Care Home: Oakcroft House

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What the care home does well Survey feedback from people using services and their representatives/relatives was overall very positive about the home. Comments included, " The home is clean, staff are friendly and attentive." "Staff are patient and care for all clients." " There is always a warm welcome when the family visit. Everyone is friendly and all staff are helpful at all times. " "My daughter is kept informed if I fall or am ill. Effort is made to involve me in activities in spite of my being profoundly deaf. Visitors can come and go at any time. " " Meals are great, individual care good, nice environment, doesn`t smell, some really first class staff who have been here for a long time. " "They are good at personal care and cleanliness, keeping my family informed of any problems, cleaning my room, the preparation and serving of food. " The inspection outcomes established that people using services are supported by a trained and competent staff team and protected by robust recruitment procedures. The atmosphere of the home was warm and friendly. People considering using this service have access to helpful information about what life is like at the home.They receive a comprehensive, holistic assessment of their needs, usually before admission. Their care is planned with them in a way that takes account of individual needs and preferences. Health and personal care needs are understood and an efficient medication policy ensures safe practice.Care and support is flexible, consistent and able to meet the changing needs of the individual. Principles of respect, dignity and privacy are put into practice.Nutritional needs are assessed and the chef visits each person soon after admission to establish food preferences and dietary needs. Menus offer a choice of meals and are nutritionally checked. Effort is made to meet the religious needs of people currently accommodated. There is an interesting, varied activities programme providing group and one to one stimulation. A hairdresser visits the home providing a regular service. Social indoor and outdoor events take place and community access facilitated through organised excursions, from time to time.People using services are encouraged to maintain contact with families and friends. The building is domestic in character, comfortably furnished, immaculately clean and fully accessible to people with physical disabilities.The furnished landscaped grounds affords a secluded area to sit and walk, with mature trees and shrubs and patio area, wide pathways and sensory garden. The home`s registered manager is competent and suitably qualified and experienced. She demonstrates a clear understanding of the key principles and focus of the service, based on organisational values and priorities, working to ensure continuous service improvement and development. Service users and staff are protected from harm through safe working practices and benefit from robust quality assurance and quality monitoring systems. Regional and national experts are available within the company for advice and guidance to management. What has improved since the last inspection? The home`s latest annual quality survey demonstrates an overall high level of satisfaction with most aspects of the services and 100 % satisfaction with catering standards. Developments since the last inspection include the Bupa Menu Master, ensuring menus meet nutritional needs; also the Nite Bite menu which offers a range of fresh and health snacks and hot and cold beverages available between 6.30 pm and 6.30 am. A standardised assessment and care planning system has been implemented which promotes a person-centred approach to this process, based on comprehensive assessment of needs and risks. People using services and their representatives are encouraged to complete a map of their life which helps staff get to know each person as an individual. This enhances staffs` ability to respond to the emotional and social needs of people using services as well as their physical needs. The structured activities programme planned and delivered by a designated full time activities organiser has been further developed. The organisation has also introduced a monthly themed activity for all its homes to participate in which was stated to have been well-received by service users. Other developments include a senior registered nurse working with the housekeeping team, providing infection control advice and guidance. Additionally, two registered nurses now coordinate the staff training programme, ensuring consistency and continuity. What the care home could do better: Observations highlighted the need to review the needs, risks and other assessments for a person using services to ensure the safety and best interests of this individual. A major refurbishment programme is imminent which will substantially enhance the environment, refreshing paintwork, replacing carpets and soft furnishings and items of furniture. Plans to replace bedroom doors with those fitted with safety locks and for lockable bedside cupboards will enhance the privacy of people using services. The need for some attention to records, specifically the storage, recording and disposal of staff Criminal Record Bureau disclosures and retention of food records was identified. Suggested service improvements from service users and relatives included comment on weekend staffing levels which were felt to be inadequate and perceived to be lower than during the week. The rotas sampled evidenced this was not the case, however the home manager stated her intention to review practice, routines and social activities at weekends in light of this feedback. Survey feedback from one individual of delays in responding to call bells was also discussed. Comments