Inspection on 24/10/06 for Oriel Care Home Ltd

This inspection was carried out on 24th October 2006.

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 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

Oriel Care Home Ltd 04/09/07

Oriel Care Home Ltd 21/01/06

Oriel Care Home Ltd 05/09/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Oriel Care Home Ltd 87 Hagley Road Old Swinford Stourbridge West Midlands DY8 1QY Lead Inspector Mrs Cathy Moore Unannounced Inspection 24th October 2006 07:35 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 Oriel Care Home Ltd DS0000063620.V314420.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. Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Oriel Care Home Ltd Address 87 Hagley Road Old Swinford Stourbridge West Midlands DY8 1QY 01384 375867 01384 443597 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) Oriel Care Home Ltd Elizabeth Jane Linford Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21/01/06 Brief Description of the Service: Oriel House is situated on the main Stourbridge to Oldswinford Road, a short distance from Stourbridge town centre, where there is a range of local facilities. The home comprises two properties, which are linked by an enclosed walkway. The larger of the properties was constructed as a private dwelling in the mid 19th century and conversion works have been carried out in a sensitive way, with care being taken to retain many of the original features. All areas are decorated and maintained to high standards, with a rolling programme of maintenance being evident. There are twenty-five single rooms, twenty-one having en-suite facilities. Two conservatories, in addition to the living room and two dining rooms, ensure that residents have a choice of seating areas and association. There is an attractive garden, which provides a pleasant view from the conservatory and a safe area in which residents may exercise. The owners visit the home at least once a week to monitor standards and obtain up to date information about its functioning and operation. The weekly fees for Oriel Care Home range from £400- £420. Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector on one day between 07.35 and 18.15 hours. The inspection process assessed all of the key National Minimum Standards for older people. To aid the inspection process a pre- inspection questionnaire and service user questionnaires were forwarded to the home for completion. A proportion of the inspection was conducted in the living areas where care practices and staff/resident interaction could be observed. During the course of the inspection three residents’ files to include; assessment of need and care plan documents were assessed. Four staff files to include; recruitment documents, supervision and training were also assessed. The premises were part assessed to include; the lounges, the conservatory, dining rooms, four bedrooms, the laundry, kitchen, bathrooms and toilets. Medication systems were observed and assessed. Both breakfast and main meal times were partly observed. Eight residents and three staff were spoken to during the inspection. The manager and a senior were involved in the inspection process. What the service does well: The home is situated in a pleasant residential area. It is located on a main road not far from Stourbridge town centre. Bus routes, shops and many other facilities and amenities are readily accessible. Most parts of the home accessible to residents are well maintained. The homes’ atmosphere, is warm, welcoming and friendly. Staff observed during the inspection were friendly polite and respectful to the residents in their care. Positive staff / resident relationships were apparent. The home actively encourages residents to maintain contact with family and friends. It operates open, flexible visiting times. Well over 55 of the staff have achieved NVQ level 2 or above in care. The manager has achieved her Registered Managers Award. The home actively encourages residents to interact with each other and participate in various activities. Residents birthdays are well celebrated. One resident had a party during the inspection. All residents were asked to join in. The home has its own new ‘people carrier’ transport which allows residents’ to go out regularly on trips and outings. To meet the religious needs of one service user the manager regularly takes her to church. Recruitment practices were seen to be in good order. Many positive comments about the home were made by residents’ and relatives’ and included the following; “Oriel is really nice”. “ The staff are excellent”. “ This home is the best”. “Excellent care home”. “”..is very well cared for at Oriel House, the family can only praise the care that she gets”. Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 6 “My mother is very happy and feels safe and loved by all.” “ The management and staff are always there for us”. One resident said to the inspector, “ I hope you like it here because I do. I have been here 8 years”. What has improved since the last inspection? 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. Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 7 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 Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4. The overall outcome for this group of standards is judged to be adequate. No service user moves into the home without having their needs assessed however, they are not always given assurance that these will be met. The registered persons must develop assessment of need processes to ensure that they can be sure and evidence that the needs of each service user entering the home can be fully met. EVIDENCE: It was positive to determine from completed resident questionnaires that 14 of the 15 felt that that they had been given enough information pre- admission to the home to enable them to make the decision that the home would be suitable for them. One resident commented, “I made enquires and visited twice. I stayed for the whole day on these occasions. Management provided me with full information”. Another commented,“The home had a very good reputation I had references from friends whose relatives had been at the home”. Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 9 It was positive to see written evidence to demonstrate that an assessment of need had been carried out for each resident before they were admitted. However, at least two residents presently accommodated have confusion caused by various reasons one of whom has displayed inappropriate behaviour and wanders. The registered persons must be able to demonstrate at all times that they are only offering places to residents who have needs which fall within the category of old age and that they can demonstrate at all times that they can meet their needs. A basic form was seen in use on one resident’s file saying how the home would meet their needs but not on others. However, there was no evidence that this document had been made available to the resident to assure them of how the home would meet their needs. The inspector saw mention on one residents record of an offer of day care at the home. A discussion took place with the manager who confirmed that although they had 5 day care places these had not been used for some months. The inspector told the manager that the CSCI would not approve any day care places as it did not register or inspect day care. She further informed the manager that if day care were provided in the home the CSCI would have to be informed of where this would be provided ( as it would have to be separate from the residential facilities) and staffed ( as it would have to be staffed by additional staff). The manager was reminded that the home was registered to provide care to up to 25 residents- no one else. Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. The overall outcome for this group of standards is judged to be poor. Care plans need further development and improvement. Some ‘ fine tuning ‘ and developments are needed to ensure that all resident healthcare needs are fully met. Medication systems need major improvements to ensure that service users are not at risk. Service users feel that they are treated with respect. Last wishes are suitably determined and recorded. EVIDENCE: Feedback from completed resident questionnaires revealed the following; 12 of the 15 felt that they always received the care and support that they need, 3 answered usually to this question. 11 of the 15 felt that they always receive the medical support that they need, 3 usually and 1 sometimes. Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 11 Three resident files were examined. Two separate care plans were available on two of the three. One basic information giving care plan the other a lengthy computerised care plan. Neither version was very effective as they were either too basic or too long rather than full care instructions. It was noted that a number of major care needs known or identified were not reflected in the care plans. For example; one resident is doubly incontinent yet, there was little instruction in the care plan to inform staff what to do to manage the situation or indeed promote continence. Similarly, there was insufficient instruction in another care plan for staff on how to deal with the resident’s challenging behaviour and wandering. It was positive to see that nutritional and falls risk assessments were in place for the residents. However, more development is needed to ensure that risks identified from using these risk assessments are reflected back into the residents care plans. For example; two falls/ moving and handling assessments had shown that residents were at risk yet these were not highlighted sufficiently in their care plans. It was positive to see that residents’ are weighed on admission and monthly thereafter to enable the home to identify any weight gain/loss. Evidence was available to demonstrate that residents’ are receiving assessment and treatment from a range of health care professionals examples being; the chiropodist and optician. One concern was identified in that there had been no follow up from a doctors visit on 28 September 2006 for one resident who had displayed ‘ extreme behaviour’ as it was described in their daily notes. Bloods had been taken for testing and the doctor was considering a psychiatric referral yet nothing else had happened since this day. It was noted that there is no routine assessment carried out in the home concerning tissue viability. These assessments can be a vital element of tissue breakdown prevention and a way to alert staff to who is at risk and who is not. It was extremely positive to see certificates to demonstrate that the majority of staff who administer medications have received accredited medication training. However, it was concerning to see that a letter had been issued to two new staff stating; “This is to demonstrate that .. can transfer medication from cassettes into pill dispensing pot”. This issue was brought to the attention of the manager who did not deny that these staff gave medications. The manager was informed that staff must not give medication unless they have received formal training. The homes’ medication policy was assessed. This did not contain clear instruction to staff on what to do if a medication error occurred and did not instruct staff that medication error must be reported to the CSCI. A second medication policy was given to the inspector produced by Mulberry House. It was unclear which medication policy is in operation. A decision must be made which policy is the ‘operational’ one. This operational policy must then contain instruction to staff on all aspects of safe medication handling. It was concerning that there is not process for the holding of the medication keys. When not in use the medication key is kept on a key rack in the kitchen. Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 12 The senior on duty and manager were told that the medication keys must be held by the person responsible for them on each shift from this time onwards. Although a letter dated 2005 had been issued and was held on two service user files from their doctor approving homely remedies. These did not relate to all residents accommodated and certainly could not relate to any service users admitted to the home after 2005. A box containing Paracetamol, cough syrup and Senna were seen. The senior on duty explained that these were given to service users when needed. No homely remedies should be given unless each one has been approved for each resident by their doctor. CSCI guidance on homely remedies, with an example authorisation doctors letter, was given to the manager to help rectify this shortfall. It was noted that there were no service user photographs on or near their medication records to enhance safe medication administration. It was also noted that a number of medication records were handwritten but had not been verified by two staff to confirm information transferred is correct. At least two service users’ ‘self administer’ some of their medication yet there were no risk assessments to demonstrate that they had been deemed safe to do so. The subject of the lack of a medication trolley was discussed. The medications are stored in a lockable box inside a lockable wooden cupboard when not in use. The medication box is taken into the kitchen for medication administration where the person responsible for the medications leaves it when giving medications in other parts of the home. The box could easily be removed from the kitchen during these times. Other issues are the time effectiveness of the system staff having to go to and fro from the kitchen to give medication and the hygiene aspects due to the frequent entering and existing of the kitchen. Staff observed during the inspection were friendly polite and respectful to the residents in their care. Positive staff / resident relationships were apparent. Toilet and bathroom doors were seen to be shut when in use to enhance privacy and dignity. One resident said, “ I am semi-independent, I like to dress myself when I can. The staff respect this and give me privacy”. Review notes for one resident further confirmed the positive ethos concerning the respect shown to residents’ as follows, “feels that she is treated with dignity and respect”. It was pleasing to see that the manager has taken the initiative to determine and record the preferred last wishes of residents’ in as much detail as this delicate subject allows. Oriel Care Home Ltd DS0000063620.V314420.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. The overall outcome for this group of standards is judged to be good. The lifestyle experienced by service users matches their expectations. Service users are very much encouraged to maintain contact with family and friends and are given the opportunity to visit the local community if they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome balanced diet in pleasant surroundings. EVIDENCE: It was extremely positive to see that a range of preferred daily routines has been determined for each resident in terms of rising and retiring and whether or not they want to be woken for an early morning cup of tea. That residents’ can choose if they wish to stay in bed later in the mornings was evidenced on one resident’s daily notes which read; “ Went in this morning at 07.30 to see if … wanted help. She said she wanted to stay in bed longer. Went back at 07.50 hours and she was asleep”. One resident said; “ I get up and go to bed when I want”. Feedback from completed resident questionnaires showed the following; 6 of 15 commented that there are always activities that they can take part in. 8 answered usually to this question. Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 14 One resident view on activity provision was that; “Weekdays there is a lot going on, weekends are a bit dead though, nothing much happens then”. Generally, the home very much encourages social interaction and activity provision within the home. The home does not at the present time have a activities co-ordinator but is considering the possible employment of one. Two female persons come to the home, one on Tuesday and one on Thursday, to provide craft and other activities. Activity provision is then provided the rest of the week by staff. Activity provision varies and includes in-house events and external trips and outings enabled by the homes’ own transport. One staff member said; “ A few weeks ago 16 residents went to Old Swinford school’s harvest festival which they really enjoyed. The home has its own transport to enable regular trips and outings. The manager regularly takes one resident who wishes to continue with her religious following to church, which is extremely positive. One issue discussed with the manager was the moving of (lounge) TV’s in the day time to deter them from being watched. Whilst it is acknowledged that this is done to encourage social interaction and many residents who want to watch TV’s during the day view them in their bedrooms, the restriction should be clearly noted in the homes’ service user guide/ statement of purpose so that all prospective residents are aware of this before deciding if the home will be suitable for them. The home very much encourages residents’ to maintain contact with family and friends. A visiting policy is on display in the main entrance hall. One resident said; “ My family can visit me anytime but I choose to go to them instead”. Bedrooms briefly viewed were seen to hold a range of personal effects that residents’ have chosen to bring into the home with them. Information concerning external advocacy services was available within the home. Completed resident questionnaires revealed that; 10 of the 15 always liked the meals at the home, 2 usually and 2 sometimes. It was noted that a cooked breakfast is not offered by the home. This needs