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Inspection on 06/11/07 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 6th November 2007.

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.

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

The service user information documents are readily available for prospective residents and their representatives, and they are aware that a review is presently underway and a new document will be available imminently. The new care plan documentation is now in place and appears to be an effective working document. Individual care plans are in place for people who live in this home. They include personal preferences and have been written in consultation with individuals and their representative.

What has improved since the last inspection?

There were many improvements observed during this inspection. It is hoped that the company can maintain and sustain these. The home is still working without a manager although an appointment has been made and a start date arranged. Meanwhile the area manager has been spending most of her time at this home, leading with a positive attitude and by example. People who live in this home are engaging in a selection of activities, and evidence indicated that they are being encouraged to make choices about their everyday lives. Systems in place for the administration of medication appear robust, however it was not clearly evident that food supplements and thickeners were being used as prescribed. Staff supervision had been a previous concern, with many staff receiving very inadequate support. During this inspection, ten staff supervision files were checked. This included, care staff, kitchen and ancillary staff. All had received at least two supervision sessions over the past three months. There was a vast improvement in staff interactions with residents, and there appeared to be a clearer staff understanding of the individuals needs, observed throughout this inspection. New menus have just been prepared and introduced for the winter months; these include more casseroles, roast dinners and traditional favourites, including fruit crumbles and hot puddings. It would have been encouraging to see the picture menus, previously discussed, being used to help people make their meal choices. Accident and incident reporting had been raised as a major concern at the previous inspections in May and July 2007. The reporting procedure is now working effectively, with appropriate reports being submitted as required. The home has recently purchased a minibus. It is hoped this will enable activities to take place involving people who live in the home integrating into the local community, outside the home. Individual care plans are in place for people who live in this home. They include personal preferences and have been written in consultation with individuals and their representative

What the care home could do better:

The home is still working without a manager although an appointment has been made and a start date arranged. The first phase of the refurbishment of this home is now complete and communal areas generally provide a pleasant environment for the people who live here. Phase two is due to commence in the near future and will be focusing on individual`s private rooms. The numbers and skill mix in this home are appropriate, however they must ensure Criminal Record Bureau (CRB) checks are received before staff commence duty.

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 6th November 2007 07:45 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.V353973.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.V353973.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.V353973.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Elderly over 65 Date of last inspection 13th July 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.V353973.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second Key Inspection for this year. Since the previous Key Inspection on the 22nd of May 2007, there have been three Random Inspections in this home. These took place on the 13th of July 2007, the 7th of August 2007 and the 17th of September 2007 respectively. This inspection was carried out on the 6th of November 2007, between the hours of 07:45 and 13:00 hours by Lead Regulatory Inspector Louise Trainor, accompanied by Regulatory Inspector Sally Snelson. 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. The main focus of this inspection was to monitor improvements in the home, and compliance from the requirements made at the previous Key Inspection. The files of three people who live in this home were examined and observations of the care provided were undertaken throughout the visit. The supervision records of ten staff were checked, as was the recruitment details of the homes most recent employee. Numerous staff from different designated roles were informally interviewed, and the views of two visitors are also acknowledged in this report. Other documentation examined and considered during this inspection included Medication Administration Records, the Complaints file, Staff meeting minutes, staff rotas, new menus, accident and incident reports and the statements for the personal allowance of two of the residents. The inspectors would like to thank everyone involved for their support and assistance throughout this visit. What the service does well: The service user information documents are readily available for prospective residents and their representatives, and they are aware that a review