Care Home: Oakdene

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What the care home does well All the people living at Oakdene have their needs assessed before they coming to live in the home to ensure the service will be able to meet their identified needs and preferences. People living there and relatives spoke highly of the manager and the staff and the care and support they received from them. Staff spoken with and those observed demonstrated an awareness of people as individuals and had a good rapport with them. There is a care planning system in place that generally puts the individual at the centre so they can be part of planning their care with help from their families or advocates if appropriate. Oakdene has a relaxed and homely atmosphere and visitors we spoke to said staff made them feel welcome in the home. One visitor told us the admission process was "good" and they found the home "small and personal". They were pleased that they had been able to personalise their relatives room ready for their arrival. People living there are able to bring in their own things to make their rooms more personal and those bedrooms we saw had people`s own possessions and items of significance to them. Although this is not a large home there is a good level of social activity that people commented positively on. A senior carer now oversees the activities and staff have been working well with people to provide meaningful activities suited to their abilities and preferences inside and outside the home. People living there said how much effort the staff put into these activities and trips and how much being able to take part in the outings and group activities meant to them. Staff receive suitable training to provide the care people need and the with the manager deliver a good general standard of care. The manager makes sure the recruitment procedures are followed for any staff and the thoroughness of pre employment checks means people living there can feel confident the service tries to make sure they get the right staff to work with vulnerable people. The home has comprehensive systems in place to monitor quality against the national Minimum S tandardsand this helps to make sure that overall performance is being monitored and areas for improvement can be highlighted for action. What has improved since the last inspection? There have been improvements in the care planning since the last inspection and include a personal profile and more information about the person, on what people wanted and how they preferred to be cared for and their backgrounds and interests . helps to develop and promote a more person centered approach to care and activities. Due to staffing issues last year the opportunity people had for trips out was reduced and these were not taking place as people wanted. Improvements in the stability of the care staff levels have meant that people have been able to take trips out and have appreciated this improvement in the services available to them. The provision of activities within the home has also been improved with input from people living there reflected in the programme. a new senior carer has been employed and has been overseeing activities and the implementation of person centered care planning. The new administration assistant has also helped with making sure administration is up to date. Improvements have been made to environment within the home. The kitchen has been completely redecorated to improve the working environment and two bedrooms have been redecorated and re carpeted to make them more pleasant for the people using them. the providers have also installed a new hot water cistern to improve this aspect of plumbing for people living there. the exterior of the home is also due for redecoration and upgrading of the garden. These are being done following audits of the premises identified the need. What the care home could do better: We did not make any requirements under regulations at this visit. We did make some good practice recommendations that the manager needs to give serious consideration to in order to maintain standards and good practice in the home. Generally medication systems were found to be effective and safe. To increase safe practice the manager should consider using a system for staff to check and confirm any handwritten changes to medication record charts. this is to reduce th risk of errors in writing the changes. When administering `as required` medicines for specific needs care staff need to have information and guidance or `protocols` for their use to make sure they give them only when needed. The medication is stored in the kitchen area and we recommend that the manager should find an more appropriate place for safe storage of medicines so that products are secure and not damaged during storage by changes of temperature or humidity in this area. Medicines should also be stored securely when being taken around the home by staff for administration to people. This is to make sure that in the event of an emergency people`s medicines can be secured quickly. Generally people were satisfied with the food provided. However for better food hygiene we recommended that when taking meals out to people eating in their rooms staff use plate covers to keep food hot and covered in transit. Staff are given training in infection control but we observed an episode of poor practice in this respect. We recommended that the manager ensures that all staff understand and are familiar with the infection control policies and procedures used in the home and that their training is up to date to reflect best practice for both care and domestic duties. As staff now take more responsibility for domestic tasks in the home the manager should consider a more frequent formal audit system for monitoring standards of cleanliness regularly to make sure standards do not slip. This is especially important if the number of people living