Care Home: Oaklands Grange

What the care home does well Daily life at Oaklands Grange is informal and relaxed and the people who live there tell us that this suits them. Most of them go out on their own to pursue their interests and pursuits. Staff go out with those who do not like going out alone. Relationships between the staff and the people who live there are relaxed and were summed up by one person thus: `Staff give us respect and we also give respect to staff`. This sums up the views of the people who talked to us. What has improved since the last inspection? More people now have single rooms and activities are based on individual needs rather than the group. The informal, family atmosphere of the home has been maintained and developed. What the care home could do better: Staff need to have access to a full training programme to enable them to continue to develop their skills and knowledge. The statement of purpose and service user guide need to be regularly updated to reflect what the home provides. Key inspection report Care homes for adults (18-65 years) Name: Address: Oaklands Grange 53 Seabank Road Wallasey Wirral CH45 7PA     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: Peter Cresswell     Date: 0 7 1 0 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 Adults (18-65 years) Page 2 of 24 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 24 Information about the care home Name of care home: Address: Oaklands Grange 53 Seabank Road Wallasey Wirral CH45 7PA 01516305804 F/P01516305804 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Pinpoint Developments Limited care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 15 Date of last inspection Brief description of the care home Oaklands Grange provides care for adults who are experiencing mental health problems. The building is a three storey detached house on the main road between New Brighton and Seacombe, within half a mile of Liscard town centre. Shops, a post office and other community facilities are nearby and the riverfront at Egremont promenade is just a short walk away. Buses to New Brighton and Seacombe stop close by. Two bedrooms are shared but all residents have been given the option of having their own room. Oaklands Grange has a TV lounge, lounge/dining room and a spacious back garden. A small quiet room on the first floor can also be used for seeing visitors. There is space for car parking at the rear of the building. Fees at Oaklands Grange are Care Homes for Adults (18-65 years) Page 4 of 24 Over 65 0 15 Brief description of the care home £393.89 a week. Care Homes for Adults (18-65 years) Page 5 of 24 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: As part of this inspection we went to the home without telling anyone that we were going. We talked to the manager, the two staff who were on duty and all of the residents who were in at the time. During the visit we also looked at staff files, care plans, records of activities and training records. We checked the medication for a sample of residents. Before we visited the owners completed an Annual Quality Assurance Assessment (AQAA) or the commission. This has to be sent to us and includes the services own assessment of how it is performing as well as some useful statistical information. We sent out survey forms to a number of residents and four of them replied, giving their views on how the home meets their needs.The homes fees are £303.89 a week. Care Homes for Adults (18-65 years) Page 6 of 24 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 Adults (18-65 years) Page 7 of 24 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 24 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are only admitted after their needs have been properly assessed. People considering admission would not have all of the written information about the home they need before moving in. Evidence: There have been no new admissions to the home since we last visited but Oaklands Grange has an admissions policy in place. Anyone who wants to come and live in the home would be fully assessed by the manager and given the chance to visit and even have a trial stay before making a final decision. The service user guide does not include details of how to obtain inspection reports from the Care Quality Commission. A statement of purpose is included in the service user guide but it does not include all of the details that are needed and should be fully reviewed and updated as required when we last inspected the home. This is needed to make sure that anyone who is thinking about moving in has full written details of what the home provides. Care Homes for Adults (18-65 years) Page 9 of 24 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Service users play a full part in the life and running of the home. Care plans are reviewed regularly to ensure that care is based on up to date information but more detail is needed. Evidence: There is a care plan in place for everyone who lives in the home and we looked at three of them. The plans contain a lot of detail about the individual, their background and their needs. However they are not in the form of a plan for action which can be readily followed by staff. It would help if a care plan summary was dawn up setting out the main points for action on a weekly and daily basis. This might help to make the daily reports a bit more informative as - understandably given how long most people have lived there - the daily notes have become rather bland. The home does not have a computer so the plans are handwritten and therefore not easy to update. They are reviewed regularly and the reviews are signed by the keyworker and the resident. If any changes are needed to the plan the manager told us that the plans are if necessary rewritten. Using a computer would make this process a lot easier. Life at Care Homes for Adults (18-65 years) Page 10 of 24 Evidence: Oaklands Grange is relaxed and informal and people told us how much they value this. One told us I still retain my freedom to go out. Another reflected that there were no restrictions - care when I need it. We talked to all of the