Care Home: Oakford Manor Nursing Home

Similar services:

• Byars Care Home
• St Marys Nursing Home
• Bramble Lodge
• Parkmanor Residential Home
• Thornham Grove
• Hunter`s Lodge
• London Road Neurological and Specialist Care Unit
• Carlton Care Home

What the care home does well Since the problems at the home were identified at the beginning of this year, substantial progress has been made by the people responsible for the running of the home, monitored and supported closely by the statutory agencies, in all areas of operation. Throughout this time people living at the home have continued to be cared for by staff who are knowledgeable about their needs and who are very committed to making sure that the best care is provided. All of the legal requirements for improvement made at the key inspection in January have been met and the things are now working well across a broad front. With the help of professionals from the Council and PCT the documentation that supports staff to care properly has been thoroughly updated and all instances of poor practice have been responded to and put right. People`s needs are assessed when they come to live at the home and the actions staff need to take to care for them properly are laid out in detailed care plans. After a number of poor results, the audits of systems for managing medicines are now assessed as being fully safe and functioning properly. The day to day lives of people at the home have been enhaced by a revived range of activities and leisure pursuits and individual preferences have been looked at by the activities coordinator to make sure that things are right for everybody. The home has continued to provide a choice of meals and people told us that they are very satisfied with the food provided and that their individual preferences are recognised and respected. Staff told us that since the beginning of the year the levels of training they have received has been `intense` and that they now feel that they are better prepared to do their jobs properly. Morale amongst the staff group is very high at present and staff told us that because staffing levels have been increased to match the level of need amongst the people living at the home, their working day is less hurried, better planned and they have time to talk to people. Staff recruitment systems have been brought back into line with company requirements and the right people are being employed to work there; new staff are introduced to the home and people living there according to a careful programme. Of particular note is the quality of the home`s physical environment and the level of investment that has occurred to make the standard of the `old` building comparable with the new extension that has just been registered with the Commission. Everybody at the home told us how impressed they have been with this development and the level of comfort and facility they now enjoy. What has improved since the last inspection? The key area that has supported the improved performance of the home has been better communication at all levels and a much more open and supportive style on the part of the people resonsible for running the home; staff told us there is `less stick and more carrot`. As noted above all of the requirements made at the key inspection in January have been complied with and these were in the areas of improved staffing levels, safe and hygienic management of the laundry, arrangements for assessing people`s needs before they come to live at the home, improved respect for people`s privacy and dignity, the provision of a better range of activities, better management of complaints and improvement in response to the safeguarding needs of people, substantial improvements to the physical standard of the home, improved levels of staff recruitment, training and formal support and better developed systems operated by the home`s management that tell them how well the home is doing. As a point of summary for all of these improvements, our `Expert`, who had no previous knowledge of the home before this inspection, reported that `this is one of the best homes I`ve been in recently`. What the care home could do better: There were no legal requirements made as a result of this inspection but there are good practice recommendations that relate to indirect aspects of care and people`s lives. The improved performance of the home assessed at this inspection is reflected in the overall quality rating that has been reached. Key inspection report Care homes for older people Name: Address: Oakford Manor Nursing Home Newshaw Lane Hadfield Glossop Derbyshire SK13 2AJ     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: Brian Marks     Date: 1 6 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 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 29 Information about the care home Name of care home: Address: Oakford Manor Nursing Home Newshaw Lane Hadfield Glossop Derbyshire SK13 2AJ 01457861117 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Rushcliffe Care Limited care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 50 The registered person may provide the following category of service only Care home with nursing code N To service users of the following gender Both Whose primary care needs on admission to the home are within the following categories Old Age, not falling within any other category code OP Physical disability code PD Date of last inspection Brief description of the care home Oakford Manor was purchased and registered by Rushcliffe Care Ltd. in October 2007 and the new manager, who was appointed soon afterwards, has completed her registration with CQC. The home was established by the previous owners for some years, and its registration for the care of 34 people with nursing and personal care needs who are over 65 years of age or who have a substantial physical disability, has recently been inreased to 50. This is a modern purpose built home situated in Hadfield, near the town of Glossop. The home is on two floors with passenger lifts and staircase Care Homes for Older People Page 4 of 29 1 1 0 2 2 0 0 9 0 50 Over 65 50 0 Brief description of the care home access, and its accommodation comprises of 32 single bedrooms (31 with en-suite) and 9 shared bedrooms (8 with en-suite). There are spacious lounge/dining rooms, and a range of small quiet areas throughout the building. The home has an activities coordinator who works with residents individually or in small groups to develop their interests and social activities. Support services are in place from local GPs and people are referred to other health support services on request or as required. Information about the service is provided in the Statement of Purpose and Service User Guide; the former is available upon request and people are given a copy of the latter when they move into the home. The current weekly fee for accommodation is in the range 344 to 596 pounds. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 was a Key unannounced inspection that took place at the home over two days. We were accompanied on the inspection by our Expert by Experience, a lay person who has been recruited by the Commission because they have had direct experience of receiving care services. This inspection was carried out to follow up a key inspection on January 14th 2009 which occurred after urgent meetings and discussions that we had had with professionals from the three key authorities who are responsible for financial sponsorship of people living at the home, Derbyshire County Council, Tameside Borough Council and Tameside and Glossop Primary Care Trust (PCT). They had become very concerned with aspects of the way the home was being run, so much so that all three authorities had suspended contracts with the homes owners in December 2008. We also carried out a random inspection on 6th May 2009 to see if any progress had been made in improving the homes operation. Time was spent in preparation for this visit, looking at key documents such as previous Care Homes for Older People Page 6 of 29 inspection reports, records held by us, the written Annual Quality Assurance Assessment document (AQAA), which was prepared and returned to us by the manager before the inspection, and a number of written surveys sent back to us by staff working at the home and people living there. All of the above material assisted with the preparation of a structured plan for the inspection. At the home, apart from examining documents, files and records, time was spent speaking to the homes registered manager and a senior manager of the Company that owns the home, who were there throughout the visit, and a number of staff working on the early day shifts. As there were twenty two people living at the home at the time of the inspection, we looked at the care records of three of these in detail, and these were interviewed personally by our Expert along with others who were able to speak to us, and a number of relatives and visitors who were at the home during the inspection. The assessment was made against the key National Minimum Standards (NMS) identified at the beginning of each section of this report, as well as other Standards that were felt to be most relevant. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The key area that has supported the improved performance of the home has been better communication at all levels and a much more open and supportive style on the part of the people resonsible for running the home; staff told us there is less stick and more carrot. As noted above all of the requirements made at the key inspection in January have been complied with and these were in the areas of improved staffing levels, safe and hygienic management of the laundry, arrangements for assessing peoples needs before they come to live at the home, improved respect for peoples privacy and dignity, the provision of a better range of activities, better management of complaints and improvement in response to the safeguarding needs of people, substantial improvements to the physical standard of the home, improved levels of staff recruitment, training and formal support and better developed systems operated Care Homes for Older People Page 8 of 29 by the homes management that tell them how well the home is doing. As a point of summary for all of these improvements, our Expert, who had no previous knowledge of the home before this inspection, reported that this is one of the best homes Ive been in recently. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience 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 come to live at the home without the care they need being properly identified but a more person centred approach to care for everybody would be achieved if more attention is paid to their social world and background history. Evidence: In the AQAA we were told that all prospective residents are visited in their own homes or at hospital for an assessment, and that they are assisted to make an informed decision about their future. Information, contained in the homes brochure and Statement of Purpose, is given to people and their families, which also helps them make that decision. We were also told that the home operates an open door policy that allows people to visit and meet staff, judge the homes facilities and see the homes environment. For the purpose of this inspection we looked at the care records of three people living at the home, including somebody who had moved in about three weeks before the Care Homes for Older People Page 11 of 29 Evidence: inspection and somebody who had lived there for some years. The former is the only person who has come to live at the home in the past six months since contracting with the statutory authorities was suspended. Within all of these records, there were clear assessments of the physical care needs of the person concerned including details of health and medical issues, communication problems and all the other key areas that will help staff care properly. The information had been obtained from the person concerned, from their family, or from outside professionals such as the family doctor, hospital ward staff, social worker/care manager or healthcare therapists. All of care records looked at contained a recent photograph of the person concerned, as well as satisfactory amounts of personal information and signed consent forms; these all indicate personalisation of peoples records. None of the records looked at contained anything more than brief amounts of information about the psychological and social worlds of the people concerned, which does not support person centred care for everybody living at the home. All of the care records looked at contained a set of assessments of the general and specific areas of risk that are relevant to the individuals concerned, such as safe manual handling, skin breakdown and pressure areas, falls and nutrition. Some, but not all, indicated high areas of risk and these were directly linked to actions for staff to take when providing care and described the detail of how staff work safely and consistently and maintain the persons welfare whilst living at the home. All of these risk assessments had been looked at regularly to make sure that the information being used by staff is current and that the level of risk has not changed. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at the home have care and risk assessment records that support safety and consistency, and staff work in ways that respect individuality, privacy and dignity. Evidence: In the AQAA we were told how staff at the home provide high standards of personal care to people living there and that they meet their individual needs wherever possible. We were also told that they promote as high a level of independence as possible whilst maintaining the health, safety and wellbeing of the resident group, and that the dignity and privacay of everybody is promoted at all times. The care records that we looked at contained clear descriptions of the areas where people need help or where they experience risk, as well as the areas in which they are independent, and the care and nursing activities to be carried out by staff are identified in a number of key areas. For the person with very complex needs and a high level of dependency this amounted to a total of nineteen areas. In all of the records examined the various elements of the care plans had been reviewed on a Care Homes for Older People Page 13 of 29 Evidence: monthly basis and staff told us that this is now a systemeatic and routine part of our work. As referred to above, the descriptions of social interests and life background are generally brief in all the records we looked at and, although the care plans were comprehensive and well laid out, they were traditional in style and much of the activities of staff were described in terms of problems and needs rather than in ways that promote a person centred approach to care. In addition to the improvements that have been carried out to the homes documentation since the last key inspection and noted at the last random inspection, we were happy to note a massive improvement in the homes capability to meet the personal and healthcare needs of everybody living there. The observations made by us around the home during the inspection, the comments received from staff, people living at the home and relatives and information given to us before the inspection from the representatives of the key local statutory agencies indicate that the home has made substantial steps in putting everything right. This was backed up by information given to us during the inspection visit by one of the two outside professionals who had earlier been based at the home carrying out a programme of assessments and care plan updates for everybody living there. We were told by staff that things are much improved and particularly so over the last two months. The shifts are relaxed and we have time to talk to people, and that staffing levels have been improved and the new staff are becoming much more settled and are very much part of the team. For one resident, whom we spoke to at the last two inspections, the improvements in his daily care routine have made him feel much more relaxed about continuing to live at the home and that everything is much better, and staff are always available when I need them; my morning routine is as it should be. The staff are much happier and even the new ones always say hello, how are you and do you need anything. Theyre doing my meds properly again and all the equipment is looked after properly and Im fully confident that things dont get missed any more. We observed that the arrangements at meal times worked smoothly and everybody who needed to be up had had their breakfast by 10:00 am; this had been a particular issue at the last key inspection and was one of the factors that told to us how badly the home was performing at that time. The above residents positive view was repeated by the reports given to us by other residents spoken to during the inspection, and in all of the written surveys we received people told us that they always or usually receive the care and support they need, and that staff are available when needed. The care files we looked at contained clear records of the medical and health needs of people living at the home being regularly monitored, and also of visits by outside professionals such as G.P, chiropodist, optician and dentist. Additionally in the written Care Homes for Older People Page 14 of 29 Evidence: records and from the direct comments from people, it was clear that the staff at the home work hard to care in sensitive and dignified ways, and to keep people as independent as possible. Staff told us that they carry more responsibility and are more accountable for their actions. One of the newly appointed nurses told us that everybodys roles are clear and that problems are solved rather than being left unresolved and troublesome. She told us that the new treatment room upstairs is well equipped and supports safe and consistent nursing and personal care activity. Full inspections of medicines practice were carried out by a pharmacy inspector and separately by the PCT pharmacy technician in June 2009 and these both produced positive reports. The former included just one quality recommendation and the latter a score of 90 percent. During this visit we made a brief examination of the arrangements for the storage, recording and administration of medicines at the home, and the nurses on duty told us about the way that systems had been improved by a weekly audit carried out by the homes manager. They also told how we audit each other so that we are aware of doing things right. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home enjoy lifestyles and routines that suit them and have good opportunities to take part in organised leisure and social activities. Evidence: In the AQAA we were told about the increasing activities taking place for people living at the home, and how these are planned to be appropriate for identified needs. We were also told how documentation about individual needs is recorded and retained in care records and how training is to be provided to the activities co-ordinator to assist her role. We confirmed that an established activities coordinator is in post but that she had been on long term sickness and has been replaced by somebody who is available for the summer months. She has been responsible for encouraging activities and better use of peoples leisure time and was able to demonstrate more structure in place, with something planned for every day of the week. She told us that she has made contact with everybody living here at the home, to look at their needs and interests and she has also been keeping detailed records that illustrate her work with individuals and small groups. During the inspection she organised a craft activity for a small group and also made a planned visit to local shops with two individuals. All of the feedback Care Homes for Older People Page 16 of 29 Evidence: we received was much more positive than at the last key inspection about this aspect of the homes activities, although most staff we received feedback from was clear that this is something that could still be improved if more time and resources were applied. We have already noted that care plans still contain only brief details of peoples social and leisure needs but the coordinator has carried out her own assessments to support the activities already taking place. There are a number of more independent people living at the home who are encouraged and supported to continue with outside community activities, and this includes day centre and education activities as well as visits to shops, family homes and church attendance. An issue that was raised as a serious concern by people living at the home and some relatives at the last inspection was general communication and the lack of involvement in the operation of the home. The people responsible for the running of the home have attempted to put this right and all the feedback we received confirmed that this was much improved. We were told that there is more information for the residents and relatives and I think the home is now more welcoming as a result. The manager has arranged for regular meetings for people to speak out about the home but attendance at these has been variable. A newsletter has been produced and this is available to everybody and gives information about what is happening at the home and about the people living there. Staff told us that management is more responsive now and we get involved in some of the important decisions; its nice to be asked for your opinion. We spoke at length to two family members who had previously been very critical of the home and they were keen to let us know how things had improved and that everything is communicated properly now and we know what is going on; praise where praise is due. The home is now being restored to its former high position in the local community. A brief visit was made to the kitchen and the cook and kitchen assistant described current arrangements. The cook described how she had tried to maintain good standards in the catering service, and told us that the menu in place at the last inspection is being followed. The menu indicates a choice at the main meals of the day and a hot option available for breakfast and at lunchtime; the main meal had reverted to late afternoon on Mondays to Fridays, as requested by the people living at the home. We received some strongly favourable comments about the homes catering, as we did at the last inspection, and all of the written feedback we received was positive and people told us that they always or usually like the food of the home. Arrangements for purchase, storage and stock control remains satisfactory. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home responds to complaints made by residents and their representatives according to a written procedure, and aims to protect them from harm. Evidence: In the AQAA we were told that complaints are responded to promptly according to Company Policy and Procedure and that all complaints are duly recorded. We were also told how a problem solving approach is used to address isssues before they become formal complaints. Since the last key inspection the home has been subject to a number of complaints about the standard of care performance and these have resulted in a systematic approach to their response. However, there have now been no fomal complaints recorded by the statutory agencies or the homes management since the beginning of April 2009. Examination of the complaints record book at the home indicated there have been three verbal complaints since the last random inspection in May, and these were resolved and responded to on the same day, with full written records maintained. Most of the people who sent us back a written survey response indicated that they knew how to make a formal complaint. Similarly since the last key inspection there have also been a higher than average number of situations reported to the Adult Social Care Department of Derbyshiire Couty Council under safeguarding procedures. The associated investigations have now Care Homes for Older People Page 18 of 29 Evidence: been concluded and we received information before the inspection that all the required actions had been taken by the home to get things right and that care plans have been changed to ensure that staff always act in safe and consistent ways. We were informed by staff that everybody had received training in their responsibilities to recognise and alert others to suspected abuse, and the staff training records confirmed this. The policies and procedures in place are in line with the statutory procedures on safeguarding vulnerable adults and these have been clarified to eliminate any confusion from the homes dealings with a number of different Local Authorities. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is purpose built and standards of maintenace, decoration and physical comfort have been reestablished by a high level of investment by the homes owners. The people living there can now enjoy an environment suited to their physical needs and comfort requirements. Evidence: In the AQAA we were told that the homes environment is homely and welcoming and that homes management are refurbishing rooms to improve its appearance. We were also told that the homes management plans to continue with refurbishment and improvement in all areas. At the last key inspection we found considerable deterioration in the homes condition and presentation and that a programme of intense cleaning and maintenance was underway. This had been comtinued up to the last random inspection and at this inspection we found that this programme of improvement had been maintained. We found the following key changes: The new extension had been completed and registered with the Commission, with an additional 16 single bedrooms (all ensuite showers and toilets) and with additional communal rooms for hairdressing, activities and staff room. The new laundry had been created and fully equipped. Bathrooms had been upgraded and modernised and fitted with specialist baths, and the one downstairs is planned for imminent upgrading. Dining and living room areas, both Care Homes for Older People Page 20 of 29 Evidence: upstairs and downstairs have been redecorated and refurnished, involving a substantial financial investment. All bedrooms have been redecorated where neccesary and all had been supplied with new furniture and furnishings. A new sluicing machine have been provided on each floor. The reception area of the home has been redecorated and provided with new furniture, and more secure arrangements have been made to the front entrance, with wide automatic doors suitable for people with wheelchairs. All items of minor maintenance previously identified have been dealt with. We spoke to some of the domestic and laundry staff on duty during this inspection and they were very positive that resources and staff time were now available to allow them to do their jobs properly and to provide a quality service that had been lost at the beginning of this year. This was particularly true of the homes laundry service and all residents observed in the home were seen wearing clean and well-presented clothing. It was clear that the homes owners have invested considerable resources in the physical environment of the home and have addressed the previous deterioration in the standards of maintenance and cleanliness highlighted at the last key inspection. The home was exceptionally clean, safe and well maintained throughout at the time of this visit. All the people we spoke to expressed considerable pleasure at the progress made within the home and told us that the building has been really smartened up, itss just like a hotel now and that the improvements are incredible. And it was only when it stopped that we realised how disruptive the buiding works had become. All the people who sent us back written feedback said that home is always or usually fresh and clean. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has adequate numbers of staff to carry out the physical care needs of the people living there and they have been recruited and trained to do their jobs properly and in a professional way. Evidence: In the AQAA we were told how the home has a good record of staff training and about staff involvement with and commitment to the people in their care. We were also told that homes ability to avoid the use of agency staff was good. As we have noted elsewhere in this report the reduction of staffing levels at the home during the latter part of 2008 was responsilbe for the dramatic downturn in the homes performance seen at the last key inspection. Since that time the home has experienced a high turnover of staff and because of the suspension of contracts with the statutory agencies there has been a steady decline in the numbers of people living at the home, which numbered 22 at the time of this visit. From our discussions with the homes staff and managers, and from feedback from some of the people living at the home and their relatives we have been told that the home is now functioning properly and peoples needs are being properly attended to. We looked at the duty rosters for nursing and care staff and found that stability had been regained with minimal use of agency staff and sufficient numbers deployed on both floors of the building. There were two qualified staff on the morning shifts with one on the Care Homes for Older People Page 22 of 29 Evidence: afternoon and night shifts; the manager is now completely supernumery and only works hands on during unexpected shortfalls. We also noted that at the present time there are usually 5 carers on the morning shift with 4 in the afternoon and 3 at night. Although shortfalls in numbers was a key factor previously noted, the skill mix of those actually on duty, particularly those recently recruited and those being supplied by agencies, was also identified as presenting problems for efficient and effective working. However we were told that the new staff work much better now and they shadow the more experienced staff and are gradually able to pick up on responsibility and that new staff dont interupt the work flow like they used to. Were all doing things right now. The staff we spoke to also told us about the continuing opportunities for training that had occurred and that training has been intense. We looked at the training record for all staff, which has been carefully maintained to assist with monitoring the training needs of the staff group, and this indicated a substantial improvement in training achievements over the past six months. Everybody has now received refresher training in all the key areas and the subjects of dementia care and the Mental Capacity Act are targetted as the next priorities. The AQQA told us that the national target for care staff achieving the National Vocational Qualification (NVQ) level 2 has been reached and this was confirmed by the records which indicated 15 out of 24 staff passed at this level and a further 7 at level 3. The file of a recently appointed carer indicated that she had