Records showed that tests of fire alarms take place weekly, emergency lighting monthly. Community Fire Safety officer visited the home in August 2008 and found that all was as required and satisfactory. Lift service regularly last being 26/01/09. Equipment such as hoists and bathing serviced yearly. Staff undertake fire drills as required (3 monthly). Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 22 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP30 OP27 Good Practice Recommendations Staff to undertake training relating to specific conditions associated with old age such as strokes and mental health in old age. The manager to undertake regular review of staffing levels in the home against the dependency and care needs of individuals. Mile Oak Rest Home DS0000073096.V375152.R01.S.doc Version 5.2 Page 24 Care Quality Commission South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: 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). 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. 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