there goes up from the present level. We recommend the manager keeps under frequent review the dependency of people living in the home, the numbers living there, the roles staff fulfill, the training required to fulfill their roles to make sure there are sufficient competent staff at peak times of activity in the home to meet people`s needs in a person centered way. Where care staff are to undertake domestic duties they should have appropriate training in place to make sure they are competent to fulfill that role and to ensure safe working practices are maintained in their new responsibilities. Key inspection report Care homes for older people Name: Address: Oakdene 21 Kendal Green Kendal Cumbria LA9 5PN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marian Whittam     Date: 1 5 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Oakdene 21 Kendal Green Kendal Cumbria LA9 5PN 01539723396 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Kendal Care Limited care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 19. Date of last inspection Brief description of the care home Oakdene is a care home providing care for 19 residents over the age of 65. The home is in the residential area of Kendal Green and is owned and run by Kendal Care Limited. The extended house overlooks a large green surrounded by trees. The bedrooms at the front of the house have attractive views of the green and over the rooftops of Kendal towards the surrounding hills. The home is approximately a mile from the town centre with the shops, banks and other amenities. The home has a communal lounge, dining room and a small conservatory. The kitchen is in the basement area of the home. There is a small front garden area with some Care Homes for Older People Page 4 of 31 Over 65 19 0 Brief description of the care home seating for residents. The laundry is outside the home, away from bedrooms, food preparation and dining areas. There have been extensions to the rear of the property on two floors and three of the four floors of the property have residents rooms on them. The home had a passenger lift from the ground to the upper floors. Fees payable at the home are 398 pounds to 423 pounds a week as at the time of the visit. There are additional charges made for hairdressing, personal toiletries newspapers and magazines. The home makes information about its services available through its service user guide and statement of purpose and inspection reports. These are available within the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for Oakdene Residential Home is 2 star. This means that the people who use this service experience good quality outcomes. This site visit to Oakdene forms part of a key inspection. It took place 15.07.09 and we (CQC, The Care quality commission) were in the home for five and a half hours. Information about the service was gathered in different ways: 1. We sent an Annual Quality Assurance Assessment (AQAA) form to the home and this was completed by the manager Mrs Cath Carradice and returned by the date requested. The AQAA is a self assessment and a dataset that is completed annually by all providers of registered services. It is one of the ways we gather information from the providers of services about their service and how they believe they are meeting outcomes for the people living there and using their service. The AQAA also gives us statistical information about the individual service and trends and patterns in social Care Homes for Older People Page 6 of 31 care. 2.We sent out surveys to people living at Oakdene and to the staff who work there to get their views on living and working in the home. We also sent out surveys for people living there to give to their family and friends if they wanted to so they could give their views too. 3. We looked at all the information we have about the service, any changes the Providers have made and how the manager has dealt with any complaints or safeguarding of vulnerable adults issues. 4.We looked at what the manager has told us about things that happened in the service, these are called notifications and are a legal requirement. 5.We looked at the previous key inspection and any calls or visits we have made to the home since their last inspection. We looked at any relevant information we had received from other agencies and organisations and any written comments people have made to us. 6. We spent time talking to people who live there and during the day to see what happens during their day and see what they think about the way the home is run for them. During the day we spent time talking with people living at Oakdene and visitors, in the lounge and also in private. We looked at care planning documents and assessments to make sure that people received the level of care they needed and expected. We made a tour of the premises to look at the environment people lined in and what facilities were available to them. We also looked at staff training and recruitment files and a sample of records and safety assessments required by regulation. As part of this key inspection we assessed the handling of medicines through the inspection of relevant documents, storage, and meeting with the manager. The last key inspection visit to Oakdene was on 31st Otober 2007. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? There have been improvements in the care planning since the last inspection and include a personal profile and more information about the person, on what people wanted and how they preferred to be cared for and their backgrounds and interests . helps to develop and promote a more person centered approach to care and activities. Due to staffing issues last year the opportunity people had for trips out was reduced and these were not taking place as people wanted. Improvements in the stability of the care staff levels have meant that people have been able to take trips out and have appreciated this improvement in the services available to them. The provision of activities within the home has also been improved with input from people living there reflected in the programme. a new senior carer has been employed and has been overseeing activities and the implementation of person centered care planning. The new administration assistant has also helped with making sure administration is up to date. Improvements have been made to environment within the home. The kitchen has been completely redecorated to improve the working environment and two bedrooms have Care Homes for Older People Page 8 of 31 been redecorated and re carpeted to make them more pleasant for the people using them. the providers have also installed a new hot water cistern to improve this aspect of plumbing for people living there. the exterior of the home is also due for redecoration and upgrading of the garden. These are being done following audits of the premises identified the need. 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 Care Homes for Older People Page 9 of 31 order line 0870 240 7535. Care Homes for Older People Page 10 of 31 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 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are admission and assessment procedures in place to help make sure that people have information about the home before they live there and that their assessed care needs can be met when they do come into the home. Evidence: The service has an up to date and Statement of Purpose and service user guide that is available to current and prospective users of the service. Copies of the last inspection reports are also available for people to read if they wish. People we spoke with during the visit, and their returned surveys, indicated that people felt they had sufficient information about the service before coming there to live. People considering moving into the home and their families may visit the home and look around if they want to. We spoke to visiting relatives who confirmed they had visited before admission and looked at available rooms and had the opportunity to help prepare their relatives room ready for their arrival from hospital. In this way the room could be made more personal with their own things from home before the person arrived. The relative told Care Homes for Older People Page 12 of 31 Evidence: us, it was a good admission and staff gave her relative lots of attention and that their relative thought they must have come on holiday. They told us that they had looked at other homes before deciding on this one because it was small and personal and that suited their relative. They praised the effort being put into activities by senior carers and had been pleased to see their relative getting out on trips, baking and painting and drawing. We looked at the pre admission assessments of 3 people in detail to see if their individual needs had been assessed before admission to help ensure that the home would be able to met their needs when they came in. The records on file indicated that the manager had done an assessment of their individual needs before people come to live there. The information was in sufficient detail and covered relevant areas of assessment to begin developing a plan of care with someone. Where people had been assessed by social services the care management plans from assessing social workers were on file for these people. The service develops its initial care plans from this information before and at admission and also has an introductory period followed by a review with the individual to help make sure they are satisfied and that the service is meeting their needs. We saw that residents files contained copies of terms and condition of residence and the homes contracts with the purchasing agencies. The terms and conditions outlined peoples rights and responsibilities. The service does not provide intermediate care. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Oakdene receive the care and support they need in a way that meets their expectations. Evidence: The service has individual care plans for people living there based on initial needs assessments and risk assessments. The plans set out assessed health, personal and social care needs and have been reviewed and updated where needed. There have been improvements in the care planning since the last inspection and now include a personal profile and more information about the person, on what people wanted and how they preferred to be cared for and their backgrounds. We asked people living there about their care and the support they received from staff. People we talked with made positive comments about their care, including, I am content here, they look after you well enough and Its very well here for making sure folk have got what they need. From what we saw of positive staff interaction during the day and what people told us about living there the indication is that people feel generally well cared for and supported by staff. Care Homes for Older People Page 14 of 31 Evidence: We looked at the care plans and 3 peoples care plans in more detail and found their plans covered information for staff on moving and handling needs, skin condition, mobility, nutrition, personal care, continence, communication and information on specific conditions and needs. Appropriate equipment to prevent pressure sores is in use and effective nutritional screening is being done with weights recorded and monitored. We examined medication policies and procedures, the storage, recording and handling of medicines kept for people in the home. Our checks of the records and current stock showed that medicines were being given to people properly and accurate records were being made. No one living there was having controlled drugs but the service has suitable storage and recording systems in place when needed. The home has a monitored dosage system for handling peoples medicines