from surveys included, " Possibly more time could be spent communicating with me which requires staff to write things down because I cannot hear. Checking that subtitles are available on television programmes." "More baths and more activities that I can do and be part of music really good. More people coming in to do things, e.g. bingo, reminiscence groups, a guy used to come in from the local gym." " More community involvement." Key inspection report Care homes for older people Name: Address: Oakcroft House Oakcroft Road West Byfleet Surrey KT14 6JG     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Patricia Collins     Date: 3 0 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Oakcroft House Oakcroft Road West Byfleet Surrey KT14 6JG 01932352766 01932352869 grievev@bupa.com www.bupa.com BUPA Care Homes (BNH) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Vivien Rosemary Traquair Grieve Type of registration: Number of places registered: care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 48 The registered person may provide the following category of service : Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Physical disability (PD) Date of last inspection Brief description of the care home Oakcroft House Nursing Home is situated in a quiet residential area of West Byfleet, Surrey. The home is owned and operated by BUPA Care Homes Ltd. The three-story, large detached Edwardian property has been tastefully converted, retaining original architectural features and provides comfortable accommodation for up to 40 older people and younger adults. Care Homes for Older People Page 4 of 29 Over 65 48 0 0 48 Brief description of the care home Communal accomodation is on the ground floor comprising of a spacious lounge, attractive dining room, conservatory, a well-stocked library and purpose-built activities room. Bedroom accommodation is arranged on three floors in thirty-six single bedrooms and two shared bedrooms, all with an en-suite facilities. The secluded enclosed grounds includes a sensory garden and furnished patio. Carparking facilities are available at the front of the property. Weekly fees at the time of this inspection range from £950.00 to £1050 00. Additional charges apply for hairdressing, private chiropody, physiotherapy services, personal newspapers and private telephone lines. Care Homes for Older People Page 5 of 29 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: three star excellent 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: Date of last Key Inspection: 31st May 2007. This unannounced inspection visit formed part of the key inspection process, using the Inspecting for Better Lives methodology. The visit carried out by one inspector over a nine hour period was facilitated by the homes registered manager.The report will say what we found as it is written on behalf of the Care Quality Commission (CQC). All available information has been taken into account when forming judgements about how well the home is meeting National Minimum Standards (NMS). This included accumulated evidence, knowledge and experience of the home since its last key inspection. We also considered feedback from six people using the service and relatives and from five staff who responded to a survey carried out as part of the inspection process. Other information was obtained through discussions with service users, a visitor and staff during the visit and from practice observations. The well-being of Care Homes for Older People Page 6 of 29 people using services unable to verbally express their views about the home was assessed by observations of their body language and personal appearance, information in their records and through conversations with staff. Each year providers registered with the Care Quality Commission (CQC) must complete a self assessment called an Annual Quality Assurance Assessment (AQAA) and send this to the CQC. It provides quantitative and some numerical information about their service. It also requires assessment of services against the NMS outcome areas, demonstrating both areas of strength and where improvements can be made. The AQAAs content was clear, validated by evidence and demonstrated awareness of service strength and areas for future development. We viewed all communal areas including sitting rooms and the dining room, bathrooms, toilets, kitchen and laundry and sampled bedrooms. We examined marketing information available to enable prospective service users to make informed decisions about whether the home is right for them. We also looked at systems and records specific to quality monitoring and quality assurance activities, staff recruitment and training, care plans and other care documents, complaints and safeguarding records and menus. Direct and indirect practice observations were carried out over lunch and throughout the duration of the visit. We looked at arrangements for meeting the social, cultural, religious and recreational needs and interests of people using services, observing group activities in progress whilst touring the building. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The homes latest annual quality survey demonstrates an overall high level of satisfaction with most aspects of the services and 100 satisfaction with catering standards. Developments since the last inspection include the Bupa Menu Master, ensuring menus meet nutritional needs; also the Nite Bite menu which offers a range of fresh and health snacks and hot and cold beverages available between 6.30 pm and 6.30 am. A standardised assessment and care planning system has been implemented which promotes a person-centred approach to this process, based on comprehensive assessment of needs and risks. People using services and their representatives are Care Homes for Older People Page 8 of 29 encouraged to complete a map of their life which helps staff get to know each person as an individual. This enhances staffs ability to respond to the emotional and social needs of people using services as well as their physical needs. The structured activities programme planned and delivered by a designated full time activities organiser has been further developed. The organisation has also introduced a monthly themed activity for all its homes to participate in which was stated to have been well-received by service users. Other developments include a senior registered nurse working with the housekeeping team, providing infection control advice and guidance. Additionally, two registered nurses now coordinate the staff training programme, ensuring consistency and continuity. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 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 10 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering using this service and their representatives receive the information they need to enable an informed choice of home. Comprehensive pre-admission assessment procedures ensure needs can be met. Standard 6 was not assessed on the basis the home does not offer intermediate care. Evidence: The homes management places a high value on responding to the need for information when choosing a care home. An informative brochure is available from the home and can be downloaded from its website. This document and other information available to the public, assists people considering using the service in determining the homes suitability to meet individual needs and aspirations. An up-to-date, comprehensive statement of purpose and service users guide prominently displayed in the reception area, provides further helpful information about what life is like at the home, describing its services and facilities.The admission criterion explicitly stated in marketing materials confirms service provision is for long-term nursing care, respite Care Homes for Older People Page 11 of 29 Evidence: and day care also convalescent and post-operative care. Service provision is for older people, for younger adults with physical disabilities or brain injuries and people with Parkinsons disease. The six files examined during the visit evidenced a person centred approach to assessment and care planning processes and understanding and respect for the diversity of people using services. Policies and procedures ensure equal access to services, non-discriminatory practice and respect for their rights and beliefs.The needs assessment process is comprehensive and holistic, establishing detailed information about personal care and nursing needs, daily activities of living and personal preferences. The planned admission process ensures all people using services have the benefit of a pre-admission assessment which ensures their needs can be met. For people already in contact with social services or social work departments the initial assessment is undertaken as part of the care management process. The homes management satisfies itself of the homes suitability before offering a placement. Observations indicate the assessment process is inclusive, involving people considering using this service and/or their relatives. It is focused on achieving positive outcomes for each individual and ensures the facilities, staffing and specialist services can meet their needs. Emergency admission procedures do not include pre-admission assessment by the home however require as much information as possible to be gathered before admission, to be sure needs can be met. Standard 6 was not inspected on the basis that intermediate care services are not provided by the home. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has substantial strengths and sustained performance in delivering quality health and personal care services. The principles of respect, dignity and privacy are put into practice. Evidence: Staff were observed to be professional, respectful and sensitive to the privacy of people using services during the visit. Direct practice observations in conjunction with survey feedback from people using services, staff and relatives confirmed they are attentive to the personal appearance of people using services, ensuring their dignity and wellbeing. The majority of people using services consulted during the visit were positive in their feedback about about their care experience, indicating delivery of effective personal and healthcare support. Survey feedback confirmed most staff are friendly, helpful, and patient. Relatives/representatives are mostly satisfied with communication systems which keeps them informed of significant health and welfare matters. Comments from people using services at the time of the visit included, This is a jolly good home, I am very well looked after and very pleased my family chose this home for me. Care Homes for Older People Page 13 of 29 Evidence: Six care plans and related care records were sampled during the visit. The corporate assessment and care planning tool used promotes a person-centred approach to these activities, based on comprehensive assessment of needs and risks. Person-centred practice being supported by the organisations Personal Best staff training programme. People using services and/or their representatives, if appropriate, are encouraged to complete a Map of Life. This is a corporate tool used to help staff get to know each person as an individual, enabling an holistic approach to meeting physical, emotional and social needs. An inclusive approach to care planning was evidenced by the practice of care plans being signed by people using services or their representatives. Care plans were also signed and dated by staff and reviewed at least monthly. Quality assurance systems include monthly sampling and audit of care