Care Home: Oxendon House

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What the care home does well Oxendon House is an established care home and has cared for many people that have lived there a long time. There is a welcoming and homely atmosphere in the home. People are encouraged to relax, socialise and talk by the way the lounges and seating areas are laid out. People are encouraged by staff to continue making decisions about their daily routines and lifestyle. People have good access to health care support on a regular basis or when required. People are encouraged to maintained links with social clubs, family and friends. Visitors are welcome at any time, which promotes people`s wellbeing. People are supported to continue observing and practising their religious beliefs. People have a good choice of meals. Meals and mealtimes are flexible to suit individuals. Concerns or complaints raised by the people using the service or their relatives are addressed quickly. There is a stable staff team, who have clear roles and responsibilities. Staff training and skills are maintained through regular updates and refresher training. The comments received from the people living at the home and their relatives included: "...it is a better place to work, the atmosphere is happy, friendly and everyone is relating to each other as it should be" "I can`t remember how long I`ve been here but this is my home" "The staff do respect my privacy and dignity, always ask me because they know I will do what I want to do" "My dignity is respected" "I don`t have anything to complain about here" "I appreciate the efforts made by the staff, especially their coffee/tea parties when they really seem to pull together as a team and their welcome to families, visitors etc" "I feel that the service provides a home that feels homely and now has a comfortable and friendly atmosphere". What has improved since the last inspection? Oxendon House has addressed the areas of concerns identified at the last inspection of the service. There have been improvements made with the management of the home. There is now a Registered Manager for the service, who has experience of working and managing a care home. There is a Regional Care & Training Manager for the company who manages staff training and supports the Registered Manager. The home has recruited an Activities Co-ordinator, who has since her appointment arranged a number of regular group and individual activities and events that people care chose to join in. There have been improvements made to the home environment to benefit the people living at the home. New radiator covers have been installed to ensure people are not at risk of being burnt by touching the hot radiators. Several people told us they liked the new covers, which has created an extra shelf for them to place pictures and ornaments. A new wet shower room has been created on the first floor. The wet shower room is not yet in use until a shower chair is delivered and the vanity unit and fixtures are fitted. Several people told us they are looking forward to using the wet shower room. What the care home could do better: This inspection of Oxendon House showed evidence of improvements being made to benefit the people using the service and the home environment.The care planning and assessments of risk needs to improve to be more holistic and personalised to ensure staff meet peoples individual needs, which was acknowledged by the Registered Manager. We have made several good practice recommendations. These relates to staffing, consider providing written information about the home more accessible to suit the needs of the people using the service, minor internal repairs to the home and the home`s quality assurance. CARE HOMES FOR OLDER PEOPLE Oxendon House 33 Main Street Great Oxendon Market Harborough Leics LE16 8NE Lead Inspector Ms Rajshree Mistry Unannounced Inspection 26th January 2009 09:45 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oxendon House Address 33 Main Street Great Oxendon Market Harborough Leics LE16 8NE 01858 464151 01858 461646 christine.skellham@jasminehealthcare.co.uk 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) Oxendon House Care Home Limited Christine Skellham Care Home 33 Category(ies) of Dementia (33), Old age, not falling within any registration, with number other category (33), Physical disability (33) of places Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Physical Disability - Code PD The maximum number of service users who can be accommodated is 33 25th February 2008 2. Date of last inspection Brief Description of the Service: Oxendon House is a care home providing personal care and accommodation for up to 33 older persons who may in addition have an associated condition of Dementia or a Physical Disability. The home is situated in the small village of Great Oxendon in Northamptonshire. There is car parking to the front of the home. There are twenty-seven bedrooms, of which two are double rooms with ensuite facilities and seventeen single bedrooms with en-suite facilities. The majority of bedrooms are single, of which fourteen have en-suite facility comprising of a toilet and wash hand basin. The remainder are shared bedrooms. Bedrooms are located on the ground, first and second floor, which are accessible via the stairwell or the passenger lift. Communal areas are on the ground floor and consist of a lounge and a further large lounge and dining room. The dining room is also used for activities such as arts and crafts. There is a small lounge on the second floor, which people can use. Oxendon House has a large garden to the rear of the property that people can use. The Registered Manager provided us with the range of fees; from £350.00 to £520.00. There are additional costs for individual expenditure such as chiropody and hairdressing services, and the fee will depend on the services. People considering using Oxendon House, should contact the Registered Manager to discuss individual needs and requirements. Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 5 The full details of the home and any specific requirements can be obtained from the home in the form of the ‘Statement of Purpose’ and ‘the Service User Guide’, which includes the complaints procedure. The latest Inspection Report from the Commission for Social Care Inspection is available at the home. Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 6 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. ‘We’ as it appears throughout this Inspection Report refers to ‘The Commission for Social Care Inspection’. This key inspection consisted of preparation by reviewing the last inspection report 25th February 2008 and the review of the Annual Service Review dated 19th December 2008. We looked at the information we had about the management of Oxendon House and the events that affected the wellbeing of the people living at the home. The Registered Manager sent to us the completed Annual Quality Assurance Assessment (AQAA) document, which reflects the home’s own assessment of the standards within the home. We sent out 24 surveys to the people living at the home and their relatives, of which 6 were returned. The responses and comments received indicated people were satisfied with the standards and the quality of care, social activities offered, the meals provided and the staff working at the home. We sent out 23 surveys to staff working at the home, of which 10 were returned. The responses and comments received indicated the staffing levels meet people’s needs, the staff work well as a team and there is good communication between the staff. There are good management systems and staff have access to regular training, updates and supervision. We visited Oxendon House on 26th January 2009, starting at 9.45am and finishing at 5pm. The Registered Manager assisted us during the site visit. The main method of inspecting we used was ‘case tracking’. This means looking at the range of care people receive that is met by the care staff who ensure their rights, choices and independence is promoted. We selected four people to case track, all whom had differing needs and abilities and included a person that was new to the home. We spoke with the four people that we case tracked along with a number of other people living at the home. We read the care files containing information about people’s care needs, lifestyle and how these were met and respected. We made observations of people, how they were treated and how staff interacted with them. We spoke with visiting relatives to gather their views about the quality of care they had observed and experienced for their relative living at the home. We spoke with the visiting District Nurse to gather their views about how the home ensured people had access to health care when needed. Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 7 We looked at the accommodation offered to people using the service. This included the communal areas, bathroom and the individual bedrooms, with permission. We spoke with the staff working on the day to ascertain their recruitment, training and skills to meet the needs of the people living at the home. We read the information people received about Oxendon House. The policies, procedures and specific records viewed demonstrated the day-to-day management of the home. The Commission for Social Care Inspection had a focus on Equality and Diversity and issues relating to these are included throughout the main body of this inspection report. What the service does well: Oxendon House is an established care home and has cared for many people that have lived there a long time. There is a welcoming and homely atmosphere in the home. People are encouraged to relax, socialise and talk by the way the lounges and seating areas are laid out. People are encouraged by staff to continue making decisions about their daily routines and lifestyle. People have good access to health care support on a regular basis or when required. People are encouraged to maintained links with social clubs, family and friends. Visitors are welcome at any time, which promotes people’s wellbeing. People are supported to continue observing and practising their religious beliefs. People have a good choice of meals. Meals and mealtimes are flexible to suit individuals. Concerns or complaints raised by the people using the service or their relatives are addressed quickly. There is a stable staff team, who have clear roles and responsibilities. Staff training and skills are maintained through regular updates and refresher training. The comments received from the people living at the home and their relatives included: “…it is a better place to work, the atmosphere is happy, friendly and everyone is relating to each other as it should be” “I can’t remember how long I’ve been here but this is my home” Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 8 “The staff do respect my privacy and dignity, always ask me because they know I will do what I want to do” “My dignity is respected” “I don’t have anything to complain about here” “I appreciate the efforts made by the staff, especially their coffee/tea parties when they really seem to pull together as a team and their welcome to families, visitors etc” “I feel that the service provides a home that feels homely and now has a comfortable and friendly atmosphere”. What has improved since the last inspection? What they could do better: This inspection of Oxendon House showed evidence of improvements being made to benefit the people using the service and the home environment. Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 9 The care planning and assessments of risk needs to improve to be more holistic and personalised to ensure staff meet peoples individual needs, which was acknowledged by the Registered Manager. We have made several good practice recommendations. These relates to staffing, consider providing written information about the home more accessible to suit the needs of the people using the service, minor internal repairs to the home and the home’s quality assurance. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 10 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 Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive good information about the service, are involved in the assessment process to make sure their needs are met. EVIDENCE: Oxendon House provides information to people when they are looking for a care home, known as a ‘service user guide’, which contains the ‘statement of purpose’. We read the statement of purpose, which clearly sets out the aims and objectives of the service, range of facilities, the skill mix of staff to meet people’s needs including supporting people with dementia or other age related illnesses. People are informed of the complaints procedure and they have opportunities to comment and influence the quality of the service provided. We wanted to find out whether the information provided to people considering using the service was available on time and in alternative formats. The Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 12 Registered Manager told us that the information could be made available in large print if required. We discussed with the Registered Manager that consideration should be made to make the information more accessible to people with dementia or poor eyesight. The survey responses received from the people using the service and directly from the people that we spoke with confirmed they were given information in advance and encouraged to visit the home. One person that we case tracked was having a ‘trial stay’ and told us that they had decided to move into the home permanently. The comments received directly from people and in the surveys included: “I came to have a look around with my family” “I was brought here” “I can’t remember how long I’ve been here but this is my home” “It is local to me and I’d heard good things about Oxendon House”. “I’ve only been here for a few weeks” “Mum, has dementia and came to this home from hospital. The home was chosen by the family and mum is settling well” The evidence gathered confirmed people are encouraged to visit and their care needs are assessed before they move into the home, which ensures needs can be met and the Oxendon House is the right place for them. We wanted to find out if the assessment process helped to identify peoples’ care needs. We read the care files for the people we case tracked. We saw evidence of a ‘comprehensive assessment of needs’ carried out by the social worker for the people funded by Social Services. We saw copies of the assessment of needs carried out by the Registered Manager. The assessment showed information was gathered about the individual person, ranging from their personal details, care needs, mental and physical health, medical history and medication and dietary needs. It also included details of significant people that are important to their wellbeing such as family members and General Practitioner. This showed the assessment process is robust. Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health and care needs are met and better care planning that is holistic; personalised and gives clear guidance to staff would promote their wellbeing. EVIDENCE: We wanted to find out how individuals health and care needs are met. The information we received from the Registered Manager before the site visit indicated that ‘care planning takes into account the information gathered from the assessment of needs’ and their choice of lifestyle. We saw people were relaxing in various seating areas around the home. Some people were participating in activities in the lounge and the dining room. This showed people appeared to be comfortable and relaxed at home. Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 14 We spoke with the people we case tracked and other people living at the home. They told us that staff looked after them well and they were able to see the General Practitioner and the District Nurse as and when needed. They described the help they needed on a daily basis and felt the staff were encouraging and supportive, which promoted their independence. The survey responses supported what people told us on the day of the site visit. We wanted to find out how staff received information about people’s individual care needs. Staff said they get information about peoples care needs at handover meetings and can read the care plans. The comments received directly from staff that we spoke with and the staff surveys, confirmed they were made aware of the help and care needs, and there was good communication between the staff. This showed individual there is good communication of information between staff that promotes people’s wellbeing. The comments received from staff directly and in the surveys included: “We all understand the importance of keeping care plans up to date with service users daily information and any significant changes no matter how big or small they seem” “We have training in diversity and equality” We read the care files for the people we case tracked. The files contained copies of the assessment of risks showing the risks posed to individuals in relation to their mobility and breathing. The safety measures being considered to ensure people’s health and safety were identified, such as ‘needs two carers’. The care plan is made up of a number of ‘individual plans’ ranging from personal care to mobility and breathing. The care plans were basic