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Inspection on 22/05/07 for Orchid Lawns Nursing Home

Also see our care home review for Orchid Lawns Nursing Home for more information

This inspection was carried out on 22nd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Care plans and assessments provided sufficient information and were being reviewed regularly to ensure service users changing needs were being addressed. There is a robust complaints policy in place, and documentation indicates that complaints are responded to appropriately and within the identified timeframe. Relatives that were spoken to during the inspection knew who they should approach if they had any concerns, and appeared confident that any concerns would be addressed efficiently. The recruitment policy and procedures are being adhered to. . Four staff files were examined during this inspection. All contained appropriate documentation.

What has improved since the last inspection?

There were no areas with any notable improvements.

What the care home could do better:

The Statement of Purpose gives prospective service users and their representative`s sufficient information so that they can make an informed choice about where they want to live. However the information relating to staff knowledge and skills could not be accurately reflected through this inspection. This home is in the process of being redecorated and the flooring is in desperate need of attention to make this a clean, pleasant and hygienic environment for the people who live here. Staffing numbers in this home have recently been increased. There are now six staff on the morning shift, five on the afternoon shift and three on the night shift. There was however a period of time during the inspection, during the handover from night to day shift when there were no staff available or in a position to observe or assist the people who live in this home in an emergency. Although staff have a basic awareness of dementia, evidence indicated that specialist knowledge relating to dementia care is very limited, so that the needs of the people who live here may be un met. The Medication Administration Record (MAR) sheets were examined. There were missing signatures and omission codes on several of the sheets. Variable doses were not being recorded appropriately therefore very few reconciled with stocks correctly. The individual choices of people who live in this home are clearly restricted depending on which staff are on duty. It appears that decisions regarding simple issues such as menus are still made autonomously by the manager without regard for the opinions of others. The previous inspection report identified the introduction of a new supervision system for staff. Staff personal files indicate that supervision does not take place for all staff on a regular basis.There are health and safety risk assessments in place for this home, and safety checks are carried out to ensure that fire and moving and handling equipment is properly maintained. But some practices need to be reviewed as a matter of urgency.

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 22nd May 2007 07:00 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.V338304.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.V338304.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.V338304.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Elderly over 65 Date of last inspection 25th April 2006 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.V338304.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key Inspection carried out on by Regulatory Inspector Louise Trainor on the 22nd of May 2007 between the hours of 07:00 and 15:30 hours. Unfortunately the manager was on sick leave on the day of the inspection, however the manager from another one of the Company’s Homes, was in attendance for most of the day to assist where necessary. On arrival, the inspector observed the handover meeting between the night shift and the morning shift, and then proceeded to tour the premises. Three of the people who live in this home were picked at random by the inspector 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. Seven staff were interviewed during the course of the day and four staff files were examined. Other documentation relating to staff training, supervision, complaints, medication administration and quality assurance were inspected. The inspector also had the opportunity to interview several visitors to the home during this inspection. Following discussion and agreement with the manager, the inspector returned to Orchid Lawns on Thursday the 24th of May 2007. During this visit the inspector carried out a two hour close observation session on three specific people who live in this home. All observations were followed up by discussions with staff and linked to the homes records and the skills and knowledge of the staff. It has been necessary to restate some requirements in this report that have now been outstanding for 2 inspections. These shortfalls have poor outcomes for people who use the service. If the provider continues with the non compliance with regulations, which is an offence, then the commission will use its enforcement powers to progress this matter. What the service does well: Care plans and assessments provided sufficient information and were being reviewed regularly to ensure service users changing needs were being addressed. There is a robust complaints policy in place, and documentation indicates that complaints are responded to appropriately and within the identified timeframe. Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 6 Relatives that were spoken to during the inspection knew who they should approach if they had any concerns, and appeared confident that any concerns would be addressed efficiently. The recruitment policy and procedures are being adhered to. . Four staff files were examined during this inspection. All contained appropriate documentation. What has improved since the last inspection? What they could do better: The Statement of Purpose gives prospective service users and their representative’s sufficient information so that they can make an informed choice about where they want to live. However the information relating to staff knowledge and skills could not be accurately reflected through this inspection. This home is in the process of being redecorated and the flooring is in desperate need of attention to make this a clean, pleasant and hygienic environment for the people who live here. Staffing numbers in this home have recently been increased. There are now six staff on the morning shift, five on the afternoon shift and three on the night shift. There was however a period of time during the inspection, during the handover from night to day shift when there were no staff available or in a position to observe or assist the people who live in this home in an emergency. Although staff have a basic awareness of dementia, evidence indicated that specialist knowledge relating to dementia care is very limited, so that the needs of the people who live here may be un met. The Medication Administration Record (MAR) sheets were examined. There were missing signatures and omission codes on several of the sheets. Variable doses were not being recorded appropriately therefore very few reconciled with stocks correctly. The individual choices of people who live in this home are clearly restricted depending on which staff are on duty. It appears that decisions regarding simple issues such as menus are still made autonomously by the manager without regard for the opinions of others. The previous inspection report identified the introduction of a new supervision system for staff. Staff personal files indicate that supervision does not take place for all staff on a regular basis. Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 7 There are health and safety risk assessments in place for this home, and safety checks are carried out to ensure that fire and moving and handling equipment is properly maintained. But some practices need to be reviewed as a matter of urgency. 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.V338304.R01.S.doc Version 5.2 Page 8 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.V338304.R01.S.doc Version 5.2 Page 9 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. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose gives prospective service users and their representative’s sufficient information so that they can make an informed choice about where they want to live. However the information relating to staff knowledge and skills could not be accurately reflected through this inspection. EVIDENCE: There is a Statement of Purpose and a Service User Guide in place that had recently been reviewed. These are detailed documents that include information relating to all aspects of care provided, and facilities available within the home. The services such as chiropody, that are not included in the initial fees, were all detailed within this document. The Statement of Purpose states that ‘all carers are aware of the latest initiatives in care provision for older people with dementia’. This is somewhat misleading. Staff are encouraged to attend a one day dementia awareness Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 10 course. However records show that not all staff have attended, and care practices detailed elsewhere in this report also reflect that some staff lack both the knowledge and the skills required to fully meet the needs of this specialist group of service users. Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 11 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans and assessments provided sufficient information and were being reviewed regularly to ensure service users changing needs were being addressed. However there was still evidence of poor practices relating to medication administration. EVIDENCE: The inspector examined the personal files of three people who live in this home. These were picked at random by the inspector. All contained numerous care plans that had been generated by risk assessments, and contained detailed information reflecting the level of care required. However some care plans appeared rather confusing because too many issues were being addressed at once and care instructions were not always clear. One care plan detailed information relating to isolation, refusal to eat and drink, mental health issues and hallucinations. Another was addressing personal care, aggression and continence. All these issues are important and need to be addressed, but because they were all written into one care plan, Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 12 the focus on some of these needs was lost, and the interventions required by staff were unclear so that continuity of care would be difficult to achieve. Risk assessments and care plans were being reviewed regularly to reflect changing needs, and where appropriate other disciplines such as the tissue viability nurse were being involved in the care. Charts for monitoring weight, blood pressure and blood sugar levels were in place where necessary and in general concerns were being actioned and recorded. It was however noted by the inspector when checking the Medication Administration Record (MAR) sheets, that one service user that was prescribed a calcium supplement, rarely accepted this medication. There was no record of any action being taken to address this problem. The MAR sheets were examined. There were missing signatures and omission codes on