Care Home: Oak Tree Manor

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What the care home does well "I am perfectly happy here", "The carers are wonderful" and "Staff are very pleasant" are just some of the many positive comments made about Oak Tree Manor by people who live there. The standard of care seen during this inspection was never less than good and there was a pleasant, relaxed atmosphere in the home throughout. When we spoke to care staff they told us that they were very well trained and supported " I have enjoyed working at Oak Tree Manor" was one comment made to us. The environment of the home is well maintained and set out and in terms of facilities and communal areas in some ways exceptional. The steps taken to make the environment supportive rather than challenging for people who live with dementia is a particular feature. What has improved since the last inspection? The requirements and recommendations made following the previous key inspection in July 2007, which were about medication and activities have been addressed. Additional activity staff have been taken on, care and activity staff are having additional dementia care training and the standard of administration and storage of medication has greatly improved. The home`s environment has been significantly improved for those people living with dementia with pictorial signage and `memory` boxes as some examples of this. What the care home could do better: The lack of success with relatives` forums was a disappointment, however steps are being taken to devise a new system and format to enable relatives` views and experiences to be taken into account in the way the home is organised. Many of the improvements that are identified by the home in their AQAA, for example improving the garden area and the personal history part of care plans represent continuations of work that has already started. This suggests that both the proprietor and manager are pro actively working together to identify and then address any areas where the care outcomes for people living in Oak Tree Manor can be improved. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oak Tree Manor 2 Chene Drive Off Waverley Road St Albans Hertfordshire AL3 5QP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jeffrey Orange     Date: 2 2 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Oak Tree Manor 2 Chene Drive Off Waverley Road St Albans Hertfordshire AL3 5QP 01727832393 01727866653 oak.care@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Oak Care Limited care home 80 Number of places (if applicable): Under 65 Over 65 80 80 80 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 0 0 Oak Tree Manor provides non-nursing care services and accommodation for up to eighty older people who may also have a physical disability, or dementia. Detailed information about the services offered including the latest report by the Care Quality Commission (CQC) is available in the home. Weekly fees for services range from £520 to £545 per week. Additional charges are made for newspapers, toiletries, chiropody and hairdressing services. (This information was correct at July 2009) The purpose built home is owned by Oak Care Ltd. and is situated in a residential area close to the city centre of St. Albans with its good transport links and extensive Care Homes for Older People Page 4 of 26 Brief description of the care home shopping and leisure facilities. The home has three floors served by a passenger lift. The bedrooms are on the ground and first floor and are all single occupancy with en-suite facilities. Each of the residential floors has a dining room, kitchenette, hairdressing room and lounges. The main kitchen and laundry are on the ground floor and the top floor provides living accommodation for staff. There is ample parking and the home has attractively laid out gardens to the rear of the building, with the recent addition of a covered pavilion area where residents can sit outside protected from the sun. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection for this service was in July 2007, in July 2008 we carried out an annual service review of the service, when we reviewed any information that we had received about Oak Tree Manor since July 2007. In February 2009 we carried out a random inspection of the home, starting at 5.30 am specifically to look into allegations made that people living in the home were being got up unreasonably early in the morning.We found that where people were getting up early, this was because they chose to do so and was usually recorded appropriately in their care plans under personal choices. Where people wanted to get up later during the morning we found that they were able to do so, without any undue pressure being exerted on them. The current inspection was unannounced and was carried out by one inspector. Where Care Homes for Older People Page 6 of 26 this report refers to we it recognises that it is written on behalf of the Care Quality Commission (CQC). The inspection began early in the morning and lasted into the early afternoon. During that time it was possible to observe the morning routine of the home as people who live there were being assisted to get up and ready for the day ahead. We observed the mealtime experience at breakfast and lunchtime and any activity sessions that took place during the day. We spoke to people who live in Oak Tree Manor, to visitors and care staff. We also had very open and useful discussions with the homes manager. During the inspection we also looked at some key records, including those for staff recruitment, care planning and the administration of medication. This report also draws on information contained in the large number of surveys that were returned to us and also to the information sent to us by the home in their annual quality assurance assessment or AQAA. The AQAA is a self assessment document that sets out how well care outcomes are being achieved for people who live in Oak Tree Manor. It also includes some useful statistical information, for example about complaints and staff training. We have also made use of any information that we have received about Oak Tree Manor since the last key inspection in July 2007. This could be in the form of notifications from the home about significant events affecting people who live there or from other health and social care professionals associated with the home in any way, from relatives and friends of people living in Oak Tree Manor or other people who have experience or knowledge of Oak Tree Manor. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering Oak Tree Manor as a home for themselves or someone they are responsible for can be confident that they will only be admitted if their needs have been thoroughly assessed and can be met. They can also be confident that they will be able to visit the home before they make a decision about moving in and that they will have sufficient information, in an appropriate and clear format to help them in reaching that decision. Evidence: When we asked people who live in Oak Tree Manor if they had enough information about the home before they moved in to help them decide if it was the right place for them, 88 said they had and only 12 said they did not. Family viewed the home and were very impressed was one comment and another person indicated that the home had been strongly recommended to them. Care Homes for Older People Page 10 of 26 Evidence: When we looked at the homes welcome information and Service User Guide, we found that they contained sufficient detail to enable people to make a well informed decision about the home, including details as to charges for the services provided within the contract price and for additional services such as hairdressing etc. The majority of those people who replied to our survey indicated that they had received a contract. People we spoke to on the day of our inspection visit told us that they, or their families had been able to visit the home before moving in so that they could see if it was a home where they thought they could be happy. When we looked at some recent pre-admission documentation for people now living in Oak Tree Manor, we found that they contained sufficient detail to enable care staff to identify their needs and how they were to be met. 99 of staff told us in their survey responses that they felt that they had enough details of peoples needs in their care plans to enable them to meet them appropriately. 53 of people who returned surveys to us said that they always receive the care and support they need, 35 said that they usually did and 12 said that they sometimes did. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Oak Tree Manor can be confident that they will receive effective health and personal care support, that they will be treated with respect and as an individual and that the systems and practice of the home assist staff to provide support with their medication safely and effectively. Evidence: When people living in Oak Tree Manor responded to our surveys asking if they received the medical support they need, 75 said they always did and 25 that they sometimes did. When we spoke to relatives about the standard of care they saw, they were overwhelmingly positive; Excellent My sister and I are really very satisfied with the care provided were some typical comments received. When we looked at care plans for people who live in Oak Tree Manor we found that they were comprehensive and well completed and provided care staff with an up to Care Homes for Older People Page 12 of 26 Evidence: date picture of the care needs of the person concerned and how they were to be met. In their AQAA the home emphasises the person centred basis of care and this was borne out by the records we saw. There is good evidence of a process of regular review of care needs and also of the involvement of health and social care professionals when required. We were told in their AQAA that the home have recently registered with the NHS Nutrition and Hydration in Social Care Programme and this material is to be incorporated into all care staff training. When we looked at the system and records for the administration of medication in the home, we found that with some quite minor exceptions the system and practice was very good. All of this should reassure people living in Oak Tree Manor that their health care needs will be identified and met and that their care will be provided on the basis of comprehensive and up to date information. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Oak Tree Manor can be confident that they will be encouraged and enabled to exercise choice in and control over their daily activities and routines. They can be assured that they will be able to build and maintain contacts with family and friends in the community. Evidence: When we asked people who live in Oak Tree Manor if there are activities arranged by the home for them to join in, 53 said that there always were, 41 that there usually were and 6 that there sometimes were. Very enjoyable and love to join in, Variety of activities on everyday if I decide to join in and I tend to spend all my time in my room as I enjoy my own music and always find plenty to do. These last two comments are important in that they demonstrate that people who live in Oak Tree Manor can choose whether or not to participate in organised activities depending on their own wishes. When we spoke to activities staff and looked at some of the routine and special activities organised recently we found these were varied and imaginative, for example a Ladies Day horse-racing event. We were told that the home belong to a national organisation for the promotion of good practice in activities within the care sector and they were taking part in an upcoming competition A breath of fresh air Care Homes for Older People Page 14 of 26 Evidence: which aimed to promote outdoor activities in particular. The activities staff were busy decorating a beach hut as part of this initiative. When we looked at care plans we found that in most cases they included social histories and records of activities attended so that wherever possible, activities can be targeted and evaluated. When we asked people if they liked the meals in Oak Tree Manor 41 said they always did, 41 said they usually did and 18 said they sometimes did. The only specific comment was that there was too much rice pudding! When we observed the breakfast and lunchtime experience for people living in Oak Tree Manor, we found that they were in general very sociable occasions, with choices clearly being offered,with care staff helping discreetly where necessary, and with people being able to choose where they ate. We were told that menus have just been updated and that people living in the home have contributed to this process. We spoke to several visitors to the home and observed people being taken out by family and friends. We are always made to feel welcome was one comment made to us by a family visitor. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Oak Tree Manor can be confident that they are able to make a complaint and that they will be listened to with appropriate action taken. They can also be assured that staff have received training to help them protect people living in Oak Tree Manor from abuse. Evidence: When we asked people living in Oak Tree Manor if they knew who to speak to if they were not happy, the vast majority said that they did and paid tribute to the openness of the manager; I would speak to the manager she is wonderful and always on my side and I have always been happy so far Im perfectly happy here and the manager is a good listener were some of the comments made. All but one of the people we asked knew how to make a complaint. The home has a very full complaints policy and procedure that is clearly publicised and available to anyone who wishes to use it. In their AQAA the home tells us that there has only been one complaint in the past year which was resolved within 28 days and was not upheld. We were told that there are currently no complaints outstanding. This unusually low incidence of formal complaints in a home the size of Oak Tree Manor might indicate that some complaints are being dealt with informally and not necessarily recorded, which would mean that it would be harder for the manager to identify any trends or patterns in areas of minor concern to people living in the home. Care Homes for Older People Page 16 of 26 Evidence: When we spoke to care staff and looked at staff training records we were able to confirm that the training provided should ensure that they understand what abuse is and what to do if it is seen or suspected. This should provide people living in Oak Tree Manor with confidence that they are being protected from potential abuse and that were it to be seen or suspected rigorous and appropriate action would be taken to address it. Care Homes for Older People Page 17 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living and working in Oak Tree Manor benefit from a safe, comfortable clean and well-maintained environment and those people living with dementia can be assured that their specific needs are well catered for. Evidence: When we asked people who live in the home in surveys if they thought it was fresh and clean 77 said it always was and 23 that it usually was. On the day of the inspection visit there were no noticeable problems with unpleasant odour and the home was clean and tidy. When we saw, with their permission, some bedrooms of people living in Oak Tree Manor we found that they reflected their individual tastes and preferences in the way that they had been personalised with ornaments, pictures and items of furniture. Whilst we were in the home we saw decorators working in some of the bedrooms and we also met the homes maintenance manager who was attending to routine maintenance issues. The home has a significant number of communal areas as well as the garden and all of this mean that people living in the home benefit from a range of different size rooms, Care Homes for Older People Page 18 of 26 Evidence: some for quieter activities and others for more sociable ones. In their own quality assurance questionnaire, the home received very positive feedback about the homes environment with 98 saying the home is homely and inviting,86 saying the garden is accessible and well laid out and 98 again saying residents rooms are comfortable and clean. This is a tribute to the homes domestic and maintenance staff. When we looked at the way the environment has been enhanced for people living with dementia we found that it demonstrates what can be done in this regard with a little imagination, specific training on dementia care and sufficient commitment of resources. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Oak Tree Manor can be assured that they are protected by the recruitment policies and procedures followed by the home and that there are sufficient numbers of care and ancillary staff, with the training, support, skills and experience to meet their needs. Evidence: When we asked people living in the home if the staff were available when they needed them, 52 said they always were, 41 that they usually were, and 7 that they sometimes were. In their own quality assurance surveys, the home found that 85 thought there are sufficient staff on duty to provide for residents care needs. The carers are lovely was a typical comment made to us about the care staff. When we spoke to care staff and received comments from them in surveys they were overwhelmingly positive about working in Oak Tree Manor, and felt that they received sufficient training, supervision and support to enable them to safely provide a high standard of care for people living in the home. When we looked at staff training and supervision records we found that the staffs view was borne out from the records, for example the homes AQAA indicates that 55 of care staff have achieved at least level 2 in the National Vocational Qualification in care. Care Homes for Older People Page 20 of 26 Evidence: When we looked at the recruitment files for some recently recruited staff, we found that all of the required checks had been completed to protect people living in the home from the employment of people who would not be suitable to provide care for them. Care Homes for Older People Page 21 of 26 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. Oak Tree Manor is a well managed and run home and people who live or work there can be confident that their best interests are central in decisions made about the routines and management of the home. Evidence: When we spoke to people living in the home they were very positive about the manager and the way that the home was run. She is excellent was a very typical assessment. When we asked care staff about the support and supervision they receive they were again very positive and this was borne out by the supervision records seen. We saw copies of the reports drawn up by the proprietor following regular routine monthly visits. These were challenging and thorough and gave rise to action plans to address any issues raised. We also saw the summary of the homes own quality assurance questionnaires, which had been provided to all people living in the home. We were told that the home does not hold any monies on behalf of people living there and that individuals deal with these themselves or through family, legal or financial Care Homes for Older People Page 22 of 26 Evidence: advisers. When we looked at the homes care plans we found that they contained a range of risk assessments to promote the health, safety and well-being of people living in Oak Tree Manor. We were told that the relatives forums had been discontinued as they had been very poorly attended, an alternative annual meeting is now being considered and the future provision of meetings and communication between the home and relatives was to be kept under review. Care Homes for Older People Page 23 of 26 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 24 of 26 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 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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