Care Home: Oxenford House

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What the care home does well The home provides an excellent standard of accommodation in a home that is very well maintained. The standard of cleanliness is also extremely good. People enjoy the food and variety of meals on offer. The home is well managed and the staff spoken to said the manager and Head of Care provide support and guidance about their work. Many of the comments we received mention the happy and homely atmosphere. Relatives said that the home manager and staff are good at keeping in touch with them and act promptly to resolve any problems should they arise. The staff are praised as being `helpful, friendly and patient`, `skilled professionally`, `very approachable` and because they `treat each resident as a valued individual`. What has improved since the last inspection? Recommendations for improvements that we made in our last inspection report have been addressed and met. We see this as an indication that the provider organisation does act on suggestions about improvements. One of our survey respondents also summed this up by writing `the staff are always willing to listen and discuss any way in which a relative feels any aspect of care could be improved - however small`. The home has appointed a head of care and an administrator and this has improved the opportunities for residents to have `one to one` time with staff, to discuss how they like to be supported in their daily life and activities. The manager is better able to focus on her role, with some of the administrative, staff supervisory and training work undertaken by others in the staff team. Improved computer facilities and copier equipment has resulted in the home being able to have better communication with residents families via e-mail and a electronic newsletter, and update policies, procedures and the homes records. The home has a 5 year maintenance plan that has been budgeted for. Recent improvements to the facilities for residents have been the installation of a jacuzzi bath, new call bell system, and thermostatic control of all radiators. The kitchen equipment has been replaced; provision of a commercial steamer has improved the nutritional value of meals for residents. What the care home could do better: We consider that this home continues to provide an excellent service and therefore have made no requirements or recommendations following this inspection visit. The manager has identified the organisational plans for ongoing improvements and development in the homes AQAA. These plans focus on the continued development and training of staff and appear realistic and achievable within the constraints of the current financial recession. Key inspection report Care homes for older people Name: Address: Oxenford House The Glebe Cumnor Oxford Oxfordshire OX2 9RL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Delia Styles     Date: 3 0 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Oxenford House The Glebe Cumnor Oxford Oxfordshire OX2 9RL 01865865116 01865865923 care@oxenfordhouse.fsnet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Abbeyfield Oxenford Society Limited care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users ot be accommodated is 25 The registered perosn may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) The total number of persons that may be accommodated at any one time must not exceed 25. Date of last inspection Brief description of the care home Oxenford House was purpose built and first registered in 1990 and is run by a charity, The Abbeyfield Oxenford Society Ltd. The accommodation is on two floors with 25 bedrooms and a central lift. Ten of the bedrooms have en-suite facilities and one room is designated as a short stay for a holiday or convalescence. This room is also used for prospective residents who may like to experience living in the home whilst considering Care Homes for Older People Page 4 of 30 Over 65 25 0 Brief description of the care home permanent residence. There is a spacious sitting room and dining room on the ground floor with a large conservatory leading into attractive gardens. There is also a small sitting room on the ground floor. There is a summerhouse at the rear of the home and ample space to walk around the gardens. The first floor has a sitting room with kitchenette facilities. There are four bathrooms with shower facilities. A ground floor room is used for hairdressing, aromatherapy and physiotherapy. A physiotherapist, a hairdresser, aromatherapist and reflexologist visit twice a week. The library service and chiropody visit monthly and a trolley shop service weekly. The fees for the home (from January 2010) are between 611.50 and 662.50 pounds per week. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the service was an unannounced Key Inspection during which we assessed a number of the standards considered most important by the Commission out of the 38 standards set by the government for care homes for older people. The inspection visit took place over 6 hours and was a thorough look at how well the service is doing. We took into account detailed information provided by the homes manager in the form of the Annual Quality Assurance Assessment (AQAA) - a self assessment and summary of services questionnaire that all registered homes and agencies must submit to the Commission each year. We also considered any information that the Commission had received about Oxenford House since the last inspection in 2006. A tour of the building, and inspection of a sample of the records and documents about the care of the residents and the recruitment and training of staff, were part of the Care Homes for Older People Page 6 of 30 inspection. Talking with a number of residents and staff gave us information about the home and peoples opinions about what it is like to live here. Some of the Commissions comment cards (surveys) were left at the home for residents, staff, relatives, and visiting health and social care workers to have an opportunity to have their say about the home. We received completed surveys from 1 resident, 4 relatives, 1 health care professional and 2 staff and their opinions are included in the report. We would like to thank all the residents, staff, and manager for their welcome and the time taken to help us with the inspection process. Care Homes for Older People Page 7 of 30 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 Care Homes for Older People Page 8 of 30 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have good information about the home in order to make an informed decision about whether the home is likely to be right for them. The personalised needs assessment means that peoples diverse needs are identified and planned for before they move to the home. Evidence: All the residents who returned questionnaires to the commission said they had received enough information about the home before moving in. The manager confirmed that the information available to prospective residents and their families on their Internet website, and in the written documents - the Statement of Purpose, Service User Guide - is reviewed and updated every month. The website is now linked to the Abbeyfield (the home providers) site so that people are aware of the aims and ethos of the organisation. Information and the most recent inspection report are available in large print. Care Homes for Older People Page 11 of 30 Evidence: The quarterly House newsletter, a welcome information booklet and a hard copy of the bi-monthly electronic newsletter sent to relatives (Shout) is available for all prospective residents and their families to read. Information about the home is also distributed to local medical centres and Age Concern for easy access. The manager or head of care for the home visit prospective residents to talk to them about the home and about their individual care needs. They are invited to come and spend a day at the home prior to making a decision and are welcome to visit more often if they wish, so that they have as much information about the home as possible. They are invited to meet with residents already living here and to chat about life in the house. All prospective residents are offered a 2 week stay at Oxenford house before going on the waiting list. This gives them a good opportunity to decide whether the home is likely to suit them and meet their needs. A relatives survey showed that the home is skilled and sensitive when introducing new or prospective residents to the home at a time of major change in the individuals life. They wrote that - The staff have been very helpful, friendly and patient as well as skilled professionally. They have been very supportive in helping (our relative) settle in - they got to know as much as possible about her before she came, not only medically, but getting to know her interests so they could get to know her personally as quickly as possible and find her things to do that she will enjoy. The sample of care records we looked at during the inspection visit showed a detailed assessment of peoples likes, dislikes, abilities, and disabilities and the action staff should take to meet their individual care and support needs. Assessments are written in a way the focus on the individuals wishes and abilities and describe the way they wish to be assisted and the pattern of their day. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health needs of residents are well met with evidence of good multi disciplinary working taking place. Staff have the information they need and meet residents care and support needs in a way that promotes their dignity and wellbeing. Evidence: A sample of three residents care plans was examined and found to have comprehensive information about each persons care needs. The action that carers need to take to assist residents was also listed so that they are clear about what they have to do. The care plans are written in a way that is person-centred and reflect each individuals preferred way of being assisted and supported, and that encourages them to remain as independent as possible. The care plans are reviewed each month and the Head of Care takes time with each resident to make sure that their care plans are up to date and any changes have been discussed and agreed with the individual. One person had written their own amendments to their care plans The inspector spoke individually to one resident in their room and also a number of other residents during the visit. They all expressed satisfaction with their care. One of Care Homes for Older People Page 13 of 30 Evidence: several very positive comments written by relatives in our survey included the following - X always receives the best of care and attention. It is good to know that if she has a medical need it is always dealt with promptly. The carers are always cheerful and helpful as well a being sensitive to Xs condition. I am very thankful that X is able to spend her final years in such a loving environment. GPs and district nurses visit the home regularly to provide NHS health care and there was evidence of these visits in the care plans looked at. Good feedback was received from The organisation employs a physiotherapist to visit the home twice a week and pays for any treatment that residents need. This is excellent provision of specialist care and the company is commended for providing this. The physiotherapist assesses all new residents and plans any treatment that is needed. Included in this initial assessment is a handling and moving assessment to find out if the resident requires help to move, and if so how staff should do this and what equipment (if any) is needed. This protects residents and staff from injury. The physiotherapist also provides training for the homes staff in safe moving and handling techniques