Care Home: Oakdene Rest Home

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What the care home does well The home had a relaxed atmosphere and was clean and tidy. Service users appeared contented and relaxed. Service user comments on completed surveys about what the home does well included `Listen to us` `The staff are friendly and always available. The food is excellent I think all is done well`. `Look after us well. Usually provides nice meals`. `The staff look after me very well, they are always there to help me`. `I have nothing to complain about. The meals are good`. Staff retention was high which offers a continuity of service to the service users. The home exceeds the 50% requirement of staff with NVQ level two or above. What has improved since the last inspection? Purchase of additional suitable activities for people with dementia for example memory cards. New staff have POVA checks, and further staff have been trained in safeguarding of vulnerable adults. A sliding door has been fitted in the conservatory to improve access. All radiators have been fitted with new protective covers and all sinks and baths now have thermostatic control valves installed to British Safety Standards TMV3. An outside area is now secure and ramps have been installed to take out any steps on the pathways. Several new armchairs have been purchased as have various carpets. A new very large screen television has been purchased. Management have had training from the Alzheimers Society, and Mental Capacity Act training is booked. What the care home could do better: Medication administration practice needs to be improved. All staff need to complete all required mandatory training for example Moving and Handling and Health and Safety. Key inspection report Care homes for older people Name: Address: Oakdene Rest Home 165 Minster Road Minster On Sea Sheerness Kent ME12 3LH     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: Sandra Crosby     Date: 0 4 1 1 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 27 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 27 Information about the care home Name of care home: Address: Oakdene Rest Home 165 Minster Road Minster On Sea Sheerness Kent ME12 3LH 01795874985 01795871704 Tracey.Gobbi@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Tracey Melanie Gobbi care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 26 The registered person may provide the following category/ies of service only: Care home only - 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 - OP. Dementia DE. Date of last inspection Brief description of the care home Oakdene is a large detached property providing accommodation on two floors. Oakdene is a residential service provider, providing care and support for up to 26 older people and or older people who have dementia. The owner manages the home, and she employs two deputy managers, 4 senior carers, 5-day care staff, and 5 nights care staff. In addition to this the home employs two cooks, 2 kitchen assistants, a housekeeper and a cleaner. The Registered Care Homes for Older People Page 4 of 27 26 0 Over 65 0 26 Brief description of the care home Owner/Manager, Mrs Tracy Gobbi has several years experience as a manager and owner of residential care homes for the elderly. Mrs Gobbi manages the home herself and deals with the day-to-day running of the establishment. The home is located on the main road in Sheerness (Minster on Sea). It is within walking distance of public transport, (bus) and has local shops and facilities nearby. The fees range from £342.85 to £520.00 per week. Care Homes for Older People Page 5 of 27 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: This service was originally registered to provide care for older people. Since 20th May 2009 the service has been registered to provide care for the additional category of dementia. A gradual change is taking place at the home in relation to the admission of persons who have dementia. Staff have received training for caring for people who have dementia and are currently putting this training into practice as the number of persons who have dementia on admission to the home slowly increases. This report contains the findings of the homes key inspection and takes account of information obtained from various sources since the last Key Inspection of 11th September 2007 together with the Annual Service Review dated 21st August 2008 and a visit to the home. The key inspection visit was unannounced and carried out on Wednesday 04th November 2009 between 10:00 and 15:00. During the inspection the inspector spoke Care Homes for Older People Page 6 of 27 with the registered person, staff on duty and people who use the service. Various records were seen during the visit, together with an accompanied tour of some areas of the premises. Information contained in the completed Annual Quality Assurance Assessment (AQAA), completed by the registered person was clear and informative. This information has been used together with information gained and observations made at the time of the inspection visit all of which has been used when completing this report. Eight service user surveys and eight staff surveys were sent to the home, six service user surveys and four staff surveys were returned before the inspection visit, and a further two service user surveys and three staff surveys have been returned at the time of completing this report. The aim of the visit was to carry out an inspection against the key standards of the National Minimum Standards for Older Persons in accordance with the Inspecting for Better Lives (IBL) process. Judgements have been made for each outcome area in this report and these have been made using the Key Lines of Regulatory Assessment (KLORA), which is guidance used to ensure that a fair and proportionate judgement is made in each outcome area. More information about KLORAs can be found on the Care Quality Commissions (CQC) website. The requirements made at the last inspection had been complied with. The findings of this inspection were discussed with the registered persons at the end of the visit, and overall indicate that this home is providing good quality outcomes provision for the residents and in line with CQC ratings agenda this service has achieved a good 2* rating. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 27 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 27 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 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the information they need to make an informed choice about moving into the home. Pre-admission assessments ensure that the home can meet the persons needs. People benefit from the opportunity to visit the home prior to admission to assess the quality, facilities and suitability of the service. Evidence: The revised Statement of Purpose and Service User Guide documentation was approved at the time of the change in registered category. These documents were seen on display on the noticeboard, and the registered person agreed to date the documents in order that evidence can be provided that these working documents are regularly updated. Five of the eight service user surveys returned confirmed that people had received enough information to help them decide if the home was the right place for them, before they moved in. Two surveys stated dont know and one survey stated no. Care Homes for Older People Page 11 of 27 Evidence: Each prospective service user in encouraged to visit the home prior to admission and to join the home in a meal. Four weeks after admission a review is usually held to ensure all parties are happy for the service user to remain. If the service user is funded by Social Services their care manager will be involved with the process. The home carries out a pre-assessment on each prospective service user prior to admission to ensure the home can meet their needs. Samples of these assessments were seen on residents files. The registered person has previously explained that normally herself and/or the deputy manager would visit the prospective service user in their current setting, be it at home or in hospital, to gather the relevant information. Relatives are asked to provide details of the life history of the person to enable a full picture to be drawn up, however sometimes this information is difficult to obtain. Part of the assessment process takes into account and identifies any social or cultural requirements and equality and diversity is part of the review process. The registered person said that she would be undertaking a pre-assessment visit for a prospective service user later in the day. Service user contracts/terms and conditions were seen as part of the care planning system. Four completed service user surveys confirmed they had been given written information about the homes terms and conditions and four stated dont know. The home does not offer intermediate care. Care Homes for Older People Page 12 of 27 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 do not fully benefit from care planning that shows that person centred care is promoted. Peoples health care needs are mainly met, as medication arrangements in the home may not always protect people. People can feel confident that they will be treated with respect and their right to privacy is upheld. Evidence: Each service user has a comprehensive care plan which details and gives guidance to staff on aspects of health, personal and social care needs. Although the care planning system includes all components as required by regulation, in light of the recent change in the registration category of the home, the benefits of a wholly person centred care plan approach was discussed. This would ensure that all the information about the person is collated and maintained in one place. Discussion took place with the registered person about the need for additional risk assessments to be implemented as appropriate to meet individual needs. Care Homes for Older People Page 13 of 27 Evidence: Records seen indicate that all medical needs are met, although information was found in places other than the care plan documentation and the registered person discussed actions taken for example telephone call to care manager who was going to visit and carry out a review, but confirmed that she had no written record to support this. The eight service user surveys confirmed that they always get the medical care they need. All service users are registered with a local GP and receive support from other health professionals as required. Chiropody is available at a cost to the service users. A local optician is also available. Six service user surveys confirmed that they always received the care and support they needed, and two stated they usually received the care and support they needed. Comments received included we are well cared for by the staff and they are always there to help me. The system for the recording of administered medication was seen and the MARS sheets showed that on the whole they were mostly appropriately signed and up date, however a number of gaps were seen. When looking at the records sight of a prescribed controlled drug was requested and seen. The medication was not in the blister pack but had been placed in a medicine pot ready to be administered that evening, with a piece of paper stating the medication and dosage. This does not promote good practice and was discussed with the registered person. The home does not have a controlled drug book, and the registered person said that she would address this issue. Only staff who have undertaken training administer medication. People feel their independence is encouraged and their privacy and dignity is respected. Staff were observed to always knocked on doors before entering peoples rooms. Care Homes for Older People Page 14 of 27 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 are encouraged to participate in a range of activities that suits their choices and preferences. People are supported to make choices enabling them to have some control over their daily lives. People are supported to maintain contacts with families and friends and are provided with a balanced and healthy diet. Evidence: The current levels of social activities in the home are fairly low, but most of the residents appear happy with this. Surveys returned showed that in answer to does the home arrange activities that you can take part in if you want, four replied always, two replied sometimes and two replied never. An activities programme was seen on the noticeboard and staff spoken with confirmed that for example bingo, painting, memory cards, floor games and videos are some of the activities undertaken. Comments from returned surveys include there are not many activities but there has been attempts in the past but most residents have shown no interest, and from staff surveys more time and staffing needed as the shifts can get busy and there is not time to sit and talk to the clients or participate in any activities and we have a lady come in her organization is called music for health and clients really enjoy it and they Care Homes for Older People Page 15 of 27 Evidence: join in. The service may wish to look to employing a dedicated activities co-ordinator to ensure service users find the lifestyle in the home matches their expectations and provides stimulation for persons who have dementia. The daily routines in the home are fairly flexible and service users say they can get up when they want and go to bed when they want, they mostly prefer to retire early. Families and friends are actively encouraged to maintain contact with their relatives and to be involved with their care where possible. The meals seen on the day looked appetising and all the service users spoken with were happy with the food. All said drinks were freely available and fresh fruit and vegetables were used where possible. Specialist diets are catered for. The eight surveys returned indicated that four people always liked the meals at the home, three stated usually and one stated sometimes. Residents and staff spoken with said that the food was good at the home and that alternatives were available. Comments from completed surveys included the food is excellent, the meals are good and usually provides nice meals. Care Homes for Older People Page 16 of 27 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. Concerns