Mile Oak Rest Home

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People and relatives told us, without exception, that staff were extremely kind and that they could not wish to live at a better home. We were given several examples of the difference that the support from Mile Oak had made to people who lived there and everyone spoke with great warmth about the staff and the management. Professionals told us about the exceptional care that people received at Mile Oak and told us that they recommended the home to others. People were offered choices about how they spent their time and were supported with respect by staff who protected people’s dignity and promoted their independence. Visitors were welcomed whenever they wished to visit and were encouraged to feedback through regular meetings and annual surveys.

People were protected from the risks of abuse because staff understood the potential signs and how to report concerns. There were sufficient numbers of safely recruited staff available to meet people’s needs and staff knew people well and understood the risks they faced and how to manage these. Accidents and incidents were reported, recorded and learning shared with staff. People received their medication safely and these were recorded accurately.

People were involved in pre-admission assessments which identified their physical, religious, emotional and mental health needs to ensure that these could be effectively met. There were assessments of capacity and decisions made in people’s best interests where required. People had a choice of meals and drinks and spoke positively about the food. Staff received regular support through supervision and had access to relevant training opportunities to provide them with the correct skills and knowledge for their role.

People’s care records were reviewed regularly with their involvements and was therefore responsive to changing needs. People were supported by staff to engage in a range of social opportunities both in group settings and one to one time. People and relatives were aware about how to raise concerns if needed and felt that these would be listened and responded to. End of life care was person centred and planned with people to ensure that wishes and preferences were understood and respected.

Feedback from people, relatives and staff was that Mile Oak was well managed. Everyone spoke positively about the registered manager who placed an emphasis on ensuring they worked with staff on shifts and was available and approachable. Feedback was gathered and used to drive changes at the home and audits were used to identify any gaps or trends to continually improve the service people received.

Further information is in the detailed findings below.

The service has a Registered Manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

People commented to us they felt safe living in the service. A person told us, “I am happy here, I know I am safe and that’s important to me. I’m happy to spend the rest of my days here”.

Staff were able to tell us how they would recognise if someone was being abused. Staff told us that they would raise concerns with senior staff or management. Staff were aware of external agencies they could contact if they had concerns including the Care Quality Commission. A staff member said, “It’s a safe service, the Registered Manager makes sure it’s a safe working environment and we all make sure that people are safe from abuse”.

We reviewed three care files which identified people’s individual risks and detailed control measures staff needed to follow to ensure risks were managed and people were kept safe. A staff member told us, “One person is at risk of pressure sores. I reduce this through hourly checks and re-positioning as per the risk assessment”. We reviewed this person’s risk assessment which confirmed that these control measures were in place and re positing times were recorded. Risk assessments were completed by the Registered Manager and Senior.

The Registered Manager told us that they don’t use a specific staff dependency tool to assess staffing levels. They said that the management team work care shifts to assess the levels. The Registered Manager fed back that last year staffing levels were assessed and increased by one additional staff member per shift. This was in response to staff feedback and management observation. A staff member commented that they had concerns regarding night shift staffing numbers as some people require two staff for transferring. The Registered Manager told us they would look into this when they next review the staffing levels. Another staff member said, “I feel there are enough staff. Sometimes people who require two staff can call at the same time but this doesn’t happen all the time”. People we spoke to felt there were enough staff to meet their needs. A relative told us, “I think there are enough staff here. They are adequate to support mum”.

Medicines were managed safely. Medicines were securely stored and only given by staff that were trained to give medicines.

Staff were knowledgeable of people’s needs and received regular training which related to their roles and responsibilities. We reviewed the training matrix which confirmed that staff had received training in topics such as moving and handling, first aid, infection control and mental capacity act, to name a few. A staff member told us, “There are good training opportunities here, If I feel I need more training I can request it and nine times out of 10 it will be arranged. A refresher in Health and safety was my most recent”. A District Nurse told us, “Staff seem well trained and if they aren’t sure of something they contact us”.

