Care Home: Twin Oaks

What the care home does well The home offers a unique service to older people being on a small scale and having a very personal touch. Health care needs are met through good working relationships with the local doctors and district nursing service. Professionals had this to say about the home and manager: "The manager is really good at liaising with other professionals." A District Nurse said : "Twin Oaks provides a warm friendly, homely environment. The residents needs vary greatly- and the manager assesses individuals needs using a truly holistic approach. The level of care is excellent. The residents are well cared for emotionally, physically and spiritually". A relative said "provides a warm, comfortable and safe environment. The house is always spotless and the furnishings are in good taste- it is a welcoming home". It is an extremely well kept building with both the internal and external features maintained to a very high standard. Feedback was good about the staff. For example a relatives said: "Neale and Adele(and Helen) go out of their way to provide excellent care and support. They all treat their residents as though they were family". and "Carers are cheerful, helpful and dedicated. They deserve all the support and help they should have in continuing their excellent quality of care ". People living in the home said they were well cared for and liked the staff. Feedback from a relative stated: "The care at Twin Oaks is second to none. Before our friend went to Twin Oaks, we looked at 13 other potential homes- none of them were suitable", and another said " I would recommend Twin Oaks to anyone- I just hope they will have a room for me when I need one!". A social worker said "The thing I also like about Twin Oaks is that it does not feel like an `institutional` residential home. I have found that clients and their families who have been fearful of residential care have been so relieved when they have seen Twin Oaks.". What has improved since the last inspection? The use of a volunteer has provided more stimulation for people, and has been well received by people living in the home. The manager must ensure that the recruitment and selection process for any volunteers involved in the home is thorough and includes police checks. We, Care Quality Commission(CQC), carried out a Random Inspection recently to specifically look at the care of medicines, after concerns had been raised at a previous visit. On this key inspection we looked at these deficiencies and found that the manager had made good progress to address these areas. For example over the counter creams and prescribed creams are now recorded when admistered. What the care home could do better: People have their needs assessed before they move into Twin Oaks to ensure that the home can cater for their needs. However, information given to prospective residents and professionals needs to be up-dated to include the range of people catered for and the arrangements about night time care. Currently the home only has "On-call" staff available at night. The manager`s partner, and co-owner, sleeps in the dining room of the home, and if a person rings the call bell he will then go and check what sort of support they need. The manager must review these staffing arrangements to ensure they are more professional and can meet peoples needs, and that people are supported by trained and competent staff at all times. We judge that the manager is running the establishment in the best interests of people living there and that it is a unique style of care home for older people, in that it is of a very small scale. However we are of the opinion that the manager can sometimes over look aspects of the efficient running of the home, for example the paperwork and administration, and is not as familiar with the law relating to running a home as she should be. The following serve to demsontrate this: The home must carry out its own Fire Risk assessment, and should have been doing so since 2007, where they take responsibility for ensuring that the home is safe from fire and that staff and other people living in the home have training and are aware of what to do in the event of a fire. The manager must ensure that records required by statue are kept in the home and are up to date, for example staff records. These are required for the safe and efficeint running of the home to protect service users and staff. While the home has a set of policies in place there were some which we felt needed to be added to ensure its safe and efficient running. For example: for missing persons procedure: for the use of restraint in a care home; for reducing the risk of Legionella in the home; and a policy and procedure for the recruitment of volunteers. The home has no formal training plan, and training is arranged in an ad hoc manner, as to whats available locally. There were no records available of important training such as fire instruction training and moving and handling. This needs to be better co-ordinated to target the needs of all staff, including volunteers and the co-owner who offers care, in order to meet the needs of residents. Key inspection report Care homes for older people Name: Address: Twin Oaks Victoria Road Windermere Cumbria LA23 2DL     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: Elizabeth Kelley     Date: 2 5 0 2 2 0 1 0 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 31 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 31 Information about the care home Name of care home: Address: Twin Oaks Victoria Road Windermere Cumbria LA23 2DL 01539448994 01539448994 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Heathwaite Care Homes Limited care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The home is registered for a maximum of 6 service users to include: up to 6 service users in the category of OP (Older People not falling within any other category) Date of last inspection Brief description of the care home Twin Oaks is a domestic style property which has been equipped to provide accommodation and care for up to six older people. The home is furnished and decorated to a good standard, and provides a very comfortable and pleasant environment for the people who live there. The accommodation is on two floors, on the ground floor there is a spacious lounge, dining room, bathroom, toilet and kitchen, and on the first floor there are four single bedrooms and one registered as a double each