and the pharmacy provides printed medicine administration record Sheets (MAR). Sometimes charts have to be written out for new residents or changes made to charts by hand. We recommended to the manager that for additional safety it is good practice to have a system to check that the details copied are correct. This helps reduce the risk of someone writing the changes down incorrectly. Currently no one living at Oakdene has chosen to administer their own medicines and peoples medicines are stored centrally for administration by staff from the monitored dose packs. Staff have received in house training on this medication system and take the monitored dosage system packs out to give the medicines to the people living there when they are due. Medicines are currently stored in the kitchen area and we discussed with the registered manager the need to make sure medicines are stored in the right place and that when they are being transported about the home it is done in a safe and secure way. Kitchens are not ideal places to store medicines, it may be too damp or too warm and temperatures cannot be adjusted. We recommended that the manager find an more suitable place for safe storage that is big enough, well constructed and has a good quality lock. This will ensure safe storage so that products are not damaged during storage and are also secure. We also recommended that medicines are always stored securely when being taken around the home for administration to people. This is to make sure that in the event of an emergency peoples medicines can be secured quickly. This complies with safe and best practice in line with Royal Pharmaceutical Society Guidance and the manager agreed these would improve their facilities. There were storage facilities for the small quantities of medicines that need to be refrigerated and the temperatures for this were monitored. We saw some medicines people take are meant to be taken occasionally for a specific need such as tablets for pain or constipation. These are as required medicines and Care Homes for Older People Page 15 of 31 Evidence: care staff need to have clear instructions or protocols for their use and what they are intended to do to make sure they are given them only when needed. We found some examples of good practice in the handling of medicines where doses of medicines are not constant but depend on the results of blood tests. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Oakdene can exercise choice and have support to meet their expectations and preferences in their daily lifestyles. Evidence: We saw from our observations during the visit, from surveys we got back from people living there and from records and speaking to people living in the home that there are opportunities available to take part in a programme of organised activities and social events. The activities programme is on display in the foyer and following the residents meeting an activity planner for the year. During the visit we saw staff spending time with people in the lounges in the morning chatting with people. The television was not on and people were able to talk and some people were doing puzzles, reading their newspaper. Care staff were seen leading an exercise session during the afternoon. One person told us They are a good bunch of girls, we have a good laugh. We looked at the activities programme, individual records, survey responses and asked people and relatives about activities provided. From this it was evident that there are now more planned social outings and activities on offer. People we talked with who had been on these outings told us about the places they had been and that they had enjoyed the visists. One person told us of their recent visit to Bowness and Care Homes for Older People Page 17 of 31 Evidence: that they had a lovely time and had fed the ducks and had a big ice cream. This is an improvement for people as trips out had stopped when the service had an earlier period of low staffing. Some people we talked to preferred not to take part in organised sessions and did not have to do so. One person told us I am rather independent, if I want something I will ring the bell . One person had wanted their own kettle to make their own drinks as they wanted in their room and following risk assessment they were able to do this. The activities people had chosen to take part in were recorded and information on their preferences and what they wanted to do was in their care plan for reference and use. The home provides better opportunities for people to take part in religious observance than at the last visit with access to their own church, priests or ministers. There is now a regular multi denominational church service and holy communion for those who want it. We talked with a relative who was visiting and they told us they were made welcome by the staff and that they felt at home here . They felt they could speak to staff and were kept informed about any changes that would affect their relatives or their care. All the care plans we looked at had a personal profile and social assessment and preferences for people. We observed that staff spoke to people in a calm and kindly manner and asked them what they wanted. We visited the kitchen and spoke with the manager who now does the cooking and looked at the menus in use. The kitchen was clean and tidy and the service had achieved a 5 star rating from their last environmental health assessment. Since the cook left the manager has done the cooking and planned menus. The menus we saw and the food we saw being served to people at mealtimes was nutritious and from what we could see and what people told us was well presented and hot when served. The meals are put out in the kitchen and taken to the dining room at their table. We recommended that when taking meals out to people eating in their rooms staff use plate covers to keep food hot and covered in transit. Lunch time