Care Home: Oakwood House Residential And Nursing Home

What the care home does well The residents we saw were very well cared for including their personal grooming and healthcare needs. The staff team were very responsive, and provided care in a kind and respectful way, and were well trained, skilled and experienced to meet the needs of the residents. Comments received from some of the relatives said, `On our visit we can see that my relative and all the other residents in the home receive the most amazing care and this is always appropriate to their individual needs` or, `As a family member, I could not wish for my relative to be cared for anywhere else. Over the years they have received exceptional care and support`. Staff told us, `The home adheres to high standards of care and they continually seek to find new ways to improve the service`. People with specialised diets would be offered a range of nutritional food options, to maximise their personal health. The atmosphere during the inspection was calm, warm and friendly, and visitors were welcomed to the home throughout the day. The home was found well decorated, clean, comfortable and appropriately maintained. The home provides people with good opportunities which allow for choice and control over their preferred lifestyle. This includes opportunities for them to access home activities and opportunities in the wider community. People who live at the home will benefit from a well run service with an open and approachable management style that ensures their specialised care needs would be met. There is a commitment by the management to provide the residents with a good service demonstrated by a willingness to listen to peoples` concerns, and allow feedback to the home about the service provision. The home showed us they have good recruitment and selection processes in place, which should ensure that only appropriately cleared staff are employed to care for the residents. What has improved since the last inspection? Some previous minor concerns have been fully addressed by the home. The information provided by the service told us that they have increased resident/relative and community links to the home, and further increased the scope of the residents` occupation and activities. The residents` care plans have also been improved. What the care home could do better: This inspection evidenced that the home continues with the positive provision of a service that fully meets the needs of the residents. There were no requirements or recommendations as a result of the inspection. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oakwood House Residential And Nursing Home Stollery Close, Off Ropes Drive Grange Farm, Kesgrave Ipswich Suffolk IP5 2GD     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kevin Dally     Date: 2 6 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 33 Information about the care home Name of care home: Address: Oakwood House Residential And Nursing Home Stollery Close, Off Ropes Drive Grange Farm, Kesgrave Ipswich Suffolk IP5 2GD 01473612300 01473623933 helen.rollin@anchor.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Anchor Trust care home 24 Number of places (if applicable): Under 65 Over 65 0 12 dementia mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home 24 12 Oakwood House is a care home owned by Anchor Trust, which provides accommodation and nursing care for twenty-four older people with dementia and or mental health needs. The house was purpose built in 1993 and is arranged in three units of eight residents each. The home is located on the outskirts of Ipswich in a newly developed area of the village of Kesgrave. It is within easy reach of local shops, churches and the GP surgery. The accommodation is over two floors, which are connected by a passenger lift, with two units on the ground floor and one on the first floor. All twenty-four bedrooms, referred to as flats, have en-suite toilet and shower facilities. Each unit has a lounge/dining area with a kitchenette for making hot drinks and snacks. There is a large communal lounge on the ground floor and some smaller quiet seating areas. There is access to an attractive secure garden with seating. The weekly fees are £914. Care Homes for Older People Page 4 of 33 Care Homes for Older People Page 5 of 33 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: three star excellent 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 key inspection of Oakwood House took place on the 25th and 26th March 2009, and they were not told in advance of our inspection. Seven outcome areas for older people were checked during this time. Mrs Helen Rollin, the manager, assisted us and provided information that was relevant to our assessment of the service. Mr David Miller, area manager for Anchor, was also visiting the home during our inspection. We spent time talking with a number of the residents and relatives, who told us what living at the home was like. We spoke with some of the staff group and observed them caring for the residents throughout the day. We observed some of the residents being assisted during the lunchtime period, and we followed one of the nurses during the medicine round. A selection of the residents care plans and medicine records; risk Care Homes for Older People Page 6 of 33 assessments, menu records, maintenance and training records were also checked, as were a selection of other documents, including some staff files, and duty rotas. Surveys were sent to the home to distribute to the residents and/or their relatives before the inspection took place, and