Inspection on 12/03/08 for Orchid Lawns Nursing Home

This inspection was carried out on 12th March 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Orchid Lawns Nursing Home 06/11/07

Orchid Lawns Nursing Home 22/05/07

Orchid Lawns Nursing Home 25/04/06

Orchid Lawns Nursing Home 24/10/05

Orchid Lawns Nursing Home 30/06/05

Orchid Lawns Nursing Home 08/02/05

Orchid Lawns Nursing Home 21/09/04

Orchid Lawns Nursing Home 10/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Orchid Lawns Nursing Home Steppingley Hospital Grounds Ampthill Road Steppingley Bedfordshire MK45 1AB Lead Inspector Mrs Louise Trainor Unannounced Inspection 12th March 2008 10:30 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchid Lawns Nursing Home Address Steppingley Hospital Grounds Ampthill Road Steppingley Bedfordshire MK45 1AB 01525 713630 01525 718624 orchid.lawns@craegmoor.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Health & Care Services (NW) Limited Manager post vacant Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (24) Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Elderly over 65 Date of last inspection 6th November 2007 Brief Description of the Service: Orchid Lawns is a purpose built nursing/care home situated in the grounds of Steppingley Hospital. Steppingley is a small village near to Flitwick town in MidBedfordshire. Flitwick has good public transport and road access but there is a limited bus service to Steppingley. The home is single storey, with accommodation separated into three wings each with it’s own living area and communal space. The home has a large garden and there is a large parking area at the front. Orchid Lawns provides places for up to twenty-four older adults with mental health care needs. All the places at Orchid Lawns are contracted to the local Primary Care Trusts (PCT) with admission via referral to a placement panel. Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate, quality outcomes. This was the third Key Inspection for this service this year. It was carried out by Regulatory Inspectors Louise Trainor and Sally Snelson on the 12th of March 2008, between the hours of 10:30 and 14:30 hours. Following serious concerns raised regarding the poor standard of care in this home in July 2007, there have been four Random Inspections carried out over the past eight months in addition to the Key Inspections. These took place on the 13th of July 2007, the 7th of August 2007, 17th of September 2007 and the 9th of January 2008 respectively. This level of regulatory activity was imposed in order to regulate and monitor compliance from requirements, identify improvements made and assess their sustainability. This inspection was carried out in accordance with the Commission for Social Care Inspection’s (CSCI) policy and methodologies, which require review of the key standards for the provision of a care home for older people that takes account of service users’ views and information received about the service since the last inspection. Information and evidence from the afore mentioned Random Inspections has been used and judgements made within the main body of the report include information from this visit. During this inspection two of the people who live in this home were picked at random by one the inspectors to track. This involved examination of all documentation relating to their care, observations of care delivery and communication with the individuals. Communication was however, rather limited due to the cognitive impairment of these people. The other inspector carried out a two-hour close observation session on three specific people who live in this home. All observations and findings were followed up by a feedback session and discussion with the home manager, Tony Gabaza, and linked to the homes records, skills and knowledge of the staff. A tour of the premises, and documentation relating to staff recruitment, training and supervision, medication administration were also examined during this inspection. The inspector also had the opportunity to speak with staff visitors to the home. There has been a high level of regulatory activity in this home over the last year. This was the result of serious concerns identified by the PCT and CSCI in July 2007. Since that time the company have made considerable improvements in all aspects of the home. Only one requirement was made at Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 6 the Key Inspection in November 2007, this was relating to food thickeners, and although three requirements were left at the Random Inspection in January 2008, two of these were relating to the practices of one member of staff observed during this inspection. She is no longer with the company. The other was related to environmental factors, which had again improved when we returned for this inspection. No requirements or recommendations have been made in this report and we now consider that the home have achieved full compliance with the regulations and national minimum standards. We trust that the company will continue to sustain the level of care and positive outcomes for people that we saw at this inspection. In order that we are reassured this is the case we will carry out another key inspection before the end of September 2008. However we can inspect the service at any time if we have concerns about the quality of the service or the safety of the people using the service The inspectors would like to thank everyone involve for their assistance and support during this inspection. What the service does well: Information documents, for people who are considering living in this home and their representatives, are on display in the home and readily available on request. Care plans had been completed in sufficient detail to ensure that staff could provide consistent care. They include personal preferences and have been written in consultation with individuals and their representatives. The Medication Administration Record (MAR) sheets and medication stocks were examined during this visit. MAR sheets had been appropriately completed with signatures and omission codes, and reconciled with stocks correctly. Information in care plans was addressing the mental capacity of the person and reflected that staff had an understanding of the new Mental capacity Act. Visitors are welcome in this home at any time, and are offered the opportunity to enjoy a meal with their loved ones if they so wish. Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 7 The complaints procedure is supplied to everyone living in the home and is displayed, both in written and pictorial format, in the entrance to the home, so that it can be understood and easily accessed by everyone entering the home. Staff are aware of the reporting procedures for safeguarding issues so that people in this home are protected. Accidents and incidents are being reported appropriately to the Commission for Social Care inspection (CSCI), and any unwitnessed injuries are also being reported to the safeguarding team for review, and CSCI are always involved in these meetings. What has improved since the last inspection? This home provides a clean and comfortable environment for the people who live here, and individual rooms are furnished with personal possessions to make them more homely. Observations of care practices throughout this visit identified people being treated with respect in a dignified way by staff. Communication was spontaneous and reflected that the staff new the people they were caring for well. Residents are encouraged to participate in meaningful activities, and staff practices are respectful and promote personal choices for the people living in this home. Risk assessments had been completed as the need arose, and it was apparent that staff were considering the effects of any actions on residents. Meal choices were being integrated into the activities, with the use of conversation and a file of photographs. The manager has taken photographs of ‘plated meals’ served in the home to help these people make their choices. A new wet room has been installed, and all existing bathing facilities have been decorated. A new assisted bath is due to be installed on the 26th of March 2008. Water temperatures are being recorded every time the bath or shower is used. Staffing levels reflect the needs of the people using this service, and all staff receives training that is focussed on delivering improved outcomes for the people who live here. Staff files indicated that the staff are receiving regular supervision, appraisals and capability assessments relating to medication administration. Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, 5, 6 Quality in this outcome area is adequate. Information documents for people who are considering living in this home and their representatives are on display in the home and readily available on request. Pre admission processes are in place however due to a restriction on admissions, the effectiveness could not be fully assessed at this time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a Statement of Purpose displayed in the entrance to the home. It is issued to prospective residents and gives them and their representative’s sufficient information so that they can make an informed choice about where Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 11 they want to live. This document had been reviewed on the 19/11/07, and now accurately reflects information relating to the new management, the staffing and facilities available in this home. This home has not been receiving admissions during the past eight months therefore we could not assess the effectiveness of the new pre admission assessments. However the files that we inspected of people who live in this home, had pre admission assessments in them. These identify their individual needs and the level of care they require. This home is not providing intermediate care. Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11. Quality in this outcome area is good. Care plans had been completed in sufficient detail to ensure that staff could provide consistent care. They include personal preferences and have been written in consultation with individuals and their representatives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two care plans were chosen by the inspector for reading at random. Both were detailed and covered all the areas of care that the person was perceived to have. All were reviewed monthly and had been altered as situations and conditions changed. For example, following a fall, many of the care plans for one person had been altered to reflect this and the action that staff needed to take to reduce further injury or risk. Care plans were written in a person centred style and covered all areas of care both physical and mental. Each person now had an activity plan that listed past interests and hobbies, and any Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 13 activities that they, or the family felt they would enjoy. Any activities that people participated in were recorded during the month. Information in care plans was addressing the mental capacity of the person and reflected that staff had an understanding of the Mental capacity Act, and the need for advocates where appropriate. Risk assessments had been completed as the need arose, and it was apparent that staff were considering the effects of any actions on residents. Most risk assessments had been written for individuals, however there were some that were generic for situations such as, during the decoration of communal areas of the home. During the visit we