Care Home: Okecroft Nursing Home

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What the care home does well People who use the service, all of whom have complex needs, receive a very high standard of care. Staff are able to understand their communication, which is mostly non verbal. This ensures people`s needs and wishes can be met and their health promoted. The manager and a small staff team work closely together providing care, doing cleaning and domestic tasks, such as cooking, so that the home operates as a `family unit`. This benefits people using the service as staff are able to share first hand information about all aspects of the life in the home. The standard of personal and health care delivered at the home is very high. People who use the service are protected from harm. They live in a clean and homely environment and receive a healthy and varied diet. What has improved since the last inspection? Staffing numbers are now improved and so there is more flexibility around activities, contact with the local community and individual choice. For example, one person wanted to visit a pub in the evening and this was arranged. The garden now has an attractive and accessible patio area with raised beds, scented flowers and equipment, such as swing chair, for people to use. This ensures they have access to fresh air in their garden and a nice place to spend time in good weather. What the care home could do better: Equipment must not obstruct fire exits. We made an Immediate Requirement that this be made safe. We received confirmation that this was done. Storage is a problem within the home as specialist equipment can be large but suitable storage must always be available and not impact negatively on people`s space or safety. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Okecroft Nursing Home Exeter Road Okehampton Devon EX20 1QF     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: Anita Sutcliffe     Date: 2 1 0 5 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 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 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 Adults (18-65 years) Page 2 of 26 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 Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Okecroft Nursing Home Exeter Road Okehampton Devon EX20 1QF 0183752144 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) : Okecroft@Guinness.org.uk Guinness Care and Support Ltd care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 5 The maximum number of service users who can be accommodated is 5. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Learning disability (Code LD) Date of last inspection Brief description of the care home Okecroft is a care home registered for five people of either gender with learning disabilities who require nursing care. The provider is Guinness Care and Support Ltd. The home is an adapted bungalow, built in the 1940s. It is set back from the road that leads into Okehampton, a rural town on the outskirts of Dartmoor National Park. Accommodation is provided on one floor and has access to the front and rear of the property by ramps and grab rails. Communal accommodation comprises: A lounge/dining room with small conservatory area leading to a garden. All bedrooms are for single occupancy and have a hand basin. There are no en suite facilities but all rooms are within close proximity to adapted bathing/toilet facilities. Staff are provided 24 hours a day with a trained nurse on duty through the day time. Care Homes for Adults (18-65 years) Page 4 of 26 Brief description of the care home We were told by the provider that the highest fee is £1334.46 per week and the lowest fee is £1331.30 per week, which includes private contributions, i.e. rent from benefits. Additional charges, as quoted in the homes current guide to the service and statement of terms and conditions, are made for newspapers, the coin operated telephone, hairdressing, chiropody, toiletries, personal clothing and dry cleaning, share of the mini bus lease, insurance, petrol/diesel for trips out and activities and holidays. The homes service users guide could be found in the entrance to the home and in service users folders. Care Homes for Adults (18-65 years) Page 5 of 26 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 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: We have collected information toward this key inspection since the last inspection 22nd May 2008. The inspection was to check the homes compliance with the National Minimum Standards for Younger Adults by finding out, as much as possible, what it is like to live at Okecroft. The information sent to the Commission each year by the care provider gave us some numerical information about the service, such as now many people are resident and how many staff employed. It was also an opportunity for the home to tell us what improvements they have made and any problems they have to overcome. The home received one unannounced visit. Care records were examined and all people Care Homes for Adults (18-65 years) Page 6 of 26 who use the service were met. We spoke with four staff and watched them interact with people. We looked in detail at the service two people receive. We also saw the homes own quality survey results. All parts of the home were visited. Discussion was held with the manager. Some records and policies were examined. 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 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 Adults (18-65 years) Page 8 of 26 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 9 of 26 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 who move to Okecroft can be assured the home will be suitable for their needs, which will be fully assessed prior to admission. Evidence: The people who live at Okecroft have done so for several years and there have been no recent admissions to the home. However, the needs of people who use the service are regularly reviewed. Care Homes for Adults (18-65 years) Page 10 of 26 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. People who use the service are well understood by an experienced staff who try hard to interpret peoples wishes and needs and support them to achieve. Risk is understood and managed in peoples best interest. Evidence: People using the service were clearly relaxed and comfortable in their relationships with staff, who knew their needs very well. We saw people laughing when staff engaged closely with them and staff had noted that one person was becoming unwell through their body language. We looked at two peoples care plans. These documents should be clear to inform staff what care and support are needed. Records/plans showed a range of assessment tools and records, which were detailed and would provide necessary information for staff to support people with activities of daily needs. Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: People using the service have complex needs and their communication is very limited. However, there is detailed information for staff on how best to communicate with each person and we saw that staff are very experienced in this. The ability to have a choice or be consulted is dependant on how well the staff can interpret their needs and we saw that they were doing so. Members of staff were observed offering choices to people and using their experience to interpret the response. Risk, which mostly relates to health care, is well understood and managed. Care Homes for Adults (18-65 years) Page 12 of 26 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. People are enabled to lead fulfilled lives within their capabilities and they receive quality food. Evidence: People who use the service are profoundly disabled and rely totally on others to provide for all of their needs. Staff said that there are yearly planning meetings to which family are invited and when peoples goals and plans are reviewed. People at the home are of similar age and of both gender. Their rooms reflect them as individuals. Family, through the homes own surveys, report: Varied activitiies and good variety of food. Staff told us about activities now arranged for people. At previous inspection we found Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: the opportunity for activities very restricted due to staff numbers and a problem accessing peoples own money at the time the provider for the home changed. This has now changed. People go to regular club meetings and events, including a disco/night club. They go swimming, shopping, to a local pub and some recently went on a boat ride. There is more opportunity for fresh air and outside activities and new equipment is availble toward this. We were told, and saw records to support, that people are helped to visit their family and family ties are well supported. The home keeps a good supply of quality foods for people and peoples diet is closely monitored. Food is home cooked and varied. The day we visited the lunch was a spicy tomato course with rice. In a small building the smell of the food cooking was very pleasant. People appeared to enjoy their meal and staff were attentive and expert in assisting them. Care Homes for Adults (18-65 years) Page 14 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complex personal and health care needs of people who use the service are well understood and met in their best interest by an experienced staff. Evidence: We looked closely at the care of two people at the home. Peoples needs, and how staff are to deliver care, was detailed in their plan of care. We saw correspondence indicating that health care is also provided through outside agencies, such as dentist, physiotherapist and epilepsy specialist nurse. We saw at one review a physiotherapist said of the home: Staff are very supportive and committed to xxxs well being. The home has made arrangements for each peson to receive a weekly aromatherapy massage as it appeared people enjoy this and it appeared to aid restful sleep. Care plans are reviewed regularly. Members of staff, and the manager, were able to describe peoples care needs in detail. Supplementary care plans are used where a short term concern needs to be dealt with, an example being an infection. Towards the rating of excellent we take into account the continuing standard of good health of the people who have very complex physical needs and who, without a very high standard Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: of care, would not continue in their good health. A family representative said through the homes own surveys: Well cared for in every way. Each reported that health care is available as needed. We looked at how medicines are managed in the home. None of the people using the service are able to look after their own so staff must do this for them. We saw that medicines were correctly stored and records were clear and complete. We looked in each persons plan of how medicines are to be administered and we discussed how the home uses emergency medicines. Care Homes for Adults (18-65 years) Page 16 of 26 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. People who use the service are fully protected. Evidence: Staff receive training in how to protect people from abuse and the strong family ethos of the home, and good leadership, also protects people. People who use the service have very limited ability to communicate and so rely heavily on the staff to interpret their needs. Staff were observed responding to these communication signs, such as a nod of the head or a smile, and said they could easily identify if a person was upset. The home has a complaints procedure, which is displayed in the entrance and is within the homes written information. The manager says there have been no complaints and we have received no complaints about the service. Care Homes for Adults (18-65 years) Page 17 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a pleasant and well maintained home but lack of storage has a negative impact. Evidence: The rooms of people who use the service are personalised and contain equipment necessary to meet their health care needs. This promotes the safety and well being of people and the staff who assist them. We saw people using the lounge, dining area and