and there was limited guidance for staff. The plans were seen as separate issues and did not look at the person in full with regards to preferences and the benefits to their quality of life. This also indicates that people might not be involved in developing their plan of care to live as independently as far as practicable. We discussed with the Registered Manager how the individual care planning does not take into account the safety measures identified from the assessment of risk or people’s choice of lifestyle and routines. The example we shared related to a person we case tracked, who said they were able to walk with a walking aid but struggle breathing at times. Although the assessment of risk identified the person uses a walking aid that promotes their independence, this was not linked with the breathing assessment that stated, ‘suffers from being short of breath and needs to use the nebuliser’ in the care plan. This could place people at risk; especially people are not able to express their preferences or choices due to their dementia. The Registered Manager accepted that risk assessments and care plans need to be improved, linked, personalised using a ‘person centred approach’ and give clearer guidance to staff to follow. Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 15 We observed good moving and handling practices with staff encouraging and guiding people to ensure they were steady on their feet. We saw staff speak with people by their preferred names, as stated in the care files. This showed people were respected. Staff told us that they have put into practice the knowledge gained from attending a dementia awareness course, using techniques such as returning a short while later with another cup of tea if they refused on the first occasion. People living at the home and the visiting relatives said the staff are respectful. People described to us how staff helping them with their personal care respects their privacy and dignity. Comments received included: “The staff do respect my privacy and dignity, always ask me because they know I will do what I want to do” “My dignity is respected” “Staff respond quickly and care for the residents in a right way” “The staff are very supportive but care needs to be given to detail – the little touches mean a great deal. This is more noticeable at weekends”. The care files showed records of visits made by health care professionals such as the General Practitioner and the District Nurse. We spoke with one gentleman who was waiting for his daughter to attend a routine hospital appointment. We briefly spoke with the visiting District Nurse who expressed there were no concerns about the care provided to the people living at the home. This showed people were receiving support to ensure their health needs were met. The comments we received included: “Never heard from ….the regular District Nurse about any concerns about the care or the home”, “I think they do call to check and get advice”, “I’ve been asked to see 3 people this morning, which includes changing the dressing”. A visiting relative expressed concerns to us about the home’s expectation for them to collect a prescription given by the GP following the home visit. After some discussion we encouraged them to raise the issue with the Registered Manager, which they did. The Registered Manager told us that one person continues to administer his own insulin, which is kept securely in the fridge. Although people are Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 16 supported to manage their own medication, assessments of risk should be completed to ensure this is done safely and reviewed regularly. We saw the locked medication trolley stored securely and medication prepared into blistered packs by the Pharmacist. The senior carer confirmed she had been trained to give people their medication, which supported the staff training records viewed. The senior carer described the procedure followed when giving medication out to people, which was in line with best practice. We found gaps in the medication records for the people we case tracked, even though the medication was not in the blistered pack. We also found the staff had used a code but had not stated what that meant. The senior carer was unable to tell us why there were gaps and said, she “had not noticed the gap, maybe the staff forgot to sign the sheet”. This indicated staff were not reporting issues immediately to the Registered Manager nor was there a system in place to randomly check the medication records. This places people at risk staff are unsure if medication has been given or not. We brought this to the attention of the Registered Manager. She, with the Regional Care and Training Manager, agreed to address the issue immediately. Following the site visit we received from the Registered Manager confirmation that all senior carers attended a briefing regarding completing the medication records. Additionally, ‘Medication Competency Practical Assessments’ are being conducted; weekly medication records audits and the senior management team on a monthly basis will carry out an audit. At present there is no-one living at the home that needs controlled medications. However, we advised the Registered Manager to make sure the controlled drugs storage complies with the Misuse of Drugs (Safe Custody) (Amendment) Regulation 2007. Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can choose to take part in activities and social events; keep contact with family and are offered a choice of meals that promotes their wellbeing. EVIDENCE: The information we received from the Registered Manager before the site visit stated “there is open visiting”, and “encourage service users to continue with their social contacts and continue to attend meetings, clubs and other social gatherings”. We saw people were receiving visitors. We spoke with visiting relatives who said they visit at different times and are always made to feel welcome. This also supported the responses we received from the people using the service, and included, “Good for visitors/families to have support from staff”. During the site visit to Oxendon House, we saw people relaxing in various seating areas, participating in arts and crafts activity or the “motivation to music” sessions (music and exercise). People appeared to be relaxed, Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 18 comfortable in the home surroundings and see moving about without any restrictions. We spoke with a group of people making placemats. They told us they enjoyed doing different activities and felt they could choose to join in or not. They proudly showed us the placemats that they had made, including the artwork displayed in the door to the dining room. This further supported the responses received in the surveys from people using the service, saying ‘there are activities arranged by the home’. The comments received from the people directly and in the surveys included: - “I’m very happy here, I made new friends and there’s always things to do here so I don’t get bored or feel alone, anyway my house is being sold” - “I appreciate the efforts made by the staff, especially their coffee/tea parties when they really seem to pull together as a team and their welcome to families, visitors etc” - “I enjoy having my breakfast in my room then take my time getting washed and dressed with help from one of the staff then come down to talk to the other ladies and gentleman” We spoke with the new Activities Co-ordinator who works 5 days a week. They showed us the individual activity record book that is maintained and this demonstrated people do participate in activities in small groups or individually. The Activity Co-ordinator recognised the importance of some people preferring to spend time doing nothing or watching television as one lady said, “I have to say they did ask me if I wanted to go downstairs but I prefer my own company”. We were told about the activities people enjoyed and saw records that showed people were offered a range of activities and social events that they can choose to join in. These included: bingo, quizzes, arts and crafts, motivation and exercise, film afternoons, skittles and sing-a-long to name a few. One gentleman has expressed an interest to set the questions for the quiz and likes to spend time researching the questions. There has been shopping trips out to Market Harborough and some ladies enjoy ‘nail painting’ sessions and having their hair done by the visiting hairdresser. This showed people were offered opportunities to continue living their choice of lifestyle. The information we received from the Registered Manager before the site visit and surveys received from the people living at the home, confirmed they enjoyed the choice and variety of meals offered. People complimented the meals provided and pointed to the menus on the dining table to show us the menu for the day. There was a choice of Turkey a la King with rice or salad or Pork Supreme with vegetables and potatoes. We saw staff helping people to choose their meals from the menu. Consideration should be made to using picture menus, to suit the needs of people that may have dementia or poor eyesight, to enable them to make choices. Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are confident to complain and protected by staff recruitment processes and training to ensure people are safe from harm and abuse. EVIDENCE: We wanted to find out how people can express concerns or make a complaint. The people we spoke with during the site visit and the surveys responses received confirmed they received a copy of the complaints procedure. The complaints procedure is included in the ‘Service User Guide and the Statement of Purpose’. It sets out the process and timescales by which complaints would be resolved. People who live at the home told us they were confident to speak with the Registered Manager if they had any concerns. We observed a gentleman complain to the Registered Manager about the ‘banging lift door. A visiting relative shared their concerns with us regarding the collection of a prescription and we advised them to speak with the Registered Manager in the first instance. They did this and were satisfied that it was being addressed. We received comments directly from the people who use the service and through the surveys. These included: Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 20 “I don’t have anything to complain about here” “Never had to complain, I guess I would tell staff” “I’ve always spoken to the manager” We read the complaints log, which detailed two complaints received and how it was addressed by the home. This demonstrated the home’s complaints procedure was followed. We spoke with the staff who demonstrated a good understanding of ‘safeguarding issues’. This means promoting the wellbeing of people using the service from harm, risk and abuse. Staff were aware of the types of abuse that could occur and were confident to listen and raise the concerns with the senior carer or the Registered Manager. This was consistent with staff survey responses received that demonstrated people’s wellbeing and safety was promoted. The comments received included: “The home has a confidentiality policy, whistle-blowing policy, all concerns raised are treated with the utmost importance if any concerns should arise” Oxendon House reported to us concerns using the ‘safeguarding alert’, which was referred to Social Services. The procedures were followed by the home and appropriate actions were taken to protect the people living at the home. The staff we spoke with confirmed they started work after checks were carried out. The staff