The physiotherapist also carries out a falls risk assessment and implements action to minimise falls. Accident reports that are completed if any resident has a fall, are audited twice a month. The homes annual quality assurance assessment (AQAA) tells us that this audit process identified a particular time of day when one resident was liable to be more at risk of falling. As a result, they made sure that extra staff input was available and this has dramatically reduced the number of falls for this person. This is a good example where good observation and monitoring of a problem and taking appropriate action, has reduced the risk of preventable accidents in the home. The manager and staff have also been proactive in introducing other health promotion measures to improve the quality of life and wellbeing for people living here. These include a Hydration Plan for all residents to make sure everyone has enough to drink throughout the day which helps prevent some medical problems for example, urinary infection and reduces agitation and confusion for those with dementia. The home has also introduced twice weekly fresh fruit platters, and has offered residents more fresh fruit juices and fruit smoothie drinks. This has resulted in a marked reduction in the need for people to take laxatives. The home uses a nationally recognised assessment tool to monitor peoples nutritional status and takes action if they appear to be at risk of becoming malnourished. Because it is a relatively small home, and residents likes and dislikes are known and Care Homes for Older People Page 14 of 30 Evidence: carefully catered for, there is evidence that any nutritional problems are noticed promptly and can be remedied more quickly as a result. The home also offers aromatherapy and gentle massage - provided by an aromatherapist. A ground floor sitting room is used for physiotherapy, aromatherapy and hairdressing. There is a mobile sensory light unit that some residents have found restful and calming to watch and touch and that can either be enjoyed in the therapy room or their own room Appropriate procedures are in place to manage peoples medicines safely in the home. Medication administration record (MAR) charts showed that residents had received their medicines as prescribed. One MAR seen had handwritten instructions for the medication - dosages and times to be taken - for a resident who has come into the home for a short period. It is good practice to have a second person (ideally the GP who has prescribed the medicines) to check and countersign any handwritten instructions in the home. If this is not possible, the member of the home staff who has written the list of medicines and instructions should have them checked by a second staff member and countersigned. This is an additional safeguard to reduce the risk of mistakes and the potential for medication errors being made. This was discussed with the home manager during the inspection. The manager said that none of the current residents manage or keep their own medicines in their rooms, but would be supported to do so if they wished and were assessed as safe to do so. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers a good range of activities and opportunities for people to take part in meaningful and enjoyable pastimes that suit their personal preferences and abilities. Mealtimes are relaxed and social occasions. The food is varied, nutritious and meets peoples needs and expectations. Evidence: From what the home AQAA tells us, comments in the surveys we received and from direct observation and conversations with people on the day of our inspection, we found that the home organises a good range of activities and entertainments. However, the staff do not rely solely on external or designated activities workers, preferring to emphasize their motto for activity, that Everything in life is an activity, it depends on the level of participation. This means that all staff have a responsibility for making sure that residents have individual attention for social and enhancing life events. Each person when they come to live here, is invited to share their individual life history, so that staff get to know peoples preferences about the way they spend their days and the activities they may like to be involved in, or try as a new experience. Care Homes for Older People Page 16 of 30 Evidence: Relatives and friends are encouraged to be involved in small group activities with residents. One person enjoys playing the piano in the living room and there are impromptu singing sessions. Another regular visitor to the home also plays the piano and accompanies sing-alongs. The home is going to buy a piano to replace the current instrument that is worn out. It is evident that the home tries hard to tailor activities and entertainments to meet individual needs of residents. A new recreational activity plan made on the day gives more resident choice, rather than having a monthly set activities calendar. One day a month is allocated to a carer to devote their time to social and quality time with residents - some on a one to one basis or in small groups. This is in response to residents feedback that they do not always want to do things as a group, and prefer to have support to go out or have time with just one carer for a chat, or do crosswords or word games, for example. There is a monthly Reminiscence session with a different theme each month, for example, scents and smells. Twice weekly Sherry mornings are enjoyed by most residents. The September 2009 copy of the House newsletter had photos of some of the most recent outings - several people visiting Highgrove Gardens, Picnic in the Park (to mark Family week) and St Giles Fair, in Oxford. Annual social events, such as a summer barbecue and Christmas party encourage residents and their families and friends, and staff and their families, to get together socially. The homes AQAA