Care Home: Three Oaks

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What the care home does well The home provides care in a pleasant and welcoming environment by a stable, well managed supported, motivated, staff team who work in a manner that recognises resident`s need for personal privacy and dignity. the qualityand of the food came in for paticular praise by residents. What has improved since the last inspection? No requirements, recommendations were made or any concerns noted at the previous inspection. What the care home could do better: Staff training could be improve by ensuring all staff receive training in all subjects and that the number of staff qualified to NVQ level two is increased. The carpet in the conservatory needs to be replaced. An internal management structure needs to be put in place so it is clear who is responsible for the home and residents at all times in the absence of the manager. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Three Oaks Southwick Road North Boarhunt Wickham Hampshire PO17 6JF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Peter McNeillie     Date: 1 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Three Oaks Southwick Road North Boarhunt Wickham Hampshire PO17 6JF 01329833412 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Camellia Care (Three Oaks) Limited Name of registered manager (if applicable) Mrs Julie Jacobs Type of registration: Number of places registered: 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 who can be accommodated is: 20 The registered person may provide the following category/ies 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 categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Three Oaks is privatley owned and managed care home registered to provide support and care for up to twenty older persons. The home is situated in a rural location at North Boarhunt with easy access to the M27 and M3 motorways and the cities of Winchester, Southampton and Portsmouth. Residents personal accomodation comprises sixteen single and two double bedrooms.There are also three lounges, a Care Homes for Older People Page 4 of 27 care home 20 Over 65 20 0 Brief description of the care home separate dining room and a large conservatory which overlooks a large mature garden and a view over the countyside available for use. Care Homes for Older People Page 5 of 27 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: two star good 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 report was written after taking into consideration a number of sources of information and evidence including a site visit to the premises, previous reports, sampling residents, staff training and recruitment records,talking with the Registered Manager, the Registered Person, residents, staff. Pre inspection CSCI and an in house satistaction surveys plus information provided by the manager in a pre inspection Annual Quality Assurance Assessment. (AQAA) was also considered. During this inspection which took place on 19/01/09 between the hours of 9:15 am and 1:15 pm we inspected all of the key standards for older persons. The results and findings contained in this report will determine the frequency and type of future inspections. At the time of our visit we were informed that costs varied between four hundred and Care Homes for Older People Page 6 of 27 twenty five pounds and five hundred and forty five pounds per week. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 27 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 9 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a system of assessing and identifying residents needs which ensures residents safety and that their assessed needs can be met. Intermediate care is not provided so this standard does not apply. Evidence: The manager informed us that residents were only admitted in accordance with the homes pre admission policy and procedure that requires a detailed written assessment of needs and risks being carried out by a member of the homes management team in consultation with the prospective resident. A Sample of four residents pre admission assessments chosen at random were viewed. Care Homes for Older People Page 10 of 27 Evidence: All were produced in accordance with the policy and procedure previously referred to and took into consideration residents care, nutritional and communication needs, wishes, choices, aspirations as well as any attendant risks and confirmed that potential residents are consulted about and were involved in the assessment process.Where the resident is funded by a local authorities social services department this would also include an assessment by a care manager. As part of the admission process management also liaise with external health and social care professionals regarding any care needs, risks, equipment and aids, that need to be considered and included when developing a plan of care. Records also confirmed ongoing assessments of need and risk for all residents are carried out on a regular basis and care plans (Section 7-11 of this report refers) updated to reflect any changes. Intermediate care is not available in the home. Care Homes for Older People Page 11 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a well-developed system of planning and reviewing care, which reflects residents, wishes, and aspirations and ensures residents needs are met within a risk management policy involves residents in decisions that affect them. Evidence: As part of our inspection plan, we viewed a random sample of four residents care plans chosen at random. All of the detailed care plans which included confirmation that residents were involved in producing, were reviewed at least monthly were based on pre admission assessments as described in the previous section of this report. In discussion, some residents verbally confirmed they were consulted about and participated in the production of the plan, others could not remember. Care Homes for Older People Page 12 of 27 Evidence: All of the residents spoken with and responses to our pre inspection satisfaction survey confirmed they were very satisfied with the care and support they received. They advised us they were contented, liked the staff and management and were treated