several of the sheets. Variable doses were not being recorded appropriately therefore very few reconciled with stocks correctly. On one of the MAR sheets that the inspector examined, the personal information of the service user was incorrect. The date of birth was recorded as 1906, indicating that this service user was ninety-nine, but when asked, staff informed the inspector this documentation was incorrect and the service user was only about seventy years old. Care observations on the day of the key inspection and the day that the close observation session was carried out, revealed staff delivering care in a respectful way, and service users dignity was being protected. However some staff clearly found it very difficult to engage with, or manage service users that displayed more difficult behaviour, or those that did not initiate engagement themselves. One service user kept sliding down his chair and attempting to kick anyone that approached him or walked past him. In response to this behaviour staff kept, hoisting him back in his chair, reprimanding him for kicking and occasionally gave him a large physiotherapy ball to kick. There was no evidence of staff trying to understand what this service user was trying to communicate through this behaviour. Another service user was walking round wearing one slipper. Several times staff acknowledged to each other that she maybe looking for the other slipper, but no one assisted her to look for it or found her alternative footwear. Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 13 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 poor. This judgement has been made using available evidence including a visit to this service. Activities are limited for people who live in this home so that their social, cultural and recreational needs may not be fully met. Menus are varied and generally offer a balanced diet, however choices for some of the people who live in this home are very limited. EVIDENCE: Activities in this home are very limited at present. One of the care staff has been appointed to the role of activity coordinator, however has not taken up this position as yet. It is unsure when this will happen, although the inspector was told that it would not be until new care staff started work in the home. This member of staff was able to discuss the importance of activities for people who live here, but had not had any specific training in how to deliver appropriate activities to service users with challenging behaviour and severe cognitive impairment. On the day of the inspection there was no evidence of activities or any kind of stimulation for these service users except for ‘wartime songs’ playing in the background continuously. There did not appear to be any attempt from staff to Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 14 develop this into a sing- a –long or a dancing session, despite some service users showing a desire for this to happen. One gentleman was clearly looking for a partner to dance with, but no one responded. Others were trying to sing along but needed someone to lead, which would have generated participation from others. Staff appeared too busy for this engagement. It was obvious from comments made by visitors, that they feel the staff in this home do a wonderful job, but do not have time for these interactions which people, for some reason see as an extra and not as an integral part of the cares/ nurses role. One said. “They are marvellous, they‘re angels, but they’re so busy”. When the inspector returned to the home on the 24th of May 2007, as pre planned with the staff, to carry out the close observation session, two hours were spent observing three particular service users, monitoring any interactions they had from staff or other service users. There was a noticeable difference from the day of the inspection. Staff were seen offering magazines to service users, playing ball, and one member of staff was doing hand massage for one or two people. The same ‘war time songs’ were playing in the background as on the day of the inspection, but still the staff did not take the opportunity to develop this into an enjoyable and meaningful session of stimulation. The results of the close observation session identified that the three people that were being observed, were either sleeping or in a withdrawn state with no interactions from staff for two thirds of this two hour period. When staff did interact with them, over half of the interactions were task orientated. This indicated that many staff did not have the skills to interact beyond asking service users if they would like a drink or taking them to the toilet. There is a new ‘summer menu’ in place in this home. However this had been developed by the manager without any input from the people who live in this home, their representatives or the staff. The menu had a wide variety of meals listed on it, but daily choices were very limited. For example on one of the days the inspectors visited, there was a choice of tuna or salmon salad. This meant that if service users did not like fish there was no alternative listed for them. It was also very unlikely that service users would be able to identify one from the other as the fish was chopped up in bowls waiting to be served. On the previous day the menu choice had been cheese and bacon pasta or tomato and basil pasta, again this meant that if service users did not like pasta, there was no listed alternative. Anyone living in this home that had difficulties related to swallowing or eating, were automatically given pureed meat and vegetables. There was no evidence of any choices being offered to the majority of the service users. The breakfast menu for every day shows a choice of cereals, toast, preserves, porridge, cooked breakfast to order, fruit