tells us that the fund raising trustees for the Residents Social Fund are very active in inviting residents to be involved in both in-house activities and village social life. The monies raised by the trustees and staff help cover the costs of the physiotherapist , aromatherapist and social activities at the House with no extra cost to residents. There is a weekly trolley shop that two residents help to run, assisted by a volunteer who will visit those residents who are less mobile, in their rooms. This has proved to be a good social event and encouraged contact and friendships between residents. On the afternoon of the inspection visit, a group of residents were enjoying a poetry reading (with a Christmas theme) in the conservatory room. The conservatory room is a popular and well-used room where people can sit and read, access the garden or watch the birds outside. There are plans to create a new sensory garden in the New Year and to improve the security of the grounds, so that those people with memory problems can also safely walk around and enjoy the gardens outside unaccompanied by staff, without the risk that they may wander off unnoticed. Care Homes for Older People Page 17 of 30 Evidence: A resident who prefers their own room and company said that they feel comfortable doing their own thing and that staff often pop in for a chat, so they do not feel isolated. People living here are supported to maintain their spiritual and religious observances some residents prefer to take Holy Communion in their own rooms as well as attending the Communal Services held in house. One person who is from a nonconformist faith tradition has visits from their local congregation and is supported to attend their faith centre. The dining room looks attractive and during lunch staff were seen being attentive to residents who needed help. A good choice of food is provided to ensure that residents individual likes and dislikes are catered for. There are 3 choices of menu for lunch. The home has developed picture menus and food photos to enable those with memory problems to recognise and choose from the menus. The menus for the following days meals are taken around to residents during the afternoon. Only one person spoken with before lunch could remember what they had chosen for their meal on the day of the inspection, but all agreed that the food was very good and they enjoyed most meals. Oxfordshire County Council has a new Food Standard Award - Scores on the Doors. A recent inspection by the Environmental Health Inspector awarded a score of 4 (out of a maximum of 5) for the catering facility standards in the House. The home uses fresh food from local suppliers as much as possible. Residents have chosen at their Residents Meetings not to have visitors at meal times and this request has been shared with all visitors. It has also been agreed that (most) residents would like light music played during mealtimes and they would prefer to eat buffet supper food at the dining room tables and these suggestions have been implemented. Visitors are made welcome at the home and there is a first floor sitting room with kitchenette facilities where residents and their families can meet and make tea and coffee. Survey comments we received from relatives, both written and on the day of inspection, showed that visitors feel that they are made welcome when they visit and that the home communicates well with them. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel safe and listened to. The homes policies and procedures are available, understood and consistently applied. Evidence: Relatives confirmed in their survey responses that they are aware of the homes complaints procedure. All residents who returned questionnaires said they were aware of the homes complaints procedure, or that their family were aware of it. Additional comments made support our opinion that the manager and staff communicate well with residents and their families and representatives, so that any problems or grumbles are acted upon and quickly resolved. One person wrote that (the home) keeps me well informed - phone, email, personal contact. Always acts promptly to address issues. Makes a record of conversations and changing needs. The manager confirmed that they have received no formal complaints since our last key inspection in November 2006. One person contacted the commission with a concern about low staffing numbers and short notice given to staff about the next rota. This person was advised to follow Abbeyfields own complaints and grievance procedure, and to discuss this with the manager or Abbeyfield Trustees. Following this advice the individual has not contacted the commission again with information to suggest their concern has not been resolved. Residents meet together regularly to comment and make suggestions about the Care Homes for Older People Page 19 of 30 Evidence: running of the home and facilities. The minutes of the most recent Residents meeting, held in November 2009, showed that peoples views are listened to and acted upon. The manager said that the organisation provides adult protection training for all grades of staff. Booklets and literature is available in house for staff to read, in addition to the training booklet. Staff have had training in the implications of Deprivation of Liberty and the Mental Capacity Act. Staff handover report and meetings are also used as a time to discuss any matters that may affect residents safety and well-being. The homes AQAA tells us that they plan to extend adult protection training to all Volunteers and Trustees. A staff member spoken with at the inspection visit described appropriately the action they would take if they suspected that someone living at the home was the victim of abuse. However, this staff member was not familiar with the local Oxfordshire multiagency guidance for safeguarding adults or the lead role of the local authority in investigating allegations of suspected abuse. A copy of this guidance is available in the office and was made available to the inspector during the inspection. The home manager was given information about the Oxfordshire Safeguarding Adults website. We suggest that information about this website should be made available in the home as a useful source of advice and information about how to raise concerns about adult protection issues. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides people living here with a clean, comfortable, safe and very attractive environment. Evidence: The home is well maintained and the standard of decor and furnishings is very good. The attractive garden at the rear of the home provides an extremely pleasant and safe area of garden for residents and visitors to use. The home has a contract gardening service that maintains the garden weekly. The gardeners were mowing the lawns on the day of the inspection. The home felt comfortably warm during the inspection. Radiator guards are fitted to radiators to prevent residents touching hot surfaces. The temperature setting of the radiators can be adjusted in individual rooms to suit their personal preferences for their room temperature. There is an on-going maintenance programme within an overall 5 year maintenance plan, and this ensures that the standard of decoration and furnishing is high and funding allocated for any larger repairs and upgrading work that may be needed. Since our last visit, the home has had a new call bell system installed, kitchen equipment upgraded, and has almost completed the programme of replacing double glazed doors and windows (to improve the security and energy efficiency of the Care Homes for Older People Page 21 of 30 Evidence: house). A tour of the building showed that the standard of cleanliness is very high and staff are commended for their work in this aspect. The survey comments we received also confirmed that the home is always clean and pleasant. The home was fresh smelling, airy and bright in most areas on the day of this unannounced inspection. There were two rooms that had an unpleasant odour which the manager explained is because of individuals continence problems and that they are aware of the problems and addressing them. Carpets are regularly shampooed and odour neutralisers are used to minimize any odour problems. If necessary, and residents and their families agree, washable flooring could be considered to replace some or all of the floor covering. The carpeting on the first floor atrium landing is stained in places following a water leak that had occurred from the bathroom during the weekend before the inspection visit - this is scheduled for replacement. The high windows of the first floor atrium landing area, and the conservatory room can be opened and closed with remote control devices so that ventilation in these areas can be controlled for residents comfort. Two residents whom the inspector spoke to in their own rooms, were very pleased with their surroundings and had very personalised rooms, with small items of their own furniture, pictures, ornaments and soft furnishings. The bath and shower facilities have also been improved with the installation of a jacuzzi bath on the ground floor and the addition of a more up to date bath on the first floor, that also has a seated shower facility. The jacuzzi bath is especially popular with residents as they find it relaxing and therapeutic. The home has improved the bathroom decor also, to make the facilities look more homely and attractive with the addition of transfers on wall tiles and painted stencil motifs on the walls. The home has two sluice rooms and facilities to clean and disinfect commode and sanitary equipment; these were clean and tidy. The laundry facilities are good and the AQAA tells us that they manage residents personal laundry items well, so that there is a quick return of clean items to residents. Residents can choose to have their own bed linen - the manager said most people have the sheets provided, but some like their own bedspreads and duvet covers. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment and training is well managed, so that the people living here can be confident that the care and support provided is given by suitably skilled staff. The homes processes for vetting and screening new employees protects people from harm and abuse. Evidence: Responses to the questionnaires we sent out were very complimentary about the staff - some of the comments received included - The carers appear to me to feel valued and happy working there...the manager and her staff know the residents inside out and treat each resident as a valued individual. All the staff are very approachable and always willing to listen and discuss any way in which a relative feels any aspect of care could be improved - however small. A happy place - lots of humour. My mother acknowledges the high level of support and care she has and has nothing but praise for the staff. My mother says the staff are all always very kind. All of the survey answers to questions about the care service and staff availability indicate that the numbers and skill mix of the staff team meet the needs of the people who live here. The manager said that she very rarely has to bring in agency staff as there are two NVQ qualified agency staff who have worked here for 4 years and 18 months respectively and who can work flexibly to cover shifts when permanent staff are absent. This means that there is continuity in the standard of care and support for Care Homes for Older People Page 23 of 30 Evidence: residents. The manager also has a budget that allows flexibility in staffing so that if a resident needs additional care and attention, extra staff can be brought in to provide this. Staff who completed one of our surveys, and those spoken with during the inspection visit, said they enjoyed working here and