residents who were in when we visited. Care Homes for Adults (18-65 years) Page 11 of 24 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. Daily routines at Oaklands Grange are relaxed and based on the choices of the people who live there. People have healthy meals which are of their choice. Evidence: The people who live at Oaklands Grange take part in a wide variety of different activities in the community and within the home itself. Staff support them when necessary but many people go out on their own. Whilst we were there some people had gone out to a local day centre and others came and went to local shops and pubs. The person who went shopping also did some shopping for another resident who is less keen on going out. One person was arranging a hospital appointment visit and staff were going to accompany him. Several of the service users go to drop in centres and day centres and told us about the activities they take part in. One person told us he was doing a course at a local college. One person was taking part in meditation exercises. Inside the home people watch television, listen to music and read. Although Care Homes for Adults (18-65 years) Page 12 of 24 Evidence: staff support service users in their activities there are not many group activities or outings now, as the manager said that people prefer individual activities. People also help out around the home and some laid the tables for lunch whilst we were there. Two of the people we chatted to said that they do their own laundry. Some people who used to live in the home still call in from time to time to see staff and old friends. People make decisions about their own lives and in a survey one pointed out that I still retain my freedom to go out. Everyone we talked to felt that they were able to do their own thing but would be supported if they needed it. It was clear from talking to the manager and staff that they have a clear and well informed view as to how much support each person needs and will accept. When people do go out they sign in and out of the home, a measure that they accept and support as a reasonable precaution. The owner told us (in the Annual Quality Assurance Assessment) that people at the home vote in local and national elections and one resident told us that he always voted and felt that this was important. Most people prepare their own breakfast when they get up throughout the morning. The menu for the other meals was varied and based on the meals that people in the home enjoy. Lunch on the day of our visit was described as residents choice and the people in at the time both chose grilled spam on toast, a perennial favourite which they greatly enjoyed. Everyone we talked to said that they enjoyed the meals at Oaklands Grange and in a survey one person told us they provide a good quality of food; another said I get the proper meals, which is healthy. The manager told us that they try to avoid too much fried food for health reasons. Fresh fruit is always available and the home uses fresh vegetables wherever possible. The home does not employ a dedicated cook so care staff do the cooking. Care Homes for Adults (18-65 years) Page 13 of 24 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Peoples physical and emotional needs are met. Service users are protected by the homes medication procedures. Evidence: Most people who live at Oaklands Grange do not routinely need physical personal support but they are given any personal support that they need, including emotional support and encouragement. Everyone has access to all community and specialist health care services and several have a community psychiatric nurse (CPN). The individual files included the details and up to date notes of all contact with relevant health care professionals. One person looks after his own medication and has the facilities to store it safely. Medication is supplied to the home in individual cassettes every week. We checked the medication for three people and it was accurately recorded. One medication to be given as required (PRN) did not have details of the circumstances in which it was to be administered. Although the manager knew the correct procedure it is good practice to record PRN instructions in these circumstances. Medication is reviewed by peoples GPs or community psychiatric nurse where they have one. Care Homes for Adults (18-65 years) Page 14 of 24 Evidence: Details of peoples wishes on their death were recorded on the files we looked at. Two people have sadly died since the last inspection and are greatly missed by staff and other residents. Owners, staff and some residents attended a requiem mass for one of the deceased. Family members of both residents had sent in letters and cards of thanks to the manager, one of them thanking staff for the patient and dedicated care and attention they had given to their late relative. The family of one of the people who had died have given the home a new garden bench in his memory. Care Homes for Adults (18-65 years) Page 15 of 24 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. Service users are protected from abuse by the homes safeguarding procedures. Evidence: Oaklands Grange has suitable complaints and safeguarding policies. There have been no complaints or safeguarding referrals since we last visited. One person told us that I know when I have a complaint I discuss it with staff or with the homes manageress. Care Homes for Adults (18-65 years) Page 16 of 24 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. Oaklands Grange provides comfortable, homely accommodation that meets the needs of the people who live there. Evidence: Oaklands Grange was clean and tidy when we visited. We looked at all the rooms in the home, including the bedrooms. Only two rooms are shared now and those people have said that they prefer to share; they have been given the opportunity to move into single rooms but do not want to do so. The bedrooms reflect the personalities and tastes of the people who live in them. In several rooms there were photomontages that staff had helped people to put together. These consisted of personal photos from