Care Home: Oakhurst

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What has improved since the last inspection? There have been substantial improvements made since the last inspection. The standards of care have improved with the introduction of extra staff on duty. People tell us staff are lovely and they are enjoying the increase in activities. Staff tell us they are enjoying spending more time with people each day and having the chance to go out with people more. Care plans and records have improved with the introduction of clearer records and risk assessments. This means people are cared for in a more consistent way. Nutrition management in the home has improved with positive feedback from health care professionals. Highly qualified staff have been employed to help with this aspect of care. The environment has improved. Redecoration is ongoing. The conservatory is now used by people and the extension has provided extra rooms and laundry to a high standard. The recommendations made at the last inspection and that of the Environmental health department have been addressed and met. There have been many changes in staff at the home. Many new staff have been recruited. New roles have been developed to provide senior care cover which releases the manager for more administration roles. Staff supervision is now in process so staff have opportunities to have training and development needs highlighted. The numbers of staff on duty have also increased which has had a major impact on the quality of life for people in the home. Staff have more time to spend with people and more time to perform informal activities and interactions with people. This has also resulted in an increase in staff moral. Staff say the biggest change is the amount of training that has occurred and is booked at the home. Mandatory training programmes now mean staff have been updated on fire safety and first aid. Further specialist training such as medication and dementia courses has also been booked. Since the introduction of more staff the manager and provider have invested a lot of time to improve the management systems are the home. The recruitment system has improved and the supervision and appraisal programme been encouraged. A quality assurance programme and associated surveys have been introduced which highlight areas of development which have already been addressed.OakhurstDS0000066583.V375358.R01.S.docVersion 5.2Page 9 What the care home could do better: The manager and provider now need to sustain the improvements and systems that have been introduced. Staff should ensure it is easy to show that individual assessments and reviews have been reviewed for each person. The manager should also ensure staff photographs are kept on staff files. Key inspection report CARE HOMES FOR OLDER PEOPLE Oakhurst 4 Courtland Road Paignton Devon TQ3 2AB Lead Inspector Clare Medlock Key Unannounced Inspection 11th May 2009 10:00 DS0000066583.V375358.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 2 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 Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oakhurst Address 4 Courtland Road Paignton Devon TQ3 2AB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 524414 01803 524414 Oakhurst@saffroncare.co.uk www.saffroncare.co.uk Saffron Care Ltd Mrs Deborah June Tilcock Care Home 16 Category(ies) of Dementia (16), Old age, not falling within any registration, with number other category (16) of places Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) The maximum number of service users who can be accommodated is 16. One specific service user in the category MD(E) may be accommodated. 27th August 2008 2. 3. Date of last inspection Brief Description of the Service: Oakhurst is an attractive detached house next door to the library. It has views across the local park, and is a short walk from shops and Paignton sea front. There are five steps with a rail up to the front door. Easier access is via the back door. Oakhurst is built on four levels, with stair lifts provided to all. There are steps to three rooms on the ground floor. There is no passenger lift so people would need to be able to negotiate the stair lift. The six rooms at lower ground floor level have direct access on to the homes garden. As well as the Manager’s office, there is one bedroom on the top floor, which is only offered to people only after risk assessment. The home provides accommodation for up to 16 people who are generally over the age of 65. Most residents now are mentally and physically frail. There is a communal lounge, large conservatory, and dining room available to people who use the service. Fees range from £380 to £480 per week and depend upon the level of care that Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 5 is required. There are extra charges for clothes, personal items, hairdressing, chiropody, trips and newspapers. Information for prospective residents, including the most recent inspection report, was on display in the entrance hall. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means the people who use this service experience good quality outcomes. Usually prior to inspection we request an annual quality assurance assessment from the registered manager. This was not requested prior to this inspection as the previous AQAA was still valid and the information provided was still relevant. This key inspection included a visit to the home on Monday the 11th of May 2009. During this time we spoke to the registered manager and the provider. We spoke at length to five people who live in the home and to three members of staff. We case tracked two people who use the service. This means we looked in detail at the care these people receive. We spoke to staff about their care, we looked records that related to them, and made observations if they were unable to speak to us or provide feedback. We inspected this service with an expert by experience. The Care quality commission consider an expert by experience as a person who either has a shared experience of using services or understands how people in this service communicate. They visited the service, spoke with five people in their rooms and had lunch with a group of three people in the dining room. This helps us get a picture of what it is like to live in or use the service. We looked at three staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the recruitment and safeguarding systems work and what this means the people who use the service. During inspection we also watched interactions between staff and people living at the home. All this information helps us to develop a picture of how the home is managed and what it is like to live at Oakhurst. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 7 What the service does well: People who use the service and their relatives have the information they need to decide whether Oakhurst is the right home for them to move into. The admission procedure shows that staff make sure they can meet the person’s needs. People tell us that the admission process is made easier by the attitude of staff at the home. People receive a good standard of personal care. People tell us ‘We are looked after very well.’ Communication with health care professionals in the community is good. The care people receive is well planned, delivered to a good standard and provided in a safe and respectful way. Medicines are well managed at the home by the well trained staff. Staff at the home ensure people see the doctor or other health care professionals when they need to. The care planning systems and documentation at the home are good and mean that staff know how to care for some one in a safe and consistent way that meets their individual needs and preferences. People have access to a varied programme of activities and are able to maintain contact with their family and friends. People enjoy the activities at the home particularly the trips out, pet visits, 1:1 sessions and opportunities to chat with staff. People tell us that the food is excellent at the home and any issues regarding dietary requirements, preferences or weight issues are sensitively managed to a high standard. The attitude of complaints is excellent at the home. The manager views complaints as a positive event and likes to record all concerns formally to monitor any minor issues. Complaints and concerns are listened to and acted on professionally and promptly. Safeguarding referrals are well managed and dealt with appropriately. Oakhurst is a safe and pleasant place to live and work. People tell us ‘I love my room with the garden view’ and ‘I love the patio and view of the park from my room’. People tell us they like the staff at Oakhurst. People said ‘staff are very good’ and ‘The staff are all so good and always do something for you’ The manager and her staff group have suitable qualifications and experience to care for people who require personal care. The recruitment process is good and training programmes present to show that people have the skills and knowledge to care for people at the home. The home is well managed by the manager and Provider. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? There have been substantial improvements made since the last inspection. The standards of care have improved with the introduction of extra staff on duty. People tell us staff are lovely and they are enjoying the increase in activities. Staff tell us they are enjoying spending more time with people each day and having the chance to go out with people more. Care plans and records have improved with the introduction of clearer records and risk assessments. This means people are cared for in a more consistent way. Nutrition management in the home has improved with positive feedback from health care professionals. Highly qualified staff have been employed to help with this aspect of care. The environment has improved. Redecoration is ongoing. The conservatory is now used by people and the extension has provided extra rooms and laundry to a high standard. The recommendations made at the last inspection and that of the Environmental health department have been addressed and met. There have been many changes in staff at the home. Many new staff have been recruited. New roles have been developed to provide senior care cover which releases the manager for more administration roles. Staff supervision is now in process so staff have opportunities to have training and development needs highlighted. The numbers of staff on duty have also increased which has had a major impact on the quality of life for people in the home. Staff have more time to spend with people and more time to perform informal activities and interactions with people. This has also resulted in an increase in staff moral. Staff say the biggest change is the amount of training that has occurred and is booked at the home. Mandatory training programmes now mean staff have been updated on fire safety and first aid. Further specialist training such as medication and dementia courses has also been booked. Since the introduction of more staff the manager and provider have invested a lot of time to improve the management systems are the home. The recruitment system has improved and the supervision and appraisal programme been encouraged. A quality assurance programme and associated surveys have been introduced which highlight areas of development which have already been addressed. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 9 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. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process is good and means that people have relevant information to decide whether Oakhurst staff can meet their needs. EVIDENCE: Information about the home is on display in the entrance hall and also available on request. The home also have a web site which can be used to access information. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 12 The manager produced a Statement of Purpose/Service User Guide which contains all the information people may need to decide whether Oakhurst is the right place for them to be. These documents have been updated in recent months to reflect the increase in staffing levels, the new menus and contact information for the Care Quality Commission. The Provider also showed us a ‘mini brochure’ which is issued on first contact, used for publicity purposes and general enquiries before the statement of purpose is given. Each person is assessed before they come to the home. This assessment makes sure staff are able to meet the person’s needs before they come to the home. A formal record of this process is made and used to base the plan of care and support for each person. Once agreements has been made the staff then write to the person and arrange any trial visits or day care before the person decides to stay and sign the contract. Information and assessments are gathered from health professionals who had worked with people, their families and other health care professionals, which includes occupational therapists and members of the Community Mental Health Team. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. People have their personal and health care needs met in a dignified person centred way. The improved care plans mean staff have clear instructions on how to care for a person, minor adjustments would clearly show what reviews had taken place. The management of medicines is good and helps to protect people from risk. EVIDENCE: People were very complimentary about the care they receive at Oakhurst. Comments included ‘We are looked after very well’ ‘staff are very good and take me out in the wheelchair’ and ‘I love it here’ Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 14 Staff were able to explain the specific needs and preferences of each person at the home. When asked about the routines of the home staff told us this ‘depends upon what the person wants’ or ‘asks for’. One person said there are some routines in the home, such as bath and shower days, but these were often changed as other things cropped up. Care Plans reflected the knowledge of staff and were clear to read and follow. There have been significant improvements in the care plans since the last inspection. Care Plans have been separated into two parts, one showing the care needs of the person and another part containing the assessments. Care Plans are reviewed monthly by the key worker or other members of the team. The additional risk assessments relating to nutrition, falls, moving and handling and risk of developing pressure damage and more general risks were reviewed as part of this general review. A discussion was held about ways to show these assessments had been specifically reviewed. Night care plans also show what specific needs and requests each person has. Other sets of records and notes are also used within the home. Communication books, handover books (containing contact addresses and notes for the day) and a diary ensure staff are aware of the events of the day. Staff sign all meeting notes, reviews and new policies to show they are up to date with any changes. Staff also hold records for district nurses who come to provide care. The Liverpool Care pathway notes are being introduced for people being cared for at the end of their life. This is where all healthcare professionals work together and record the care that is planned and given, in one set of notes, to ensure that care people receive is continuous and effective. This care package is seen as good practice. People told us they felt very well cared for at the home and receive visits from other healthcare professionals including the doctor, nurse, occupational therapist, optician, chiropodist, and other specialist health care professionals. These visits are recorded in the persons care plan. The manager told us they had employed a member of staff who is a qualified dietician and a chef who has substantial experience of working within care home settings and caring for peoples dietary needs. Since the last inspection the standard of assessment and care of nutritional needs has improved. The manager told us the community dietician had complimented the home on how staff were achieving and managing the nutritional status of people. Weights show that people are having their nutritional status well managed. All of the interactions seen between staff and people in the home were of a high standard. Much laughter and use of appropriate affection and sensitive approaches were seen throughout the inspection. Staff that were heard speaking and interacting with people behind closed doors were heard to Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 15 interact to a high and positive standard. Natural affection was shared between people and staff. During the inspection people looked well cared for with finer details such as eye care, nail care and appropriate footwear present. If they were sitting in a chair, they had blankets around their knees, or had feet resting on footstools etc. People we spoke with were satisfied with all aspects of support with their personal care. The people we saw all had drinks within easy reach and all had a call bell to enable them to call for assistance, everyone said there was usually a very good response to the call bell. People being cared for in bed appeared warm, pain-free, comfortable, and well presented. Specialist equipment such as mattresses, specialist hoists, mobility aids and feeding equipment were present throughout the home where indicated. Grab rails were present throughout the home and ramps were available to promote independence the reduced risk of trips and falls. People were seen to be free and encouraged to wander around the home. Exercise sessions are provided to encourage movement for people in the home. Staff at the home care for and support people with dementia type illnesses. Staff at the home access information, guidance and advice from the Alzheimer’s society. The manager told us she adopting the ethos of an approach called ‘Eden Alternative’ where the home is seen as a community where peoples needs ‘drive’ the home and where care is person centred. The management of medication systems is performed very well at the home. Medication is stored in either locked trolleys or locked cupboards. Storage was well organised and secure. Named senior care staff are responsible for the management of medication from the receipt to disposal. These staff have now received specialist training in medicine management and are booked on further advanced medication courses. Medicines are supplied mainly in monitored dose systems using a blister pack with extra supplies being supplied for each person. Medication trolleys were clean, tidy and securely stored. Fridge temperatures for medication are recorded. The records of administration were clear. Each person has been photographed to aid identification and where hand written prescriptions are copied onto the medication administration record, two staff sign to ensure the prescription is written correctly. Disposal of medications is also well-managed at the home and signed for collection by the waste management company. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the 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 improved activities programme means that people have access to meaningful entertainment and stimulation. Meals at the home are of good quality. EVIDENCE: The majority of people said they were happy at the home. Only one person said anything negative which included ‘I feel a bit lonely at times’ Of the five people we met with in their rooms, one said she was able to go out, one said that staff would take her out in a wheel chair, but the remainder said Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 17 that they spent most of the time in their rooms, three were able to go to the Dining Room for their meals. Staff told us the increase in staffing levels now means that staff ‘have more time to be with the residents’. One person said we can get out more for walks into town or to the park and we have more time to sit with people. Evidence was seen to show that the activities had improved at the home. A local activities company ‘Brixham activities’ provide some entertainment and the services of a wheelchair accessible mini bus. On the day of inspection some people at the home were off to ‘Bygones’ a museum showing what shops used to look like. For those people not going on the outing there was an afternoon of ‘Pampering’ planned, this included manicures and use of a Foot Spa for those that wanted this. Other formal activities planned included ‘film sessions with popcorn’ ‘pet visits’ ‘craft sessions’ ‘1:1 sessions’ ‘pamper sessions’ and ‘trips’. Staff told us other informal activities include art and crafts, silver cleaning and walks to the park. One member of staff told us one person at the home had introduced knitting and had taught staff how to knit. Future activities planned included clay modelling, colour and sound therapy and movement to music classes. Discussion with staff confirmed that all people at the home had access to some sort of activity, with more frail people having 1:1 sessions or staff ensuring they were involved in some activities. An example was given of a musician performing outside the patio doors of one person confined to bed. Records are maintained of what activities people partake in. These show that the programme is varied and has improved since the last inspection. Some activities include joining in the running of the home by helping with such activities as drying up and setting the table for meals if people wish to join in. Life histories are obtained by staff and list information about what people used to do and enjoy. Spiritual needs were assessed with one person maintaining contact with their local church community. Food in the home is good. The menu for the day is displayed on a notice board but staff also said they reminded people what was for lunch. Staff told us people are asked what they want a few days/weeks in advance. Should they forget what they want or change their mind alternatives and changes are made. The manager told us they had employed a member of staff who is a qualified dietician and a chef who has substantial experience of working within care home settings and caring for peoples dietary needs. Since the last inspection the standard of assessment and care of nutritional needs has improved. The manager told us the community dietician had complimented the home on how staff were achieving and managing the nutritional status of people. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 18 Our expert had lunch in the dining room with a small group of three people. The dining room was small but bright, with a large table which could seat eight people. The table was set with a cloth and cotton napkins, there was two types of fruit juice and glasses on the table for people to have a cold drink with their meal. The owner of the home joined people at lunch; it seemed that this was something she was used to doing. The meal served was chicken casserole; broccoli, carrots, and mashed potato, with a choice of fruit crumble or yoghurt for pudding. The food was of good quality, it looked appetising on the plate and the vegetables were fresh, the chicken in the casserole was chicken breast. The lunch time overall, was pleasant, with support from staff available. The meal was not rushed and tea/coffee could be taken either in the dining room, or out in the sitting room. General comments made about the food were: ‘We are well fed with good choice’ and ‘the food is lovely, there is good choice’. Other comments included ‘It’s very good food’ and ‘they know what I like’ Home made cakes were being prepared on the day of inspection and were served with afternoon tea. A bowl of fruit was available if people wanted a snack between meals. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 People using the 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 be confident that complaints and safeguarding issues will be managed well at the home. EVIDENCE: People said they felt safe at the home. During conversations no one expressed any concerns about feeling unsafe. On the ground floor, rooms had safety chains fitted to patio doors and safety chains were fitted to windows to maintain safety and security. No one expressed any concerns regarding getting in and out of the shower. People had walking frames close by which were safely positioned by their chairs. Good responses to call bells and a view from most people that there was always staff around seemed to give a feeling of safety and support. There is a clear complaints procedure in use at the home. It is displayed in the home, and each person had their own copy. People told us they felt able to make complaints known to the manager or Provider and felt satisfied they would be dealt with. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 20 A full and complete record of complaints made had been kept, with action taken in response. The manager records all issues as complaints even if they appear minor so the number of complaints may appear high on first glance. The manager explained that she welcomes feedback and sees complaints as a way of improving services at the home and likes to record any concerns to look for trends. The Care Quality Commission have not received any complaints regarding this home since the last inspection and have not received any safeguarding alerts. The Manager told us the home have not made any safeguarding alerts but records showed that historical safeguarding alerts have been dealt with professionally and appropriately by the manager and provider. Notifications had been sent to the Commission for Social Care Inspection as required. The AQAA showed the home have a policy on safeguarding adults and the prevention of abuse which makes reference to the Mental Capacity Act 2005 (MCA). Training on the implementation of the MCA has taken place. Complaints, Whistle blowing and safeguarding are covered in the home’s induction programme and DVDs for in-house training to complement external training on safeguarding procedures takes place. Staff were aware of how and who to report the different types of abuse both in and outside of the home. Staff do not work at the hoe until they have been through the recruitment procedure which includes performing CRB (criminal records bureau-police check) and POVA (Protection of Vulnerable adults register) check. There were no obvious examples to suspect people were being deprived of their liberties, and no signs of restraint were seen. The manager was in the process of ensuring all residents were included on the electoral register and said they would be supported in placing their vote. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 People using the 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 improvements in the environment mean that people live in a safe and pleasant home. EVIDENCE: Oakhurst is a large period property, which we were advised was in a conservation area which affects any work that is carried out on the exterior of the building. It was very bright and clean with furniture and soft furnishings which gave it a very homely feel. There were three communal sitting areas in the Home, a main sitting room a conservatory and a wide corridor area, which were all very pleasant, uncluttered and with views out to the gardens and adjacent park area. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 22 People we met with were all very satisfied with their rooms. Comments we received included ‘I am very happy’ ‘I love my room with the garden view’ and ‘I love the patio and view of the park from my room’. The rooms were all bright and clean, with good bedding, carpets and curtains. The majority of rooms had pleasant outlook, one was a larger flat type room which had a darker but cosier appearance with direct access to the patio. One of the people we visited did express some concern that they were unable to open the door which led out onto a patio. We were also unable to open the door and this was reported to the provider and manager of the Home at the feedback session. This was immediately rectified and has not caused a problem since. Works following a recent environmental health inspection have been completed and an Occupational Therapist report had been acted upon to enhance the safety and independence of people in the home. Communal areas of the home were attractive and provided several sitting areas which people appeared to enjoy. The project to provide more bedrooms on the lower ground floor had been finished to a high standard with some rooms having direct access to the re designed garden. Raised flower beds, seating areas and flooring had been introduced. The Provider said, subject to funding, the door to make access easier and safer is still part of the improvement plan. People were enjoying the conservatory although most people seemed to gather at the kitchen table where there was more hustle and bustle. The dining room was not large enough for people to all eat together, so they are served in two sittings. People told us they are quite happy with this arrangement. The provider told us that plans had been approved for an extension, and this will be done when funds allow. The access to a terrace roof garden is near completion will allow people to access outside space from the conservatory area. Maintenance work in the home is carried out by the provider and maintenance man employed by the home. Books confirmed prompt response was made to maintenance requests. There is no toilet close to the lounges and dining room unless their bedroom is very close. There is a toilet by the front door, which involves negotiating steps. Two new grab rails had been installed, but this remains a slight inconvenience for people. There was a call bell system, whose buzzers could be placed beside people wherever they were. The display box had been re-sited at the Carers’ Station, with pagers being carried by staff. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 23 All doors had new locks fitted which could be used by people if they chose. On the top floor of the house there is one bedroom and office which get very hot. This person said they liked their room. A new laundry has been installed with specialised washing machines and ventilation system. The home was well maintained, clean, tidy and free from offensive odours. Hand washing facilities including protective equipment, gloves, paper hand towels and soap were provided throughout the home. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the 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 improved staffing levels and training programme now mean the standard of care has increased. The robust recruitment system helps to protect people from potential harm. EVIDENCE: Everyone we met with gave very spontaneous very complimentary feedback about the staff, manager and the owner. Comments we heard included: ‘The girls are lovely’ ‘Debbie is lovely’, ‘staff are very good’ and ‘The staff are all so good and always do something for you’ People told us there were enough staff. Comments included ‘There are plenty of staff and they are all very pleasant’ and ‘Staff are always around’ The staff we saw were professional, friendly and kind towards the people living at the home. They appeared responsive and understanding of peoples needs. Staff were attentive and professional towards the inspection team and knowledgeable of the home and the people living there. As a staff group they Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 25 were enthusiastic about providing high quality care and were aware of what to do if they had any concerns about practice issues. Since the last inspection the provider and manager have listened to feedback from people who use the service and the Care Quality Commission. Since the last inspection an increase in staffing levels to three on shift was implemented. The Provider explained this was for two primary reasons. ‘Firstly to allow the senior care assistants to perform their role, and secondly to be ready, with a fully trained and experienced staff team, to increase our occupancy to sixteen on completion of the extension’. The staff numbers were increased in August last year in anticipation of this. This increase has meant that staff have more time to spend with people and more time to offer personal programmes of activity which people in the home have appreciated. Staff also told us they have had access to a substantial amount of training, both mandatory and additional more specialised training. Staff said the provider and manager were supportive in accessing funding for NVQ training and as a result the majority of staff had achieved at least level 2. We looked at three staff files, including two of recently recruited staff. These showed that two written references had been obtained, and Criminal Records Bureau and POVA checks had been received, including for a voluntary worker. Forms of identification and interview records are well maintained and records of disciplinary procedures are also well maintained. There were no photographs of staff on file. The manager explained these had been taken but the camera had gone missing so needed to be taken again. Staff were satisfied with their induction training. Records of induction were not closely inspected. Training records showed that substantial investment has been invested in staff training, including night staff. DVDs had been purchased to complement this training. Training programmes are on going with evidence of further sessions being booked and planned. Staff told us they were particularly looking forward to the advanced medication and accredited dementia training. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34 35, 36, 37 and 38 People using the 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 improvements in management and administration have improved the standard of care for people and staff. EVIDENCE: The Responsible Individual for Saffron Care Ltd is Mr Simon Spurle. The other provider Mrs Spurle has engaged on the Registered Managers Award education programme. The Manager has been in post since the last inspection. Since her appointment and the presence of Mrs Spurle there have been significant improvements at the home. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 27 Issues had risen at the previous inspection which had highlighted weaknesses in management and administration of the home. Since this time there have been significant improvements at the home resulting in an increase in standards. The provider and manager had listened to people who use the service, the staff and CSCI to introduce a dedicated team of senior care staff who now work together to release the manager for more administration tasks, such as supervision and training. The increase in staffing numbers has also helped with this meaning the manager and provider have had time to address issues that had arisen. As a result of these changes the home was running smoothly, complaints had decreased and safeguarding referrals stopped. Staff said the manager and Provider were very supportive and ‘led by example’. One member of staff said ‘we can go to them at any time’. Staff meetings are held with minutes kept for staff who have missed the meeting to sign. A profit and loss statement had been produced since the last inspection and not requested on this occasion. Staff said the manager and providers had ‘upped the training’ and ‘given us an extra member of staff’. The provider told us considerable investment had been made to increase staffing levels despite not being full. This was due to the fact they were committed to introducing training and increasing activities. The provider told us that once the home was full, continued work will be carried out on the fabric of the building. People are able to manage their finances independently if they chose, however, the majority have families, friends or power of attorneys to help with this. People are able to hold small amounts of money with the manager to use for trips, hairdressing and chiropody. Each person has a named wallet which contained a detailed record and two signatures. The provider said that if any one ran out of money they would be subsidised by the homes petty cash and the family later invoiced. The manager was keen to show the quality assurance monthly checks that have started at the home to show the audit of systems and procedures. Staff said these systems were easy to use. The manager also told us families are more involved and a newsletter issued to let people know what was going on at the home. Surveys had been sent to relatives and people who use the service. The manager told us the results looked good on first glance but were being collated. Time and effort has been spent to improve the health and safety aspects at the home. The manager, provider and staff all told us mandatory training has been the biggest change at the home. This training is now complete meaning there is a 1st adier on site at all times and fire safety training and risk assessments has been updated. Hot pipes have been made safe. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP29 Good Practice Recommendations The manager should introduce systems to show that each assessment is kept under review. The manager should ensure staff photos are kept on staff files. Oakhurst DS0000066583.V375358.R01.S.doc Version 5.2 Page 30 Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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