Care Home: Oakhurst Court Rest Home

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What the care home does well The home is generally clean and homely. There is a relaxed atmosphere and a friendly rapport was noted between staff and residents. Residents say that staff are `wonderful` and they feel well looked after and safe in the home. People say the food is good and there is always enough to eat. People are treated as individuals and as members of the family. What has improved since the last inspection? There were no significant improvements noted since the last inspection. What the care home could do better: The management of the home and organisation of the paperwork needs to improve to ensure the safety and well being of people living in the home. This includes all mandatory training for staff must be kept up to date, Regulation 26 visits must take place and Regulation 37 forms must be completed and sent to us as appropriate. Key inspection report Care homes for older people Name: Address: Oakhurst Court Rest Home Carron Lane Midhurst West Sussex GU29 9LF     The quality rating for this care home is:   one star adequate 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: Liz Palmer     Date: 0 9 1 2 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 23 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 23 Information about the care home Name of care home: Address: Oakhurst Court Rest Home Carron Lane Midhurst West Sussex GU29 9LF 01730816242 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Gerald Michael Elliott,Mr Ivor Elliott,Mrs Hazel Jane Elliott The registered provider is responsible for running the service care home 6 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 6 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Oakhurst Court is a privately owned establishment registered to accommodate six persons in the category of OP (Old Age over 65 years of age). The detached property is set in its own attractive grounds and is situated in a rural area approximately one mile from Midhurst town centre. Care Homes for Older People Page 4 of 23 Over 65 6 0 1 3 0 2 2 0 0 9 Brief description of the care home Accommodation is provided on the ground and first floor level. There is no lift available, therefore only people who can manage the stairs are to be accommodated above ground floor level. The establishment has been in the same ownership since 1986 when first registered. Mr. I Elliott, Mrs. H Elliott and Mr. G Elliott are the registered providers. Mrs. H Elliott is the registered manager. The range of fees charged (at the time of this report) are 420 - 470 pounds per week, with additional charges for chiropody, hairdressing, toiletries, and any newspapers. Care Homes for Older People Page 5 of 23 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection included a site visit to the home over a period of 4.5 hours, from 10.00am to 2.30pm. During this time all the staff were met spoken to and the person in charge assisted with the inspection. All service users were met and three assisted with the inspection. Care plans, medication records, policies and staff records were sampled. We also looked at the last inspection report and other information received by us since the last inspection including notifications of any events in the home. Care Homes for Older People Page 6 of 23 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 23 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured their needs will be assessed prior to moving into the home. Only those whose needs can be met will be admitted. Standard 6 does not apply. Evidence: The initial assessments of one person who had moved into the home since the last inspection was seen. It contained enough relevant detail to enable the home to be sure they could meet her needs. Details of their next of kin, General Practitioner (GP), past medical history, current health care issues and their personal care needs were included. Religious preferences were noted as were preferred daily routine, funeral arrangements and likes and dilikes regarding activities and food. The person was privately funded and chose to move in on the day of the assessment and first visit to the home. The manager stated people can visit and sample the service prior to moving in but on Care Homes for Older People Page 9 of 23 Evidence: this occasion it was the individuals choice not to do this. Care Homes for Older People Page 10 of 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. From talking to the people living and working in the home it is clear that staff know residents very well and are meeting their needs in an individual and caring way. This is not always translated in to the written records kept in the home. Evidence: Three care plans were looked at. They all had a photograph of each resident, apart from the new resident. The manager said she did not want to have her photograph taken at the moment. Care plans were seen to contain detailed, relevant information and are kept under regular review and changes are made as necessary. There was written evidence that medical assistance is sought when needed and residents confirmed they can ask to see a doctor if the need to. District nurses visit when needed and the manager stated he has a good relationship with the local GP. Residents said they felt well cared for and in safe hands. One said I couldnt wish to live anywhere better another said I consider myself very lucky to live here, they added I never thought I could settle in a home, but I have settled here. Risk assessments were seen, they are basic. Further development of care plans was discussed with the manager at the last inspection when he stated his intention to write Care Homes for Older People Page 11 of 23 Evidence: a pen portrait of each resident. This has not yet been completed. The medication is stored in a lockable cupboard. It is not used soley for the purpose of storing residents medication and was untidy and disorganised. The home uses a monthly blister pack system delivered by a local pharmacy. No errors or omissions were seen on the records. Currently no controlled drugs medication is being used by the home. The person in charge told us that when they do have controlled drugs they are stored in a lockable metal tin within the cupboard used to store other medication. The home does not have a controlled drugs storage facility that complies with the Misuse of Drugs (Safe Custody) Regulations 1973. Care Homes for Older People Page 12 of 23 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported and encouraged to maintain contact with family and friends. The food is home cooked and enjoyed by residents. Evidence: All the residents were met and spoken to during the inspection. One person was not feeling well so did not contribute to the inspection process. At the last inspection residents said they spend most of their day in the lounge as they like each others company. They said they could choose how to spend their time and were never bored. During this inspection three residents were observed playing a board game with one of the staff. They said this was a daily activity. They were also observed sat in the lounge together, reading their papers. One said we live like a family. The manager told us that they have time for individual activities with people in the afternoon, such as, reading and discussing the newspaper with them. Residents told us that their visitors are made welcome in the home and can stay for meals and are offered cups of tea. Daily records confirmed this and showed it is a busy and open home where people are encouraged to treat the home as if it was their own. Care Homes for Older People Page 13 of 23 Evidence: Care plans details peoples preferred daily routines and getting up and going to bed are flexible based on peoples choices. Hobbie and interests are encouraged. Resident confirmed they