is presently underway and a new document will be available imminently. The new care plan documentation is now in place and appears to be an effective working document. Individual care plans are in place for people who Orchid Lawns Nursing Home DS0000017684.V353973.R01.S.doc Version 5.2 Page 6 live in this home. They include personal preferences and have been written in consultation with individuals and their representative. What has improved since the last inspection? There were many improvements observed during this inspection. It is hoped that the company can maintain and sustain these. The home is still working without a manager although an appointment has been made and a start date arranged. Meanwhile the area manager has been spending most of her time at this home, leading with a positive attitude and by example. People who live in this home are engaging in a selection of activities, and evidence indicated that they are being encouraged to make choices about their everyday lives. Systems in place for the administration of medication appear robust, however it was not clearly evident that food supplements and thickeners were being used as prescribed. Staff supervision had been a previous concern, with many staff receiving very inadequate support. During this inspection, ten staff supervision files were checked. This included, care staff, kitchen and ancillary staff. All had received at least two supervision sessions over the past three months. There was a vast improvement in staff interactions with residents, and there appeared to be a clearer staff understanding of the individuals needs, observed throughout this inspection. New menus have just been prepared and introduced for the winter months; these include more casseroles, roast dinners and traditional favourites, including fruit crumbles and hot puddings. It would have been encouraging to see the picture menus, previously discussed, being used to help people make their meal choices. Accident and incident reporting had been raised as a major concern at the previous inspections in May and July 2007. The reporting procedure is now working effectively, with appropriate reports being submitted as required. The home has recently purchased a minibus. It is hoped this will enable activities to take place involving people who live in the home integrating into the local community, outside the home. Individual care plans are in place for people who live in this home. They include personal preferences and have been written in consultation with individuals and their representative Orchid Lawns Nursing Home DS0000017684.V353973.R01.S.doc Version 5.2 Page 7 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.V353973.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.V353973.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, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service user information documents are readily available for prospective residents and their representatives, and they are aware that a review in presently underway and a new document will be available imminently. 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 they want to live. The document displayed has a notice attached to it informing it’s readers that it is in the process of being reviewed due to the appointment of a new manager, and some required additions, such as information relating to fees. Orchid Lawns Nursing Home DS0000017684.V353973.R01.S.doc Version 5.2 Page 10 This home has not had any admissions during the past five months. 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.V353973.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, 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care plans are in place for people who live in this home. They include personal preferences and have been written in consultation with individuals and their representatives. EVIDENCE: The files of three people who live in this home were examined in detail during this inspection. All contained thorough documentation. Families and friends had been involved in completing additional sheets in the care plans. These sheets included personal details, and preferences in the way their care is delivered. One person’s sheet read. “I like carers to be gentle and chat with me, I like good food in colourful china, enjoy baking and am fond of home baked cakes, I am distrustful of people culturally different to myself”. This was an essential piece of information that may explain a resistance to care being delivered should it occur. Orchid Lawns Nursing Home DS0000017684.V353973.R01.S.doc Version 5.2 Page 12 Another person’s file read. “I like to be up early in the morning, I like to be dressed in matching clothes and have moisturiser on my face”. Care plans were detailed, and addressed a wide range of needs from, maintaining body weight and mobilising to transferring and activities. It was identified that this individual does ‘lash out at times’ but that they sometimes like a quiet time with conversation about their childhood. Information relating to personal wishes at their time of death were also addressed and recorded in these documents. Risk assessments were in place in all the files examined. These included, pressure area / skin care, mobilising and nutrition. These assessments were reviewed on a regular basis as were the care plans to reflect the changing needs of the individual. The care plans were reflective of the information in the risk assessments. The Medication Administration Record (MAR) sheets were examined. There was an up to date list of