Staff were aware of the Mental Capacity Act and told us they had received Mental Capacity training. The training record we reviewed confirmed this. A staff member told us, “The Mental Capacity Act makes sure we assess people’s ability to make decisions and support them to do so safely. I would report any concerns regarding capacity to the Registered Manager who would complete a capacity assessment and arrange a best interest meeting if necessary. My Diploma covered this a lot”. Care files showed evidence that capacity assessments and best interest meetings had taken place in topics such as administration of medicines and personal care. These were signed and dated by the Registered Manager and person or a family member.

A person told us, “I love my food, its great here”. Another person said, “I’m a vegetarian, they cater for my needs. They ask me what I would like to eat. The chef visits me in my room”. We met with the chef who started recently. He took us through the menu which evidenced that there were choices and a good variety of foods to support people to maintain a healthy and balanced diet. The chef told us, “We try and make sure there is a good mix of fresh food. I know who has soft diets and other dietary requirements”.

People had access to health care services as and when needed. A relative told us, “The service arranges health visits and transport. We are going to the hospital today and just waiting for the transport to arrive”. Health professional visits were recorded in peoples care files which detailed the reason for the visit, the outcome and any actions which needed to be taken by the care staff. Recent visits included; District Nurse, GP, Chiropodist and hospital appointments. A person said, “I have a health appointment at the hospital tomorrow, the service arranged this for me”. A chiropodist said, “The service always records my visits and if I feel I need to give advice I will let them know”.

People, staff, relatives and health professionals all said that the service was caring. One person told us, “Staff are caring here and I get on well with them”. Another person said, “I can’t fault the home, staff are very good here”. We saw staff and management acknowledging people as they entered the communal areas on several occasions. People seemed comfortable in staff’s company and often engaged in conversation. Visitors were made welcome and seemed relaxed with staff and management.

People’s privacy and dignity was respected. We saw on several occasion staff knocking on doors before entering people’s rooms or communal bathrooms. We observed a domestic staff member knocking on a person’s door before entering. She said good morning and explained why she was there which was to replace the old toilet brush. A person said, “Staff respect my privacy and dignity. I’m lucky to be pretty independent and staff support this”.

The Senior Staff member told us, “The home tries its upmost to retain people for life and meet ongoing changing needs with equipment and regular health professional visits. It’s a really good vision to have”.

Care files had completed pre admission assessments which formed the foundation of basic information sheets and care plans. We noted that there were actions under each key area of care which detailed how staff should support people. As people’s health and care needs changed ways of supporting them were reviewed. All changes were recorded in the care files and on a care review sheet which is shared with staff in a handover folder which they were expected to read and sign.

A staff member told us, “I make time to talk to people and support them to feedback”. An agency staff member said, “If someone asks me for something I try my best to deliver”. They went onto say “A person this morning asked me if they could take a sandwich to a health appointment tomorrow so I logged this in the handover notes and diary so that it is done”. We reviewed the notes and diary which confirmed this.

We reviewed the Resident Meeting notes which take place every other month. These evidenced feedback from people and actions the service had taken in response, for example; people had said they wanted additional chairs in their rooms for when visitors came to see them. The service has since purchased a number of foldable chairs which are readily available to people and families as and when they visit.

A person told us, “We don’t do badly for entertainment here; we have singers and violinists which are good”. In the reception hall there was a large notice board which displayed upcoming activities and events for people to participate in. Some of these included; musical bingo, cards, a visit from a violinist and singer. Activities were logged on people’s daily record sheets.

Each year the service sends people and relatives feedback questionnaires. This was lead and coordinated by the Area Manager who also analysed the data and set action plans for the service to work towards. There were some areas of improvement identified which were set out in an action plan which linked the Key Lines of Enquiry next to them for example people wanted more variety and better food presentation which had been linked to “Effective”. People also fed back that they wanted the trees in the garden chopped to allow more light to come through. In response to these food is now a regular item on the Resident Meeting agenda and the owner / Responsible Individual has paid a contractor to chop the tree and let more light into the garden.

We reviewed the services complaints procedure and recording system. Complaints were recorded on a form this captured the complaint and evidenced the steps taken to address it as well as any learning. A relative told us, “I have never had to complain but I know how to. The service gave us a complaints procedure when mum first moved in”.

We observed a very positive culture between people and staff supporting them. The service had a set of Aims and Values which put people in the centre of the