conservatory, which looks over the garden. Communal spaces are nicely decorated with warm colours and wall hangings. It is comfortable and homely in appearance and we are told it is always fresh and odour free. One area that needs redecoration is a bathroom which has become somewhat worn. We found that areas of the home were clean and fresh. The laundry facility meets the needs of the home and staff receive training in Infection Control. Staff have protective clothing to prevent the possibility of cross infection. We looked at the garden. Previously we made a requirement that there must be Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: outdoor space available at the home that is suitable for, and safe to use by, people who live there. This has now been achieved. Charity funding was found to provide a pleasant patio area, with shade, scented plants and some equipment. We saw people using this when we visited. We noted a lack of space for equipment storage and made an immediate requirement that equipment must not obstruct fire exits. (See the standard on Conduct and Management of the home). We saw no other concerns relating to safety of the environment which is well maintained. Care Homes for Adults (18-65 years) Page 19 of 26 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. People who use the service benefit from a staff which is properly recruited, trained, supervisied and in sufficient numbers to meet their needs. Evidence: When we visited the home we found one staff cleaning and three staff providing care for the five service users; one nurse and two care assistants. (The manager arrived whilst we were there.) Two of those staff were agency supplied. We found each appeared very capable. We were told that the home ensures the same agency staff are used for consistency. The home has had several staff changes. However, staff told us their numbers are now improved and this has a positive impact on peoples care, especially the opportunity for outside activities. They also told us that the skill mix is always considered when making staff arrangements and each person has a primary and secondary key worker. Staff told us that the high standard of training they receive has continued. Discussion indicated that they were very knowledgeable about the people for whom they care and how to meet their needs. Some staff have worked with the residents for very many years. The home reports that the majority of staff have National Vocational Qualifications (NVQ) to level 3 in care, which is an indicator of their knowledge and Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: competence. We saw that the home follows the Skills for Care staff induction programme to ensure staff have a good understanding from the outset. We looked at the recruitment records of the last two people employed at the home. All necessary checks, which ensure they are safe to work with vulnerable adults, were completed prior to them starting employment. Staff told us they feel well supported and we found that they receive regular supervision of their work, although this had recently lapsed a little. Staff are clear about their roles and responsibilities. Care Homes for Adults (18-65 years) Page 21 of 26 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. People who use the service can be assured that their best interest is the priority at Oakcroft. Evidence: The registered manager is very experienced and has run the home for many years. Staff hold her in high regard. Family of people who use the service said of the home: Good staff, good food, good company and Well looked after and has everything he needs. A recent investigation by Guiness Care and Support, into a concern identified during an unannounced visit by the organisation, concluded that, although there is a question mark over the accuracy of the managers recording regarding medicines, there was no risk to any person who uses the service. Staff confirmed that they have regular meetings and can contribute to the agenda, so they have a voice. They regularly review peoples care plans together discussing how they can improve the care they provide. There are no specific meetings for people who use the service but they share some of Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: the staff meetings and Guinness Care and Trust have surveyed their opinion of the service through their family representatives. There is also a yearly formal review of peoples care, with family invited to attend. We are told that Guinness Care and Trust are currently surveying staff opinion of the service and the organisation meets its responsibilities through a monthly unannounced visit to the home to ensure standards are satisfactory. The health and welfare of people are a high priority at the home. There are individual risk assessments, a good standard of health and safety training and equipment is properly maintained and serviced. However, we found the lack of storage facilities at the home was a health and safety issue. At our visit we found equipment obstructing a fire exit. We left an immediate requirement for the equipment to be safely stored. Care Homes for Adults (18-65 years) Page 23 of 26 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 13 16(2)(m)18(1 There must be arrangements 31/07/2008 ) in place for people to be able to leave the care home to engage in local, social and community activities of interest to them and which will enable them to have a full life within their capabilities. This must not be restricted through insufficient staff availability. Care Homes for Adults (18-65 years) Page 24 of 26 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 1 42 13 (4) Steps must be taken for 31/05/2009 equipment storage that does not obstruct fire exits and which complies with the homes own fire risk assessment. We must be informed what steps have been taken. So that peoples safety will not be compromised should there be a fire at the home. 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 Adults (18-65 years) Page 25 of 26 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. 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