Care Home: Red Oaks

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What the care home does well What has improved since the last inspection? What the care home could do better: No areas of concern were noted during this inspection however, there is a need to expand the current in house quality monitoring system to include formal responses from visiting health and social care professionals. CARE HOMES FOR OLDER PEOPLE Red Oaks Red Oaks The Hooks Henfield West Sussex BN5 9UY Lead Inspector Peter J McNeillie Unannounced Inspection 26th June 2007 09:00 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 Red Oaks DS0000060415.V338919.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. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Red Oaks Address Red Oaks The Hooks Henfield West Sussex BN5 9UY 01273 493043 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) Barchester Healthcare Mrs Jacqueline Ann Welch Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60), Physical disability (10), Physical disability of places over 65 years of age (2) Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 60 Service Users may be accommodated at any one time. 5th December 2005 Date of last inspection Brief Description of the Service: Red Oaks is a care home providing support and nursing care for up to 60 residents and is owned and managed by Barchester Health Care who are also responsible for operating similar establishments nationwide. The home is located in the West Sussex village of Henfield close to shops and other local amenities. Accommodation is available on three floors in single rooms all of which have en suite facilities. All parts of the home and gardens are accessible to residents including those who use a wheelchair. At the time of this inspection fees ranged between £800 and £1,000 per week. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Apart from on site observations made during a visit in compiling this report, we considered information/evidence from a number of sources both external and internal to the home. These included an Annual Quality Assurance Assessment (A.Q.A.A.) completed by the registered manager, responses to a C.S.C.I./ in house satisfaction surveys, previous reports, examining residents /staff records, talks with residents, staff and the acting manager. This key unannounced visit was the first inspection for the year 2007/08 and took place on 26/06/07 between the hours of 09:00am and 2:15pm during which all of the key standards were inspected. This is a consistently high achieving home and has a history of proactively improving the services for its residents. This inspection, following which no requirements or recommendations were made highlighted, practices above the minimum standards in fourteen of the twenty-one key standards inspected. The results and findings contained in this report will determine the frequency and type of future inspections. What the service does well: What has improved since the last inspection? A number changes have taken place to improve the service offered as result of talking to residents these include: Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 6 • Employing a physiotherapist. • Increase of one to one activities. • Introduction of a residents support group. • Refurbishment of ground and lower floor kitchens. •Appointment of an in house trainer. •Introduction of a rapid response procedure to concerns/complaints. • Adding six addition single rooms equipped with ensuite facilities What they could do better: 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. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 7 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 Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 8 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): 3 and 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has a system of assessing and identifying residents needs which ensures residents safety and their assessed needs can be met. Intermediate care is not available. EVIDENCE: The home has an admission procedure that requires that no resident be admitted without an assessments of their needs and any risks being undertaken by the manager or another member of senior staff at the resident’s own home if possible. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 9 Potential residents would also be encouraged to visit the home and stay overnight or for a short period of respite care to see whether they liked the home. Following admission for an initial three-month trial stay, for the first seven days a further in depth total care assessment would be undertaken to add further information to the initial pre admission assessment. At the end of the three-month stay a review of the placement would take place, where if all needs could be met a permanent place in the home would be offered. A sample of three residents pre admission assessments were viewed. All of the assessments on which care plans would be based (section 7-11 of this report refers) were very detailed, easy to understand and included the signature of the person responsible for the assessment and written confirmation that the resident had been involved in and consulted about their assessment. Intermediate care is not available. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 10 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 excellent. This judgement has been made using available evidence including a visit to this service. The arrangements for planning care are clear ensuring the health; care and medication needs of residents are met in a manner that respects their privacy and dignity. EVIDENCE: Three residents care plans/records were viewed and a number of residents and spoken with individually and in groups. All of the care plans viewed which were based on very detailed assessments of needs and risk included information on how care staff were to meet identified individual needs. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 11 Evidence was also seen that confirmed all plans are reviewed monthly and that residents or their representatives had been consulted when plans were produced, updated or changed. Records viewed also indicated consultation between the home and external health/social care professionals such as doctors, district nurses, and care managers and other disciplines as required. In the months prior to our visit all care plans apart from monthly from being had been updated and produced in a corporate style that makes then more user friendly easy to use. The responses about the home from all of the residents were very complimentary and included such comments as “ Hotel service”, “ A1”, “Wonderful,” ”We are all well looked after,” “Almost better than home” ”Lovely staff, good food with plenty of choice.” All residents said they would recommend living in the home if asked. During the visit our observations confirmed the comments made by residents. Residents also informed us staff were respectful, caring, pleasant and always willing to help them and any care was given in private. Staff were seen to deal with residents in a kindly, professional friendly and pleasant manner, knock on bedroom doors and wait before entering and treat residents with respect, and dignity. The Manager, care staff, and residents all confirmed residents were free to choose the source of all personal services. A range of health care professionals visit the home including, specialist nurses as required, G.P. (weekly clinic or on request), physiotherapist (twice weekly), chiropodist (fortnightly), audiologist (six monthly) and the community psychiatric nurse who undertake six monthly reviews on residents or by request or as required. Approximately ten doctors from one local practices were likely to visit the home. Evidence seen confirmed that the home has introduced robust policies and procedure for the safe handling of residents drugs and medicines including residents whom are self medicating. All residents prescribed medication, which is dispensed by a pharmacist and administered by trained staff, is securely stored. Complete records were available for all drugs and medicines administered to or refused by residents and medication returned to the pharmacist to be destroyed. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 12 Following a risk assessment any resident who wished may assume responsibility for his or her own medication. At the time of the inspection one resident was totally responsible and three residents partially responsible for their own medication. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides excellent support to residents to take part in religious observance, activities and encourage/assist visitors who are made to feel welcome. A very wide choice of good food that changes with the seasons is provided for residents and meal times are a relaxed, social occasion. EVIDENCE: A wide range of activities is available organised by three specialist activity coordinators trained to National Vocational Qualification (N.V.Q.) level two. All of the activities, which are constantly reviewed, to ensure they meet residents needs and choices have been developed in consultation with residents and are based on pre admission assessments. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 14 Activities available include, board games, computers, gardening, music, art/craft, bingo films, shopping trips, and outings to places of interest and external entertainers. Some activities take place in a dedicated activities area but others in places to suit residents including one to one in the resident’s own room. Residents commented on how much they enjoyed the activities as well as the “Special events” such as birthday parties, garden parties, Christmas and Easter. All of the activities were well attended as evidenced by the activities records. Apart from the activities detailed above the home has regular visits from local clergy who conduct services in the home. The needs of members from all Christian denominations can be catered for. No members from other faiths are currently residing in the home. We were informed if a member of other faiths were resident, arrangements would be made to meet their needs. We were informed by residents and staff, that visitors are welcome at any time and should the need arise assistance can be given with travelling and overnight accommodation in family rooms within the home. The home provides a support group for all residents, this has been found to be of a particular benefit to residents who do not have regular visitors or have no relatives. The homes management place a very high priority on the quality quantity choice and presentation of food available in the home. Three cooks under the guidance of a catering manager prepare all food. The home provides two menus from which residents can choose, one a set seasonal menu that changes according to Summer or Winter and the other a daily menu which offers a choice of up to seven main dishes. Meals, which are served in a relaxed and friendly manner, are restaurant style. Residents make their choices of their main dish at the table, vegetables come in separate serve your self-dishes and puddings from a sweet trolley. Wine and other drinks are also available. All of the residents were full of praise regarding the food served food, a sentiment we would highly endorse after joining them for the mid day meal. Residents confirmed they are free to take their main meal at a time to suit themselves i.e. in the evening if they prefer. Tea and coffee and cold drinks are available at all times. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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. The home has clear policies and procedures in place which ensures residents are able to complain and are protected from abuse and that residents feel they will be listened in the event of making a complaint. EVIDENCE: An in house Adult Protection policy/procedure and whistle blowing policy that operates in tandem with the policy and procedure produced by West Sussex County Council designed to protect vulnerable residents from abuse was available. Records viewed, management and staff spoken with confirmed they had received training in recognising abuse, all were able to demonstrate they were familiar with the procedure to follow should they witness or suspect the abuse of any resident. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 16 The homes complaints procedure, which included information on how to contact The Commission for Social Care Inspection (C.S.C.I), was seen, as was a record of complaints. Residents spoken with said they felt comfortable in raising any concerns they had with the homes management and confident any matters raised would be dealt with fairly and promptly. Staff informed us they also felt confident that they could on behalf of a resident bring any concerns to the attention of the manager and be sure it would be acted upon. As a result of talking to residents the home has introduced a rapid response procedure to any concerns /complaints to ensure any matters raised are dealt with promptly within designated time scales. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 17 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): 24 and 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A safe, well maintained, clean and suitably furnished home is provided for residents which meets their needs. EVIDENCE: All areas of the home were clean and free from unpleasant odours and obvious hazards. Furniture was comfortable, homely, met residents needs and was in keeping with the décor. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 18 Residents spoken with and comments by both residents and relatives in the C.S.C.I. pre inspection satisfaction survey confirmed the home is always clean, smells fresh and residents were happy with their accommodation. A great deal and of time, resources and expertise had clearly gone into the design, building, furnishing, equipping and decorating the spacious purpose build building. Throughout the building there are examples of best practice, e.g. wide corridors wide doorways allowing the free movement of wheelchairs. All communal rooms that were equipped with furniture designed to meet resident’s needs were tastefully decorated and had large windows that ensured a light airy environment. All areas of the building and the well-maintained award-winning garden (trophies and certificates on display) were accessible by all residents who commented how pleasant it was to sit outside in the good weather. Apart from personal mobility aids a number of communal aids had also been provided to assist residents, these included, lifts (passenger and stair), hoists, special baths, grab rails, and ramps. A regular programme of maintenance/improvements was in place, since the last inspection the refurbishment of kitchens of the ground and lower floor has been completed Future plans include refurbishment of bathrooms and the conservatory. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 19 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): 32,34 and 35. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Resident’s needs are met by sufficient numbers of well trained and supported staff who are recruited and selected using a procedure designed to protect all residents. EVIDENCE: Residents and staff spoken with during the visit said they felt there was sufficient care staff to meet the needs of residents. These comments mirrored residents and relative’s responses in the pre inspection satisfaction survey. A staff rota was seen which indicated the usual deployment of staff was ten care staff plus two qualified nurses on in the morning, six care staff plus one qualified nurse in the afternoon/ evening plus a manager and staff trainer on both shifts and during the night five care staff and one qualified nurse. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 20 In addition to care staff there were are kitchen, laundry, cleaning, administration, reception and maintenance support staff available. A sample of the recruitment and training records of three staff were viewed. All records indicated that prior to commencing their employment all staff who have completed a detailed application form and signed a rehabilitation of offenders declaration were interviewed followed by at least two reference (including their last employer) a criminal records bureau (C.R.B.) and protection of vulnerable adults (P.O.V.A.) checks. Staff turnover is low. Records also confirmed on commencement of their employment all staff are involved in an in house induction training followed by a skills for care induction programme delivered by an on site trainer. Subjects covered during the induction period/training included dementia care, the protection of vulnerable adults challenging behaviour, infection control, first aid, medication, moving/handling, food hygiene and fire safety. A dedicated training room equipped with video and I.T. equipment is available. In addition to attending the above all staff are expected top participate in National Vocational Qualification Training (N.V.Q.) to at least level two in care. At the time of the visit pre inspection information provided by the home indicated 92.7 of care staff had completed their level 2 courses and the remaining 6.6 all of whom have recently been employed are currently on courses. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 21 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. The management of the home ensures the health, safety and welfare of residents and staff are promoted and the home is run in the best interests of the residents whose views about living in the home are formally sought. EVIDENCE: At the time of the inspection the Registered manager was absent from the home on a secondment at another of the company’s services. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 22 It was clear from discussions with residents and staff the acting manager that a clearly defined management structure was in place and all staff were aware of their roles and responsibilities Staff said they felt valued, enjoyed their jobs and were encouraged to contribute with ideas and suggestions on improving the current service either on a one to one basis via personal supervision or at a regular staff meeting. Resident’s and relatives views about living in the home are sought at regular residents/relatives forums or via a satisfaction questionnaire. Currently the views of visiting health and social care professionals are not formally sought. The acting manager gave a verbal undertaking she would ensure the survey was expanded to reflect these views. We were informed no money was being held on behalf of residents. A health and safety policy and procedure (department of health guidelines seen) designed to protect both residents and staff was in place. During the visit no obvious hazards to health and safety were seen. Cleaning materials and chemicals were securely stored and staff observed good infection control practices by using disinfectant soap/hand gel, disposal aprons and gloves. Control of substances hazardous to health (COSHH) assessments, equipment servicing records, fire risk assessments and accident records were all available, as were records to confirm all staff have receive training in the techniques of moving and handling first aid health and safety and the procedures to follow in the event of fire, including evacuation. The home has a laundry procedure and a washing machine, which is capable of disinfecting soiled items. All of the hot water supplies to baths and individual basins were fitted with thermostatic controls; hand basins were set at 45 degrees centigrade. All radiators and hot pipes were covered. Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 23 . Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 24 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 X X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Red Oaks DS0000060415.V338919.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. 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