with respect. They felt wanted and would recommend the home to anyone. Comments such as I am very happy, No complaints , Care is very good The staff and Manager are very kind and look after us all very well Resident also confirmed that their individual privacy was respected and that staff always knock on their bedroom door and wait before entering, a practice we observed during this visit. Residents right, and the opportunity to take risks is seen as fundamental. Residents were supported to make decisions for themselves within a risk assessment framework with the help of staff if required. This process identified individual risks and how they were to be managed. Staff who had a good understanding of the contents of the care plans and risk assessments were able to explain how the care plan was put into day-to-day practice. This was confirmed by a health care professional in a response to our pre inspection survey who also stated the home Allow residents the chance to live independently whilst caring for them at the same time. A very informal care home but one who monitors the residents closely. Residents informed us were able to see the doctor of their choice including on of the same gender or any other health and social care professional when they needed to. The records viewed indicated that apart from doctors, district nurses other specialists would be consulted as required. Records were kept of appointments with GPs, dentist, optician, chiropodist and any other external health and social care professional and included details of any advice and treatment given. In response to our questions relation to equality and diversity, in there AQAA we were told that the home had Added a data sheet to our care plan to enable service users to volunteer information about their race, gender, identity disability, sexuall orientation and beliefs if they wish to do so. Church of England services are held in the home and clergy of other denominations and religions are welcome, although rarely required. We remain alert to issues of equality and diversity but do not find them to be of ant concern. All medication which is dispensed by a pharmacist into blister packs is securely stored Care Homes for Older People Page 13 of 27 Evidence: and administered in accordance with a medication policy and procedure by staff all of whom have received training in the administration, recording and the security required when handling residents drugs and medication. The procedure also includes provision for those residents who wish subject to a risk assessment to retain responsibility for their own medication. The record of drugs and medicines administered to residents were complete and accurate. Care Homes for Older People Page 14 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities, family contacts and the provision of varied and nutritious meals were wellmanaged and reflected residents interests and choices. Evidence: A rolling two weekly programmes of activities that residents in their responses to our pre inspection survey and the homes internal survey expresses satisfaction was available. During our visit we observed a group playing bingo which they appeared to enjoy. Other activities on offer include, an outside entertainer, reminiscence, board games and a sing a long. Residents confirmed that participation was up to the individual and no one was forced to join in. We were informed in the past trips out had been offered but response was poor however this did not preclude the opportunity being made available in the future. Residents spoken with informed us they were fully consulted and were able to exercise choice in all aspects of their lives for example; when to get up and go to bed, mealtimes and where meals are taken, visiting times, the right to receive and converse Care Homes for Older People Page 15 of 27 Evidence: with visitors and to make and receive telephone calls in private. The quality, quantity, presentation and choice of food served came in for particular praise from the residents. A written daily menu based on residents likes and dislikes was displayed. We observed residents taking their mid day meal. This was conducted in a relaxed unhurried manner with staff available to give any resident assistance should they require it. Residents informed us meals could be taken in their own rooms if they wished. We sampled a portion of the home made baking produced earlier in the day and would confirm the views of the residents previously expresses regarding the quality of the food served. Tea and coffee were available to residents and visitors at all times as was water and fruit squash. Care Homes for Older People Page 16 of 27 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. A complaints procedure with which residents had confidence was in place. The home has clear policies and procedures in place, which ensures residents, are protected from abuse. Evidence: An Adult Protection policy and procedure designed to protect residents from abuse that works in tandem with that produced by Hampshire County Council as the lead agency for safeguarding residents. Records viewed, management and staff spoken with confirmed they had received training in recognising abuse and demonstrated they knew the procedure to follow should they witness or suspect the abuse of any resident. The homes complaints procedure was which was also included in the service users guide included information on how to contact The Commission for Social Care Inspection who have received no complaints since our last visit. Resident and staff spoken with stated they felt comfortable in discussing any concerns they had with the homes management and confident any matters raised would be dealt with fairly and promptly. Care Homes for Older People Page 17 of 27 Care Homes for Older People Page 18 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A safe, well maintained, clean, suitably furnished home is provided for residents, which meets their needs Evidence: The home is located in a rural setting in its own grounds with ample parking within easy access to the M27 and M3 motorways and the cities of Winchester, Southampton and Portsmouth. We noted, all areas of the home were clean and free from unpleasant odors and obvious