surveys responses received confirmed staff were appointed after the employer carried out checks on them. Although the Registered Manager did not have access to all the staff files, we were able to view the records of a new member of staff, which contained evidence of the checks carried out and an application made for a criminal records bureau (CRB) check, whereby to confirm the person is suitable to work with vulnerable people. This demonstrated staff recruitment procedures were followed to ensure people’s health, safety and wellbeing. The Registered manager described the system in place to manage people’s money that is held in safekeeping. The individual financial records are kept in the care files. We saw the records were double singed, clear and auditable. The Registered Manager and the seniors carers are responsible to make sure people’s money is secure and records are correct and up to date. Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a homely, clean and tidy home that promotes their wellbeing. EVIDENCE: We wanted to find out the type of home environment people lived in. The information we received from the Registered Manager before the site visit supported the surveys received from the people using the service and their relatives. We saw people had a choice of lounges, including a lounge/dining room and other seating areas around the home. The ambience was pleasant and relaxing. There is lots of natural light and good lighting throughout the home. We saw people moving around the home freely, which was promoted by the layout and lighting within the home. There are a number of bathrooms and Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 22 toilets around the home, which people can use. We saw the new wet shower room, which is not yet in use until the new shower chair is delivered and the fitting of the vanity unit and furnishing. People living at the home, the visiting relative and the staff were looking forward to using the shower room, recognising how it will improve the quality of life in relation to personal hygiene and choice. We saw a lady who preferred her own company and enjoyed being in her bedroom. They complimented the home environment and told us that the staff check on her regularly and the cleaner comes and cleans the bedroom daily. We saw cobwebs in the ceiling and when this was pointed the lady said, “I don’t like cobwebs or spiders”. The Registered Manager immediately got the cleaner to remove the cobwebs and gave us assurance that all the bedrooms and lounges would be checked again to ensure cobwebs are removed. We saw a number of bedrooms, all of which have en-suite facilities, which promotes people’s independence, privacy and wellbeing. All were individual and well decorated to make the bedroom homely, clean and comfortable. One gentleman complained about the ‘banging lift door’. We checked this with the Registered Manager and confirming the noise was very loud. They arranged for this to be repaired. The other comments received in the surveys and directly from the people living at the home included: - “I enjoy having my breakfast in my room then take my time getting washed and dressed with help from one of the staff them come down to talk to the other ladies and gentleman” - “The is a very happy home, just like my own home was. I am much happier knowing there is always someone here 24-7 …. now I feel safe and very well cared for” - “Very happy with my bedroom, I can see for miles around”. - “Please do go and have a look at my bedroom, the view is spectacular” - “Have found the home to be clean, fresh and dad’s bedroom is always clean and there is no problem with the laundry either” - “I feel that the service provides a home that feels homely and now has a comfortable and friendly atmosphere” We saw two staff responsible for cleaning and laundry. This showed the home has employed staff for specific duties to ensure people’s wellbeing. We saw staff wearing protective gloves and aprons when they were preparing to assist people with personal care tasks or serving meals. Staff told us they have a good supply of protective clothing and demonstrated a good understanding of safe practice in relation to health, safety, hygiene and infection control practices. The staff training records confirmed staff receive regular training and updates. Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are supported by staff that have undergone a recruitment process and trained to promote people’s health and wellbeing. EVIDENCE: We wanted to find out whether staff recruitment and their care skills meet the needs of the people living at Oxendon House. The information received from the Registered Manager stated the staffing levels sufficiently meet the needs of the people living at the home, which supported our findings and from looking at the staff rota. However, we received mixed comments in the surveys from the people using the service, relatives and the staff that we spoke with indicated at times the staffing levels are not enough, which we shared with the Registered Manager. People we spoke with said they liked the staff working at the home, they felt safe, happy and comfortable. We observed how staff interacted with the people living at the home, showing staff respected people. The comments received included: “Sometimes, there is not enough staff on duty. Communication with relatives could be improved” Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 24 “The staff are very supportive but care needs to be given to detail – the little touches mean a great deal. This is more noticeable at the weekends” “The staff are very nice, always helpful and always willing to do anything to help me” “As the resident’s only outside contact, I find the staff always willing to listen” “I think staff need to be more honest at team meetings and