ten surveys were returned to us. Five staff members also returned their surveys, and a selection of their views and opinions about the home are included within this report. The service also completed the CSCI annual quality assurance assessment form (AQAA), which provides key information about the home, and allows them to say what they do well, what they could do better and any plans to improve the service. The report has been written using some of the information gathered before, or during the inspection. What the care home does well: What has improved since the last inspection? What they could do better: This inspection evidenced that the home continues with the positive provision of a service that fully meets the needs of the residents. There were no requirements or recommendations as a result of the inspection. Care Homes for Older People Page 8 of 33 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People moving into the home could expect to receive very detailed information about the service, to allow them to make an informed decision, if the home would be suitable for them. Evidence: The home provides comprehensive information for new residents in a colourful Anchor Homes brochure and CD, a welcome to Oakwood house brochure and the service user guide. Information included the purpose of the home and the services available, and how a resident can make a complaint to Anchor Homes. There was information about the management structure of the home, the qualifications of the staff group and a sample copy of the terms and conditions of the service. Anchor Homes also provide a checklist for residents to compare, when choosing a care home. Information provided by the home (AQAA) told us, all enquires are followed up with a letter and information pack, and visits to the home are offered to potential customers and their family. Care Homes for Older People Page 11 of 33 Evidence: Feedback received from 9 of 10 residents told us that they had received sufficient information about the home before they had moved in. One said, no, but did not say why. One relative told us, We visited 3 local homes, and this one was the best by far. The home told us, pre-admission assessment pro-forma action is taken prior to admission, and we use the information gleaned to ensure that identified need is met, from the time of admission. Some of the residents pre-admission assessment forms were checked and these showed us that information is gathered about the residents specialised care and support needs, before they enter the home. The assessments included past history and mental health information, medicines needed, and the aims of the care to be provided. An activities of daily living assessment included around 14 areas of assessed need, for example communication or mobility needs. The assessments allow staff to assess if the home can meet the needs of each individual and ensure that appropriate information is gathered about them, before they move in. As many of the residents are quite vulnerable, the assessments included detailed information about their preferred lifestyle choices. For example their particular specialist dietary needs, behaviour patterns, or preferred rising and bed times. This information provided staff with a valuable insight into the persons behaviour, or preferred choices, in order that they can plan how to best support the resident. During the day we spoke with and observed some of the care staff responsible for some of the residents, and they were able to tell us in depth, how they support residents with very specialised needs. One example was a member of staff was able to demonstrate their knowledge by telling us about particular residents specialised nutritional and behavioural needs. Another staff member was seen applying positive support techniques with a very anxious resident. This approach gained the residents trust and they responded and settled very quickly to this support. The home showed us that the staff group had received, and continued to receive comprehensive training (please refer to the staffing outcome area). This showed us that their knowledge, care skills and experience was able to support people who have specialised or challenging needs, including people with dementia, or mental healthcare needs. Each shift has a lead registered nurse and usually a second nurse who are responsible for the day to day care and direction of the home, and care staff are trained to provide support for the residents. One example of training was that some of the staff group were able to describe the training sessions they had received around dementia care and unisafe training, and how they would apply it at the home. They told us The training at Oakwood house is excellent or the service provides excellent care to each of the residents. It provided staff with all areas of training that is required. The home provided new staff members with induction training which covered the Care Homes for Older People Page 12 of 33 Evidence: matters they needed to know, when they started the job. Information provided by the home told us that 19 of 25 care staff (76 ) had achieved a national vocational qualification (NVQ) level 2 in care or higher, with a further 5 working towards this or higher care qualification. (Please refer to staffing outcome area). This would ensure that care staff have appropriate care skills and qualifications to meet the needs of the residents. A selection of feedback received from the residents, or relatives about their views of the service are as follows. On our visit we can see that my relative