juices, tea and coffee. On the day of inspection the only thing on offer was cereal, fruit juice and tea. The inspector challenged staff as to why no one was being offered any alternative. Toast Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 15 then became available, but was just put in front of people, not offered as an alternative. This was another indication of the lack of knowledge of the staff in this home relating to people with dementia. None of the people who live in this home have the ability to pre order a cooked breakfast, and would not remember what choices were available to them unless they were offered it visually, or repeatedly reminded on a daily basis. The home promotes an open visiting policy. This is clearly appreciated by many relatives that visit very regularly. During the inspectors visits three visitors were informally interviewed, and all spoke positively of the flexibility of visiting hours. Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. Staff are all trained in the Protection of Vulnerable Adults (POVA), however evidence indicates that not all staff are fully aware of all actions or behaviours that may constitute abuse. EVIDENCE: All staff that were interviewed had attended POVA training and were able to discuss different behaviours and actions that they understood to be abuse. However during the inspection, the inspector toured the premises and visited several service users in their rooms. One service user was locked in her room. When this was brought to the attention of staff, they reacted by saying. “Another resident must have locked it”. There was no evidence to suggest that any immediate action was taken to look into this matter any further. Another service user was attempting to kick other service users as they walked passed him. Staff were not being proactive in trying to prevent this. Both of these observations and the lack of management of these situations were neglectful and therefore constitute abuse. There is a robust company complaints policy in place, and documentation indicates that complaints are responded to appropriately within the identified timeframe, although the content of responses needs to be more specific and proactive in preventing reoccurrence of issue. Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 17 Relatives that were spoken to during the inspection knew who they should approach if they had any concerns, and appeared confident that any concerns would be addressed efficiently by the manager. Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 18 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, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. This home is in the process of being redecorated and the flooring is in desperate need of attention to make this a clean, pleasant and hygienic environment for the people who live here. EVIDENCE: This home is in the process of being redecorated at present. Some of the bedrooms that were visited have been recently decorated and are furnished with personal belongings making them more homely, however others were very bare and in urgent need of painting. The large lounge on Woodrush had recently been decorated and appeared clean and bright however the is an overwhelming smell that is indicative of poor continence management throughout the building. This makes the whole building a rather unpleasant environment to be in. It is thought that the Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 19 carpets in this home are responsible for this odour, and there are plans in place to replace all the flooring imminently. This will hopefully eradicate the smell and make it a more pleasant environment for the people who live here. Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Staffing numbers in this home are adequate, however evidence indicates that although staff have a basic awareness of dementia, specialist knowledge relating to dementia care is very limited, so that the needs of the people who live here may be un met. EVIDENCE: Staffing numbers in this home have recently been increased. There are now six staff on the morning shift, five on the afternoon shift and three on the night shift. These changes have boosted staff morale. However it was of some concern to the inspector, that while the nurse in charge of the night shift was ‘handing over’ to the morning shift, the other two members of the night team had gone off duty. This meant that all the staff on the premises, were in the office at the handover meeting, and for a fifteen minute period, while this meeting took place, there were no staff in the building in a position to observe or respond to any service user that may need assistance or attention. The recruitment policy and procedures are being adhered to. Four staff files were examined during this inspection. All contained appropriate documentation that included; fully completed application forms including employment history, appropriate references, photographic identification, caller code ID checks with the Nursing Midwifery Council (for registered nurses), Criminal Records Bureau Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 21 and POVA First checks, passports, various forms of identification including birth and marriage certificates, Home Office documentation for overseas staff, health questionnaires and copies of contracts signed and dated appropriately. Two of the files also contained copies of letters relating to management issues. This provided an audit trail of evidence for staff issues that had previously been addressed. Observations of care generally indicated that staff were competent and confident in their roles. However some interactions between staff and the people who live here, indicated that the knowledge and skills relating to the care of people with challenging behaviour and dementia were very limited. Staff appeared either unaware of the importance of stimulation for the people, or ill equipped with the knowledge and skills to interact effectively. On the day of the Key Inspection there was no stimulation or activities evident, and on the day that the inspector returned, as pre arranged, to do the close observation session, the inspector felt that most of the efforts from staff relating to activities were performed extraordinarily and were not reflective of a normal day in the life of people who live in this home. Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 22 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, 33, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has appropriate policies and procedures in place, however evidence indicates that service users’ health, safety and welfare are not always protected. EVIDENCE: Unfortunately the manager was not available during this inspection, and although the manager from a local sister home attended to assist the inspector, some standards such as service user’s finances were not assessed during this visit. The manager for this home has now been in post for approximately two years generally comments indicated that staff, service users and their representatives have confidence in his management skills. However he has still Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 23 failed to start the registration process with the Commission for Social Care Inspection (CSCI) as registered manager for this home. Person centred care and service user satisfaction is promoted through quality surveys and service user / representatives meetings, however individuals’ choices are clearly restricted depending on which staff are on duty, and it appears that decisions regarding simple issues such as menus are still made autonomously by the manager without regard for the opinions of others. The previous inspection report identified the introduction of a new supervision system for staff. Staff personal files indicate that supervision does not take place for all staff on a regular basis. Two staff that have been in post for approximately six months stated that to date they had not had any supervision. Supervision booklets that were inspected also reflected a lack of supervision. Although it is recognised that at present the manager does not have the support of a deputy, it is essential an alternative system is introduced so that staff are sufficiently supported. There are health and safety risk assessments in place for this home, and safety checks are carried out to ensure that fire and moving and handling equipment is properly maintained. But some practices need to be reviewed as a matter of urgency. The inspector was very concerned that on the day of the inspection, staff had blocked every fire exit from the main lounge with benches to stop the service users wandering into the garden. This appeared to be the normal practice for them. This was brought to the attention of the visiting manager who immediately who rectified the situation, however this could have been catastrophic had there been a fire. Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 24 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 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 1 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 1 X 1 Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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. 1. Standard OP1 Regulation 4(1)( c) Requirement Timescale for action 31/07/07 2. OP7 12(1)(a) 12(3) The Statement of Purpose for this home must accurately reflect the knowledge and skills of the staff that work here, to ensure that they can meet the needs of people who use this service. The care requirements for people 30/06/07 who use this service must be clearly documented in individual care plans to ensure that care is delivered with continuity and in a way that they prefer. When medication is administered to people who use this service, it must be clearly recorded to ensure that people receive the correct medication at the correct time. The people who use this service must be offered activities that are delivered competently in order to provide them with appropriate stimulation. Original timescales 01/07/06 & 01/11/06 unmet-new timescale applied 30/06/07 3. OP9 13(2) 4. OP12 16(2) 31/07/07 Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 26 5. OP15 16(2)(i) 12 (2) 23(2)(d) 6. OP26 7. OP30 18(1) People who use this service must 31/07/07 be offered a choice of nutritious meals, which are suitably prepared to meet their needs. All areas of this home must be 31/07/07 kept clean, free from offensive odours and reasonably decorated so that people who use this service feel comfortable as they would in their own home. Training for staff who works in 31/07/07 this home must be clearly recorded and refresher dates identified to ensure that people who use this service are cared for by staff that have appropriate knowledge and skills in dementia care. Timescale 31/10/06 unmet – new timescale applied Staff must receive a minimum of six supervision sessions a year. Original timescale 01/07/06 & 01/11/07 - unmet new timescale applied People who use this home must always have a safe and suitable means of escape in case of fire. 01/08/07 8. OP36 18(2) 9. OP38 23(4)(b) 30/06/07 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.V338304.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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. Extracts may not be used or reproduced without the express permission of CSCI Orchid Lawns Nursing Home DS0000017684.V338304.R01.S.doc Version 5.2 Page 28 - 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. 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