with an en-suite shower and toilet. There is a small car park, and gardens with level access and seating. The home is situated in the town of Windermere, close to all of the usual amenities. The fees for this service range from 495.00 605.00 per week, with additional charges for hairdressing, chiropody and newspapers. A brochure is available for prospective Care Homes for Older People Page 4 of 31 Over 65 6 0 1 7 0 3 2 0 0 9 Brief description of the care home residents, and a summary of the latest Commission for Social Care Inspection report is made available on request. Care Homes for Older People Page 5 of 31 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 visit to this service, that forms part of the key inspection, took place in Feburary and all the key standards were assessed during this time. Information about the home was gathered in different ways and this formed the basis for our inspection. The manager had completed an Annual Quality Assurance Assessment (AQAA) that was returned within the timescale allowed. It is a legal requirement that this document is completed annually by all regulated services. We spoke to staff residents and toured the building looking at the environmental standards. We received completed survey forms from residents, staff, relatives and professionals whose comments helped us to assess this service. We looked at the care planning system and examined the records for the administration of medicines. Care Homes for Older People Page 6 of 31 Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? The use of a volunteer has provided more stimulation for people, and has been well received by people living in the home. The manager must ensure that the recruitment and selection process for any volunteers involved in the home is thorough and includes police checks. We, Care Quality Commission(CQC), carried out a Random Inspection recently to specifically look at the care of medicines, after concerns had been raised at a previous visit. On this key inspection we looked at these deficiencies and found that the manager had made good progress to address these areas. For example over the counter creams and prescribed creams are now recorded when admistered. Care Homes for Older People Page 8 of 31 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 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before they move into Twin Oaks to ensure that the home can cater for their needs. However, the level of information given to prospective residents and professionals needs to be up-dated. Evidence: All residents are given a contract to sign and there is a copy kept on file for reference. The contracts are set out in good detail and give people a good indication of what services are included and the conditions of their stay. The manager completes an assessment of needs prior to offering a place to any prospective resident. This helps to ensure Twin Oaks will be able to provide the level of care required to meet those needs in an appropriate manner. The manager stated that Twin Oaks was designed to meet the needs of older people with less complex needs, and the assessment process she undertook helped to ensure this, so that people could be properly matched. However, if a persons care needs increased once Care Homes for Older People Page 11 of 31 Evidence: living at the home she would do her utmost to keep the person living at the home, if this is what they wished. All prospective residents and their families are invited and encouraged to visit the home to meet the staff and other residents prior to accepting a place. The home has to by law produce a Statement of Purpose, and this currently needs updating, to include the arrangements the home has in place for night time care, which is along the lines of an on-call. Currently this involves the co-owner sleeping in the dining room, and calling the manager in, from their own house next door, if anyone requires personal care. The manager stated if anyone was ill or required more assistance then she would make herself more availer to meet their needs. This needs to be set out for people to decide if they are happy with this arrangement. A socialworker feed back to us their view on the home: They provide a service for people with a certain level of independence, and as such offer a stairlift rather than a lift, and an on-call night cover rather than regular checks which does mean that some people would not manage there. However I would not suggest they necessarily need to change this, as all residential homes carnt cater for every need and I think Twin Oaks does an excellent job with the residents they are gearing their service towards. Prospective residents are given a leaflet with information about the home. This however, does not include important information that is necessary for people to make an informed choice. It is reccommended that the home develops a pack of information thats includes both a Statement of Purpose and a Service Users Guide. Care Homes for Older People Page 12 of 31 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. Following improvements in the care of peoples medication, healthcare is now being better managed and people are supported to keep well and healthy. Evidence: The manager takes the responsibility for preparing and updating the care plans and every resident was re-assessed recently. It would be good practice to develop care plans with each person and have the person sign that they agree with their plan. Health care needs are documented and details are kept of hospital and doctors appointments. While most people had Appointment sheets, Daily Routines and a Personal Profile in their files not everyone did. As this is a good way of keeping track of these important consultations this was discussed and recommended to the manager. Health care needs are met through good working relationships with the local doctors and district nursing service. There was good evidence to show how this happens, for example recent work had been undertaken with the local Mental Health team to help manage behaviour, related to a particular condition, to improve the quality of life for a Care Homes for Older People Page 13 of 31 Evidence: person in the home. Chiropody is provided by 2-weekly visits to the local health centre. Dental and optical services are available when necessary. The home provides equipment as necessary to maintain peoples health and independence. The manager is well known to