staff signature samples filed with the MAR sheets. The present charts were sixteen days into the dispensed period. Sheets were signed correctly and omission codes were appropriately recorded. One individual had been given a dose of Haloperidol, due to being restless and agitated. This was also documented in his daily records and care plan. Dressings and ointments were signed in on the MAR sheets and appropriately signed when used. There was however, evidence to indicate that tins of ‘Thick and Easy’ were being left in the dining areas and used communally as required and not for the individual they had been prescribed for, and there was also evidence to that food supplements were not being given as prescribed. This matter was discussed with the area manager, who assured us she would rectify this immediately. Throughout the day staff were observing addressing people in a respectful and dignified way. Orchid Lawns Nursing Home DS0000017684.V353973.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 good. This judgement has been made using available evidence including a visit to this service. People who live in this home are engaging in a selection of activities, and evidence indicated that they are being encouraged to make choices about their everyday lives. EVIDENCE: There was a vast improvement in staff interactions with residents, and there appeared to be a clearer staff understanding of the individuals needs, observed throughout this inspection. There was no one wandering aimlessly without intervention from staff, and everyone was receiving periods of one to one attention and stimulation. There was old time music songs playing in the main lounge as there had been at previous inspections, but this time individuals were singing and dancing. The people who live in this home appeared animated and happy. Some people were engaged with musical instruments and others in ball games. Those who were not able to throw the balls and balloons, were just holding them, but were alert and their facial expressions indicated that they were watching the activities and were engaged. Since the last inspection the outreach worker from the Mental Health for Older Peoples’ team had been to the home and delivered some training on activities Orchid Lawns Nursing Home DS0000017684.V353973.R01.S.doc Version 5.2 Page 14 and interacting with residents. Staff had clearly learned a lot from this, and it was reflected in their working practices. In one of the smaller lounges, where there were only three residents, a carer was doing some sensory work. She had a box containing a selection of different objects, such as a large domino, seashells and a tennis ball. She was encouraging individuals’ to hold, feel, shake, and smell, and where possible identify these items and talking about them. There was gentle background music playing. This was relaxing but not a distraction. In the other small lounge a carer was doing some work with large skittles and a ball. Although these people were unable to play skittles, they were engaged in touching them and talking about them. The home has recently purchased a mini bus that will enable staff to take the people who live here out into the community on trips. This minibus is to be shared with a sister home, situated locally. The gentleman who had been observed at previous inspections, lying on the corridor floor without interventions from staff, continues to spend periods of time on the floor, but now is accompanied by an individual carer at all times. He has a large pillow to lie on, and the staff are communicating with him and appear more aware of his needs and how to manage them in a more dignified way. New menus have just been prepared and introduced for the winter months; these include more casseroles, roast dinners and traditional favourites, including fruit crumbles and hot puddings for desserts. On the day of the inspection there was a choice of gammon or turkey escallops with a selection of vegetables and potatoes. The choice of menus was being integrated into the activities for the day. The activity coordinator and care staff were spending time with individuals, explaining menus verbally and encouraging them to indicate their preferences. However there was no evidence of aids such picture menus, which were discussed at the last inspection, being used to assist these people, with dementia, with their choices. We observed the breakfast serving and the midday meal. Breakfast was served to individuals as and when they were ready from about 08:15 hours onwards. This meant that people were not left sitting at empty tables for long periods unattended, as had been seen at previous inspections. The improvements were overwhelming. Individuals were being given choices and the attention they deserved. Although cooked breakfasts do not appear on the written menu, one gentleman was served a full English breakfast that he clearly enjoyed immensely. Tea was served in mugs not plastic beakers, and there was a friendly relaxed staff presence throughout. At 12:15 hours everyone was informed that it was lunchtime, and everyone in the main lounge was assisted to the dining tables. This immediately made this mealtime a social occasion where everyone was involved, and staff gave Orchid Lawns Nursing Home DS0000017684.V353973.R01.S.doc Version 5.2 Page 15 varying levels of assistance as required. This was such as contrast to mealtimes observed at previous inspections where staff stood over individuals, feeding them in silence. Despite one or two people being a little restless, staff managed this very well and there were no major disruptions throughout the meal. In the two smaller lounge / dining areas, where most of the people had a higher level of assistance required, similar processes were observed, with staff sitting assisting residents in a relaxed way, communicating well and encouraging them to enjoy their meals. Two visitors to the home spoke with us during this inspection, and both expressed positive comments about the home and the improvements in care they had noticed over recent weeks. Orchid Lawns Nursing Home DS0000017684.V353973.