appreciated the training opportunities and support they receive. Written comments included - (the home) also looks after staff well, which results in a content working environment. I have worked in several homes as a carer... and this is by far the best. The manager confirmed that just over half of the care staff have a nationally recognised qualification in care - National Vocational Qualification (NVQ) at Level 2 or above. There have been some delays in getting staff enrolled on the training organisation (Skills for Care) courses because of government funding issues in the current financial situation, but the home is aiming to have 75 percent of care staff with an NVQ qualification by the end of 2010. Staff records of training and discussion with some staff, confirmed that they keep up to date with mandatory training topics such as moving and handling, safe handling of medication, and safeguarding of adults. Staff spoken with said they valued the additional training they had been able to attend in caring for people living with dementia and end of life care. The AQAA tells us that the staff have also attended training in Dignity and Deprivation of Liberty (in relation to the Mental Capacity Act and how residents rights to self determination and making independent decisions is protected). Three staff files were selected and checked and were found to be well organised and showed evidence of a thorough and consistent vetting and recruitment process for new staff. Staff training files are now held on computer file, so that it is easier to maintain and update them. New staff have to successfully complete a 3 month probationary period in the home before their employment is confirmed. This shows that the organisation takes time to assess peoples aptitude and suitability to work with the people living here. All prospective staff when they come to the home meet informally with some residents and staff, whose feedback comments and impressions are taken into account as part of the interview process. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements in this home are very good. People who live here are consulted about, and do influence, the way in which the home is run. Since our last inspection the home has improved the way it gets formal feedback about the service from residents and their families. Evidence: The registered manager has obtained the level 4 NVQ in management and has a nursing qualification equivalent to the level 4 NVQ in care. She has many years experience of running care homes for older people and has been the registered manager for Oxenford House for 11 years. Since our last inspection the home has appointed a new head of care and an administrator. These appointments have improved the way in which the home is run and allows the manager to focus more fully on her overall management role and planning the ways in which the staff can be supported and developed in new initiatives and training - such as the end of life care standards, person-centred care and Care Homes for Older People Page 25 of 30 Evidence: Dignity champions. The purchase of new computers and a colour printer has improved the way in which relatives can keep in touch with the home and residents via e-mail and via an electronic newsletter. It has also improved the way in which records are stored and transferred electronically and more securely, in line with the Data Protection Act. The manager obtains feedback informally during day-to-day conversations with residents visitors, and staff, as well as during residents meetings. The results of a recent quality assurance questionnaire sent to residents that was seen at the inspection, shows that there is a high level of satisfaction with the service, and that any comments or suggestions are considered and acted upon promptly. Residents are encouraged to manage their financial affairs for as long as they can. When this is no longer possible a named representative for the resident takes on this responsibility. The Abbeyfield policy is not to have any staff or volunteers who work at the home acting as appointees for residents finances. At the inspection we checked a sample of the records of the small sums of money held on behalf of residents for their podiatry, hairdressing and any small purchases they may want to make from the weekly trolley shop that is taken around the home. The financial records seen were up to date. The administrator confirmed that the record of receipts and expenditure made on behalf of residents is regularly audited. We found that there are good health and safety procedures in place to protect residents. Maintenance records are kept of safety checks, showing these are regularly carried out. The company provides health and safety workshops for its senior staff to ensure they are up to date with current good practice. There are also bi-monthly quizzes on health and safety issues for all staff to complete to encourage staff to read and use the available policies and procedures to find the answers to questions and keep up to date with current advice. The home employs a part-time maintenance person to deal with day-to-day repairs and employs specialist contractors as needed. The annual check of the water systems was undertaken by a specialist contractor on the day of our inspection. He commented that the standard of maintenance was very good, but was heard to recommend that the routine hot water temperature tests undertaken throughout the home are recorded to help identify any potential risks and adjust the water temperatures accordingly. The homes AQAA gave us a good picture of the developments in the home and the Care Homes for Older People Page 26 of 30 Evidence: ways in which the home intends to continue to develop and improve in the next 12 months. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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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