say what they really think” “Christine the manger took time to explain the job role and the home’s ethos, she was very approachable and informative and was very willing to answer any of my questions” “More permanent staff instead of agency staff” “… we have training in diversity and equality” “The manager makes sure everyone is trained to a high standards and puts us all on courses that we need” We wanted to look to see if the home’s staff recruitment procedure was followed. All the staff surveys responses received confirmed staff were recruited after the employer had carried out the checks. We were only able to view the recruitment records of a new member of staff as the filing cabinet was locked and not accessible to the Registered Manager. The file contained evidence of two satisfactory references; protection of vulnerable adults check (pova) and evidence that an application has been made for a criminal records bureau check (CRB). Both of these checks are to confirm the person is suitable to work with vulnerable people. Staff we spoke with confirmed they had received induction training from the Registered Manager. The induction training is an in-house induction training that included the home’s policies and procedures. We advised the Registered Manager and the Regional Care and Training Manager to consider looking at the training organisation such as ‘Skills for Care’. Training would ensure staff receive training and knowledge in line with the current best practice, specific disability issues and promoting people’s independence and wellbeing. We received a copy of the staff training matrix, which showed staff received a range of training that included moving and handling, infection control, first aid, fire and dementia awareness. Staff spoken with demonstrated how they had put the knowledge gained from the dementia awareness course into practice. This showed staff recognised the value of knowing people’s experience of Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 25 disability and how they can support people that gives them a better quality of life. The information we received from the Registered Manager before the site visit stated over 50 of staff have attained National Vocational Qualification in care, level 2 or above. Two staff spoken with confirmed they had started NVQ level 3 in care. We spoke with the Regional Care and Training Manager, who is new in the post. They told us they have ensured the staff training has been updated and gave assurance that the senior staff receive refresher training in the safe administration and recording of medication, which was highlighted as a shortfall during the site visit. This showed the management recognises the importance of having a staff team that continue to learn to support and care for the people living at the home safely. Our observations made during the site visit and discussions with the staff on duty showed they have a good awareness of people’s needs. Staff recognised people’s strengths and levels of confidence, especially with the added opportunities people have to participate in social activities arranged by the home. Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a well managed home, have their interests protects and their health, safety and wellbeing promoted. EVIDENCE: Since the last inspection of the service, the home appointed Christine Skellham, who successfully underwent a CSCI process to determine her fitness to be Registered Manager for the home. She has many years experience of working in a care home and has completed the registered Managers Award and the National Vocational Qualification level 4 in care. Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 27 We wanted to find out how the management of the home benefits the people living there. People living at the home and visiting relatives were seen approaching the Registered Manager on first name terms. People felt able and confident to approach and discuss concerns directly with the Registered Manager. The observations made during the site visit and from discussions with staff, it was evident that the staff have clear roles and responsibilities. This supported the responses received from people using the service, relatives and staff including the comments received in the surveys: “Good for visitors/families to have support from staff” “The manager (Christine) is always very helpful but often seems to be overworked” “Christine the manger took time to explain the job role and the home’s ethos, she was very approachable and informative and was very willing to answer any of my questions” “…it is a better place to work, the atmosphere is happy, friendly and everyone is relating to each other as it should be” “The manager is very approachable and listens to me and others, also helps us with any problems” Oxendon House has received a number of compliments in the form of cards and letters of thanks from the people using the home or their relatives. We read a number of cards and letters of thanks, and included: “Thank you all my aunties for looking after me so well when … was in hospital”. We regularly receive copies of the monthly visit reports carried out by the Responsible Individual, known as Regulation 26 visit. This demonstrated that the service has an internal system of monitoring and checking the service that ensures it continues to comply with the rules and regulations set. The staff surveys received indicated staff receive regular supervision and appraisals meeting with the Registered Manager. The Regional Care and Training Manager now oversees staff supervision and appraisals. We read the minutes of the staff team meeting that included discussion on; the new manager, suggestion box, staff meetings, head of care, care plans and occupancy. This demonstrated staff are kept informed about key issues that may affect the