Care Home: Oakfield

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What the care home does well There is a good amount of information made available for people to find out about the home and if the service could be right for them. Residents needs are being met by kind, caring staff and care plans show clearly the help and support that people require. Residents can take part in a range of social and therapeutic activities. Residents are provided with a well cooked well balanced diet. Staff are offered a good range of training to make sure they can do their job effectively. The home is well run and is run with kindness. Mrs Drewe is a thoughtful and very experienced manager. What has improved since the last inspection? We did not set any requirements at the last inspection. What the care home could do better: Make sure that the home is free from unpleasant odour in all areas. This is for peoples health and well being. Key inspection report Care homes for older people Name: Address: Oakfield Weston Park Bath Bath & N E Somerset BA1 4AS     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: Melanie Edwards     Date: 0 6 0 9 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 25 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 25 Information about the care home Name of care home: Address: Oakfield Weston Park Bath Bath & N E Somerset BA1 4AS 01225335645 01225336498 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Acegold Limited (a wholly owned subsidiary of Four Seasons Health Care Ltd) care home 28 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 28 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Oakfield is a converted older property, which provides nursing care for up to 28 people over 50 years of age . A short distance from Baths city centre. Oakfield is located in the leafy, Victorian suburb of Weston Park. The accommodation is provided on three floors, all served by a lift, and comprises both single and double rooms. Fees range from around 500 to 600 pounds per week. 0 Over 65 28 Care Homes for Older People Page 4 of 25 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: We were able to meet fourteen of the twenty six residents living at the home. We spoke to the deputy manager, a nurse, three care assistants and a cook about roles, responsibilities, training needs and the way that they help residents. We saw staff help residents with their needs. We saw lunch being served. We saw a selection of records relating to the running and management of the home. The records we saw included, the service users guide, the statement of purpose, information about social activities, menus, the complaints procedure, the record of complaints, training information, the staff duty rota, finance information, quality assurance information, accident records and health and safety information. Care Homes for Older People Page 5 of 25 We read three residents care records and care plans. We saw most of the environment and the only parts we did not check were a small number of bedrooms. We found the home was operating within the required conditions of registration which we impose. The conditions of registration detail the type of care and the needs of residents and the numbers of residents who may stay at the home. Care Homes for Older People Page 6 of 25 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. 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 7 of 25 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 8 of 25 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 can get hold of a good level of information to help them decide if the home is suitable for them. Residents range of nursing and personal care needs are properly identified and are assessed. Evidence: To find out about what type of information is available for prospective residents and their representatives to find out about the home, we read the statement of purpose and the service users guide. The residents have their own copy of the service users guide so they can find out about life in the home. We saw colour photographs of the home to show what daily life is like there. We saw in the service users guide information about the service provided, qualifications of the staff and the accommodation that residents can expect. The statement of purpose includes the Care Homes for Older People Page 9 of 25 Evidence: philosophy of the home and how the service aim to meet residents needs. The complaints procedure is in the service users guide so that people know how to complaint. There is a website that has a lot of useful information on it about the home and the services provided. We read some helpful information in the AQAA document about how people are helped to make a choice about the home and we have quoted this extract:We ensure that all enquirers are given as much time as possible to ensure that they feel all their answers and or doubts have been addressed the information we give upon their first enquiry is comprehensive. We also ensure that residents and their families are treated on an individual basis and are given the time needed to ensure their needs are met. We looked at three of the residents nursing assessment records, to see how well needs are identified and then how the help they need is planned and put in place. We found the assessment records that we saw were informative and they set out the residents range of physical, mental and social nursing and personal care needs. We also saw that the actions taken to support the person had been recorded in the assessment records. The assessment records we saw were being regularly reviewed and updated. The staff talked to us about how residents needs