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 good. This judgement has been made using available evidence including a visit to this service. There is a robust complaints procedure in place so that service users and their representatives are confident they will be listened to and their complaints acted upon. EVIDENCE: There is a robust company complaints policy in place, and documentation indicates that complaints are responded to appropriately within the identified timeframe. There had only been one complaint received by the home since the May inspection. This was received on the 3rd of October 2007. It was a verbal complaint regarding the heating of the building. This was responded to appropriately in writing, on the 31st of October by the Area Manager. The matter is now resolved. We did note that the date on the response letter was exactly twenty eight days from the date of the complaint, this meant that it was unlikely the complainant would have received the response within the procedures twenty eight day time frame. Staff in this home are appropriately trained in safeguarding issues, and there is now a clear understanding amongst staff, of the procedures for reporting any untoward incidents. Orchid Lawns Nursing Home DS0000017684.V353973.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. The first phase of the refurbishment of this home is now complete and communal areas generally provide a pleasant environment for the people who live here. Phase two is due to commence in the near future and will be focusing on individual’s private rooms. EVIDENCE: There have been ongoing requirements relating to the environment in this home for the past two years. It was encouraging to see that the first phase of the refurbishment programme for this home is now complete. This has involved the redecoration of the homes’ corridors, some communal areas and eight of the bedrooms. The remaining sixteen bedrooms, including new flooring, will be addressed in the Orchid Lawns Nursing Home DS0000017684.V353973.R01.S.doc Version 5.2 Page 18 second phase of the programme, as will the replacement of furniture such as dining room tables. This is due to start in the near future. The entrance hall to the home is now more welcoming. Information for residents and visitors, including; registration certificates, a philosophy of care, inspection reports, the complaints procedure, activities programme and menus, are displayed and easily accessible. There is a collage of photographs taken during recent home activities on display. It is clean and light and free from offensive odours. A washable non- slip flooring has now been laid throughout the corridors of the building, so that any spillages and accidents may be cleaned up immediately leaving no lingering odours. An array of framed pictures has been put up along the corridors, making it more homely. These are all easy to wipe clean. The temperature was comfortably warm, and a few windows were open allowing fresh air into the home. When we arrived at the home, one of the first comments received from a member of staff was. “Its’ lovely now, we can breath fresh air in this home”. The day rooms in the home were clean and tidy, and although some of the furniture is old, it was clean. There are sufficient armchairs or varying heights, and specialist seating for those that require it. A new chair was being delivered on the day of the inspection. It had been donated to the home. It was a specialist piece of equipment, and the area manager stated she needed to assess whose needs this would best meet. The conservatory door was open allowing people to wander in and out as they pleased. The bathrooms and toilets were clean and tidy, with no lotions and potions accessible to unaccompanied residents. Individual bedrooms were decorated to varying degrees. Some bedrooms are well decorated and the remainder are due to be decorated during the next phase of the refurbishment in this home. Some rooms displayed personal assets, ornaments and photographs, reflective of the individual’s past, however some were rather bare. The manager told us that she has requested that families assist with this matter by bringing in things that may help personalise individual’s personal rooms. There was a notice in the foyer reflecting this request. The gardens that are mainly laid to lawn on these premises, were well tendered, so that risks of falls is minimised for those people choosing to wander in the garden. Orchid Lawns Nursing Home DS0000017684.V353973.R01.S.doc Version 5.2 Page 19 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. The numbers and skill mix in this home are appropriate, however they must ensure Criminal Record Bureau (CRB) checks are received before staff commence duty. EVIDENCE: The home has recruited two new Registered Mental Nurse to their team since the previous inspection. One of these nurses has commenced her post and appears positive and enthusiastic. However when her recruitment documents