Care Home: Oasis House

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What the care home does well Areas that the service does well include: When people feel unwell and need to see a health care professional, staff make sure this happens quickly. An example of this was one person had commented to a staff member that they felt ‘light headed’ that morning and was feeling nauseous, staff arranged for a Doctor to visit them by one o’clock on the same day. This means people gain prompt access to healthcare support when they need to.Oasis HouseDS0000070190.V378658.R01.S.docVersion 5.2When we undertook a key inspection 12 months ago of this home we reported that both people living at the home and staff thought the manager was very supportive, this remained the same at this inspection. Everyone we spoke with made comments on her being trustworthy, kind and that she would always help them. We observed the way she interacted with the people living at the home; the interaction we saw was professional and showed that she had developed good relationships with them. The way medication is managed on behalf of the people living at the home is good. There are safe systems in place to make sure that every ones medication is in stock, is stored securely and given to people when they need it. Staff make sure they keep clear records on all medications that come into the home and when they have been administered to a person. What has improved since the last inspection? There have been changes to the way some staff are recruited. We made a requirement at the last inspection as not all staff had the references that were needed in place, before they started work in the home. This had been acted on straight away by the manager and changes were made. When we looked at staff files at this inspection we saw that all the vetting checks that must be in place were, so helping to protect the people living at the home. Over the past 12 months there has been redecoration in many parts of the home and replacement of carpets in several areas. At the time of this inspection building contractors were still on site, they were converting a former conservatory into an extension of the large lounge area on the ground floor. General comments from people living at the home included, “it has made the place look brighter” and “very nice”. What the care home could do better: We had made a requirement at the last inspection for improvements to be made in care planning. Staff had been working towards this and their standard had improved from last year, however further development is still needed. There must be a plan in place for every need a person has, and then there must be guidance on that plan that guides and directs staff to how they must support a person in meeting those needs.Oasis HouseDS0000070190.V378658.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Oasis House 20 Linden Road Bedford Bedfordshire MK40 2DA Lead Inspector Katrina Derbyshire Key Unannounced Inspection 4th December 2009 09:30 DS0000070190.V378658.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Oasis House DS0000070190.V378658.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Oasis House DS0000070190.V378658.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oasis House Address 20 Linden Road Bedford Bedfordshire MK40 2DA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01234 346269 01234 345355 GB Care Ltd Mrs Jacqueline Cousins Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30) of places Oasis House DS0000070190.V378658.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Can include residents who have physical disabilities. Date of last inspection 12th December 2008 Brief Description of the Service: Oasis House is a large detached Victorian House that has been adapted to provide permanent and respite residential care for thirty people who are 65 years of age and may have dementia. New owners took over the running of the home in July 2007. The home is situated in a popular residential suburb of Bedford within walking distance of the town‘s amenities, which include rail and bus stations. The accommodation is provided on three floors and there is a shaft lift. There is a large lounge with views over the garden at the rear, and a smaller lounge is located to the front of the property. A variety of bedrooms for single and double occupancy are provided. Privacy screens are provided in the three shared rooms. Eleven bedrooms have en suite facilities. Toilet and bathing/showering facilities are located on each level of the home. There is a pleasant garden with patio furniture at the rear and side of the property. A few parking spaces are provided at the front of the house with metered parking on the road. Further information about this home can be obtained by telephoning or visiting the home direct. Oasis House DS0000070190.V378658.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection carried out on the 4th December 2009. The care of three people was looked at in detail and this is known as case tracking. Tracking people’s care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who use a service. During the visit the communal areas of the home were seen alongside some of the individual rooms. Time was spent with many of the people who live at the home in one of the sitting areas. Observations of care practice and communication between the people living at the home and staff was also made at the inspection. Prior to the visit taking place the Care Quality Commission had sent to the home an Annual Quality Assurance Assessment (AQAA). This was returned prior to the visit and provided information on how the service self assess their own performance. During the visit we checked some of this information to make sure that what had been submitted was accurate. We did speak with the manager of the home as the standard of the information submitted needs to improve. The focus of this inspection was to look at the key standards. What the service does well: Areas that the service does well include: When people feel unwell and need to see a health care professional, staff make sure this happens quickly. An example of this was one person had commented to a staff member that they felt ‘light headed’ that morning and was feeling nauseous, staff arranged for a Doctor to visit them by one o’clock on the same day. This means people gain prompt access to healthcare support when they need to. Oasis House DS0000070190.V378658.R01.S.doc Version 5.2 Page 6 When we undertook a key inspection 12 months ago of this home we reported that both people living at the home and staff thought the manager was very supportive, this remained the same at this inspection. Everyone we spoke with made comments on her being trustworthy, kind and that she would always help them. We observed the way she interacted with the people living at the home; the interaction we saw was professional and showed that she had developed good relationships with them. The way medication is managed on behalf of the people living at the home is good. There are safe systems in place to make sure that every ones medication is in stock, is stored securely and given to people when they need it. Staff make sure they keep clear records on all medications that come into the home and when they have been administered to a person. What has improved since the last inspection? What they could do better: We had made a requirement at the last inspection for improvements to be made in care planning. Staff had been working towards this and their standard had improved from last year, however further development is still needed. There must be a plan in place for every need a person has, and then there must be guidance on that plan that guides and directs staff to how they must support a person in meeting those needs. Oasis House DS0000070190.V378658.R01.S.doc Version 5.2 Page 7 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. Oasis House DS0000070190.V378658.