Care Home: Townsend House

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What the care home does well Prospective service users and their representatives are encouraged to visit the home before making a decision to move in for a trial period. Service users expressed their satisfaction of living in Townsend House, the care provided and the facilities available. The home is run in the best interests of service users. The home is well maintained, clean and comfortable. Service users are confident that any concerns or complaints will be listened to, taken seriously and acted upon. What has improved since the last inspection? The manager was registered with the commission in November 2007. The three requirements and good practice recommendations made at the last inspection have been actioned. Night staffing levels have been increased. What the care home could do better: Following the inspection we received an action plan from the manager, detailing actions to be taken in areas identified in the body of the report. No requirements have been made at this inspection. Key inspection report Care homes for older people Name: Address: Townsend House Bayswater Road Headington Oxfordshire OX3 9NX     The quality rating for this care home is:   two star good 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: Marie Carvell     Date: 2 6 0 8 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 27 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 27 Information about the care home Name of care home: Address: Townsend House Bayswater Road Headington Oxfordshire OX3 9NX 01865762232 01865744681 manager.townsendhouse@osjctoxon.co.uk www.oxfordshire.gov.uk The Orders Of St John Care Trust care home 45 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 45. 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) Dementia (DE) Physical disability (PD). Date of last inspection Brief description of the care home Townsend House is a purpose-built residential care home, dating from the 1960s, situated in Headington, on the outskirts of the city of Oxford. It can provide care for 45 older people managed by The Orders of St John Care Trust, a charitable organisation. The home is a two-storey building with a passenger lift provided, and each room is linked to a call system to summon staff assistance when required. The care home Care Homes for Older People Page 4 of 27 Over 65 0 45 0 45 0 45 Brief description of the care home provides 45 single bedrooms with several lounge areas, one of which is designated for smoking. There is a communal dining room, an attractive conservatory room and pleasant accessible grounds with seating. The fees for this service range from 505.00 pounds per week to 760.00 pounds per week. Items not covered by the fees include hairdressing, podiatry, newspapers, magazines, toiletries and contributions to some outings and activities. 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: The last key inspection of this service was completed in October 2007. This inspection was an unannounced key inspection. We ( the commission) arrived at the service 10.30am and we were in the service until 6pm. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager, Valerie Jarvis in July 2009 and any other information that we have received about the service since the last inspection. We looked at how well the service is meeting the standards set by the government and have in this report made judgements about the standards of the service. Time was spent talking to the manager, service users and staff on duty. We looked at communal areas of the home, examined a sample of records required to be kept in the home, including the case tracking of service user records and spent time talking to service users in communal areas of the home and in private. We observed how care was being delivered to service users and joined service users in the dining room for the midday Care Homes for Older People Page 6 of 27 meal. Three surveys were received from relatives, carers and advocates. Care Homes for Older People Page 7 of 27 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 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 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. Service users are provided with sufficient information to make an informed choice about moving into the home for a trial period. Service users are provided with a contract/terms and conditions. Prospective service users are assessed prior to admission to ensure that the home is able to meet their assessed needs. Evidence: All prospective service users are provided with information about the home, including the service user guide and a copy of the homes most recent inspection report. Oxfordshire County Council have a block contract with the home for twenty eight of the forty five beds. Time was spent with two service users who had recently been admitted to the home, both confirmed that they had been given sufficient information to make a decision to move into the home for a trial period, had been encouraged to Care Homes for Older People Page 10 of 27 Evidence: visit the home to look at the premises and facilities and to meet other service users and staff. Both service users said that when they visited the home, they were welcomed and staff took as much time answering questions as needed. One service user said that she had visited several homes, but felt that Townsend House was the right home to move into, and having moved in on a trial period, then decided to stay permanently. The manager or head of care undertake a pre -admission assessment of all prospective service users, to ensure that the home is able to meet their assessed needs. This is well documented in service user files. Service users are provided with a contract/terms and conditions, this was confirmed in discussion with service users and examination of service user files. 