and all the other residents in the home receive the most amazing care and this is always appropriate to their individual needs. We think that the residents feel safe here. I am very satisfied with the home and the care. The home go to great pains to understand my relatives needs, wishes and anxieties, and this is far from easy, as they have dementia. We think that Oakwood House is in a premier league of its own. I cannot imagine my relative anywhere else. Despite our relatives care problems the staff deal with their personal hygiene, as they are always smart, fresh and clean. Care Homes for Older People Page 13 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can expect to have their specialised healthcare needs recorded and met by competent staff. The staff group support vulnerable people in a way that promotes them as an individual, and ensures they are treated with the utmost respect. Evidence: The information provided by the home told us, Holistic assessment tools available as part of the service users plan enable effective identification of individual needs. We provide a person centred reality approach to care needs. During our visit, we checked two residents care plans which included comprehensive information around the care and risk assessment aspects of their support. We also tracked a number of the residents to see if the recorded care matched with the care given. In addition to the activities of daily living assessments provided, the home identified key risks that applied to each resident. For example one risk assessment identified the resident as at risk of aspiration and choking and so needed support with Care Homes for Older People Page 14 of 33 Evidence: meals and nutrition. The home had therefore involved the community dietician who had provided guidelines for their support including providing a thickening agent with fluids, and a soft pureed diet. During the morning a staff member explained the nutritional support one resident needed and showed us that specialised diet drinks and supplements with high protein content was always kept available in the flat for them. Staff then encourage the resident to take small, frequent amounts of food to encourage their appetite, and ensure they avoid weight loss. There was evidence of additional food and fruit readily available for any of the residents in this unit. Another care plan included an alert sheet or a daily record of the care provided. Detailed sections in the care plan included information around mental health, seizures, personal care, mobility needs, medicines, assistance with meals, the risk of falls, and tissue viability and social well being. Each area was identified with their care needs, expected outcome, significant areas of risks, and the nursing care action required. The care plan highlighted individual needs in an empowering manner. For example, one entry in the mobility records said, Uses a wheelchair. Please transport in a respectful and dignified way. Additional specialised nursing care information included pressure area care risk assessments, accident records, falls records, moving and handling risk assessments, weight and nutritional information. One care plan included a record of seizures, and how staff should manage these medical events. There was information around each residents lifestyle choices. For example, their preferences for rising in the morning, or their particular likes and dislikes. An emotional and psychological wellbeing chart focused on any mental health issues including what makes them happy or how staff can recognise worry and help the resident avoid the stress of the particular problem. Management records we checked showed us that accidents are closely monitored and discussed with the nursing staff. The home had experienced some issues with one resident relating to mental capacity and their ability to make decisions. This had become detrimental to them so the home had requested an assessment of capacity. This had been completed including a plan for managing the issues raised. During the morning we observed a resident at the dining table, who became very anxious and called out to staff. Staff sensitivity supported the resident and offered a safe soft chair on the floor, where the resident immediately calmed and settled. The resident was seen to be happy and staff talked and assisted the person through out the remainder of the morning. Staff always made the residents a priority and excused themselves from discussion with us, when the resident needed their support. During the morning we saw the administrator had noted that a resident had become disorientated in the hallway, so delayed their work, and spent a few minutes Care Homes for Older People Page 15 of 33 Evidence: reassuring the resident that all was OK. The resident was politely spoken with and a good explanation was given of how they could find their room. Throughout the visit staff were always observed providing care in a patient and unhurried manner, and this put the residents at ease. The records we checked showed us the contact residents had received with various healthcare professionals, including their general practitioner (GP), the speech therapist, the dietician, and an occupational therapist. Feedback received from 9 of 10 residents surveys said they always or usually received the care and support they needed. Eight of 10 said they always received the medical support required, one said sometimes and one said never, but did not say why. A selection of comments about the care received included the following views. Our relative was brought