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oasis House DS0000070190.V378658.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3 & 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre admission assessments are sufficient so staff can ensure that they have the required information to know if they would be able to meet the person’s needs. EVIDENCE: The three care files examined included pre-admission assessment. Assessments included information from visiting the person at the hospital, or wherever he or she was living prior to admission and information from any referring social worker or health professional. There were sections covering the social, psychological and physical needs of the person. One staff member spoken with was able to describe in detail the needs of the people living at the Oasis House DS0000070190.V378658.R01.S.doc Version 5.3 Page 10 home, she advised that staff would continually talk with people and their families to gain further information about a person after their admission. Copies of the terms and conditions of residency were seen alongside contracts. These gave an outline of fees, responsibilities and notice periods. The statement of purpose was examined; a copy was on display at the time of this visit. The document provided information on the staffing, accommodation and services available at the home. Intermediate care is not provided at the home. Oasis House DS0000070190.V378658.R01.S.doc Version 5.3 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Medication systems and the management of healthcare access are good and help to promote peoples health. However the standard of documentation in the home is not sufficient to ensure clear guidance is always available to staff. EVIDENCE: Care plans and other care records were examined for the people selected for case tracking. At the previous inspection a requirement was made relating to this, acknowledgement is given that staff have been working on improvements however there remains a need for further improvement. As advised to the manager and staff it is not the template that a service uses, but the standard of entries that are important and a requirement. Every assessed need for a person must have a care plan in place that contains explicit guidance for staff Oasis House DS0000070190.V378658.R01.S.doc Version 5.3 Page 12 to follow to ensure continuity of care. The outcome of assessments of risks such as falling and moving and handling must be entered into the person’s plan of care as changes occur. One person for example had a mobility plan in place, we met them and saw that they used a zimmer frame, but there was no mention of this in their care plan. Notes were in place within the home to show that District Nurses and General Practitioners visited when needed. As outlined in the summary section we saw records that showed three weeks before this visit that someone had complained of feeling sick and dizzy, they had declined anything to eat or drink. The staff had telephoned the Doctors surgery within the hour and they were visited by them on the same day. Further documentary evidence to support that access to external healthcare professionals was being made included, chiropody, dentist and optician had occurred. Feedback from people living at the home also supported this, they confirmed that staff would arrange on their behalf appointments or home visits when needed. The site within the home for the storage of medication had moved since the last inspection. We saw that it was stored securely and only designated staff had access to it. On auditing a sample of medication for 3 of the people living at the home, it was noted that the stock balance matched the records maintained by the service. Medication administration records were in place and initialled when medication had been administered. Feedback from people living at the home suggested they feel that staff treated them in a respectful manner. We observed that staff sought the views and opinions of people, and during the inspection we saw no evidence that staff made decisions on people’s behalf without their consent. People choose the clothes that they wore and had choices from the daily menu for example. Oasis House DS0000070190.V378658.R01.S.doc Version 5.3 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home feel the standard of food is good and meets their individual tastes. EVIDENCE: As assessed at the previous inspection activities are on offer in the home, all activities are shared with anyone who wishes to participate. People are encouraged to join in, but can choose whether or not to participate. Activities specifically designed to assist people with dementia are also available. On the day of inspection one person had been attending a music therapy session outside of the home, we saw another sitting listening to music of their choice and others sitting talking with staff. Oasis House DS0000070190.V378658.R01.S.doc Version 5.3 Page 14 During the morning we observed the relatives of one person visiting the home. On their arrival staff welcomed them and they were immediately offered refreshments. The flow of the conversation demonstrated that an easy relationship between them and staff existed. Feedback to CQC from two relatives suggested that they were satisfied with the care provided at the home. One comment from a relative seen on a returned survey sent out by the home was, “The staff couldn’t do more than they already do, even the chef comes out to try and tempt my relative to eat when they are not so hungry!” A choice for breakfast and lunchtime meals is available. People living at the home and staff confirmed that if you did not like anything on offer one day the chef would always make sure that they would make you something that you like. All comments about the food available were good. Nutritional risk assessments were also in place within the care records and evidence seen that monitoring of weight was undertaken at least monthly. Oasis House DS0000070190.V378658.R01.S.doc Version 5.3 