plans. People who use this service are registered with a general practitioner (GP) at a local medical centre. A GP visits the home twice a week and at other times, as necessary. Access to primary and specialist healthcare and other professionals and services was evidenced.The company has its own specialist nurses and nursing staff also access specialist nursing advice from the local Primary Care Trust. Aids and equipment are used to maximise independence and accommodate changing needs.Healthcare, nursing and personal care needs were clearly documented in the records examined, providing a comprehensive overview of how needs are being met. The inspection focused on the frequency and availability of baths and showers following survey feedback indicating this was an area of dissatisfaction for two people. Records in bathrooms demonstrated most people using services had regular showers and some individuals had regular baths. Risks to the health and safety of people using services are assessed, using validated tools and are regularly reviewed. Examples of risk assessments and risk prevention plans include mobility and falls, moving and handling, pressure sores, use of bed-rails and nutrition. Aids and equipment support activities of daily living and the home is wheelchair accessible throughout. Practice observations identified the need to reassess the needs and risks specific to one person using services during the visit. This was discussed with a nurse and the home manager who agreed to act on this information. The home has a record of sustained compliance with statutory medication requirements. Its medication policy,procedures and practice guidance ensures safe outcomes for people using services. We looked at the system for monitoring call bell response times an sampled relevant records which identified some days when response times had been significantly slow. The home manager stated a designated staff member always follows this up and unexplained shortfalls addressed with staff on duty. A nurse on duty said the continuing professional development is supported by the Care Homes for Older People Page 14 of 29 Evidence: organisation, enabling clinical practice, knowledge and skills to updated. Care staff also receive training enabling awareness and understanding of the health conditions of the people in their care. A programme of dementia training for the team was stated to be planned. Universal infection control procedures were stated to be followed and staff noted to use protective aprons and gloves. Suitable disposal arrangements were made for clinical waste. Care Homes for Older People Page 15 of 29 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 using services are encouraged to keep in touch with family and friends. They are supported in making choices about their life styles and have opportunity to participate in meaningful, interesting social and leisure activities. Menus are nutritionally checked, affording a choice of meals that meet dietary needs and preferences. Evidence: The atmosphere of the home was warm and friendly.Personalisation of bedrooms is encouraged, affording somewhere people using services can really feel at home.The open visiting policy takes into account service users individual wishes, encouraging them to maintain relationships with families and friends. Survey feedback confirmed visitors are made welcome by staff. The homes brochure states friends and relatives are welcome to join service users for meals. A number of visitors were present in the home throughout the visit. Staff were observed to be hospitable towards them, serving them refreshments and engaging with them.The visitors register confirmed a high volume of visitors, particularly at weekends. All available information indicates staff respect the rights and autonomy of the people they support. Some people using services go out with their visitors from time to time. Care Homes for Older People Page 16 of 29 Evidence: One person attends a community group which is a private arrangement between the group leader and relative. Opportunity is available for service users to engage in meaningful daytime activities of their choice, according to individual interests, diverse needs and capabilities.A structured activities programme is delivered by an activities organiser who was on duty and observed to be enthusiastic and motivating in her approach. We observed two group activities in progress in the activities resource room during the visit in addition to one-to-one time spent by the activities organiser with individuals in their rooms. The Annual Quality Assurance Assessment (AQAA) confirmed effort had been made to source suitable activities to meet the complex needs of people using services and of interest to their families and friends. These include gardening,arts and crafts, music therapy, crossword mornings, gentle exercise and birdwatching. Some individuals prefer not to join in structured activities, but enjoy relaxing in their rooms, reading in the homes library area, petting the homes cat, watching television or listening to music. The conservatory overlooks an attractive landscaped garden which was stated to be used by some service users in the warm weather. Tea and homemade cakes were stated to be sometimes served on the furnished terrace. Various social events compliment the activities programme including seasonally-themed occasions. Also excursions stated to be arranged from time to time at no additional charge. The home manager stated these include visits to cinemas and theatres, a concert at Guildford Cathedral and trips to a National Trust garden. Last years visit from a farm in which a range of animals were brought to the home was stated to be so popular with service users that a repeat visit is booked for June. Local entertainers are included in the