was an unhurried and calm occasion and a small number of people did need encouragement or assistance with their meal. The service did cater for therapeutic diets such as for people with diabetes and kept a record of what they served to people. Staff go around during the afternoon to ask people what they wanted for the next day. People told us that there was usually one main meal provided on the menu but if they did not like this or wanted something different they could have it. One person told us The food is alright, with any number of people you are going to get one who doesnt like it. They told us they had once complained about the cheese on toast they had asked for being burnt and it was taken away and replaced straight away. Care Homes for Older People Page 18 of 31 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 living at Oakdene know how to raise concerns and make complaints and are confident that their concerns will be listened to. Evidence: The service has a complaints procedure and this is displayed in the foyer and in the service guide. Survey responses from people living there and what they and visitors told us during the visit indicated that people do know the process for making a complaint. One relative who was visiting told us they knew who to speak with to make a complaint but said, I cant fault anything. People living there we spoke with confirmed they knew how to make a complaint if needed and surveys also indicated this. One person who had lived there some years told us, I have never needed to make a complaint as such, if i am unhappy about something I tell Cath (Manager) and she will sort it out. There have not been any complaints logged as made directly to the manager since the last inspection received in the last year. A concern was received via social services and the service provided the information they asked for. The home has information available on advocacy services and some people have advocates acting for them as well as families and legal representatives. There are procedures in place on financial arrangements and the service will keep small amounts of spending money securely for people if they want this. This is recorded for each person and receipts kept. the service also has clear guidance for staff that prevents involvement in peoples wills Care Homes for Older People Page 19 of 31 Evidence: and on the giving of gifts to staff to promote peoples best interests. There have been no referrals made under safeguarding vulnerable adults procedures. There are adult protection procedures and guidelines in place to help protect the welfare of people living there and these have been reviewed. There are copies of the local multi agency guidance on safeguarding vulnerable adults available for staff to refer to. The procedures are clear and training records show that staff have been given training on safeguarding vulnerable adults and recognising what abuse may be. This should help staff be aware and act quickly should they suspect abuse. Staff we spoke to and their survey responses indicated that they knew what the procedures were should a situation arise that needed referring to other agencies for someones protection. The home has whistle blowing procedures in place for staff to report concerns about the practices of colleagues and managers. Care Homes for Older People Page 20 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Oakdene enjoy a homely, suitably adapted and comfortable environment but a lack of formal monitoring of staff infection control practices and cleaning could affect peoples welfare. Evidence: We made a tour of the building, including the laundry and kitchen, and the areas used by people living there. We found that the home was being maintained and we saw that records are kept of any maintenance work needed and done and all water testing. The lounge and dining areas were clean and homely with appropriate lighting and seating suited to peoples different needs. These areas are used by people living there for their social activities as well and we saw this during the day. There is also a small conservatory area away from the main lounges and dining room for people to use. There is a programme of testing of lighting, alarms and safety equipment and records are kept. There is a planned programme of refurbishment and the kitchen has recently been redecorated and improved to improve the catering facilities for people living there. Two peoples bedrooms have been redecorated and had new carpets fitted to improve their personal rooms and people were happy with the redecoration. The providers have also made improvements to the hot water system replacing old equipment with new and more modern ones for increased effectiveness and efficiency for people living there. Over the next year the plan is to have the exterior of the home Care Homes for Older People Page 21 of 31 Evidence: overhauled and improve the garden area for people living there as well as regular maintenance. There was a satisfactory standard of decoration throughout the home and it was clean and fresh with no lingering odours evident. The home does not have dedicated domestic staff but day and night care staff staff have a cleaning rota. Staff sign when a task has been done. If it has not been possible to do any tasks it is that highlighted so it does not get missed. Night staff clean areas that cannot be cleaned during the day, hall, lounges and dining room. Day and night shifts do the laundry and ironing and all staff are responsible for making sure the laundry is kept clean and tidy. Four days a week all rooms are dusted and polished. All staff empty bins when they are in peoples rooms and make sure stocks are maintained of soaps and cleaning items. We asked people living there and visiting the home about cleanliness and the general environment to get their views on the cleanliness and if they were happy with the current arrangements. One