were checked, although she had had a clear POVA first returned, her CRB clearance had not been received. This was discussed with the administrator and the area manager, and it was explained that this should not happen as routine, although it maybe acceptable under extraordinary circumstances following discussion and agreement with the Commission for Social Care Inspection (CSCI). At all four of the previous inspections there was concern that staff were working excessive hours that may compromise the care being delivered. Current rotas were examined, and this matter is now being closely monitored by the area manager to ensure that staff are not working any more than eight shifts between allocated days off. We felt this had been a difficult task for the area manager, that has been managed well, as some staff indicated to us that Orchid Lawns Nursing Home DS0000017684.V353973.R01.S.doc Version 5.2 Page 20 they are not happy that their working hours are being monitored, and would ideally like to do more hours. Previously agreed staff levels have been maintained and an RMN is rostered on duty at all times. Observations of care throughout the day were generally positive. Staff appeared to be communicating and integrating with the people who live here. Although the English of one particular carer remained very poor and she told us she was just learning, she was observed doing some sensory work with some of the people in the home, and she appeared to be actively engaged and getting positive responses from the residents. Generally Staff appeared more confident and understanding of the individuals’ needs. Staff morale appeared to have improved, staff were smiling and appeared happy and relaxed in their work. The area manager was observed to address each member of staff individually when she arrived on duty. Comments made by staff also indicated that they now feel well supported. One member of staff said. “My job has a role now, I enjoy coming to work, there is a happier atmosphere, things are more organised and jobs more defined, I just hope it continues when the new manager comes”. Orchid Lawns Nursing Home DS0000017684.V353973.R01.S.doc Version 5.2 Page 21 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, 35, 36, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is still working without a registered manager, however the area manager has been based in this home implementing new systems. A new manager is due to take up post imminently. EVIDENCE: The home is still working without a manager although an appointment has been made and a start date of the 12th of November arranged. Meanwhile the area manager has been spending most of her time at this home. She is very experienced and appears very committed to her role. She has been working very hard implementing new systems to improve the standard of care. We Orchid Lawns Nursing Home DS0000017684.V353973.R01.S.doc Version 5.2 Page 22 hope that this will be sustained by the new manager when they commence their post. Staff supervision had been a previous concern, with many staff receiving very inadequate support. During this inspection, ten staff supervision files were checked. This included, care staff, kitchen and ancillary staff. All had received at least two supervision sessions over the past three months. The contents of the supervision records identified that the topics discussed corresponded to the new systems being introduced, and areas that individual staff needed more direction on, such as care planning and interacting effectively with people suffering with dementia. Accident and incident reporting had been raised as a major concern at the previous inspections in May and July 2007. The reporting procedure is now working effectively, with appropriate reports being submitted as required. The company manages personal allowance accounts for the people who live in this home. Presently only the manager and the administrator have access to the safe, where a float of up to £200.00 is held. Out of office hours, a small float of approximately £30.00 is held in the medication cupboard for ‘emergencies’. This was discussed with the manager as it was felt that this may not always be sufficient if several people required spending money at the weekends for example. The manager was going to consider holding a larger amount of accessible funds for out of hours. Statements are sent out to individuals, from Head Office on a monthly basis. The statements of accounts for two individuals were examined. These all corresponded appropriately with receipts for purchases. Orchid Lawns Nursing Home DS0000017684.V353973.R01.S.doc Version 5.2 Page 23 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 17 X 18 3 2 3 3 3 2 2 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 2 3 3 3 Orchid Lawns Nursing Home DS0000017684.V353973.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 12(1)(a) Requirement Food supplements and thickeners must be used as prescribed for people who live in this home. Timescale for action 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP35 Good Practice Recommendations The home should consider putting up a sign identifying ‘banking hours’ so that the people who live in this home and their families are aware of when they can access their money. Orchid Lawns Nursing Home DS0000017684.V353973.R01.S.doc Version 5.2 Page 25 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.V353973.R01.S.doc Version 5.2 Page 26 - 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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