hazards. Residents who told us they were satisfied with their accommodation confirmed the home is always clean and smells fresh. Furniture was comfortable, homely and in a good state of repair, in keeping with the decor and met residents individual and collective needs. Apart from personal mobility aids a number of communal aids had also been provided to assist reside to access all of the communal areas including the well-tended, large established and safe garden. There is a rolling programme of maintenance to ensure that the building is well Care Homes for Older People Page 19 of 27 Evidence: maintained, decorated and kept safe for residents and staff. To the rear of the property a large conservatory overlooks the garden and a views of the countryside. The carpet in this area is very worn in front of the french and needs to be replaced. The rest of the carpet in this area is good. The registered person gave a verbal undertaking that this will be done shortly at the same time, as a bedroom is refurbished. Care Homes for Older People Page 20 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are met by sufficient numbers of staff who are recruited and selected using a procedure designed to protect all residents. Evidence: The planned daily staffing levels for the home each day is: 8am to 1pm. The Manager, three carers plus a cook two cleaners. 1pm to 4 pm The Manager (for part) plus two carers. 4pm to 8pm three carers. 8pm to 10pm two carers. 10pm to 8am two waking night carers plus on call emergency arrangements. At the time of our visit, in our view the number of management, care and support staff available met residents needs, a view supported by the manager, staff and residents who informed us there were always enough staff on duty and they rarely had to wait for attention. We viewed four staff recruitment and training files selected at random. All files viewed included evidence that staff are employed in accordance with a robust recruitment, equal opportunities and selection procedure designed to protect residents. Care Homes for Older People Page 21 of 27 Evidence: This involves the completion of an application form, the signing of a rehabilitation of offenders declaration, an interview, and satisfactory Criminal Record Bureau (CRB) disclosure, Protection of Vulnerable Adults (POVA) and reference checks. Following their appointment, records seen confirmed that all staff are subject to an in house induction and compulsory training programme that include first aid, handling medication, moving and handling, safeguarding, infection control and dementia. In viewing all staff training records it was clear that a small number of staff had not attended training as expected, this is even more important due to the absence of attending an NVQ course. The manager gave a verbal undertaking all gaps in staff training would be attended to as a matter of urgency. The manager informed us staff group is very stable many members have worked at the home for many years, and there was resistance by staff to attend NVQ training courses. At the time of our visit one staff had been trained to NVQ level two and one member of staff was on a course. We were satisfied the homes management had tried and continue to try to get staff to accept NVQ training including financial inducements. We were advised in future where possible any new staff will only be employed on condition they attend NVQ training. Care Homes for Older People Page 22 of 27 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 good quality outcomes in this area. We have made this judgement using a range of 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: The registered manager who has experience of managing resources for older persons for many years and has worked at Three Oakes since 1999. Apart from her experience the manager holds a registered managers NVQ level four qualifications in management and care. In talking with manager and the registered person staff we were concerned at the lack of a clearly defined management structure. Whilst staff were aware all of their responsibilities and the limits of their authority, there was no designated person responsible for the home in the absence of the manager or registered person. We were Care Homes for Older People Page 23 of 27 Evidence: assured this matter had been recognised by the homes management who gave us a verbal assurance they were in the process of addressing this matter. In talking with staff, the homes management both internal and external were described as supportive, approachable and accessible and willing to listen to any ideas they may have for the improvement of the service. As part of the homes quality monitoring system, residents and residents representatives and staff are invited to participate in satisfaction surveys. The views expressed in the surveys are seen as key in highlighting areas that may require improvement or attention and the future development of this service. Results from the last survey indicated that 100 of residents described the quality of care as very good or good, 100 of residents described the staff as very good, 100 described the food as very good or good. In all other areas the response from residents were very positive. We were informed that no monies are being held on behalf of residents. An in house health and safety policy was in place to ensure the day-to-day safety of staff and residents. Procedures include, health and safety checks, the regular servicing of equipment, staff training in the techniques of moving and handling infection control, control, first aid, health and safety, procedures to follow in the event of fire (including evacuation),in addition all staff are issued with protective gloves and aprons and have access to antiseptic hand gel and soap. We were informed that all of the hot water supplies to baths were fitted with thermostatic controls set at 43 degrees centigrade and all radiators and hot pipes were covered to prevent a resident or staff being burnt. Care Homes for Older People Page 24 of 27 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 25 of 27 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 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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