people living at the home and any planned training. We saw notices displaying the dates for the next ‘Residents & Relatives Meeting’. People we spoke with said they do attend and like having the opportunity to be informed and involved in the changes in the home. We read the minutes of the last meetings which showed the range of topics discussed, such as; activities, entertainment and mini-bus, staff shortages, notice board, Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 28 residents’ fund, the home environment and health and safety matters, to name a few. A visiting relative told us that she had not been aware of these meetings and would now attempt to attend them but would prefer these to be flexible and held at weekends occasionally. Oxendon House conducts quarterly quality assurance exercises to seek the views of the people living at the home and their relatives. This is done through people receiving a survey to complete about the care provision, meals, staffing, the social and leisure opportunities and the home environment. We read the results of the previous quality assurance exercise and the action plan. We discussed with the Registered Manager and the Regional Care and Training Manager, how people are supported to complete the surveys as these were all in small print format. We recommended that these could be produced in formats suitable for people using the service. We gave the example of people with dementia or poor eyesight that may like the questions supported by symbols or pictures or in larger print. We also recommended that people using the service are made aware of the findings and action plan to address any shortfalls or suggestions made and to consider measuring the findings against the home’s Statement of Purpose. This would ensure people’s experience and expectations of the service, is in line with the home’s aims and objectives. We wanted to find out how people are supported to manage their money. Some people told us they were happy for the home to look after their money, whilst others preferred the office to keep their money safe. We looked at the records and checked these with the money held in safekeeping. There was a clear audit, which showed there is a good system in place to safely manage people’s money. We saw the assessments of risk carried out for individual people, as part of the assessment and admission process or when people’s care needs changed. The assessments ranged from risk of falls, moving and handing and use of a nebuliser. Although staff had received training in health and safety, moving and handling, the care plans had little guidance for staff to follow. Refer to the section on ‘Health & Personal Care’. The information we received from the Registered Manager before the site visit detailed the programme of maintenance, serving and testing of equipment and checks in place. This was evident during the site visit and from the comments received from the people living at the home with regards to the fire alarms testing carried out regularly. This demonstrated the home environment is safe for the people and the staff at the home. Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 29 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 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 2 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 30 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 plans must be comprehensive reflecting all aspects of care, personalised including safety measures identified from the risk assessments, clear guidance for staff and provides information as to how the person wishes their care to be carried out and include their preferred daily routines, especially if the person has dementia. This would ensure care needs can be met safely, risks minimised and staff promote people’s health, safety and wellbeing. By failing to do so you are in breach of Regulation 15, which is an offence under the Care Homes Regulations 2001. Assessment of risk must be carried out and reviewed regularly with people who wish to retain responsibility for their own treatment and the administering their own medication. DS0000040280.V373687.R01.S.doc Timescale for action 28/03/09 2. OP9 12(1)(2) and 13(2) 01/03/09 Oxendon House Version 5.2 Page 31 This would ensure their health, safety and wellbeing is promoted. By failing to do so you are in breach of Regulation 12(1)(2) and 13(2) of the Care Homes Regulations 2001. 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. 2. 3. 4. Refer to Standard OP1 OP29 OP22 OP30 Good Practice Recommendations To review the accessibility of information about the home provided to people with consideration given to the needs of people living at the home such as dementia. Access to the staff recruitment files should be made available. To ensure the lift door is fixed so that it closes quietly. It is recommended that the home’s induction programme is reviewed and updated, considering the Skills for Care training, which promotes the current best practice to ensure staff have the right skills and training to support the people living at the home. The home should consider developing the quality assurance questionnaires in alternative format to suit individual needs, such as people with poor eyesight or dementia to enable them to express their opinion about the service they receive. The home should consider measuring the outcome of the quality assurance exercise against the statement of purpose to show if the expectations of the service are met, help identify areas of improvement and ensure the statement of purpose evolves as the service develops. 5. OP33 6 OP33 Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Oxendon House DS0000040280.V373687.R01.S.doc Version 5.2 Page 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. 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