are assessed. They explained that the home has a key worker system. They told us a nurse and a small group of care staff will be allocated to take specific responsibility for building up a really good relationship with the resident. The home does not provide intermediate care for residents. Care Homes for Older People Page 10 of 25 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. Residents needs are met and care plans contain enough information to help demonstrate how people are being supported and cared for. Residents medication is looked after safely. Residents are treated with respect and their privacy is maintained. Evidence: In the AQAA document it says when referring to how health and personal care needs are met: The care staff are now taking the responsibility of the residents care and where it may need updating talking to the registered nurses. Four Seasons have changed the way the care plans are filed in which has helped us to encourage to staff to be more proactive. This is good evidence to show how the home aim to improve standards even more. The residents who we spoke to said that staff are really helpful when they assist them Care Homes for Older People Page 11 of 25 Evidence: with their needs. One person said, Ive got no complaints the staff do an excellent job, another comment made was , Im more then satisfied, when talking about the care and the service from the staff. We saw the staff assisting residents in a polite and friendly manner. We saw the staff knock on bedroom doors before they went into them to maintain residents privacy. We read three residents care plans to find out more about how residents are supported by staff to meet their nursing and personal care needs. We found the information in the care plans was helpful and explained to us how to meet the health care needs of each resident. The care plans set out what actions staff must follow to help the resident to meet their needs and live their daily life to their maximum potential. We saw that care plans are being reviewed and updated regularly by registered nurses. This helps to show residents needs are being monitored and can continue to be met in the home. We read some detailed and helpful information in residents care plans which demonstrated residents are well supported with their physical health care needs by the GPs, the dentist and the chiropodist. We also read some detailed nursing needs assessments records. These showed how residents physical health care needs are assessed by the nurses and they are closely monitored and reviewed on a monthly basis. This is a really effective way to check on residents overall health. We checked the practices and procedures for administration storing and getting rid of residents medication to find out if the home has safe systems for handling medication. We looked at six medication administration charts in detail. We saw a photograph of each resident kept with his or her administration chart to help staff give out medication safely. We found that medication stock was generally satisfactorily organised and administration charts were being kept up to date. We checked and found that there is a satisfactory system for ordering and receiving medication and the records were up to date. Medication stock was stored in a metal cupboard which is kept in a locked room. A locked movable metal trolley is used to take around the home to give out medications. When giving out medicines to the residents, the nurses have started wearing a tab-bard with writing printed on stating they should not be disturbed. The deputy manager told us this helps to make giving residents medication an even safer process. Care Homes for Older People Page 12 of 25 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. Residents can do a range of social and therapeutic activities. Residents are supported to exercise choices in their daily lives. Residents can enjoy a well balanced diet. Evidence: In the AQAA document there is some useful information about residents daily life and social activities and we have quoted this extract:We allow for all our residents individual needs and actively encourage staff to spend time with the residents on a one to one basis. Our residents are all content with the care they receive and actively join in on our activities schedule. Residents benefit from a range of activities put on by the activities coordinator who works for four days a week. We saw a timetable of social activities on display in the entrance hall of the home. We also saw some photos taken at a recent musical afternoon with a musical duo. The residents looked as if they had had a really good time at this event. Activities that are planned to take place include film afternoons, Care Homes for Older People Page 13 of 25 Evidence: bingo, board games and musical afternoons. A group of residents were watching a film together in the lounge in the afternoon. There is also a mobile library with a range of larger print books for residents to read. As we saw at the last inspection,the home has two cats which are a source of obvious pleasure for residents based on their comments. We saw residents receiving visitors during the morning. We were told that the home have a relaxed visiting policy and people can come to the home when they like. We were told that residents can have a meal in the home with their visitors if they want to. This is a really good way to help residents and the people who matter to them to keep in contact. We saw residents talking with the staff, they looked really relaxed and settled in their surroundings. We also noticed that residents got up at different times during the morning. This tells