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. Care plans need to be in sufficient detail regarding lifestyle choices and the preferences of the service user with regard to how care is to be provided and when. Care plans need to be developed to include how the emotional, psychological and social care needs of service users are identified and met. The healthcare needs of service users are fully met. Medication administration, recording and storage are maintained to a high standard. Service users are treated with dignity and respect. Evidence: Care plans are drawn up from the pre-admission assessment, agreed and signed by the service user/representative as appropriate. Information regarding health and personal care is well documented. However, care plans do not evidence how the service users emotional, psychological or social care needs are identified and met. Care plans are not in sufficient detail regarding lifestyle choices or the preferences of Care Homes for Older People Page 12 of 27 Evidence: the service user with regard to how care is to be provided and when. This was subject to two good practice recommendations at the last inspection. Care planning documentation is currently being revised and updated and the manager confirmed that training is being provided in the new care planning process for all managers in October, followed by training for all care staff. Service users were observed to be well groomed and appropriately dressed, an hairdresser visits the home regularly and service users said that this is appreciated. Attention is given to ensuring that service users have their dentures, hearing aids and spectacles in place. The healthcare needs of service users are met by seven GP practices as service users are able to remain with their existing GP when admitted to the home. District nurses from each practice visit the home as and when required and other healthcare professionals as necessary. The manager and two healthcare professionals are currently updating behavioural guidelines for two service users. From discussion with the manager, service users and evidence seen in service user records the healthcare needs of service users are fully met. Medication is administered by care staff who have completed medication training and undertake an annual competency update. Medication storage, recording and administration were seen to be well organised. Regular medication audits are undertaken by the quality assurance manager and any identified deficits are addressed immediately. Staff were observed to interact with service users in a calm, respectful and kind manner. Service users expressed their satisfaction of the care provided, the accommodation and the facilities available. Comments made by service users included Nothing is too much trouble, They are very kind , The manager and staff take time to do the things that matter , We share a joke with all the staff . One service user expressed his appreciation, that the manager takes him several times per week to see his wife in hospital. From observation we consider that there is a good rapport between service users, their visitors and the staff team. Three surveys were received from relatives, carers or advocates. Comments made in response to the question What does the home do well included Keeping the relatives informed, at all times, A good caring service at all times, A very caring home and staff, very good care provided, They always meet my mothers needs and treat my mother very well. To the question what could the home do better included The provision of more staff would help and Provide more staff. Care Homes for Older People Page 13 of 27 Evidence: As in many other care homes, there is a wide range of racial, ethnic and faith backgrounds represented within the staff team compared with the current service users. From discussion with the manager, we consider that the home is able to provide a service to meet the needs of individual service users of various religious, racial or cultural needs. 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. Service users are encouraged to make choices and remain as independent for as long as possible. A range of activities and community involvement is made available to meet the social needs of service users. Service users are provided with a nutritious and wholesome diet and are able to influence the menus planning and catering arrangement by involvement in the food committee. Evidence: There is a full time activities organiser in post. Information about events, outings and activities are displayed on notice boards in the home. Although a wide range of activities take place, this is not evidenced in service user care plans or daily records. The manager confirmed that this will be addressed with the introduction of the new care planning documentation. Service user meetings take place every two months. There is a food committee group, which meets regularly to discuss food and menu planning with the catering team. Care Homes for Older People Page 15 of 27 Evidence: Many of the service users have friends and family members who are able to visit on a regular basis. Service users confirmed that their visitors are always made welcome and for a small charge, many stay for a meal. The home has good established links with the local churches, schools and voluntary groups. Approximately fifteen service users attend local churches each Sunday morning and several religious ministers visit the home to meet service users pastorial needs. Service users confirmed that the routines are generally flexible in the home, such as being able to decide how to spend their day, when to go to bed and when to get up. We joined service users for the midday meal. Service users said that the food was variable, but mostly fine. The meal served was hot and tasty. There is usually a choice of two main courses, but not on the day of our visit and service users were not given an explanation why. The dessert trolley was wheeled to each table and care staff patiently gave each service user the choice of five different puddings. Service users commented that the custard had not be sweetened. Following the inspection we received an action plan from the manager advising us that the menus had been reviewed with the chef and changes agreed with immediate affect. Service users confirmed that the last meal of the day was served at 6pm, which meets their needs, followed by supper drinks and snacks from 8pm. 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. Service users are confident that any concerns or complaints will be taken seriously, listened to and acted upon. Policies and procedures are in place to protect service users from possible harm. Evidence: The homes complaints procedure is displayed in prominent positions throughout the home. In the last twelve months the home has received five complaints either verbally or in writing. The recording of complaints was seen to be clear, detailed and included action taken and outcome. At the last inspection a good practice recommendation was made that staff training in the responding and reporting of complaints should be considered. This has been actioned. Service users said that if they had a concern or complaint then they would speak to the manager or a member of the senior staff, and were confident that action would be taken immediately. All staff receive training in safeguarding vulnerable adults from abuse procedures including whistle blowing, during their induction and then updated on a regular basis. The head of care was providing training to members of staff on the morning of this visit. No safeguarding adult referrals or safeguarding adult investigations have taken place in the last twelve months. No referrals have been made for inclusion on the protection Care Homes for Older People Page 17 of 27 Evidence: of vulnerable adults list (POVA). The home has a copy of the Oxfordshire safeguarding adults procedures, which is available to all staff. 