Care Home: Oak Trees

Similar services:

• Fairfields Country Rest Home
• Queensmount
• Poldhu
• Trevaylor Manor
• Didsbury Court Rest Home
• Belma
• Hunters Care Centre
• Manor Lodge

What the care home does well What has improved since the last inspection? The home has worked hard to ensure that service user care plans are fully reflective of an individual`s needs and preferences. Information for staff on how an individual`s needs should be met are now more detailed. Care plans to address psychological needs are much improved. The procedures for the management and administration of service users medication have improved. All requirements raised at the last inspection had been addressed and the home has systems in place to ensure its procedures are monitored. The home does need to ensure that any hand written entries on medication administration records (MAR) are confirmed with two staff signatures as this will reduce the risk of any errors. Service users spoken with were positive about the quality and quantity of the meals available at the home. Lunch was seen being served in each of the three units. The mealtime experience for service users in the specialised dementia units was noted to be much improved and was in line with the experience for service users in the main unit. As recommended at the last inspection, the home had been proactive in ensuring that service users with dementia were given the opportunity to make informed choices around meals and drinks offered. This is a very positive improvement. What the care home could do better: No requirements were raised as a result of this inspection. Under the heading of `How could the home improve`, comment cards from service users, relatives and staff, raised the following; `can`t think of anything` `Personal laundry would be better cared for if washed in domestic machines rather than industrial ones` `they could put personal clothes in named net bags so they wouldn`t get lost or misshapen` `It would be nice to be praised for what we have done` `some of the staff are always in a hurry and they always seem to have a lot to do but I`m not complaining` An anonymous analysis of all comment cards was made available to the registered manager. CARE HOMES FOR OLDER PEOPLE Oak Trees Rhode Lane Bridgwater Somerset TA6 6JF Lead Inspector Kathy McCluskey Unannounced Inspection 09:30 4 October 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oak Trees Address Rhode Lane Bridgwater Somerset TA6 6JF 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) 01278 451125 01278 431174 julie.watts@somersetcare.co.uk Somerset Care Limited Mrs Julie Ann Watts Care Home 67 Category(ies) of Dementia - over 65 years of age (31), Old age, registration, with number not falling within any other category (36) of places Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To be registered for two named persons (in the OP unit) under the age of 65 years. Rooms 51 and 52 to accommodate service users of low to moderate care needs. 16th November 2006 Date of last inspection Brief Description of the Service: Oak Trees is registered with the Commission for Social Care Inspection to provide personal care to up 67 people over the age of 65. The home specialises in providing care to 31 older people who have a dementia and has two units within the home for this service user group; the Acorn unit and the Oak Leaf unit. The home is not registered to provide Nursing Care. The home is located in a residential area in Bridgwater. Accommodation is provided in single rooms on two levels. There is ample communal space in a variety of settings. In the centre of the home is an attractive courtyard garden and there is further secure outside space attached to the Acorn and Oak leaf unit. The home has appropriate aids and adaptations in place to assist service users. Oak Trees is owned by Somerset Care and the registered manager is Julie Watts. Current fee range = £373 - £450 per week. Additional charges = hairdressing, trips, newspapers, holidays, chiropody, personal toiletries and where appropriate, continence aids. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. This unannounced Key inspection was conducted over one day (8hrs) by CSCI regulation inspector Kathy McCluskey. The registered manager, deputy and specialised manager were available throughout this inspection. The inspector was given unrestricted access to all parts of the home and all records requested were made available. As part of this key inspection the Commission sent comment cards to a number of service users, staff, relatives and healthcare professionals. Thirteen completed comment cards were received from service users, eleven from relatives and ten from staff. None were received from healthcare professionals. One visiting healthcare professional was spoken with during the inspection. Comments have been incorporated throughout the report. As required, the home provided the Commission with its’ Annual Quality Assurance Assessment (AQAA). This document is the home’s ‘self assessment’ of the service they provide. Information identifies what they feel they do well, how they can improve and their plans on how they will improve. Some of this information has been incorporated within this report. This was a very positive inspection where no requirements were raised. The inspector would like to thank service users, staff and the management team for their time and co-operation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: The home ensures that prospective service users have all the information they need to enable them to make an informed decision about moving there. Information about the home is made available in a variety of formats. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 6 Prospective service users are fully assessed by senior staff who have been well trained. The home ensures that prospective service users have the opportunity to ‘test drive’ the home so that they can be sure that their needs and aspirations can be met. Oaktrees provides a comfortable and homely environment for service users. There is an on-going programme of refurbishment and redecoration. Service users have their own bedrooms which they can personalise. Staff at the home are very well trained. Newly appointed staff undertake a comprehensive induction programme. All staff have received up to date mandatory training and other training appropriate to their role. The registered provider and management team are committed to staff training. Effective procedures are followed to ensure that all staff are appropriately supported and supervised. The home ensures that staffing levels are sufficient to meet the needs of service users. Staffing levels are increased as service users needs change. Service users benefit from an experienced and well trained management team who promote and open and inclusive style of management. The home is committed to ensuring that the home is run in the best interests of service users. The views of service users, staff, relatives and healthcare professionals are sought on a regular basis and there was evidence that the home act on views raised. Effective care planning systems are in place which ensure that staff are able to meet the assessed needs of service users in the way service users choose. The home has established excellent links and support from appropriate healthcare professionals and this ensures that service users have the medical support that they need. The home has a designated unit which cares for service users who have dementia. Service users are supported to make informed choices about their lives. Service users benefit from a varied wholesome menu. Meals are prepared and cooked by appropriately trained catering staff at the home. Service users spoken with were very positive about the meals and snacks at the home. The home follows the correct procedures to ensure the health & safety of persons at the home. Comments raised by service users, relatives and staff in completed CSCI comment cards included; Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 7 Relatives: ‘Very happy with the care relative receives – such kindness and very thoughtful’ ‘I cannot speak too highly of the support provided by Hazel and her staff, they are like part of my family’ ‘Just that I think we were so lucky to find such an excellent home for someone with Alzheimer’s’. ‘they keep in contact with the family’ ‘Food, safety of my relative and personal care is always of a high standard’ ‘The general care of my relative is very good’ ‘Continuing care with the up most respect and kindness’ ‘Happy disposition of the carers and other staff make relatives and friends feel at ease and confident to ask questions’ Service users: ‘I am very pleased and happy in the home’ ‘everybody has been very helpful and I am very grateful’ ‘if there was anything wrong with me I would always get help’ ‘All the staff are very good’ ‘staff do listen and act on information’ ‘very good carers always happy and willing to help’ ‘satisfied with the help given by staff’ ‘I had one month holiday here and one month to decide whether to move in’ ‘I feel very safe here’ Staff: ‘we work hard to deliver a good service and maintain very high standards’ ‘I very much enjoy my job and enjoy working at Oak Trees’ ‘Since joining Oak trees, I have been very well supported by my manager and other staff’ Comment cards sent to healthcare professionals had not been returned at the time of this inspection. The inspector spoke with one visiting healthcare professional who provided support to the dementia care unit. Comments were very positive regarding the care service users received and regarding communications with the home. What has improved since the last inspection? The home has worked hard to ensure that service user care plans are fully reflective of an individual’s needs and preferences. Information for staff on how an individual’s needs should be met are now more detailed. Care plans to address psychological needs are much improved. The procedures for the management and administration of service users medication have improved. All requirements raised at the last inspection had Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 8 been addressed and the home has systems in place to ensure its procedures are monitored. The home does need to ensure that any hand written entries on medication administration records (MAR) are confirmed with two staff signatures as this will reduce the risk of any errors. Service users spoken with were positive about the quality and quantity of the meals available at the home. Lunch was seen being served in each of the three units. The mealtime experience for service users in the specialised dementia units was noted to be much improved and was in line with the experience for service users in the main unit. As recommended at the last inspection, the home had been proactive in ensuring that service users with dementia were given the opportunity to make informed choices around meals and drinks offered. This is a very positive improvement. What they could do better: No requirements were raised as a result of this inspection. Under the heading of ‘How could the home improve’, comment cards from service users, relatives and staff, raised the following; ‘can’t think of anything’ ‘Personal laundry would be better cared for if washed in domestic machines rather than industrial ones’ ‘they could put personal clothes in named net bags so they wouldn’t get lost or misshapen’ ‘It would be nice to be praised for what we have done’ ‘some of the staff are always in a hurry and they always seem to have a lot to do but I’m not complaining’ An anonymous analysis of all comment cards was made available to the registered manager. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 10 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 Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5. Standard 6 is not applicable as the home is not registered to provide intermediate care. Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Information about the home is comprehensive and is available in a range of formats. The home ensures that prospective service users are fully assessed by appropriately qualified staff. The home’s arrangements for ensuring that prospective service users can make an informed choice about moving to the home are very good. Staff at the home are very well trained and the home has an appropriate range of aids and adaptations. EVIDENCE: Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 12 The home has a Statement of Purpose and Service Users Guide. Both give detailed information about the home and services offered. These documents are made available to service users, prospective service users and their representatives and are available in a range of formats. The inspectors were not advised of any changes to these documents and information continues to reflect the services offered by the home. The home completed an Annual Quality Assurance Assessment (AQAA) for the Commission and in this, it has been identified that; ‘Service User Guides are now available in different formats e g: large print, audio disc and Braille’. Results of surveys sent by the Commission to service users and relatives confirmed that they had received sufficient information about the home to enable them to make an informed choice about moving to the home. ‘I had one month holiday here and one month to decide whether to move in’ The home offers day care and respite services as well as long term care. The inspector was able to meet with two service users who were visiting for the day and both confirmed that they found this service very helpful and that ‘one day’, they may choose to live at the home. The home ensures that prospective service users are appropriately assessed before a placement is offered. Pre-admission assessments are undertaken by the registered manager, deputy or specialised manager. Assessments are obtained from appropriate healthcare professionals where available. Prospective service users and their representatives are invited to visit the home before making a decision to move there. Service users are issued with a contract/statement of terms and conditions and/or a financial agreement if funded by social services. A variety of environmental aids and adaptations are provided to enable people to move independently around the home. There is clear signage in the units for people who have a dementia to assist them to orientate themselves and maintain a degree of independence. Each unit has an orientation board where staff write the day and date and significant events for the day. The home is owned by Somerset Care who have a commitment to providing staff training appropriate to the service users living at the home. All staff at Oak Trees undertake training in dementia awareness and additional training in this area is provided by the specialist liaison nurse from the Somerset Partnership NHS and Social Care Trust. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Care Planning systems have improved and now provide more detailed information on an individual’s assessed needs and how these should be met. Care plans promote a person centred approach to care. The home’s procedures for the management and administration of service users medication have improved though further improvements could be made. Service users are treated with respect and their privacy is respected. EVIDENCE: The home uses a computerised care planning system. Information within the home’s AQAA states that this system is password protected, set at different Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 14 levels and can only be accessed by authorised staff set at a level appropriate to their role. Care records relating to three service users were viewed at this inspection with the assistance of the registered manager and deputy managers. Information regarding the assessed needs of service users and instructions for staff on how needs should be met, were found to be much improved especially regarding the psychological needs of service users. Care plans contained clear information on assessed needs. The preferences/wishes of service users had been clearly set out and care plans promoted a ‘person-centred’ approach to care. Care plans had been generated from a range of assessment to ensure that all needs had been identified. Staff record an entry as to the well being of individual’s at the end of each shift. Care plans contained detailed information relating to contact with GP’s or other healthcare professionals. Weights are monitored monthly and any concerns can be easily identified. The home has established very good links with appropriate healthcare professionals. The specialised dementia unit receives excellent support/input from a specialist liaison nurse from the Somerset Partnership (NHS) Trust. The nurse was visiting the specialist unit at the time of the inspection and the inspector was able to spend time talking to her. Very positive comments were raised about staff skills and the care service users received. An analysis of the home’s recent survey for healthcare professionals was viewed at this inspection and comments from GP’s and other healthcare professionals were very positive about the care provided and of the way the home communicated with them. During this inspection, the inspector was able to talk to a number of service users. All were very positive about the care and support they received; ‘It’s lovely here and the staff are so kind’, ‘I feel very well cared for and the staff look after me very well’, ‘The staff will do anything for you and they know the way I like things’, ‘I wouldn’t change a thing, I feel very well cared for and safe here’. Thirteen service users completed comment cards for the Commission. In response to the question, ‘Do you receive the care and support you need?’, Eleven responded ‘Always’ and two, ‘Usually’. Additional comments were; ‘Very good carers always happy and willing to help’, ‘Satisfied with the help given by staff’. Eleven comment cards were received from relatives and comments were positive; ‘They have provided support and care not only for my relative but for my wife and myself’, ‘The support and care provided is better than expected’. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 15 All confirmed that the home kept them very well informed about any changes in their relative’s care. The home’s procedures for the management and administration of service users medication were examined at this inspection and were noted to be much improved. Requirements raised at the last inspection had been addressed. Medication Administration Records (MAR) were checked. No gaps in signing for medicines were noted. There were still a few occasions where hand transcribed entries had not been confirmed by two staff signatures. This was discussed at the time. Medicines were found to be securely stored. Stock levels appeared adequate. The use of controlled drugs is very low. Appropriate records are maintained. Medicines requiring refrigeration were seen to be appropriately stored and daily temperature readings were in place. Medicines are only administered by senior staff on duty. All have received appropriate and up to date training in the management and administration of medication. Service users spoken with confirmed that they were treated with respect and that their privacy was respected. This was evident on the day of the inspection. Staff were heard communicating with service users in a kind and respectful manner. Service users commented on the kindness of staff. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is Excellent This judgement has been made using available evidence including a visit to this service. Service users are supported to live the life they choose. A range of activities are available for service users. The home welcomes visitors in line with the preferences of service users. The home has been proactive in ensuring that all service users, especially those with dementia, can exercise choice and control over their lives. The provision of meals/snacks at the home are very good. EVIDENCE: The home takes appropriate steps to ensure that individual’s have the opportunity to participate in a range of activities. Social history’s and the preferences of service users are actively sought. Service users able to express a view informed the inspector that they could choose how and where to spend their day. Service users were observed Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 17 moving freely around the home. Some service users preferred the privacy of their own bedrooms. The home employs two activity co-ordinators who cover five days a week. Daily activities are clearly displayed in the home for service users. On the day of this inspection activities planned included flexercise and nail care. A hairdresser visits the home on a regular basis. On the day of this inspection, several service users were seen to be enjoying this service. Future activities/events were also displayed in the home. Forthcoming events included; memory lane walk, harvest supper, autumn fair and a Christmas party. In the home’s completed AQAA it states that; ‘Various entertainments occur for the benefit of service users, both residential and SRC service users and we encourage dual participation throughout the whole home. We hold various social events throughout the year for the benefit of service users and their families with proceeds going towards the resident’s amenities fund. The home has a mini bus which is maintained as fit for purpose for service users and is used for trips and excursions’. Annual holidays are also arranged for service users. The provision of activities at the home is just one of the many topics discussed at regular meetings which are held for service users and relatives. Views and ideas are actively sought. Many service users attended a meeting during this inspection. In line with the wishes of service users, visitors are welcome to visit their relative at any reasonable time. Service users choose where to receive their visitors and can use the privacy of their bedroom if they wish. Service users spoken with during this inspection stated that their relatives were always made to feel welcome and were offered refreshments. Eleven relatives completed comment cards for the Commission. Under the heading ‘What do you think the home does well?’ some comments included; ‘Provides a caring, supportive environment and always courteous to my relative and visitors’ ‘It is very positive, creative and friendly’ ‘staff have made every effort to ensure relative was able to wander as she pleased’. Service users spoken with were positive about the quality and quantity of the meals available at the home. Lunch was seen being served in each of the three units. The mealtime experience for service users in the specialised dementia units was noted to be much improved and was in line with the experience for service users in the main unit. As recommended at the last inspection, the home had been Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 18 proactive in ensuring that service users with dementia were given the opportunity to make informed choices around meals and drinks offered. By using a dementia mapping tool and through staff training, areas for improvement were also highlighted by the home. The home then took appropriate action to ensure that service users could make informed choices. Serving dishes were made available to service users as appropriate. Tables had been attractively laid and condiments were available. Staff were observed showing service users two plated meals to enable them to make an informed choice about which meal they would like. These improvements have resulted in a positive outcome for service users. Menus are clearly displayed for service users throughout the home. All meals are freshly cooked at the home. The menu appears wholesome and varied. Work to refurbish/upgrade the home’s kitchen is due to commence this month. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The home has appropriate systems in place to enable service users, staff and other stakeholders to raise concerns. The home takes appropriate steps to reduce the risk of harm or abuse to service users. EVIDENCE: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. As discussed at the last inspection, the whistle blowing policy has now been updated to include the contact details of the commission and other external contacts. Records examined indicated that the home had received four complaints since the last inspection. The inspector was able to see that the registered manager had taken appropriate action to address this within the agreed timescale. No Complaints have been raised directly with the Commission. Thirteen service users completed comment cards for the Commission. All confirmed that they knew who to speak to if they had any concerns; ‘I would go to the office’, ‘I would speak to the manager or member of staff’, ‘I would speak to my key-worker or member of staff’. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 20 A comment received from a relative was the ‘Happy disposition of the carers and other staff make relatives and friends feel at ease and confident to ask questions’ Service users spoken with during the inspection did not raise any concerns with the inspector. All stated that they felt confident in raising concerns if they had any. Service users also confirmed that staff listened and acted on what they said. The home has procedures in place to protect service users from harm or abuse. Staff have received appropriate training and up to date policies are in place for staff. Robust staff recruitment procedures are followed which include criminal record checks (CRB) and protection of vulnerable adult checks (POVA). Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and homely environment for service users. Service users benefit from their own bedrooms, which they can personalise. The home provides a range of aids and adaptations to enable service users to maximise their independence. The standard of cleanliness is high and the home takes appropriate steps to reduce the risk of the spread of infection. EVIDENCE: There are three separate units within Oak Trees, the main unit provides care to up to 36 older people, Acorn unit is able to accommodate up to 15 people who Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 22 have a dementia and the Oak Leaf unit has 16 rooms for people who require specialised care due to a dementia. The home was purpose built some years ago and the Oak Leaf unit was built and opened in 2005. This unit was designed and built to meet the National Minimum Standards and environmental recommendations for people with dementia. Accommodation is provided on two levels with passenger lifts between. Other aids and adaptations have been put in place to assist people to move independently around the home. There are assisted bathing facilities, raised toilets and appropriately placed grab rails. All areas have excellent signage to assist people to orientate themselves around the home and again promote independence. A call bell system is fitted throughout the home. The home has an on-going redecorating and refurbishment programme in place. All personal rooms in the home are for single occupancy, many in the main part of the house are under 10 square meters in size but there are a variety of communal seating areas where service users are able to spend time. All bedrooms in the Oak Leaf unit are above 12 square meters and have ensuite facilities of toilet, wash hand basin and level access showers. Rooms without en suite facilities have wash hand basins as a minimum. All bedrooms are lockable and service users are able to choose whether or not to lock their rooms. Each room has a lockable facility for the storage of valuables, medication or money. A selection of bedrooms were viewed during this inspection. Bedrooms were noted to be comfortably furnished and it was evident that service users had been encouraged to personalise their rooms. All service users spoken with informed the inspector that they were happy with their bedrooms. The main part of the house has a large dining room, which easily accommodates all service users and can be used for social functions. In addition there are a variety of communal seating areas ranging from a large conservatory to small quiet lounges. In the Acorn unit there is a lounge and small dining room. The Oak Leaf unit has a large lounge/dining room. All ground floor areas of the home have direct access to outside space which service users have unrestricted access to. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 23 In all areas of the home, the inspector observed service users moving freely around each unit. The atmosphere appeared calm and relaxed. Staff interacted with service users in an unhurried manner. All areas of the home are centrally heated and radiators are either cool wall type or have been guarded to minimise risks to service users. Hot water is thermostatically controlled to prevent the risk of scalding. The temperature of one bath hot water outlet was found to exceed the HSE recommended upper limit of 44c. This was brought to the attention of the registered manager at the time of the inspection and immediate action was taken to ensure there was no risk to service users (refer to standard 38). Windows above ground floor level have been restricted in line with health and safety guidelines. The standard of cleanliness in all areas seen at this inspection was very good and no malodours were noted. The home takes appropriate steps to reduce the risk of the spread of infection. Staff confirmed that they had access to a good supply of protective clothing/equipment. This was also observed during the inspection. Hand-washing facilities and foot operated bins were seen to be appropriately sited throughout the home. Comments received from relatives included; ‘Always clean and tidy’, ‘comfortable environment’ and ‘’Very agreeable surroundings’ Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. The home ensures that staffing levels and the skill mix of staff are appropriate to the needs of service users. Somerset Care and the management team are committed to staff training. The number of staff who have achieved an NVQ qualification exceeds the National Minimum Standards. The home follows robust staff recruitment procedures which reduce the risk of harm or abuse to service users. Induction and training programmes for staff are very good. EVIDENCE: The home has a clear staffing structure in place and care is taken to ensure that the skill/experience mix of staff on duty is appropriate to the needs of service users. Examples were given to support this. Apart from the management team, senior staff are on duty at all times of the day and night. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 25 Comments received from relatives indicated that they were satisfied that staff had the right skills and experience to care for their relative. ‘I have not had any concerns about the staff they are always caring and considerate’ ‘Extremely caring in attitude to clients’, ‘Happy disposition of the carers and other staff make relatives and friends feel at ease and confident to ask questions’. Service users were also positive about the staff and all commented on the kindness of staff; ‘very good carers always happy and willing to help’, ‘the staff are very kind and always help me’ Staff comments included; ‘We work hard to deliver a good service and maintain very high standards’ ‘I very much enjoy my job and enjoy working at Oak Trees’ ‘Since joining Oak trees, I have been very well supported by my manager and other staff’ No concerns were raised regarding staffing levels at the home and being able to meet the needs of service users. Some staff indicated that it would be nice to have more staff on duty. The registered manager stated that staffing levels would always be increased as required in order to meet changing dependency levels or if somebody was poorly or if they were in their last stages of life. The management team and the registered provider are committed to ensuring that staff receive appropriate training to meet the needs of the service users. All staff who commence work in the specialist residential unit are given comprehensive information about caring for people who have a dementia and additional training is provided by the specialist liaison nurse who supports the unit. All staff receive in-depth induction training which follows the Skills for Care Common Induction Standards. The home ensure that all staff receive ongoing statutory training. The home’s policy is to ensure that all staff receive training in moving and handling once a year. Somerset Care are committed to staff training and support staff to undertake National Vocational Qualifications (NVQ). The registered manager provided the Commission with pre-inspection information (AQAA) which stated that currently 23 staff are currently undertaking NVQs at levels 2,3,4, and 61 of staff have already achieved an NVQ level relevant to their role. This exceeds the 50 recommended in the National Minimum Standards. Service users are protected by the home’s staff recruitment procedures. Two staff recruitment files were examined at this inspection and both contained all required information including criminal record checks (CRB) and protection of Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 26 vulnerable adults checks (POVA). Staff who commence employment pending a full CRB and have received a satisfactory POVA check, are supervised at all times. The inspector discussed the need to devise a risk assessment which clearly sets out the restrictions on the staff member whilst the CRB is pending. This should be signed by the staff member and employer. The registered manager gave her assurance that this would be put in place. The home has policies and procedures in place for staff relating to equality and diversity. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 and 38 Quality in this outcome area is Excellent. This judgement has been made using available evidence including a visit to this service. Service users benefit from a competent and experienced registered manager and management team who promote a very open and inclusive style of management. Staff are well supported and appropriately supervised. Service users financial interests are safeguarded by the home’s policies and procedures. The home has very effective quality assurance systems in place, which seek the views of service users and other interested stakeholders. The home’s procedures for ensuring the health & safety of persons at the home are good. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 28 EVIDENCE: The registered manager of the home is Julie Watts. She has a wealth of experience in the care of older people and demonstrates a good understanding of the needs of both staff and service users. Julie has an NVQ level 4 in care and management and a Higher National Diploma in managing health and social care. The registered manager is effectively supported by a deputy and a manager who is based on the specialised dementia unit. Each shift has a care supervisor and team leader who are responsible for the day to day co-ordination of the staff. Regular meetings are held for service users, staff and relatives. Minutes are maintained and these were viewed by the inspector. It was very apparent that views are encouraged and that action is taken/changes made as appropriate. A meeting was being held for service users at the time of the inspection. This appeared well attended. Completed comment cards from relatives highlighted some positive comments about the support they received from the home; ‘They invite us to meetings which is very much valued’ ‘Meetings keep relatives up to date with developments in the home’ ‘They have provided support and care not only for my relative but for my wife and myself’. The home has an effective quality assurance programme in place. The home carries out a yearly survey of service users, relatives and healthcare professionals views on the home. The results of completed surveys for this year were made available to the inspector and outcomes were mainly ‘good’ or ‘excellent’. Comments from healthcare professionals were very positive. The home’s area manager/responsible individual maintains close contact with the home and visits frequently. As part of these visits, monthly reports are completed. The home’s business plan was not requested for this inspection. In preinspection information (AQAA) supplied by the home, it states that the company’s plan and home’s strategic plans are shared with employees ‘to ensure the vision and ethos of the Company and the unit is explained and discussed, so that we can create and deliver imaginative responses to the changing needs of service users’. Robust policies and procedures are in place to ensure that service users financial interests are safeguarded. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 29 Staff at the home are appropriately supervised. The inspector was able to see documented evidence that all staff receive regular one to one sessions with an appropriate person. Staff also receive annual appraisals and newly appointed staff receive supervision through a probationary period. Ten staff completed comment cards for the Commission and nine stated that they received regular supervision. Comments included; ‘It would be nice to be praised for what we have done’, ‘We work hard to deliver a good service and maintain very high standards’, ‘I very much enjoy my job and enjoy working at Oak Trees’ ‘Since joining Oak trees, I have been very well supported by my manager and other staff’. In their completed AQAA, the home has stated that further improvements can be made in relation to staff supervision by; ‘linking staff training attendance and recording on supervision documentation, so it can be established what was gained or not. This will provide useful information when planning further training. The home also plan to make full use of the mentoring scheme for staff. The home ensures that all records pertaining to service users are up to date and stored in accordance with the Data Protection Act 1998. The following records were examined in relation to the home’s procedures for ensuring the health & safety of all persons at the home; FIRE SAFETY – In-house weekly checks are maintained on the home’s fire detection systems. Annual servicing was carried out by an external contractor on 31/07/06. The staff training matrix indicated that all staff had received up to date training in fire safety. ELECTRICAL SAFETY – Records indicated that an annual check on the home’s portable appliances took place in April and May 2007. The home has an up to date electrical hardwiring certificate dated 04/09/06. EQUIPMENT SERVICING – Records examined confirmed that the home’s mobile hoists, slings were last serviced on the 07/11/07 & 09/11/07. The home’s passenger lift was serviced on 22/06/07. GAS SAFETY – The home has an up to date annual landlords gas safety certificate dated 04/10/06. ACCIDENTS - Accidents are appropriately recorded and analysed monthly by the registered manager. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 30 As previously mentioned in this report, to ensure the safety of service users all upstairs windows are restricted, hot water outlets are thermostatically controlled, radiators are low heat surface type and free standing wardrobes are secured to the wall. The temperature of the hot water outlet on one bath was noted to be in excess of the HSE recommended upper limits. This was brought to the attention of the registered manager at the time of the inspection. The registered manager took immediate action to ensure that the bathroom could not be accessed by service users and made arrangements for this to be checked and adjusted. All service users spoken with at this inspection informed the inspector that they ‘felt safe’ at Oaktrees. Comprehensive risk assessments are completed for service users to ensure that they are not placed at unnecessary risk of harm. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 31 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 4 3 4 4 3 N/A 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 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 3 3 3 3 3 Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 32 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. Refer to Standard OP9 Good Practice Recommendations To reduce the risk of errors, the registered person should ensure that all hand written entries on medication administration records (MAR), are confirmed by two staff signatures. Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oak Trees DS0000015988.V349080.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!