us residents can make choices in their daily lives. We also saw the residents menu records and these showed that residents are asked what meal options they would like on a daily basis. This is another way to offer residents choices in their daily lives. The home has a hairdresser who visits regularly who cuts and sets hair while residents are at the home. We ate a portion of the lunchtime meal. The lunch was a choice of roast lamb, roast and mashed potatoes with two cooked vegetables or omelettes. There was a homemade sponge with custard for dessert. The meal was tasty and well presented. We saw staff serving meals to residents and assisting some people. The staff were polite and patient when helping the residents with their meals. We saw the daily menu on display in the dining room to assist residents to know what meals are on offer that day. We saw the cook asking the residents what meal choices they would like for the following day. The residents menu choices that we saw looked well balanced and traditional. Residents can make a choice of what meal they would like to have. The residents who we met were really positive about the quality of the meals that they have at the home. Care Homes for Older People Page 14 of 25 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. Residents are well supported to make complaints and these are dealt with well by Mrs Drewe. There are good systems in place to protect residents from abuse. Evidence: In the AQAA document it explains how complaints are addressed and we have quoted this extract as we think the information is very helpful:We deal with all complaints on the day which they are received and ensure that a swift resolution is done. All staff have training on protection when they undertake their induction and National Vocational qualification in care training. We saw a copy of the complaints procedure in the reception area. The procedure includes our details for anyone who wishes to contact us. The contact details of a senior manager are in the complaints procedure, if people wish to contact them directly to make a complaint. The residents we met told us they would make a complaint to Mrs Drewe or the nursing staff. We were told by residents that the nurses and Mrs Drewe are interested in their concerns and complaints and take them seriously. This helps to demonstrate the home welcomes and responds positively to complaints. Care Homes for Older People Page 15 of 25 Evidence: The staff on duty told us they are provided with training in understanding the subject of keeping people safe from abuse. The company have their own in house training programme on the subject of the protection of vulnerable adults. There is an up to date policy in place relating to the issue of protection of vulnerable adults from abuse. There is also a copy of a guidance document published by the Department of Health about the protection of vulnerable adults. Care Homes for Older People Page 16 of 25 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. Residents live in a safe and homely place. Evidence: We have quoted most of this section of our report from the last key inspection report in 2007, as the same good outcomes for the residents still apply. Oakfield Care Home is a large detached property,it is a listed building in the village of Weston in Bath. The home is built over three floors, which can be reached by stairs or lift. The building is over two hundred years old and is about a ten minute car ride away from Bath City Centre. There are local shops, a library, a church, a pub and Bath Royal United Hospital nearby. A number of residents commented that they liked the environment of the home and the views of the large self contained garden. Specialist equipment and adaptations are in place throughout the home to assist residents and visitors who may have reduced mobility. There is also a lift giving access to all floors of the home as well as a stair lift for people with reduced mobility. The bedrooms and all the communal areas were viewed. Bedrooms are for single occupancy however there are two double rooms. Rooms were satisfactorily decorated Care Homes for Older People Page 17 of 25 Evidence: and maintained. The environment was clean and tidy throughout. We saw that bedrooms have been personalised to reflect the tastes of residents with photograph, mementos and small items of furniture. We found the standard of furniture and fittings is satisfactory. Bedrooms have en suite facilities. There are also bathrooms and toilets located within close proximity to rooms that do not have these facilities. There is also a washbasin in each bedroom. We saw a dining room and a spacious television lounge. Residents were observed sitting in communal areas looking very relaxed and comfortable in the surroundings. There are toilets located close to the dining room and lounge. Communal bathrooms were clean and well maintained and were free of any unpleasant odours. However one small area of the home has a strong and unpleasant odour.We discussed this with the deputy manager and advised that action must be taken to ensure the home is free from strong unpleasant odour We found the home was well ventilated and warm with plenty of natural light. Radiators have been fitted with guards to protect residents from being scalded. Care Homes for Older People Page 18 of 25 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. There are enough competent and sufficiently well trained staff who care for residents. Residents are protected by the way that new staff are recruited. Evidence: In the AQAA document there is some useful information about the staffing team and we have quoted this extract: We have retained many skilled carers, which has enables us to create a team which work well together. One member of staff has returned to our employment and the residents are aware of who the staff are and feel comfortable with the team we have in place.The team we have in place at the moment are working well together and will supportive to each other in the team and the wider aspect of the house. We observed throughout the inspection the staff helping residents with their care needs in a courteous, warm and kind way. This helps suggest that staff are skilled at caring for the residents who live at the home. We counted the number of staff on duty for each shift over a twenty four hours to find out if there is enough staff to meet residents needs. There is a minimum of one registered nurse on duty at all times and five care assistants in the morning. There is Care Homes for Older People Page 19 of 25 Evidence: one registered nurse and four care assistants in the afternoon. At night there is one registered nurse and two care assistants on duty. There are three domestic staff on duty most days, a cook, a kitchen assistant and a full time maintenance person. We found that residents needs are being met by the number of staff on duty. Mrs Drewe works nine to five hours she also spends time every day with residents supporting them. Mrs Drewe is also assisted in her role by a full time administration assistant. We saw training information for one nurse and two care assistants to see if staff are keeping up to date with their knowledge and practice. We saw up to date information that showed that registered nurses and care staff have done a variety of relevant training sessions and updating over the last twelve months. The care staff we met told us they have either completed National Vocational Qualification in care awards to Level 2 or Level 3. Four Seasons have their own National Vocational Qualification trainers who come to the home and support the staff working for their award. We checked staff recruitment information for two care assistants on duty and the cook, to find out if the home carry out the required employment safety checks on all staff before they start work. We could see from the information we read that the necessary checks before employing new staff are being carried out. We saw written references taken up for all new staff before they start work as well as Criminal Records Bureau Disclosures checks and Protection of Vulnerable Adult checks. This helps to show residents are protected by the homes way of recruiting staff. Care Homes for Older People Page 20 of 25 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. The home is well run. Residents finances are looked after safely. Peoples health and safety is well protected. Evidence: In the AQAA document there is some useful information about how the home is run and how quality in the home is monitored, we have quoted this extract: Regular Four Seasons Health Care audits prove that all policies are adhered to and that all paperwork is filed correctly. All financial matters are dealt with as soon as they arise to create a good working relationship with head office. Relatives and staff are able to approach management and administration staff with the knowledge that they are dealing with efficient members of staff who will deal with them courteously and with confidence. Care Homes for Older People Page 21 of 25 Evidence: Mrs Drewe is a first level registered nurse with many years of experience caring for people with a range of nursing needs. Mrs Drewe is registered with us and she has been the manager of the home for fifteen years. We were told by residents and by staff that they see Mrs Drewe often and she will walk round the home and make time for them. This demonstrates Mrs Drewe makes herself available for residents. Two people we met told us, Naomi, (Mrs Drewe) is lovely. We read some recent information that showed how the quality of the service is being regularly checked and measured. The care and overall service in the home is reviewed and audited regularly. Residents benefit by the home improving its standards even more based on the result of these audits. We checked two residents finance records to see if the home look after residents money in a safe way. We found that the records were well maintained and in good order. We found records to do with the managing of the home were also satisfactorily maintained up to date and in order. We have referred to other records elsewhere in the report. The environment looked safe and satisfactorily maintained in all the areas that we saw. We saw training information that showed that staff do regular training in health and safety subjects including first aid, food hygiene training and safe moving and handling. This should help protect residents if staff are knowledgeable good health and safety principles and practices. We saw fire record information that showed fire alarm tests are being carried out. There are also fire drills carried out on a regular basis to help protect the health and safety of residents and staff. We saw records to demonstrate that high risk foods are temperature checked probed before serving residents. This is done to to ensure the food has reached above minimum required temperature. Care Homes for Older People Page 22 of 25 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 23 of 25 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 1 25 16 Action must be taken to ensure all parts of the home are free from unpleasant odour. Health and wellbeing. 14/09/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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