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. The home is safe, well maintained and provides comfortable accommodation. Sluice facilities need to be reviewed. Measures to prevent the potential risk of cross contamination and the spread of infection needs to be more robust. Evidence: The location and layout of the building is suitable for its stated purpose. Service users expressed their satisfaction of being able to personalise their own bedrooms and the facilities available. All bedrooms are single occupancy and there are sufficient numbers of bathrooms and toilets throughout the home. The housekeeping and maintenance person work extremely harm and take pride in maintaining the home to a high standard. However, it was observed during a tour of the premises that sluice facilities are limited, including the need for staff to manually clean commode pots. Measures to prevent the potential risk of cross contamination and the spread of infection need to be more robust. Several commode pots were thrown away as they were not longer usable and one commode pot was seen to be inadequately cleaned. Following the inspection we received an action plan from the manager advising us that she had raised concerns in relation to the risk of cross infection in sluices and asking whether a mechanical bedpan washer could be considered. The manager is advised to obtain a copy of Infection Control in Care Care Homes for Older People Page 19 of 27 Evidence: Homes. The home is well maintained, comfortable and homely. There is an ongoing redecoration and refurbishing programme in progress and the garden is safe and used by service users in the warm weather. 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. Staffing levels appear to be adequate to meet the needs of the service users. Recruitment procedures are robust. Staff are well trained and are able to carry out their roles with confidence. Evidence: From discussion with the manager, staff on duty, examination of duty rosters and observation the staffing levels appear adequate to meet the needs of the service users. At present due to staff vacancies, annual leave, maternity leave and long term sickness, the home is using agency care staff to cover vacant posts. In the last year four members of staff have resigned for a variety of reasons. The home currently has vacancies for three part time housekeeping posts and a full time care assistant for day duty. The manager is confident that these posts will be filled. Since mid August the night staffing levels have been increased to three care assistants. Members of staff are encouraged to undertake national vocational qualification training (NVQ). Currently of the thirty two permanent care staff, seventeen have completed NVQ at levels II or III, seven are working towards the qualification and the remaining care staff have been nominated or are waiting to start the training.This was subject to a good practice recommendation at the last inspection and has been actioned. Care Homes for Older People Page 21 of 27 Evidence: From examination of a sample of staff personnel files, the homes recruitment procedures are robust. The home has a well developed staff training and development programme. All staff undertake induction training, appropriate to their role once in post, complete mandatory training and specialist training as required. Training records are well organised. However, not all training records were up to date, the manager and head of care, who has responsibility for training agreed to address this. Staff were positive about the training opportunities provided to them, felt that this gave them confidence to carry out their roles and assisted with future career advancement. Staff were observed to be carrying out various tasks in a confident and professional manner. From discussion with staff on duty and observation, we consider that staff morale in the home is good. Staff spoken to said that they felt valued, enjoyed working in the home and were well supported by the manager and the Trust. 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. Service users benefit from a well managed home. Evidence: The manager, Valerie Jarvis was registered with the commission in November 2007. She is an experienced and qualified manager, she is supported by a head of care, a team of four care leaders and an experienced administrator. In discussion with service users and staff on duty all expressed the view that the home is well managed and run in the best interests of service users. Service users and staff expressed their satisfaction of the managers leadership style. Service users said that they could talk to the manager at any time and she always made time to talk to them or their visitors. Policies and procedures are in place and are reviewed on a regular basis. Staff are always informed of new procedures and these are discussed in staff meetings. Procedures are in place for dealing with service users monies and valuables, these are Care Homes for Older People Page 23 of 27 Evidence: in line with Trust procedures and are audited annually. All care staff receive formal 1-1 supervision at least six times per year, records are maintained in line with Trust procedures. Reports written by a provider representative, following a monthly unannounced visit to the home, were available for examination. This was subject to a requirement at the last inspection and has been actioned. Quality assurance systems are in place as well as monthly and annual internal audits. These are detailed and well documented. Evidence was seen that the views of service users, relatives and stakeholders are obtained to measure the homes success in meeting the aims, objectives and statement of purpose. A sample of records relating to health, safety and welfare were examined and found to be well maintained and up to date. 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: 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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