here on deaths door, as their dementia had deteriorated. The moment they came in their condition improved rapidly. We think this is a fantastic home. I am impressed with the quality of care here. This is a very good home. I was unable to cope with my relative at home, but they cope with them very well here. They have strategies for each individual person, who receive amazing treatment. The nursing staff respond immediately to any concerns raised through the carers, family, friends or indeed, the other residents. My relative has seen a specialist twice and the doctor several times. They have been placed on drink supplements. The staff always attend to our relatives needs. They are good at dealing with their moods and helping them to overcome periods of unhappiness resulting from their dementia and confusion. We saw residents were being called by their preferred name and the residents we spoke with felt that staff were patient and kind. Staff were observed to be hardworking throughout the inspection, were very patient and always resident focused. We saw that the residents dignity was maintained during care sessions, and residents were positively included in conservations. Staff were seen knocking on the residents doors before entering, and always respected their privacy. Care Homes for Older People Page 16 of 33 Evidence: The information provided by the home told us, There are new medication policies and procedures in place, and a training programme for all levels of administration. The home uses a 28 day monitored dosage system (MDS) with blister packs and medication administration record (MAR) sheets, for recording purposes. Each residents details and medicine information is maintained on the MAR records. Medicines are kept locked in the medicine trolley in each area, which the staff take to the residents. The lunchtime medication round was observed in the upstairs flat and the MAR sheets were checked, and three residents medicines were audited. Good practice was observed with the nurse in charge seen to sign the MAR sheets appropriately after medicines were administered. There were no signature gaps noted on the MAR sheets. All the medicines audited found that the total stock balanced with the records. The information provided by the home informed us that there was medicine guidance around the control, storage, disposal, recording and administration of medicines, although this was not checked on this occasion. During the previous year, the home had advised us via notifications (Reg 37) that there had been some medicine errors at the home. The manager had investigated each of these and had taken appropriate action to ensure that these errors are reduced or eliminated. To address these issues, nursing staff now audit the medicines at every handover, and provide a handover to the new staff coming onto the shift. This is to ensure accountability of nursing practice. There are also regular management random spot checks and audits of 8-9 charts, and any concerns are raised with appropriate staff members, during supervision. There is a monthly audit of all the medicines, and any shortfalls are recorded and discussed with the nursing team, at the nurses meeting. The manager also stressed the importance of encouraging a culture of openness in the home with nursing staff about any medicine errors. This was to encourage nursing staff to come forward and report errors, so that the whole team could then learn from these. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are provided with meaningful daily living opportunities that allow them to be part of the home or wider community. People could expect a nourishing and wholesome diet. Evidence: The home encourages person centred care for vulnerable residents so lifestyle opportunities are tailored to meet the individual needs of people, and not the routines of the home. People are therefore able to rise when they want, move freely around the home including the privacy of their own room, or take meals at their own leisure. Staff were aware though of each persons needs and constant monitoring is undertaken of their physical and emotional well being. On arrival at the home we spent most of the morning with the residents and staff in the ground floor flat. There was a calm and unhurried atmosphere present and considerable time was given to support the emotional needs of each of the residents. People were observed receiving personal 1:1 attention with their personal hygiene and nutritional needs, at a time when it they were ready for this. One example we saw was that a resident refused their breakfast, so staff returned later when they were more Care Homes for Older People Page 18 of 33 Evidence: receptive, and breakfast was successfully completed. A second resident who had become quite anxious was reassured by a member of staff. The resident eventually settled and continued with their day, and were later joined by a relative who was able to further support their emotional needs. There was a television in the day room in one section, and some of the residents were watching a programme. However, later in the morning with the residents agreement, music was played and fully enjoyed by them. Some of the residents had been quite active earlier, so now enjoyed the opportunity to rest and join in with some of the songs. Throughout the visit we observed staff interacting well with the residents and this included conversations with words of encouragement or support. Positively, throughout the day we saw relatives arriving at the home who were actively encouraged to join in and participate