the persons past and added a personal, unique touch to the room. Two of the bathrooms and toilets needed some attention. In a top floor toilet the floor was badly stained, the ceiling was flaking and some new wood needed to be painted. The seal between the bath and the floor on the first floor needed to be renewed. On the first floor the bathroom floor needs to be replaced if it cannot be cleaned. The kitchen was clean and tidy and the freezer in the garage was working properly, ensuring that the food was kept safely. The lounge and dining room/lounge were clean and tidy. These rooms are very popular with the residents and are the centre of the homes social activity. Care Homes for Adults (18-65 years) Page 17 of 24 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. An experienced staff group provides good quality care to service users. Staff need up to date training to perform to the highest level. Evidence: We looked at the recruitment checks for the two staff who had been recruited in the last year. All of the appropriate checks had been carried out. There are normally two care staff on duty (including the manager) plus a domestic who is employed for five days a week. The manager needs to take care to ensure that the home remains adequately staffed at weekends. Seven of the twelve care staff have NVQ2 or better, which is the appropriate qualification for their work. One other member of staff is awaiting a place on an NVQ programme. However, there had been very little other training in the past year. The manager and the owner need to put a full training programme in place covering essential areas such as health and safety, where regular training is mandatory, as well as training on emerging issues such as the Mental Capacity Act. Staff need to be up to date with their training in order to maintain the good service they provide to the the people living in the home. We spoke to two members of staff as well as the manager and staff morale and team spirit seems to remain high. One service user told us in a survey that the staff give us respect and we also give respect to the staff. Staff receive regular one to one supervision and an annual appraisal and a record is kept of these meetings. Care Homes for Adults (18-65 years) Page 18 of 24 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed with records properly kept, protecting the interests of the residents. Evidence: The registered manager is qualified and experienced. People who live in the home know her very well and we could see that they are comfortable discussing things with her. The owners visit the home regularly and another family member carries out monthly monitoring visits though the written records of these were not up to date. In such a small home quality assurance tends to be through informal feedback from the service users. They do occasionally fill in questionnaires though the manager says that they tend to get fed up if they are given them too often. There are occasional residents meetings where people can air their views about how the home is run. The most recent one in August 2009 arranged a trip to Liverpool for three people. Improvement in formal quality assurance was one of the owners objectives when we last visited and in the AQAA it is again listed as part of the improvement plan for the next twelve months. Oaklands Grange does get informal feedback from other professionals and one hospital consultant recently wrote to say that a member of staff Care Homes for Adults (18-65 years) Page 19 of 24 Evidence: who attended a recent appointment with a resident was most helpful and brought all the appropriate information with them I am sure this reflects a high standard of the staff and leadership at Oaklands Grange. Fire safety checks and training were up to date and safety certificates were in place. The food safety programme Safer Food, Better Business is used to monitor food safety in the home. Care Homes for Adults (18-65 years) Page 20 of 24 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 1 4 The statement of purpose 01/11/2007 must be amended to reflect the services provided and must therefore be amended to include the following: * service users are no longer allowed to smoke in the building; * the existing policy of supporting residents over the age of 64 for as long as the service is able to meet their needs; * reference to the Commission for Social Care Inspection rather than the now defunct `National Care Standards Commission?. The registered person must 05/09/2007 not employ a person to work at the care home unless they are fit to work at the home. In particular, the registered person must ensure that every new employee has received Protection of Vulnerable Adults (POVA) clearance before they start work. 2 34 19 Care Homes for Adults (18-65 years) Page 21 of 24 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 1 6 The statement of purpose and service user guide must be reviewed and updated. People moving into the home need to have adequate written information about the home 01/01/2010 2 27 23 All parts of the home must 01/12/2009 be kept reasonably decorated so the floors in the identified bathrooms and toilets must be cleaned or replaced. To give service users an acceptable homely environment. 3 35 18 The registered person must ensure that all staff receive training appropriate to their role and must therefore put in place a full training programme to meet statutory training needs as well as on new 01/01/2010 Care Homes for Adults (18-65 years) Page 22 of 24 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 developments such as the Mental Capacity Act. Service users needs must be met by appropriately trained staff. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 6 20 Care plans should include an up to date summary of the care to be provided. Where medication is to be administered as required (PRN) there should be a written protocol on file setting out when it is to be administered. Care Homes for Adults (18-65 years) Page 23 of 24 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). 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