person who had lived there for some years told us Its generally clean and tidy, my toilet is clean, a carer comes in to do it, then another one hoovers. They used to have a cleaner but the carers do it now and they do a good job. A visiting relative told us Its an old house but the rooms are clean and there are no smells I have noticed, it suits my mum, its homely and she likes that and she has a lovely bedroom. Survey responses from people living there and our observations of standards of cleanliness in communal areas and bedrooms supports this view. However, although the system seems to be effective at present, there is potential for tasks to get missed and standards of cleanliness to drop. The service includes in it annual audit the premises and cleanliness and consults people living there about this. We recommend that in addition to an annual quality assessment the manager consider a more frequent formal audit system for monitoring standards of cleanliness regularly to make sure standards do not slip.This is especially important if the number of people living there goes up from the present level or levels of dependency increase and staff need to support more physically frail people. There are policies and procedures in place for infection control. Training records indicated that staff have previously been given training on infection control and are due for refresher training to keep them up to date. When we arrived at the home in the morning a staff member opened the door to us wearing the protective gloves and aprons used in personal care. This protective equipment is to protect both the carer and the person having personal care needs attended to from cross infection. These should be removed if the carer needs to leave personal care to attend to something or someone else. Gloves and aprons are single use items for one procedure or episode of personal care and should be discarded as clinical waste to maintain good infection control procedures. We discussed with the manager that this poor infection control Care Homes for Older People Page 22 of 31 Evidence: practice could put people at risk from infection if procedures were not being followed by staff. We recommended that the manager ensures that all staff understand the infection control policies and procedures used in the home and that their training is up to date to reflect best practice. This is especially relevant as care staff also do domestic tasks and must apply good hygiene principles in both areas to reduce any risks from cross infection. All the bedrooms in the home are single and some have en suite toilets. There are also separate toilets, shower facilities and bathrooms with assisted baths for people to use according to need or preference. The bedrooms we saw were comfortable, appropriately furnished and decorated. People living there had been able to personalise their rooms with their own things and items of importance to them. This made them more homely and individual. There are hoists for moving and handling equipment to help people with mobility and independence according to assessed needs and a passenger lift to help people get around the home. These had been serviced to make sure they are working properly and safely. Care Homes for Older People Page 23 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are clear recruitment systems in place but the new staffing structure is not being based upon person centered outcomes for people living there and that may have an effect on their daily lives. Evidence: We looked at staff rotas and spoke with people living there, their visitors and staff about staffing levels in the home. We saw that there were two care staff on duty throughout the day for the 13 people living there and 2 carers came on night duty. Generally people living there felt staff were available when they needed them but occasionally they had to wait. The staff rotas were clear and showed who was on duty and in what capacity and indicated that usually the home has adequate care staff to make sure peoples personal needs can be met at current occupancy levels. There had been a period when staff turnover was high and the manager struggled to recruit staff locally. By recruiting overseas and taking on part time staff the manager has improved the stability of the staff levels. This improvement has allowed the service to plan better for social activities and trips out as staff are more consistently available. The Providers did not replace the cook and domestic cleaner when they left but made changes in their work patterns to accommodate this. The registered manager now undertakes cooking and rotas show this is separate to other care and management duties. The manager has effective administrative support from an administrative assistant and the responsible individual to make sure office and administrative Care Homes for Older People Page 24 of 31 Evidence: systems are maintained. We discussed the systems in place for care staff to attend to domestic tasks and how the home made sure this did not compromise personal care and that standards of cleanliness were always maintained given that care staff must prioritise personal care and support. Although there was no evidence that the outcomes for people living there in regard to care and cleanliness are not adequate at present we were aware that this new staffing structure is not one focused and based upon the needs and routines of individuals. This may undermine the managers attempts to develop more person centered approaches to care. Staff are clear about what their responsibilities are and incorporate some domestic tasks as part of general care with people. However there was no evidence in staff training or from speaking with the manager that care staff had been given the training to ensure they were competent to undertake the domestic tasks, use equipment and to ensure safe working practices for staff taking on these new responsibilities. We looked at staff personnel and training records and spoke with staff about their training and recruitment experiences. Records indicated that the service followed robust recruitment procedures to safeguard people living there and made all required checks. Staff survey responses also indicated the recruitment was thorough. Individual records of training are kept and the service has a programme of training. Staff have induction before they start work and records show NVQ Level 2 training is well established and supported and over half the staff have already done this training. the manager has a plan for training and this helps make sure mandatory training is not missed. The plan showed that all staff are due to have a refresher course on handling medications to keep them up to date. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Oakdene are consulted about the way their home is run for them and effective quality monitoring helps make sure problems can be identified early to improve the lives of people living there. Evidence: The home is effectively managed by the registered manager, Mrs Carradice, she has the appropriate qualifications and experience to fulfill her role and undertakes periodic training with staff to maintain her knowledge and skills. Staff we spoke to and staff surveys indicated that they found the manager approachable and that they received support and supervision to carry out their duties. Records are kept of training done and supervision meetings. There are regular residents and relative meetings and records are kept of these and the topics discussed and what people living there wanted. The home also has an annual satisfaction survey to get peoples views on the service and help measure their success in meeting their objectives. The manager and responsible individual also Care Homes for Older People Page 26 of 31 Evidence: complete an annual audit across the service based on the National Minimum Standards to monitor quality in the home and see what areas need improving or if changes to policies and procedures are required. An improvement plan is developed to address any areas highlighted in the audit. The audit had highlighted the increased staff turnover and the reasons for this and staff feed back when they left. The premises audit highlighted what areas needed re carpeting and that the garden areas needed upgrading. These matters are being addressed as part of annual maintenance planning. We looked at the last satisfaction survey done in May this year, which were positive. This included peoples opinions on the cleanliness of the home, food and personal support. One person had commented that it was a lovely place to live and they were Lucky to have found it. We looked at the procedures and records for finances and spoke with the responsible individual on the handling of personal finances. These were in good order and small amounts are money are kept securely for people if they want this. Records and personal information about people living in the home are being kept securely. We found from training records and from staff surveys that staff have received training updates on safe moving and handling, first aid, nutrition and fire safety.The fire safety equipment is serviced under annual contracts and records for lift and hoist servicing were up to date. There was a fire risk assessment completed this year and fire alarms and detectors, emergency lights are regularly tested. The call system has been checked regularly as were the water temperatures. This was evidenced by the records of regular fire checks, emergency equipment checks, fire drills and training. Care Homes for Older People Page 27 of 31 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 28 of 31 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 1 9 The manager should find an appropriate place for safe storage of medicines so that products are secure and not damaged during storage and are also stored securely when being taken around the home for administration to people. This is to make sure that in the event of an emergency peoples medicines can be secured quickly. For administering as required medicines for specific needs care staff need to have information and guidance or protocols for their use to make sure they give them only when needed. When medication record charts have to be written out for new residents or changes made to charts by hand there should be a system in place for staff to check and confirm that the details copied are correct. We recommended that when taking meals out to people eating in their rooms staff use plate covers to keep food hot and covered in transit. The manager should consider a more frequent formal audit system for monitoring standards of cleanliness regularly to make sure standards do not slip especially if the number of Page 29 of 31 2 9 3 9 4 15 5 26 Care Homes for Older People 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 people living there goes up from the present level. 6 26 We recommended that the manager ensures that all staff understand and are familiar with the infection control policies and procedures used in the home and that their training is up to date to reflect best practice for both care and domestic duties. We recommend the manager keeps under frequent review the dependency of people living in the home, the numbers living there, the roles staff fulfill, the training required to fulfill their roles to make sure there are sufficient competent staff at peak times of activity in the home to meet peoples needs in a person centered way. Where care staff are to undertake domestic duties they should have appropriate training in place to make sure they are competent to fulfill that role and to ensure safe working practices are maintained in their new responsibilities 7 27 8 30 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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