witnessed people being moved around the home with the aid of various equipment including hoists and belts. All were used appropriately and the staff explained procedures before using them, and continued to communicate with the individual throughout the procedure. A GP, a dietician and a psychiatrist had reviewed all of the people living at this home within the last six months. The manager had negotiated with the local GP, who is also now making routine weekly visits to the home. The manager confirmed that this was useful and had cut down on the need to call out the GP as often. It also means that a doctor reviews every resident’s care regularly, even if they are not unwell. During our visit it was noted that a dentist and a chiropodist visited to provide treatment to individuals. A tissue viability nurse was also expected to assess a person who had recently developed a pressure area. The Medication Administration Record (MAR) sheets and medication stocks were examined during this visit. MAR sheets had been appropriately completed with signatures and omission codes, and reconciled with stocks correctly. One person had not received one particular medication, Alendronic Acid 10mg, for three days. The pharmacy had failed to supply this medication at the correct time. When it was received by the home, the nurse in charge was concerned that the tablet supplied was Alendronic Acid 70mg and had been dispensed into a blister pack labelled 10mg. This matter was being pursued by the manager with the dispensing pharmacy. It was commendable that the nurse in question had observed and questioned this matter, which could easily have gone unnoticed and resulted in a resident receiving 70mg of this drug daily instead of the prescribed 10mg. Observations of care practices throughout this visit identified people being treated with respect in a dignified way by staff. Communication was spontaneous and reflected that the staff new the people they were caring for well. One carer was chatting with a resident about his ‘rambling trips’ to the Lake District, and although his communication skills were very limited, his facial expressions and gestures indicated that he was engaged in this conversation. Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 14 Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. Residents are encouraged to participate in meaningful activities, and staff practices are respectful and promote personal choices for the people living in this home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An activity co-ordinator was clearly the lead on activities during this inspection, however it was apparent that all of the staff were interacting well with the residents, and activities were an integral part of the daily routine, and as a result people living at the home were more alert and engaging with staff for more of the time. During this inspection, following discussion with the home manager, one of the inspectors spent two hours closely observing three people who live in this home. They were chosen at random by the inspector. This was done between the hours of 11:10 hours and 13:10 hours, with the use of the Commissions’ Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 16 Short Observational for Inspections tool (SOFI), which was devised by Bradford University, specifically for CSCI, based on the Dementia Care Mapping process. This process monitors any interactions that take place between residents and staff, other residents or objects. There was a noticeable improvement from the previous inspection in May 2007 when this process was also carried out. During this session, the activity organiser was doing individual work with residents using pictures and magazines. One lady was keen to share with us her knowledge of old film stars and famous personalities that she was looking at in a ‘scrap book’ that the activity coordinator had made. The pictures that she saw stimulated the knowledge of this lady. There was music playing in the background, and this was generating ‘foot tapping’ and singing from various directions in the room, staff and residents alike. One lady sitting by the inspector sang “Robin Hood, Robin Hood riding through the Glen”. She was word perfect and her facial expressions indicated she was really enjoying this ‘activity’. Another resident was listening with a smile on his face and tapping his foot in time to the music. We also observed that staff were stopping as they passed through the lounge, to enquire if individual residents were warm enough or comfortable, or just to make casual conversation. One carer held a residents hand as she enquired if he wanted his jumper on, and as she assisted him to put it on, a conversation about his wife and how he always used to wear long sleeved shirts took place. This stimulated this gentleman. He listened, and although his verbal communication was limited, his gestures and facial expressions indicated he was ‘engaged’ in this conversation. Meal choices are now being integrated into the activities, with the use of conversation, and a file of photographs, that the manager has taken of ‘plated meals’ served in the home which has been created to help these people make their choices. However this project is ongoing and not all meals have yet been photographed. People were encouraged and assisted to the table at lunchtime, and assistance was given on a one to one basis as required. Various feeding aids were observed being used, such as plate guards and adapted drinking vessels, to promote individuals independence. Visitors are welcome in this home at any time, and are offered the opportunity to enjoy a meal with their loved ones if they so wish. There were two visitors present during this inspection. Both were wives who visit on a regular basis, and remain very involved in the care of their loved ones. One had come in to take Communion with her husband, and the other was assisting her husband with his midday meal. Both appeared very comfortable and relaxed in the presence of the staff. One in particular, talks to the inspectors on a regular basis, as she is often present when we visit, and at the last inspection on 09/01/08 she told us. “The whole place is a lot better now, the staff seem more settled and happy”. Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 17 The results of the close observation session identified that the three people that were being observed, were alert and engaged for most of this two-hour period. There was no negative staff interactions observed, and interactions were not task orientated as they had been at the previous inspection in May 2007 where this method of observation was used. Staff showed empathy and understanding of individuals needs, and were able to meet those need efficiently and effectively. This indicated that the additional dementia training that has been given to staff in this home, has assisted them in developing essential skills and knowledge to interact with this specialist client group, beyond carrying out basic communication and tasks of daily living. Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. The complaints procedure is supplied to everyone living in the home and is displayed, both in written and pictorial format, in the entrance to the home, so that it can be understood and easily accessed by everyone entering the home. Staff are aware of the reporting procedures for safeguarding issues so that people in this home are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure for this home is displayed in the entrance to this home, both in print and pictorial format. However there have been no complaints received by the home, or by the Commission for Social Care Inspection (CSCI), about the home since the last Key Inspection. The whistle blowing procedure is also clearly displayed. Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 19 The staff training record indicates that all staff are trained in recognising and reporting safeguarding matters. This training is mandatory and is refreshed annually. Incidents are reported appropriately to the safeguarding team and to CSCI, and the home management are always cooperative in attending meetings and providing appropriate information where required. Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is good. This home provides a clean, safe and comfortable environment for the people who live here, and individual rooms are furnished with personal possessions to make them more homely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The environment in this home has improved tremendously since the previous Key Inspection. On the day of the inspection it was clean and bright and free from offensive odours. With the exception of the dining area in ‘Woodrush Unit’, all the flooring throughout the building has been replaced. This included the bedrooms and the en suite washrooms, although the manager is in the Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 21 process of calling the contractors back to the home as the sealants on some of the washroom floors needs redoing. A new wet room has been installed, and all existing bathing facilities have been decorated. A new assisted bath is due to be installed on the 26th of March 2008. Water temperatures are being recorded every time the bath or shower is used. The bedrooms that we visited were tastefully decorated, and furnished with personal photographs and ornaments that reflected the individual’s life history. This is work in progress, and the manager discussed with us, that in some cases it is proving quite difficult to obtain either personal possessions or funding to purchase individual furnishings for some residents. There is new signage in place throughout the home and on some of the bedroom doors were ‘Personal Collages’, which included the individual’s name, the Key Worker and Named Nurse, as well as pictures and paper cuttings that reflected personal memory joggers for the individual. From looking at these collages, we were able to identify that one person had been a seamstress, another a farmer and another had a life long love of gardening. These collages had been made by the activity coordinator in consultation with the residents and their families. This is also an ongoing project. Specialist equipment such as hoists were being used appropriately by staff throughout this visit, and the home had recently purchased three Ultra Low beds, which are in place for people who have been risk assessed as not appropriate for the use of bed rails, but may still be at risk of falling out of bed. The communal areas were bright and tidy, with new pictures and paintings in place on the walls. A wooden dresser in one of the lounge areas, displayed an array of jars filled with sweets such as Jellies and Liquorice Allsorts. This was colourful and effective in that it resembled an old sweet shop. Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. Staffing levels reflect the needs of the people using this service, and all staff receive training that is focussed on delivering improved outcomes for the people who live here. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing levels have been maintained as had previously been agreed with the commissioning PCT. New staff have been appropriately recruited, and there is now a full compliment of staff employed. The home is now only using agency staff to cover some of the one to one care required and some periods of annual leave. This is a great improvement and provides continuity of care for the people who live here. All the staff in this home, including the ancillary staff, have completed Dementia training, and observations of care practices and interactions throughout the day indicated that it has been effective. Conversations and interactions were spontaneous and respectful. Staff were seen stopping to chat with residents as they passed through the day rooms, just as they would a friend or colleague. Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 23 Since the last inspection, one of the nurses has been successful in her application to become deputy manager. She was very enthusiastic about her new role, and was aware of her learning needs. She had worked with the manager to identify how they could be met. Comments from staff indicated that in general they were happy with this appointment. One carer said. “She’s lovely and communicates well with us”. An informal interview with another member of staff who had been recently appointed, also reflected that the she felt well supported and competent to do her job. She said. “I wouldn’t complain about anything, so far so good. The manager is very supportive, and the environment conducive”. She also identified areas, such as wound care and catheter care that she felt she would like to pursue further training in. The personal files of two new carers were looked at. Both had all the documentation required by schedule 2 on the National Minimum Standards with the exception of a current photograph. The administrator reported that this was still to be done, and as neither of the carers had completed their induction yet, we considered this as acceptable. Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37, 38. Quality in this outcome area is adequate. The manager is qualified and experience to run a care home, however his registration remains in progress. He is confidently developing and improving systems that support the delivery of person centred care within the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The new manager has been in post since November 2007 and appears to be quite settled, enthusiastic and confident in his role. His application for Registered Manager is still in progress. As reported in the Random Inspection Report dated 09/01/98. He is very positive about the team of staff working Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 25 with him and said. “The staff seem happy, more calm and direction orientated”. Staff meetings are held monthly and all staff are encouraged to voice their opinions and concerns, and make suggestions about how care could be improved. However two staff did express that they would like to be kept informed more about what changes were being implemented, and whether or not their suggestions were being received in a positive way and acted upon. This was discussed with the manager who has agreed to add this information into the minutes of staff meetings. The manager is very focused on person centred care, and treating people as individuals. This is being well supported by the majority of staff. Some residents are getting up later in the day; others are spending more time in their rooms, and having meals at individual times. Staff files indicated that the staff are receiving regular supervision, appraisals and capability assessments relating to medication administration. The newly appointed deputy manager is also starting to do supervision with some staff. One member of the staff that was interviewed said. “As a newly qualified nurse I need support, and the manager is very supportive”. This person had been in post since November 2007 and had had two supervision sessions with the manager. Another member of staff said of the manager. “He really knows his stuff”. Two relatives visiting the home on the day of the inspection were observed talking with the home manager. Both appeared to be very comfortable and relaxed in his presence, and happy with the information he was giving them. One person had come in to receive communion with their loved one. Accidents and incidents are being reported appropriately to the Commission for Social Care inspection (CSCI), and any unwitnessed injuries are also being reported to the safeguarding team for review, and CSCI are always involved in these meetings. There has been a high level of regulatory activity in this home over the last year. This was the result of serious concerns identified by the PCT and CSCI in July 2007. Since that time the company have made considerable improvements in all aspects of the home. Only one requirement was made at the Key Inspection in November 2007, this was relating to food thickeners, and although three requirements were left at the Random Inspection in January 2008, two of these were relating to the practices of one member of staff observed during this inspection. She is no longer with the company. The other was related to environmental factors, which had again improved when we returned for this inspection. No requirements or recommendations have been made in this report and we now consider that the home have achieved full compliance with the regulations and national minimum standards. Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 26 We trust that the company will continue to sustain the level of care and positive outcomes for people that we saw at this inspection. In order that we are reassured this is the case we will carry out another key inspection before the end of September 2008. However we can inspect the service at any time if we have concerns about the quality of the service or the safety of the people using the service Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable klCHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X 3 3 3 3 Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Orchid Lawns Nursing Home DS0000017684.V360619.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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