Care Home: Twin Oaks Nursing Home

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What the care home does well The service delivers a well managed and co-ordinated approach to people with a range of needs, including nursing care and care for people with physical disability. The proprietors offer a hands on approach, and ensure that they speak on a daily basis to people living in the home, and the registered manager of the service has been with them since the home opened in 1995. They have a good working relationship with local health teams, and ensure that the care they provide is the same irrespective of the source of funding, and they strive to provide good value for money. Facilities are generally good, and a range of home cooked and nutritious food is served What has improved since the last inspection? Since the last inspection, staffing levels and staff turnover has improved, and the service now have a large number of staff with NVQ qualifications. The staffing in place is now utilised more flexibly, to better meet the needs of the residents. Since our last inspection these changes have provided more stability. More activities and events are available to people living in the home, which include sessions provided by external organisations. What the care home could do better: The service must ensure that all the required recruitment checks are in place, and that references they receive are checked to ensure authenticity, and they must also show how people living in the home contribute to their care planning. These plans must also be reviewed and reflect any changes in the needs of the people they relate to. Some of the decoration and carpeting in the home is now in need of replacement, and a refurbishment plan is in place. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Twin Oaks Nursing Home Hudson Way Chapel Break Bowthorpe Norfolk NR5 9NJ     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: Alan Buttery     Date: 0 3 0 4 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 25 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Twin Oaks Nursing Home Hudson Way Chapel Break Bowthorpe Norfolk NR5 9NJ 01603743195 01603748728 richard@twinoaks.fsbusiness.co.uk 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) : Mrs Ruby Jane Francis care home 49 Number of places (if applicable): Under 65 Over 65 49 0 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 49 Twin Oaks Nursing Home is located in Bowthorpe, a suburb on the outskirts of Norwich. The home is purpose built and first registered in 1995. The nursing provision offers care with nursing for older people and for service users with a physical disability. Service user accommodation is on two floors divided into four wings with the building designed on different levels. There are 37 single rooms and 6 double rooms all ensuite. The reception and main services and facilities are sited on the ground floor. There is ample parking space to the front of the premises. The gardens to the rear of the premises are mainly laid to lawn with flowerbeds, and raised gardens and patio areas. Disabled access is at the front of the premises. The weekly fee for the home is between #464.00 and #900.00. Care Homes for Older People Page 4 of 25 Care Homes for Older People Page 5 of 25 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 was an unannounced inspection, which included a visit to the premises, and we met with one of the providers, who was able to provide the information we required, including records of residents and staff, maintainance records, training records and details of events and activities. We were also able to speak with residents and staff during our visit, and comments we received are reflected in this report. The service offers a comfortable home for people living there, with both older people and people with a physical disability accommodated. Care Homes for Older People Page 6 of 25 Care Homes for Older People Page 7 of 25 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.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 25 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 25 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. Detailed information is obtained about the needs of people moving into the home to ensure that the prospective resident can be confident all their needs have been identified and the service can meet those needs. Evidence: The service provides support to people with a range of needs, mainly elderly nursing care, with some people with physical disabilities. Many of the care packages are funded by the local authority and during the inspection visit, we discussed the procedure for admissions to the home with the providers. Initial enquiries come either by telephone or from visits by relatives, and these are followed up with a visit by the manager of the home to the person, at which time an initial pre admission assessment is carried out. Care Homes for Older People Page 10 of 25 Evidence: From this assessment, the individual needs of the prospective resident are determined, and the service can ensure that these needs can be met. All new residents are encouraged to visit the home wherever possible, before they move into the home, but this is not always possible, for example where people are moving into the home following a stay in hospital. Some of the people moving into the home are there for short periods of respite, but the same procedures are followed. As part of the inspection, we looked at the care records for four people living in the home, and these all included detailed assessment information, that was gathered prior to them moving into the home. We also looked at the individual care plans for these people. Care Homes for Older People Page 11 of 25 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. Individual plans are in place which show how the identified needs are met, but more information is needed on how individuals were involved in their plan, and reviews must reflect changing needs. Evidence: As indicated earlier in the report, initial care plans are prepared in readiness for a new resident moving into the home. At the present time these are prepared by the qualified staff, and this was discussed with the providers who hope to include care staff in this process in the coming year. These initial plans are kept under review during the first few days of the persons stay in the home, and then more formally reviewed on a monthly basis. During the visit, we looked in detail at four of the individual plans, which showed how they support was to be given, but did not clearly evidence how the individual resident had been involved in the initial care planning. There was some evidence within six Care Homes for Older People Page 12 of 25 Evidence: monthly reviews of resident and family involvement, but the service must ensure that this involvement begins when the plan is first written. It was also felt that some work is needed on the plans, and on the way they are reviewed, as the present plans focus heavily on the medical needs of the individuals, and do not show enough detail on the social care of the person. In addition the monthly reviews do not show that enough emphasis is placed on the review and many show a bland statement of no change. One plan looked at failed to show an amendment to the care plan following the introduction of bed rails, instead showing no change. Medication is administered by qualified staff, and the provider and manager undertake regular medication audits to ensure it is being administered in accordance with the service procedures. Care Homes for Older People Page 13 of 25 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. A