and complaints raised by people living in the home are taken seriously and acted upon. The home has robust adult protection policies and procedures to ensure that service users are protected from abuse. Evidence: The service has a comprehensive complaints procedure in place that ensures service users are protected at all times. The registered person stated that she would be proactive when dealing with any minor issues before they escalated to any formal complaints. The home has not received any formal complaints since the last inspection. Eight surveys returned all confirmed that there was someone they could speak to informally if they were not happy. Six surveys confirmed that people knew how to make a formal complaint and two stated no they did not know how to make a formal complaint. Residents and staff spoken with said who they would speak to if they had any concerns. The service also has a comprehensive Safeguarding of Vulnerable Adults policy in place and staff on duty were able to explain their understanding of the procedure. Staff spoken with confirmed that they had undertaken training in relation to the safeguarding of people. Care Homes for Older People Page 17 of 27 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 benefit from living in a clean, safe, well-maintained environment and have safe access to comfortable indoor and outdoor communal areas. People are encouraged to maximise their independence by having access to the range of specialist equipment supplied by the home. Evidence: Several bedrooms were viewed and these were comfortable and well decorated. Many have a range of personal items thereby ensuring the people have their own belongings around them. All of the residents spoken with were happy with their rooms and with the living areas. The home has a conservatory that doubles as a second dining area and a large lounge giving people ample communal space to compliment their private area. Comments from completed surveys include the rooms are compact and nicely decorated. The gardens are maintained with good provision for seating and the decoration is good. The service users have access to specialist equipment to assist with increased independence such as walking aids, wheelchairs, grab rails, hoists and stair lift. The home has purchased several specialist mattresses. One person has a specialist electronically operated bed and armchair. To aid recognition for people who have dementia, the home has provided laminated Care Homes for Older People Page 18 of 27 Evidence: posters containing words and pictures for the toilet doors and bathrooms in the home. The returned surveys all confirmed that the home is always fresh and clean. Care Homes for Older People Page 19 of 27 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. Systems are in place to ensure peoples needs are met by a mix of qualified care staff, however not all staff have undertaken all the required mandatory training The homes practice regarding the recruitment of staff ensures that people are protected Evidence: The staff rota was seen. It was indicated and confirmed by the registered person that the home aims to provide four carers on both the morning and afternoon shifts seven days a weeks, to meet the needs of the current twenty residents. Night staffing is adequate. It was reported at the last inspection visit that the homes recruitment procedure is robust and does protect service users. Staff spoken with confirmed that all the required information had been requested, that they completed an application form, references were taken up, and CRB and POVA checks were undertaken. Fourteen of the nineteen staff have completed National Vocational Qualifications, eight at Level 2, five at Level 3 and one at Level 4. The staff training matrix was seen, and indicated that training was ongoing at the home, and staff spoken with confirmed this. However, it was seen that not all of the Care Homes for Older People Page 20 of 27 Evidence: mandatory training was up to date for example some staff need to undertake Moving and Handling training and Health and Safety training. Care Homes for Older People Page 21 of 27 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 benefit from having a manager who is supported well by senior staff in providing clear leadership throughout the home and by staff who demonstrate an awareness of their roles and responsibilities. Sound financial procedures protect people The health, safety and welfare of residents and staff are promoted and mainly protected. Evidence: The registered person/manager has the necessary experience and qualification to run the service appropriately. The registered person also manages a nearby sister home. Both homes have experienced and well qualified deputy managers in post. Comments from staff surveys include I feel the home operates well. Staff and the manager always ensure the clients are well looked after and ensure their needs are met. Evidence gathered at this inspection indicates that the management approach is creating an open, positive atmosphere and staff say they feel well supported in the Care Homes for Older People Page 22 of 27 Evidence: home. A comment from a completed staff survey states I get good support and help from my manager and deputy managers, they are always there to talk and to get advice from. The registered person said that she normally carries out a yearly quality assurance exercise. This information needs to be collated together with any regular auditing that takes place in the home for example medication audits, together with information obtained at staff and resident meetings to form the yearly quality assurance report as required by regulation. One comment in a staff survey indicated the person would like more staff meetings. It was previously reported that the system for dealing with service users personal monies was accurate with records of monies received, expenditure, dates and signatures. Several accounts were checked and all balanced. Staff supervision was not assessed at this inspection visit, however staff spoken with confirmed that they received supervision on a regular basis. The registered person stated that all necessary health and safety checks and regular maintenance had been undertaken. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 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 1 9 13 The registered person shall 30/11/2009 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. To ensure protection and safety of services uses maintain appropriate records in relation to controlled drugs and do not dispense the medication from the blister pack until it is due for administration The registered person shall 31/01/2010 ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users Staff to undertake all mandatory training for 2 27 18 Care Homes for Older People Page 25 of 27 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 example Moving and Handling and Health and Safety in order to protect and maintain the safety of service users and staff 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 26 of 27 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. 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