received the newspaper of their choice each morning. Records showed that religious preferences were respected and support given for people to practise their beliefs and be administered to if they chose. A four weekly menu operates in the home. No alternative to the main meal is offered although we were told there is always salad or fish as an alernative. Residents spoken to said they had not thought of asking for an alternative as they always like what they are given. Food was seen to be freshly cooked on the day and fresh vegetables were provided. Peoples likes and dislikes are recorded as is the support they may need regarding eating. Care Homes for Older People Page 14 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to complain and are protected by the homes policies for safeguarding them. Evidence: A complaints procedure is available in the home, this needs to be updated to reflect the Commissions current contact details. Residents spoken to say they would talk to the staff if they were unhappy about anything and felt that any concern they had would be dealt with. They said they have never had cause to complain. There was an open and relaxed atmosphere in the home. Since the last inspection the manager and one other staff member have attended one days training on the West Sussex County Council procedure for safeguarding adults. They say they have received training and were confident about their responsibilities if they suspected any abuse or were told of any. Care Homes for Older People Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a safe, clean and homely environment. Evidence: On the day of inspection the home was clean and well maintained. An odour was noticed in two of the bedrooms this was discussed with the person in charge and the reasons were known to staff and action being taken to solve this. The home does not have a program for the redecoration and renewal of the home. The person in charge said this is done as needed and for example each bedroom is refurbished once it becomes vacant. The kitchen looked worn and in need of redecoration. The floor is currently being redone. The lounge-diner is large, clean homely and comfortable. People spoken to were satisfied with the environment. Care Homes for Older People Page 16 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All mandatory training must be kept up to date to enable staff to carry out their roles confidently and competently. Evidence: Oakhurst Court is a family run home. Gerald Elliot is the person in charge and is one of the registered providers. The three other staff are all related to Mr Elliot and have worked here for many years. Everyone working in the home has undergone a thorough recruitment procedure which included a Criminal Record Bureau check and a Protection of Vulnerable Adult check. They are also trained and supported to carry out their roles. Mr Elliot and one other member of staff have National Vocational (NVQ) level four in Care and Management and one has NVQ level two. The person in charge could not show me evidence of up to date food hygiene certificates or first aid. Since the inspection we have been informed that staff are booked on a food hygiene course for January 2010. We have made a requirement for all mandatory training to be kept up to date. Residents spoke highly of the staff and said they are wonderful. Staff knew people really well and there was a relaxed and friendly atmosphere in the home. No new staff have been employed since the last inspection. Care Homes for Older People Page 17 of 23 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of the people living there, however, the management arrangements need to be formalised. Evidence: To ensure the smooth running of the home and for the safety and protection of people who live here, at the last inspection we made a requirement for the management arrangements of the home to be clarified to us. Since then the registered manager has resigned. The home continues to be run by Mr Gerald Elliott who is also one of the registered providers. We wrote to Mr Elliot on October 22nd this year and informed him that it is an offence under section 11 of the Care Standards Act 2000 for a person to manage an establishment or agency without being registered in respect of it. We informed him that if he remained in his current role he was required to attend a CQC office with a completed Criminal Records Bureau disclosure application within 3 weeks from the date of the letter. Mr Elliot informed us on December 11th that he had done this. Care Homes for Older People Page 18 of 23 Evidence: On October 8th this year we wrote to Mr Elliot informing him his AQAA was due to be returned to us by November 5th 2009. We had not received the AQAA up to the date of the inspection. During the inspection Mr Elliot could not find certificates for some of the training attended and nor could he find the Gas Safety certificate. He said he service was due this month and had probably filed the old certificate in anticipation of this. The portable electrical equipment certificate could not be found. This was seen at the last inspection and will also be due for renewal this month. Records we were able to look at included a certificate for 5 yearly testing of fixed wire and fire system. A certificate for the testing of fire fighting equipment, a certificate for the testing of the fire detection equipment. Mr Elliot informed us that there had been an expected death in the home since the last inspection. The Commision had not received notification of this. Under Regulation 37 the registered person has a duty to inform us of certain events and a death in the home is one of them. We saw that water temperature checks are carried out and recorded. The person in charge told us that the system is set up that the temperature in the bathroom is the temperature of all hot taps so this is the one checked and recorded. Random checks of outher outlets was discussed. We noted that the hot water in the downstairs toilet was very hot to the touch. The person in charge said this was not on the same system as the others and it was not a residents toilet. A resident was seen using this toilet during the inspection and there was no signage to indicate it was purely for staff use. We have made a requirement regarding this. Mr Elliot was unaware that under Regualtion 26 one of the partners in the business must carry out unannounced monthly monitoring vists. A requirement has been made for this. Care Homes for Older People Page 19 of 23 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 20 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 All Controlled Drugs must be 30/01/2010 stored in a cupboard that complies with the Misuse of Drugs (Safe Custody) Regulations 1973. This must happen to ensure the home complies with the law. The registered person must ensure that all mandatory training is kept up to date, this includes food hygiene and first aid. So staff are trained and competent to do their jobs. 17/02/2010 2 30 18 3 33 26 The registered person must ensure that unannounced monthly monitoring visits are carried out and a record kept of these. As part of the homes quality assurance. 17/01/2010 Care Homes for Older People Page 21 of 23 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 4 37 13 The registered person must ensure that all parts of the home to which service users have access are free from hazards to their safety. This includes all areas where hot water is available. To prevent unnecessary risks to the health or safety of service users. 30/12/2009 5 38 37 The Commission must be 15/01/2010 notified of all events listed in Regualtion 37. To protect the health, safety and welfare of people who use the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 22 of 23 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. 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