been subject to a proper induction, including basic health and safety training, and other staff told us that this is now routine. The files of two recently appointed staff that we looked at supported that their recruitment had been carried out properly with the right checks being made; both had worked under supervision at the beginning due to delays in getting a reply from the Criminial Records Bureau (CRB). As at the last key inspection we were again impressed by the attitudes and honest reporting from all of the homes staff. They all told us positively about the current operation of the home and how everything is now a lot better than it was. Its now a pleasure to come to work again and I do so with a smile on my face. They told us that teamwork had improved and that the homes managers were very approachable and that management is responsive and leadership is proactive. We were told that staff try to work as best they can together and that support is good within the staff team between qualified, care and support staff. One person rounded off our conversation with the comment that Ive worked here 4 years and seen lots of changes but its never been better than it is now. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience 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 a well-managed and safe environment in which to live and work with the result that the health and welfare needs of the people living there are now being met. Evidence: The new owners and manager took over the running of the home in the latter part of 2007 and the manager completed her registration process with the Commission in 2008. The latter has previous experience of running a care home before she came to Oakford Manor and has achieved the recognised managers qualification. She was present throughout during this inspection, along with a newly appointed senior manager whose initial brief from the company has been to support the manager in reestablishing Oakford Manor as a properly functioning home and place of work. At the time of the last key inspection the comments received from staff, relatives and people living at the home were very negative about the organisation and communication within the home but, as has already been noted, the opposite was very much the case during this inspection: Everything has become more systematic and, where communication was previously very poor at all levels, we all feel involved in where Care Homes for Older People Page 24 of 29 Evidence: things are going. We saw the minutes of meetings that have been held with people living at the home and their relatives, and staff told us that they now have regular meetings where thay can voice their opinions with confidence that they will be heard. Additionally staff told us about regular individual meetings with the manager now taking place and the records showed that everybody had had an initial appraisal of how they were working and how there are now monthly individual supervision meetings up to the end of 2009 for everybody. This will ensure that staff are properly supported and their work is being positively monitored. We have reported above that at the last inspection we identified substantial problems at the home in many areas, and that these stemmed from the reduction in staffing levels across a broad front in the latter part of 2008. They were brought to the attention of the authorities responsible for the financial support of peoples accommodation - the two local Councils and the Primary Care Trust (PCT) - and the Commission, and the contracts with those authorities were suspended in December 2008. With the substantial improvements made at at the home since that occurred, the contracting position of all the statutory authorities was conditionally reinstated in June 2009 and new people are now coming to live at the home. People have told us that the style of management has become much more open and a relaxed and warm atmosphere within the home was noted by us throughout this inspection. Reports from outside professionals who have continued to be in regular contact with the home have indicated total cooperation with action and improvement plans that have been set down, and that the improvements noted above have occurred as a result of this change in management style; the people responsible for the running of the home have been fully aware of the need to change in order to protect the future of the home. Additionally the homes management have audited progress for themselves and have introduced systems that will continue to tell them how well things are going into the future. Internal audits put in place of, for example, medicines systems and care planning processes have ensured that staff deliver care in safe and consistent ways and the company has started to introduce external audits that support and monitor performance of the local management; the past six months have been a period of constant examination and appraisal so that the improvements we make are maintained. The systems in place for looking after residents money were found to be satisfactory at previous inspections and remain unchanged so a full assessment of this was not carried out. Similarly the AQAA told us that standards of health and safety activity and regular servicing of equipment had been maintained, so that a full audit of health and safety matters was also not carried out. Observations made around the building and a Care Homes for Older People Page 25 of 29 Evidence: sample of fire safety activity and equipment records supported that the home was hazard free at the time of the inspection. We did note that because of the disruptions caused by the synchronising of fire safety systems of the new extension, some of the fire safety records had not been fully maintained. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Assessments of the needs of people living at the home should contain more information about their social world and background history so that a more person centred style of care can be developed. The care plans of people living at the home should contain more information about their social world and background history so that a more person centred style of care can be developed. 2 7 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!