activities programme which include a volunteer who plays the piano in the lounge, encouraging service user participation in group sing-a-longs. People using services had also recently enjoyed a concert provided by two student musicians. Regular visits by a hairdresser provide further opportunities for social stimulation. Most survey respondents said there is always or usually social activities they can participate in, though individuals had suggestions for improvement.Comments received were, Need for more activities that I can do and be part of - music really good. More people coming in to do things, e.g. bingo, reminiscence groups, a guy used to come in from the local gym. More community involvement. One person with a sensory impairment felt staff could spend more time on communication with this individual and ensure they check availability of subtitles on television programmes. The homes equal opportunity admissions policy values diversity and ensure nondiscriminatory practice. We found effort made to meet the religious and spiritual needs of people using services. A local Vicar provides a regular Communion service and arrangements made for people of Roman Catholic faith to receive Holy Communion each week. Private arrangement are in place to meet the spiritual needs of an Care Homes for Older People Page 17 of 29 Evidence: individual who is not of Christian denomination. Nutritional assessments are routinely carried out and dietary advice and swallowing assessments sought, as necessary. Weights are also regularly monitored.The chef has a one to one meeting with people using services soon after admission to establish food preferences, dietary needs and time they would like breakfast to be served in their rooms. People using services can choose to eat their meals in the traditional dining room overlooking the garden or in the comfort of their rooms. The chef manager prepares a four weekly cyclical menu which offers a choice of hot and cold meals. The Bupa Menu Master points system ensures menus meet nutritional standards.There was stated to be the option of a cooked breakfast though not taken up by many individuals. It was unclear whether people using services are all aware they may request a cooked breakfasts, from time to time, based on conversations had with individuals. The home manager confirmed discussions in progress within the organisation looking at developments in this area. The menu planning process was stated to involve consulting people using services for menu suggestions. The weeks menu is displayed in a public area and daily menus are on dining tables. A system operates enabling choice of food. Feedback to our survey from people using services and the outcome of the homes latest survey show high satisfaction with the standard of cooking and menus. The new Nite Bite menu affords opportunity for fresh healthy snacks and hot and cold beverages to be requested between 6.30 pm and 6.30 am. Practice observations confirmed appetising meals served and good presentation of food and dining tables. Arrangements for serving meals on trays in bedrooms were efficient and for staff assistance, as necessary at mealtimes. Care Homes for Older People Page 18 of 29 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 using services are listened to and protected by the homes policies and procedures. Evidence: We observed numerous complimentary cards and letters from relatives of past and present service about services and staff during the visit. The service has a clearly written complaint procedure that is easy to understand. The complaint policy has agreed timescales for managing complaints within a three tier framework, including the home manager, regional management team and national operational quality department. The complaint procedure is included in the service user guide and displayed in the home. With the exception of one respondent, survey feedback confirmed people using services and their representatives were clear how to make a complaint. People using services said staff listened to and dealt with their concerns. One respondent however expressed limited confidence in the impartiality of the management of concerns and complaints, stated to be based on personal experience. We examined complaint records for the past twelve months. Two complaints were investigated and the process and outcome was clearly documented. The corporate assessment tool used by staff has a section addressing the mental capacity of people using services. Procedures and recent staff training ensure staff are aware of their obligations under the Mental Capacity Act deprivation of liberty safeguards (DOLS). Other policies and procedures for the protection of people using Care Homes for Older People Page 19 of 29 Evidence: services include those specific to staff recruitment and training, assessment and management of risk and financial management. The home has access to a national team of quality and compliance professionals for advice and support.Staff surveyed felt they had sufficient support, experience and knowledge to meet the diverse needs of the people they care for. Equality and diversity training for the team was stated to be planned. A copy of the latest edition of the local multi-agency safeguarding procedures was available in the home. The staff team was stated to have recently undertaken safeguarding vulnerable adults refresher training. A whistle-blowing procedure is available for staff to report concerns about the practice of colleagues and managers. Discussions with the home manager and a nurse established their clear understanding of when an incident needs to be referred to the Local Authority as part of local safeguarding procedures. Records relating to two safeguarding referrals in the past twelve months which merged into one investigation undertaken by another agency evidenced openness and transparency when discussing incidents with external bodies. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using services benefit from well-maintained, clean and hygienic, good quality accommodation with specialist equipment and aids to meet their needs. Evidence: This large, detached three-story Edwardian building was originally a family home. It has been tastefully converted and designed to provide modern and suitable facilities, retaining original architectural features and character. Situated in a quiet residential area, the home is set back from the road and has a large, well-maintained secluded garden with furnished patio, sensory planted area and pathways suitable for wheelchair users.The grounds are secure and risk assessed and there is a key-pad entry systems. Communal areas on the ground floor comprise of an entrance hall with reception, library, large lounge, conservatory, dining room and purpose-built activities room. The thirty eight en-suite bedrooms promote the privacy, dignity and autonomy of people using services. They are arranged on all three floors, accessible by stairs and passenger lift. The bedrooms sampled were personalised, well lit and ventilated and fitted with thermostatically controlled radiators and emergency call bells. They were comfortably furnished with remote controlled televisions and many rooms stated to have profiling, height- adjustable beds. Various adaptations and equipment ensure the physical environment meets the individual requirements of people using the service. Care Homes for Older People Page 21 of 29 Evidence: Specialist bathing facilities and wheelchair accessible toilets are available. Other facilities include office accommodation, a staff room, fully equipped industrial kitchen with servery and laundry room. Observations confirmed a high standard of cleanliness and odour management throughout the home, using a specialist microfibre cleaning system combined with effective cleaning regimes. A planned maintenance programme was also evident. Bathrooms, toilets and sluice rooms were hygienic with suitable hand-washing facilities. A major upgrading, refurbishment and redecoration programme was due to commence the week after the visit and people using services and their relatives informed of the same.Discussions with the manager confirmed significant care in planning the worksprogramme, aimed to minimise disruption to service users.Included in the programme is provision of new carpets throughout the building, lockable bedroom doors and lockable bedside cabinets, new televisions, armchairs and upgraded bathing facilities. The industrial kitchen, which is not included in the refurbishment programme, was observed to be hygienic and the chef manager satisfied with catering equipment. Discussions with the home manager confirmed the intention to repair the ice-maker machine which had been out of order for some time. The kitchen was last inspected by the Environmental Health Department in November 2008. Care Homes for Older People Page 22 of 29 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. Staff are trained, skilled and in sufficient numbers to support the people who use this service. People using services are protected by the homes recruitment policy and practice. Evidence: Staff were observed to be professional in their manner and appearance and respectful and caring in their approach to people using services during the visit. Staff retention rates are good, the stable workforce enabling consistency and continuity of care practice and routines. A Working Guide to Bupa Care Homes supplied to employees raises awareness to their rights and responsibilities and informs them of harassment and grievance procedures. The files of three staff recruited since the last inspection we sampled evidenced robust,comprehensive human resource policies and procedures are followed for the protection of people using services. Attention necessary to the recording, storage and disposal of staff Criminal Record Bureau (CRB) disclosures in accordance with CRB policy was discussed with the home manager. The organisation demonstrates continued commitment to the training and professional development of staff. Bupa has achieved and retained Investors in People accreditation. A training needs analysis was undertaken for the team identifying individual and collective training needs which are being addressed. The training Care Homes for Older People Page 23 of 29 Evidence: programme is coordinated by two registered nurses who have shared this responsibility since September 2009. The training records sampled evidenced new staff receive a comprehensive induction and statutory and other training relevant to their roles and responsibilities.Difficulty in accessing first aid refresher training for staff was discussed and noted to be receiving attention. Staff are supported and encouraged to work towards attaining National Vocational Qualifications (NVQ) in health and social care at NVQ Level 2 or above. At the time of the visit eight staff had achieved this qualification or its equivalent. Service specific training accessible to staff includes dementia awareness and the Mental Capacity Act. Training covering equality and diversity was stated to be planned. The mandatory Personal Best customer services programme of training, develops empathy and understanding in staff of how it feels to live in the home and experience its services and promotes a person centred approach to all tasks. Staffs roles and responsibilities are clearly defined in accurate job descriptions and demonstrated to be understood by evidence of good team work.Staffing levels have been reviewed and increased since the last inspection and shift patterns noted to be flexible, responding to service needs.Survey feedback