with their relative. Friends and family stayed as long as they were able, and where privacy was needed, a quiet room was offered. One resident told me that they were quite contented living at the home. They said, The staff are very kind and help me. This included ensuring they had their preferred drink and watching them take their medicines. They also enjoyed the company of the homes cat. They told us that they received frequent visits from their family and that there were always things to do during the day. For example, exercises or reading the paper. One staff member told us we take turns with activities. There are dominos, exercises with a ball, and music sessions. Our activities person will organise a visit to the local shops, scrabble or puzzles. We spoke with the homes activities co-ordinator who informed us about the various homes activities provided. Examples included movement to music, cooking 1:1, patchwork quilt work, coffee mornings, reading or a visit to the local garden centre. A number of the relatives we met told us about life at the home. One relative said, there has been fundraising to buy a mini bus. They take the residents into the community on a regular basis. In February I was invited to join my relative for lunch, at the local coffee shop. I thought this was great! Two busloads of the residents (14), 5 staff members and 6 relatives attended, and we were also able to meet other relatives, which was really helpful. Relatives also informed us that there were remembrance services, birthday parties; and the local vicar holds a church service. During the lunch time period we visited two of the dining rooms and tables had been set in readiness for lunch. Some of the residents joined with others at the table while Care Homes for Older People Page 19 of 33 Evidence: some preferred their own side table. People were seen chatting with friends, family or staff about their particular day. Positively, we saw staff supporting the most vulnerable residents, with encouragement and patience, while others were able to manage on their own, with limited support. The meal on the day was a choice of toad in the hole or tomato and basil quiche, which looked and smelt appetising, and was served in appropriate portion sizes, so as not to discourage appetite. This was served with seasonal vegetables. Soft diets were provided for people with swallowing difficulties, and had been pureed and separated into constituent parts so that taste and colour had been maintained. Dessert was spotted dick with custard. Feedback we received from 9 of 10 residents said they usually or always like the meals at the home. A selection of the comments we received about the meals included the following views. We do get a good choice of meals. I think the meals are very good. Our relatives food has to be soft or pureed and their drinks thickened. Their food is nonetheless always appetising, which they enjoy. Meals are specially made for me , so that I can swallow them easily. Care Homes for Older People Page 20 of 33 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. Peoples complaints and concerns would be taken seriously and acted on by the home, and vulnerable people would be kept safe. Evidence: The information provided by the home said, Complaints and feedback is actively welcomed, as a mechanism to improve service provision. The complaints procedure is now in a tape format, if required. Further, there is an adults safeguarding process in place, and safeguarding training for all staff. The home has a complaints procedure available for the residents and a copy was provided in the service user guide. The complaint book was checked and 5 concerns had been recorded. All complaints related to care issues and concerns about individual residents, and the manager had investigated, recorded and responded to each of the concerns. The home has policies and procedures in place for the safeguarding of vulnerable adults including whistle-blowing procedures. The home has access to the Suffolk interagency policy on the protection of vulnerable adults, and Anchor company policy on adult protection. The manager was aware of her responsibilities in reporting any allegations of abuse to Social Services via customer first, for referral to the safeguarding team. Care Homes for Older People Page 21 of 33 Evidence: During the last year 2 safeguarding alerts had been made by the home and appropriate actions have been taken in both cases. In the first case, after investigation, two staff members were dismissed by the organisation for failing to carry out their duties, in line with Anchors polices. A second alert was referred to the adult safeguarding team about a non-member of staff and this is still being investigated by the safeguarding team. We were reassured that the home takes swift action, in the event of any allegations of abuse. Feedback received from 8 of 10 residents questionnaires said that they always or usually know who to speak to, if they are not happy, but 2 did not say. Nine of 10 residents said yes I know how to make a complaint, one said no, but did not say why. Some of the people we spoke with said the The manager , nurses and care staff have all been very open with us. A relative told us, If I had any concerns, I would call the manager and discuss them with her. Recruitment procedures checked (please refer to staff section) showed us that new employees would be checked and cleared before they work with any vulnerable adults. Staff training records checked and feedback from staff members informed us that they had been provided with safeguarding training by the home. This would ensure that the staff team would know what to do in the event of any allegations of abuse or concern. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at the home benefit from a modern, purpose built home, with pleasant surroundings. Evidence: The information provided by the home said, The home has a very welcoming entrance with flower tubs and provides a clean homely environment, a range of music, fresh flowers, fish tank, and two home cats. There are good quality facilities, which have been designed for the specific purpose. Oakwood house provides spacious, modern and safe accommodation for the residents over two floors, which are connected by a passenger lift. Two units are on the ground floor and one on the first floor. All twenty-four bedrooms, referred to as flats, have ensuite toilet and shower facilities. Each unit has a lounge/dining area with a kitchenette for making hot drinks and snacks. There is a large well appointed communal lounge on the ground floor with and some smaller quiet seating areas. Hall ways are wide and wheelchair accessible. There is access to an attractive and well maintained secure garden with seating. A tour of the building included the main lounge, and smaller lounges/dining rooms, Care Homes for Older People Page 23 of 33 Evidence: and these were decorated and maintained to very good standards, were fresh, clean and without any unpleasant odours. Domestic staff were seen cleaning throughout the day, and staff used protective aprons and gloves for infection control purposes. Most of the rooms are spacious and supplied with appropriate fixtures, fittings and furniture. The hallways were spacious, but staff had tended to leave some unused home equipment there, which should be avoided. Chairs organised in the lounges provided sufficient space around them to allow staff to assist any residents needing hoist lifting equipment. A number of the residents rooms were checked, and again these were found to be very well maintained, clean, and tidy with good furniture, and beds. Some residents preferred their own room, and were able to remain there in private. The home was found clean and fresh in the areas seen. People living at the home confirmed this. Observation, and discussion with people living and working at the home, showed that staff continued to take adequate steps to maintain hygiene and avoid the spread of infection. This included appropriate use of plastic gloves and aprons and hand hygiene, which was seen in use during the day. The information provided by the home told us they have infection control procedures and policy in place, and hand washing is promoted at all times. Training takes place at induction. When asked Is the home fresh and clean?, 10 of 10 residents surveys said always. One person told us , The home and environment is always fresh and clean, and another said, I find the home is very clean and tidy at all times. Residents always have their own clothes. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can expect a well trained staff group who meet their needs. Evidence: In addition to the manager, the home is staffed by six carers (two in each section) and two nurses in the morning, which is reduced by one in the afternoon and at weekends, with one or two nurses. On nights there is one nurse and 3 carers. The home also employs house keeping staff, laundry and kitchen staff. Staff said that there were usually sufficient numbers on duty to enable them to meet the specialist care needs of the residents, and that the manager was very supportive. There were good working relationships between all the staff team and they had regular staff meetings, so were kept up to date with the latest changes at the home. Each unit has a staff meeting which informed them about their specific residents. Staff told us, we enjoy working at the home. There is always someone we can go to, if we have any concerns the manager is always available. We were also told that the heads of department meet regularly to discuss common problems at the home. Feedback from 8 of 10 residents said staff are always or usually available when we need them. Two did not say. Staff told us, The care practice is very high. We support Care Homes for Older People Page 25 of 33 Evidence: everybody, and work as a team. The recruitment procedures of the home were checked and two staff files were examined. These records showed us the home operates good recruitment procedures which ensure that staff are checked and cleared to work with vulnerable adults. The staff members records we saw included Criminal Bureau Records (CRB) checks and Protection of Vulnerable Adults (POVA) checks. Further, staff had completed an application form, and provided a detailed record of their previous employment. Two written references had been obtained by the home for new employees, and records were maintained of proof of identity by way of a passport or birth certificate. One nurses records checked showed us that the home had obtained a check of their professional identity number (PIN) from the nursing and midwifery council, (NMC), to confirm their professional registration and right to practice in as a nurse. Staff training records checked showed us that the home provides comprehensive training that would ensure that staff were trained to meet the needs of the residents. One new employee had received induction training based on the Skills for Care common induction standards (CIS) which covers 6 key areas over a 12 week period. The records checked showed us that they had attended