all external health care professionals, and works in the health field occasionally in order to retain her nursing skills. Professionals had this to say about the home and manager: The manager is really good at liaising with other professionals. Recently I have been extremely impressed with the approach with a short term resident who was aiming to return home- as they were really well supported in terms of rebuilding their confidence and independenceeven though this was ultimately going to leave them with a vacancy. A District Nurse said of the care: Twin Oaks provides a warm friendly, homely environment. The residents needs vary greatly- and the manager assesses individuals needs using a truly holistic approach. The level of care is excellent. The residents are well cared for emotionally, physically and spiritually. We, Care Quality Commission(CQC), carried out a Random Inspection recently to specifically look at the care of medicines, after concerns had been raised at a previous visit. At this previous random inspection we found that: Overall, although generally suitable arrangements were in place for handling medication, weaknesses in the record keeping need to be addressed to better support and evidence the safe administration of medicines. On this key inspection we looked at these deficiencies and found that the manager had made good progress to address these areas. For example over the counter creams and prescribed creams are now recorded when admistered. Since the previous inspection arrangements have been made to ensure medicines are safely administered from the original pharmacy labeled container, and not as was previously happening put into pots. People choosing to self-administer medication are supported to do so, although no-one currently in the home chooses to do this. However, the home takes people on respite and at the last inspection one person was using an inhaler. The manager was instructed to in future carry out a risk assessment to ensure a person is capable of administering safely, and this should also be written in a person care plan. The assessment and care planning process could be strengthened by including the following: a nutritional assessment tool for monitoring the weight and nutrition of people on entering the home and then periodically during their stay. Some restrictive practices were observed, for example locking the front door and Care Homes for Older People Page 14 of 31 Evidence: placing a call bell out of a persons reach. This was discussed with the manager who stated that these were carried out in peoples best interest, in order to keep them safe and to respond to peoples dementia, when other approaches had failed. These practices require careful monitoring and should be made, if possible, with the persons consent, or a guardian and other professionals. How and why they are being carried out should also be documented so that the home can justify that they are not unduly depriving people of certain libertys. Care Homes for Older People Page 15 of 31 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. People are increasingly being offered more choice in what social and leisure activities they wish to take part in, which is improving their quality of life. Evidence: All visitors reported that they are made welcome by the home, and one said: My relatives faith is important and this is accommodated for. During the inspection a local clergyman conducted a service for those wishing to take part. The manager was observed to be sensitive to the needs of residents at mealtimes, for example the need for encouragement and support to retain independence. The tables was set attractively with a table cloth, napkins and flowers and with appropriate cutlery and aids to help individuals during their meal. Birthdays and celebrations are made special for individual residents. The food was judged to be of a high quality, fresh and home cooked. Mealtimes were observed to be relaxed and unhurried, and residents spoken to were complimentary about the food. People could chose where they would like to eat, and some people had meals in their rooms, particularly breakfasts. A social worker said of the social life of people in the home I think they are Care Homes for Older People Page 16 of 31 Evidence: particularly good at recognising that people can remain socially active while in residential care. They often see if residents want to pop to the supermarket with them when a member of staff is doing the shopping or collecting prescriptions. A recent development has been the recruiting of a volunteer who comes to the home and engages people in singing, crosswords, dominos or any other interest or hobby each person is interested in. People spoken to said they looked forward to her visits. Care Homes for Older People Page 17 of 31 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. People are given a clear complaints procedure, and the manager has relevant training which ensures that action will be taken to resolve any concerns. Evidence: There is a complaints process that is discussed with prospective residents and their families when they visit the home looking for accommodation. There is also a copy in each of the residents rooms. There have been no complaints to record and we, CQC, have not received any. We have not been notified of any via Social Services either. The manager has completed the train the trainers course in protection of vulnerable adults and has passed on the necessary information to her member of staff. This was also covered when the carer completed her National Vocational Qualification at levels 2 and 3. Both the manager and carer knew what process to follow should such an incident come to light. Some restrictive practices were observed and the manager should strengthen care plans by considering how certain forms of equipment may be considered as restraint and therefore require permission to be used, for example bed rails, lap belts and door locks. Such practices and equipment require careful monitoring and should only be used, with the persons consent, or that of a guardian and other professionals. And as previously mentioned, how and why they are being carried out should also be carefully documented so that the home can justify that they are not unduly depriving people of Care Homes for Older People Page 18 of 31 Evidence: certain libertys. Care Homes for Older People Page 19 of 31 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 