range of activities are available to people living in the home, giving them a choice in how they occupy their time. Evidence: A range of activities are available to people living in the home, provided by staff working there and by external agencies. The activities include quiz and crossword sessions, Aromatherapy, Keep fit, Reminiscence sessions, story writing, Bingo, musical entertainment and musical sessions. Individualised time is given to people who may not be able to join in all activities, and staff are encouraged to spend a few minutes talking to the residents whenever they get the opportunity. The provider felt that the variety and level of activity available to people living in the home has increased since our last visit, in particular for those residents unable to join in some of the sessions, and while we were in the home, we observed arrangements being made for transport so that one of the gentlemen living in the home could attend the football the following day. We were also told of another gentleman who regularly Care Homes for Older People Page 14 of 25 Evidence: goes to the football. A good selection of home cooked food is served from the dining room, with a choice available at all meals. Residents who choose to can also have their meals served in their room, and where required, a soft diet or peg feeding is facilitated, with support and training from local health professionals. The service employs two full time chefs, and there is therefore one of them available all day. They source local fresh meat and vegetables, and ensure that their menu reflects seasonal changes as well as catering for special celebrations. Care Homes for Older People Page 15 of 25 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. The service has a procedure in place to ensure that any concerns complaints or allegations are dealt with, and people know that their concerns will be listened to Evidence: Procedures are in place to ensure that everyone living in the home knows how to make concerns known, and the provider walks around the home everyday, talking to residents and staff. The terms and conditions given to people when they first move into the home contains the complaints procedure, and a copy is on display in the reception area. At the time of our visit we were informed of three complaints that had been received in the past twelve months, all of these had bee investigated in accordance with their policy. Safeguarding procedures are in place, and staff all receive suitable training, including annual refresher courses. The service has had one issue in the as year which was investigated thoroughly under the local authority procedures, and the home found to have acted very appropriately Care Homes for Older People Page 16 of 25 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 service provides facilities that are clean and safe, but some refurbishment is now needed to maintain the comfort of the people living in the home. Evidence: The home was purpose built in 1995, and offers a clean and safe environment for the people living there. As part of our visit, we looked around the home, and at some of the individual rooms. It was acknowledged by the proprietor that the facilities are now in need of updating, and a programme of improvement and replacement is in place. The home is set in attractive and well maintained grounds. Care Homes for Older People Page 17 of 25 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. Although procedures are in place the service must ensure that all the required checks are in place so that people living in the home are not placed at risk. Evidence: The service employs around 62 staff including 13 qualified nurses, and at the time of our visit was fully staffed. They are planning to recruit a part time qualified nurse shortly to ensure that they have sufficient staff during the holiday season. The home appeared to have sufficient staff on duty on the day of our inspection, and normally have 2 qualified staff and 6 or 7 carers during the day, reducing to 3 carers and the two qualified nurses at night. During our visit, we looked at four recruitment files, and the homes training records. These showed that the service has an appropriate recruitment process, which should ensure that the information required within the Care Home regulations is in place. However, we noted on one file that only one reference had been received, another showed no detail of previous employment. This was acknowledged by the proprietor on the day of our visit, and she agreed to ensure that all recruitment checks would be undertaken in future. Care Homes for Older People Page 18 of 25 Evidence: Care Homes for Older People Page 19 of 25 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 service has an established management team, and the people living in the home are involved in everyday decisions that affect them. Evidence: On the day of our visit, the manager of the service was away, but we met one of the proprietors, who spend a lot of time in the home. The service has had the same manager since it opened, and the relationship between the proprietors and manager appeared very good. This has ensured a consistent level of support is given to people living in the home. As part of a daily routine, the proprietor of the home walks around, talking to staff and residents, and during our visit we observed her interactions with people living in the home, clearly very familiar with all of them. Care Homes for Older People Page 20 of 25 Evidence: People living in the home told how much they liked the home and how well they were looked after. One of the proprietors takes responsibility for maintainance in the home, and ensures the required safety checks are all carried out. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13.2 There needs to be a clear 01/07/2007 audit trail for all medication kept in the home to ensure that the manager can be sure of how many medications are in the home at any one time. All areas of the home need to 01/07/2007 be kept free of any offensive odours to ensure that all service users live in comfortable and pleasant environment. Residents money that is 01/07/2007 looked after by the home needs to be looked after in a way that is independent from any of the homes financial systems. This will ensure financial independence and safekeeping. The registered providers are 01/07/2007 required to maintain a written record of all supervision sessions with staff to ensure development, practice, and training needs are acknowledged and form part of the annual appraisal process. This is a repeat requirement from the last inspection. Page 22 of 25 2 19 16.2 (k) 3 35 16.2l 4 36 18 Care Homes for Older People 5 37 17.2 Records relating to staff need 01/07/2007 to be in the home where the staff are employed to enable access to staff files by the commission. The home needs to have a record of all visitors to the home to ensure that they know who is in the building at any one time. 01/07/2007 6 38 17.2 Care Homes for Older People Page 23 of 25 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 1 7 15 Individual plans must be reviewed regularly To ensure that changes in need are reflected in the individual plans 30/06/2009 2 7 15 Individual care plans must show the individual contributed to their plan To ensure that needs are met in a way suited to the individual person 30/06/2009 3 29 19 The recruitment checks detailed in schedule 2 of the regulations must be undertaken for all staff To ensure that people living in the home receive support in a safe manner 30/09/2009 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 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!