training for safeguarding, fire, infection control, moving and handling training, health and safety training and communication training. New employees maintain an induction folder and new information is added on completion, to evidence new learning. Home training for the staff group was discussed and extensive training was recorded in the records. This included in addition to core training, safeguarding training and moving and handling, dementia awareness, unisafe training, challenging behaviour, medicine creams, health and safety training, food hygiene training, and mental capacity act training. When staff were asked Are you being given training which is relevant to your role and helps you understand and meets the individual needs of the service users?, all said yes. Comments received from staff members included the following views. Oakwood provides a high standard of care, which is person centred, and the residents are all treated with dignity and respect. The staff team work very hard and well together to support each other. The home looks after the residents very well. We have modern equipment which makes like a lot easier for the residents and us. Care Homes for Older People Page 26 of 33 Evidence: The service provides excellent care to each individual resident. It provides staff with all areas of training that is required. Support is always there from the manager and trained staff when needed. Information provided by the home told us that 19 of 25 care staff (76 ) had achieved a national vocational qualification (NVQ) level 2 in care or higher, with a further 5 working towards this or higher care qualification. This would ensure that care staff have appropriate care skills and qualifications to meet the needs of the residents. Care Homes for Older People Page 27 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home benefit from a well run service with an open and approachable management style that ensures their specialised needs are met. Evidence: The home had a sound management structure and team which was lead by a very capable and experienced manager, Mrs Rollin. Mrs Rollin is a registered nurse, and has achieved a BSc(Hons) in health studies. She is also a dementia care mapper, and has completed the modern matron leadership programme and the registered managers award (RMA). In 2008 she was awarded dignity champion by the department of health and Anchor trust. It was evident from the management records that the home was very well managed as these showed us that the management team maintain good communication with the residents, the relatives, and the staff group by regular meetings, and opportunities to feedback. The home also undertook detailed monthly management checks and monitoring about all aspects of the service. This enabled management to identify and deal with any problems that arise. Feedback received Care Homes for Older People Page 28 of 33 Evidence: from a relative said, I have never had to make a complaint. All comments, no matter how minor, have always been dealt with. A number of the staff group told us, The manager was always approachable. The home has good quality assurance systems in place including monthly management audits, a complaints procedure, monthly provider reports, and incident reports to the Commission. This ensured that monitoring was undertaken and that the home is run in the best interests of the residents. There was evidence of individual review meetings with the residents which ensured that any changes in their condition are highlighted, and resolved . The home completes an annual quality assurance questionnaire which was last undertaken in September 2008, when around 12 of 20 residents questionnaires were returned to the management. The feedback was summarised by the home to show what people were satisfied with, and where there were any any shortfalls, so the home could further improve the service. A selection of feedback from the homes survey of the relatives or residents was as follows. I always enjoy visiting my relative in Oakwood, and always find the staff warm and friendly. The trip for the residents for a Christmas lunch, was excellently organised and a very enjoyable experience. I am writing to you on behalf of all our family to thank you for the care and kindness you showed to our relative. I would be grateful if you would pass on my thanks to the cook for the excellent food and to the carers for the time and trouble that they have taken to prepare the table so attractively, for the meal on Sunday. The home held small amounts of peoples personal money deposited with them for safekeeping and to cover incidental expenses. Records, receipts and balances are kept to evidence this. The records we checked balanced with the money held. Records checked and discussions with the staff group showed us that staff were receiving very good support and supervision by management. Four staff members records checked showed us good evidence of support had been maintained including regular supervision and appraisal records. A tour of the premises and check of the records did not identify any health and safety issues at the home. There was evidence of regular fire safety and hot water tap temperature checks. The staff records we checked showed that these staff had Care Homes for Older People Page 29 of 33 Evidence: attended appropriate training in manual handling and fire safety, and that health and safety training was ongoing. Care Homes for Older People Page 30 of 33 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 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!