maintained to high standards and provides a homely and pleasant place to live. Evidence: Twin Oaks is a large detached property situated not too far away from the centre of Windermere. It is an extremely well kept building with both the internal and external features maintained to a very high standard. The owners partner is responsible for the maintenance programme and upkeep of the well appointed gardens. The building has been adapted for its present use as a care home. There is plenty of communal space for up to 6 people in a large lounge, dining room and well maintained outside space. There are four single bedrooms and one room registered as a double. This is currently used for single occupation and will remain so unless there is a request for shared accommodation. Accommodation for residents is on the first floor, which is accessed by a stair lift. The residents rooms are well decorated and personal to the individual as those living in the home are encouraged to bring in items from home. All bedrooms are en suite with showers and an assisted bath is available downstairs. The home while not having a passenger lift has instead a stair lift. This could be awkward for people with very limited mobility and therefore these facilities need to be documented in the homes Statement of Purpose and information given out to people. Care Homes for Older People Page 20 of 31 Evidence: The manager is aware of the need for hygiene and the control of infection and there are systems in place to avoid cross infection. A Social Worker commented on the home: Provides a very homely setting. The house is absolutely immaculate. And a District Nurse said of the environment: Twin Oaks provides a warm, friendly and homely environment for their elderly residents. It really is home from home. A relative said provides a warm, comfortable and safe environment. The house is always spotless and the furnishings are in good taste- it is a welcoming home. Care Homes for Older People Page 21 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing arrangements and training offered need to be reviewed to ensure that they are meeting the increased care demands of people living in the home. Evidence: We discussed the staffing arrangements with the manager who confirmed that she currently has one member of staff who assists her in providing care and support to the residents. This person works 24 hours a week and mostly comes in every week day morning. The managers partner supports the residents in other ways such as rides out in the car or taking residents out for walks, and provides night time on-call. The use of a volunteer has provided more stimulation for people, and has been well received by people living in the home. The manager must ensure that the recruitment and selection process for any volunteers involved in the home is thorough and includes police checks. Feedback was good about the staff. For example a relatives said: Neale and Adele(and Helen) go out of their way to provide excellent care and support. They all treat their residents as though they were family. and Carers are cheerful, helpful and dedicated. They deserve all the support and help they should have in continuing their excellent quality of care . People living in the home said they were well cared for and liked the staff. Pleasant Care Homes for Older People Page 22 of 31 Evidence: inter-actions were observed between the staff and people they were caring for.The manager was observed protecting a persons dignity by ensuring that personal care was carried out in the privacy of their own room with the door closed. On this inspection visit there was no paperwork available that pertain to the one staff member. The manager stated that the carer had all her paperwork at home. There was no more that could be assessed on this visit. The manager was advised that to comply with the Care Standards Act and ensure that all staff information is held in the home and be made available on inspection. Currently the home only has On-call staff available at night. The managers partner sleeps in the dining room of the home, and if a person rings the call bell he will then go and check what sort of support they need. If it involves personal care he will then wake the manager up and call her in from their house next door to carry out these duties. We judged that this is not really a very satisfactory arrangement, and could cause delays in receiving support. The partner also has no formal qualification or training in care, and this was also felt not to be appropriate for the night time care of residents. The manager had also stated that the needs of people coming into the home had changed significantly since they opened the home 3 years ago, and now people had much more complex and demanding care needs. She said that if anyone was poorly or required more assistance she would make herself available during the night. This however then puts a strain on the day care offered to people, as there are only two carers. The manager must review these staffing arrangements to ensure they are more professional and can meet peoples needs. A professional said of this arrangement; They provide a service for people with a certain level of independence, and as such offer an on-call night cover rather than regular checks, which does mean that some people would not manage there. The home had no formal training plan, and training is arranged in an ad hoc manner, as to whats available locally. There were no records available of important training such as fire instruction training and moving and handling. However, the service recognises the importance of training, and tries to deliver training that meets statutory requirements and the NMS. The manager is aware that there are some gaps in the training programme and plans to deal with this. The service is also able to recognise when additional training is needed, but is not always in a position to provide this training. This needs to be better co-ordinated to target the needs of staff, including volunteers and the co-owner, in order to meet the needs of residents. The manager stated that she is considering purchasing a package of DVDs to fill in some of these gaps and meet these needs by doing in-house training. Care Homes for Older People Page 23 of 31 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. While improvements need to be made to the administration of the home the outcomes for people are good overall. However gaps