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns and complaints are acted upon so residents feel that they are listened to and that staff take their concerns seriously. EVIDENCE: The homes complaints procedure, as it did previously, gave sufficient guidance to staff on the action that they should take on receiving a complaint. The procedure described the rights of residents and that all complaints must be responded to. Within the homes statement of purpose a summary of how to complain had been included for residents and their relatives. Records of complaints received were seen and showed the investigation undertaken by the home and the responses to the complainant. The homes policy for the safeguarding of adults was examined and again remained the same as previously assessed; the policy was comprehensive and included how any incident of abuse should be reported. Staff training records also showed that they had attended workshops on this area and they were able to describe the varying types of abuse, which included physical and financial. Oasis House DS0000070190.V378658.R01.S.doc Version 5.3 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in the décor help to provide a pleasant environment for people to live in. EVIDENCE: Oasis House is a large detached Victorian House. We were advised in writing in August 2009 that the owners planned on refurbishing the home the specific plans were not included. At this inspection the building contractors were on site. Several areas in the home had been decorated and the replacement of carpets had been carried out in many areas. A conservatory was being converted into an extension of the large ground floor living area. Oasis House DS0000070190.V378658.R01.S.doc Version 5.3 Page 17 All the parts of the home that were seen were clean and there were no unpleasant odours. Designated housekeeping staff are employed to clean the home. There were personal items on display in the bedrooms seen, and people spoken with said that they were satisfied with their room. Shared bedrooms were seen and were equipped with privacy screening. The home has contracts in place for pest control and clinical waste. Hand washing facilities are available throughout the home and sufficient stock is maintained of protective clothing. Oasis House DS0000070190.V378658.R01.S.doc Version 5.3 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in the décor help to provide a pleasant environment for people to live in. EVIDENCE: On examination of three staff files to look at recruitment practices it was noted that the files contained proof of identity, Criminal Records Bureau clearance, verification of employment history and references. One person had applied for a position at the home, the manager had questioned them on the authenticity of some of the information supplied and followed this through, resulting in the person not working at the home. This demonstrated that thorough vetting checks were now being carried out and a previous requirement had been met. As formerly assessed staff receive induction and on-going training. Staff training that takes place includes COSHH, Fire, First Aid, Health and Safety, Moving and handling and safeguarding of adults. Oasis House DS0000070190.V378658.R01.S.doc Version 5.3 Page 19 On the day of this visit there were 25 people living at the home. The rota showed that there should have been 5 staff on duty throughout the day; however 2 staff had called in sick that morning. The manager had acted to cover these shifts and had contacted an employment agency. Feedback from people at the home and staff was with the current numbers and dependency levels the amount of staff on duty was sufficient to meet the needs of the people living in the home. The manager advised that she would always review staffing levels and changes these if dependency levels changed or the number of people living in the home increased. Observations were made of staff supporting and providing care to people. As assessed previously a good rapport existed between the staff and residents, staff took time to explain to each person what was happening and they were given the opportunity to express their own wishes. All comments received were positive regarding how staff treated them at the home. Oasis House DS0000070190.V378658.R01.S.doc Version 5.3 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems in place to seek the views of people using the service are good; this helps the service make improvements to the service they provide. EVIDENCE: As previously assessed The Home Manager has many years experience, which is directly relevant to the role of manager in the home. 12 months ago people living in the home and staff described her as supportive and kind, the comments from them at this inspection remain the same. She had worked towards meeting the requirements that had been made at the previous Oasis House DS0000070190.V378658.R01.S.doc Version 5.3 Page 21 inspection, and with the exception of the standard of care documentation they had been met. Also at the time of this visit building contractors were on site, the disruption to the people living at the home was minimal as this development work appeared well managed. Questionnaires had been sent out by the service to gain the views of people on the standard of care that they offered. Returned surveys were seen and again the manager had acted upon any comments she had received. In addition an Area Manager visited the home once a week, the manager advised that she supported her to look at reviewing practice in the home as part of their quality assurance programme. However a copy of the Regulation 26 visits should be kept at the home. As previously assessed health and safety information provided by the home showed contracts with approved contractors are in place for the maintenance and servicing of equipment. The most recent inspections undertaken by Environmental Health and the Fire Service showed the home had maintained standards in these areas. Documentary evidence was seen to show that servicing of equipment had been undertaken including, fire, gas and lift. Oasis House DS0000070190.V378658.R01.S.doc Version 5.3 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Oasis House DS0000070190.V378658.R01.S.doc Version 5.3 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care planning within the home must be person centred, making sure there is guidance for each assessed need that is of a good standard that staff can follow to ensure continuity of care is given. Timescale for action 28/02/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP33 Good Practice Recommendations A copy of the Regulation 26 report should be kept in the home so the manager has an easy reference tool to know any actions she should be taking to improve the service. Oasis House DS0000070190.V378658.R01.S.doc Version 5.3 Page 24 Care Quality Commission Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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