from staff confirmed their opinion that staffing levels are consistently adequate to meet the needs of people using services. Staff comments included, We meet all individual needs, work well as a team and in pleasant working atmosphere and everyone gets on well with each other. We provide high quality care. It is the best place I have worked. Cant think of anything the home can do better.Since joining Oakcroft House five years ago my job has helped me deliver the highest possible care. I like working here. Discussions with a nurse during the visit established staffing levels fluctuate in accordance with occupancy numbers and dependency levels. She was also of the view that the current staffing levels were adequate, stating, The home manager listens to feedback and will increase staffing levels in response to increased dependency levels. She is very fair in her management of staff and is another reason why we all stay. Survey feedback from service users and relatives regarding staff was overall very positive. Comments included, Staff are friendly and attentive. There is always a warm welcome when the family visit. Everyone is friendly and all staff are helpful at all times. Some really first class staff who have been here for a long time. We also received feedback from two relatives who perceived staffing levels at weekends to be reduced though not evidenced by rotas sampled. This was discussed with the home manager who stated her intention to review routines and practice at weekends to consider if any changes or improvement required. The need to ensure adequate staff available to respond to call bells at peak times of activity, for example at mealtimes, was also discussed. Care Homes for Older People Page 24 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Strong leadership and an open and inclusive management approach ensures the home operates and is managed in the best interests of people using the service. Their health, safety and welfare is protected and promoted by the homes policies, procedures and practice. Evidence: The home manager is a qualified general nurse with extensive nursing and management experience. She has a relevant management qualification, is registered by the Care Quality Commission (CQC) and has competently managed the home for many years. During the visit she described a clear vision of the home based on the organisations values, corporate priorities and best practice principles. She is supported by a competent senior management team and line manager stated to be accessible and approachable, also regional and national experts within the company, available for advice and guidance.The Annual Quality Assurance Assessment (AQAA) completed by the manager contained appropriate information validated by evidence. It showed how the home listens to people using services and demonstrated selfCare Homes for Older People Page 25 of 29 Evidence: awareness of areas for further development. Communication systems were found to be overall effective, ensuring smooth service operation. A recent change of designated responsible individual on behalf of Bupa was noted at the time of the inspection. It was understood this change had been notified to the CQC in order for the register and certificate to be amended though the old certificate not yet replaced. The need to follow this matter up with the CQC was discussed with the home manager, also an outstanding amendment varying maximum occupancy levels from 48 to 40. It was understood this matter had previously been notified to the former regulator in 2007. Effective, comprehensive quality assurance and quality monitoring systems benefit people using the service, ensuring it is managed in their best interest. Monthly internal audits are carried out by management also external audits during statutory monthly visits made by the regional manager. The organisations national team of quality and compliance officers recently conducted a quality audit at the home. Work was in progress on the action plan generated from this audit. An annual internal and external customer satisfaction survey is carried out, seeking the views of people using services and their representative. The outcomes of the 2009 survey, based on 21 dispatched and returned questionnaires, demonstrated overall good levels of satisfaction with services provision, up 17 in the past twelve months. Records viewed indicated safe working practices and no preventable accidents. The regional health and safety team provide health and safety and fire safety leadership. Full and clearly written records evidence regular audits of health and safety performance. The manager and senior team demonstrate understanding of risk assessment processes. Environmental and personal risk assessments are in place and regularly reviewed. The home manager confirmed risk assessments had been undertaken to minimise risk of accidents for service users whose bedrooms open onto a balcony terrace. The home manager ensures all staff are trained, understand and consistently follow health and safety policies and procedures. The standard of record keeping is overall good, though attention required to Criminal Record Bureau record keeping practices and retention of food records. Observations confirmed management and staff are aware of their obligations under the Mental Capacity Act deprivation of liberty safeguards. We were informed that none of the people using the service were subject to a deprivation of liberty authorisation or application. Care Homes for Older People Page 26 of 29 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 27 of 29 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 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 29 of 29 - 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. 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