in knowledge and procedures should be addressed to ensure this remains the case, and people continue to receive a good, and safe service. Evidence: The registered manager is a qualified nurse with a wealth of experience in the care of vulnerable, older people. She is responsible for the day to day running of the home with the support of her partner and one member of staff. She knows the people who live in Twin Oaks very well and has a clear understanding of their needs. She runs the home in the best interests of those living there. Feedback from a relative stated: The care at Twin Oaks is second to none. Before our friend went to Twin Oaks, we looked at 13 other potential homes- none of them were suitable, and another said I would recommend Twin Oaks to anyone- I just hope they will have a room for me when I need one!. A social worker said The thing I also Care Homes for Older People Page 24 of 31 Evidence: like about Twin Oaks is that it does not feel like an institutional residential home. I have found that clients and their families who have been fearful of residential care have been so relieved when they have seen Twin Oaks.. We judge that the manager is running the establishment in the best interests of people living there and that it is a unique style of care home for older people, in that it is of a very small scale. However we are of the opinion that the manager can sometimes over look aspects of the efficient running of the home, for example the paperwork and administration, and is not as familiar with the law relating to running a home as she should be. This maybe because of the small nature of the business and the feeling that things dont apply to this setting, or it could be that there are insufficient staff hours allocated to administration. The following are examples of where more time needs to be dedicated to ensure the efficient and safe running of the home. The home should now be carrying out its own Fire Risk assessment where they take responsibility for ensuring that the home is safe from fire and that staff and other people living in the home have training and are aware of what to do in the event of a fire. This was brought in under the Regulatory Reform Fire Safety Order 2005 came into effect on 01 October 2006. The assessment has to be kept under regular review. While the home has some policies to ensure its safe and efficient running, there were some which we felt needed to be added. One for missing persons procedure, another for the use of restraint in a care home, and how this would be handled in light of new legislation, namely the Deprivation of Liberties guidance and Mental Capacity Act. Also a policy and procedure for reducing the risk of Legionella in the home, and the home should consider testing portable electrical devices in the homes periodically to ensure they are safe. A policy and procedure for the recruitment of volunteers. More work is needed in this area of policies and procedures. The Annual Quality Assurance Assessment(AQAA) sent into us, which is a new legal requirement for managers to complete, gives very little information about the service. There is minimal evidence to support any of the claims made within it. There is a lack of understanding of the purpose of the AQAA. The questions relating to the views of residents and to equality and diversity are particularly poorly completed. Areas of the data section are left blank. The AQAA does not give us a reliable picture of the service. There is no formal quality assurance system but the manager speaks to residents daily and family members often to ask their opinion of the service and is always looking for ways to improve the good level of care already provided. These need to be recorded and and more formal ways of ensuring quality need to be implemented. The manager is recommended to make herself more familiar with the guidance available on CQC Care Homes for Older People Page 25 of 31 Evidence: website, namely Guidance Logs, Key Lines of Regulatory Assessment, and Policy Guides. Care Homes for Older People Page 26 of 31 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 27 of 31 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 1 7 15 Care plans must contain 30/03/2010 details and risk assessments of where restrictive practices are used This is to ensure that where peoples liberty is restricted it is done so in peoples best interests and done in consultation with relevant people and professionals. 2 27 18 The manager must ensure 30/04/2010 that at all times people are supported by competent and trained staff. This is to ensure people receive appropriate and timely care. 3 29 1 The manager must ensure that the recruitment and selection process for any volunteers involved in the home is thorough and includes police checks. 30/04/2010 Care Homes for Older People Page 28 of 31 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 These measures protect people living in the home 4 37 17 The manager must ensure that records required by statue are kept in the home and are up to date. These are required for the safe and efficeint running of the home to protect service users and staff. 5 38 23 The manager must produce a Fire Risk Assessment for the home. To carry out an assessment of the risks of fire (a fire risk assessment) and take steps to reduce or remove that risk of fire. 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 12/05/2010 30/04/2010 1 1 The manager should update the homes Statement of Purpose, and Service Users Guide, to detail the night time care arrangements and the needs of people the home can cater for. Healthcare and other appointments, and the outcomes should be recorded on peoples files to ensure consistent practice. Nutritional screening should be undertaken on admission and subsequently on a periodic basis, including weight gain and loss, and any apprporiate actions taken. 2 7 3 8 Care Homes for Older People Page 29 of 31 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 4 18 Use of restrictive practice should only be carried out in consultation with other professionals the person themselves and/or a Representative. The manager should develop a training programme that sets out how staff will be trained to meet the needs of people living at the home, and fulfill safety requirements in the home. 5 30 Care Homes for Older People Page 30 of 31 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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