to be detailed in the service user guide/ statement of purpose and discussed with existing residents intermittently to ensure that they are happy with this arrangement. An issue was discussed because one residents’ nutritional assessment stated; “ Carers to monitor food intake- under weight”. Yet there was no consistent records to confirm that this is being done. The manager was informed that daily food/ fluid intake records must be made where nutritional or other risks have been identified or if residents are unwell or are prone to dehydration etc. The home has a written menu which details lunch, tea and supper. Breakfast is not detailed on the menu as the breakfast ‘likes’ of each resident have been determined and recorded and this is what they are given. It is positive that residents can choose to have their breakfast in their bedroom if they wish and that breakfasts’ were served individually as residents got up rather than there being a set breakfast time. Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 15 The breakfast time was briefly observed. Breakfasts were served on nice trays with little individual jugs of milk. Between meals drinks and biscuits were offered. The main meal of the day was chicken with savoury stuffing roast potatoes and vegetables followed by fruit baskets and cream. The meal looked attractive and smelt appetising. At least two residents were given their meals in large dishes to enable them to eat more independently. One resident said after eating her lunch; “I enjoyed that, very nice”. It was positive in that all residents asked during the morning what was for lunch knew what the lunch was. One resident said; “ If I don’t like what is planned I simply ask for something else and it is provided. Ample fresh fruit, vegetables and salad were available within the home. A discussion was held with the senior and cook about the possibility of increasing resident fruit and vegetable intake by offering for example; pieces of fruit in between meals and adding additional vegetables to packet or tinned soups. Oriel Care Home Ltd DS0000063620.V314420.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18. The overall outcome for this group of standards is judged to be poor. The home has complaints processes in operation giving service users’ and their families the opportunity to formally voice any dissatisfaction or complaints. Development and improvement is needed regarding the prevention of abuse to ensure that residents’ are protected at all times. EVIDENCE: No complaints have been received by the CSCI or the home. The home has a complaints procedure which is on display in the home and detailed in the homes service user guide. Feedback from completed resident questionnaires revealed that 13 of the 15 always know who to speak to if they are unhappy and 14 of the 15 know how to make a complaint. It is important however, that residents’ are continually reminded of processes within the home to ensure that they all know how to speak to if unhappy and how to make a complaint. One resident commented, “there is nothing to complain about”. Unfortunately, an incident described in a resident’s daily notes as ‘extreme behaviour’ occurred between two female residents. The home rightfully reported the incident to the CSCI and social services carried out investigations/reviews of both residents. However, since this time apart from additional record making there is little evidence that anything has been done to prevent a reoccurrence of the incident particularly at night when the risk is greater. Night notes on a number of occasions make reference to the one residents wandering. An entry written on the 15/10/06 states that the Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 17 resident was again found in the same resident’s bedroom who had been affected by the previous ‘extreme behaviour’. Oriel Care Home Ltd DS0000063620.V314420.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25,26. The overall outcome for this group of standards is judged to be poor. Areas accessible to service users are generally well maintained with the exception of the landing carpet on ‘Hagley’ unit. Service users do not live in completely safe surroundings. Although some ‘fine tuning’ is needed premises parts accessible to the service users are clean, pleasant and hygienic. The laundry in its present form however, leaves a lot to be desired and potentially is a place where infection/ bacteria can grow and be transmitted. EVIDENCE: Generally, the home is maintained to a good standard. It was positive to see that an on-going refurbishment programme has been produced and is being worked through. As described in a previous section of this report new carpets, curtains and some furniture have been purchased recently by the fairly new owners. However, it was very concerning to see the state of repair of the carpet on the landing of ‘Hagley’ unit. It was not secured properly in a number of areas as it Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 19 was badly in need of stretching. The carpet can only be described as ‘dangerous’ in that it is a tripping hazard. It is acknowledged that the home had tried to get carpet fitters to assess and put the carpet right but time had lapsed and the carpet was there as a potential hazard. It was extremely surprising to discover that a considerable number of radiators throughout the home are not guarded. This includes those in residents bedrooms and en-suite facilities. Further, although mixer valves have been installed on water outlets some hot water pipes leading to these mixer valves carrying hot water are exposed and become very hot when the hot water flows through them. Both of these shortfalls potentially place residents’ at risk of burning. Feedback from completed resident questionnaires revealed that 14 of 15 felt that the home is always fresh and clean; 1 answered usually to this question. The parts of the home accessible to residents was seen to be clean and fresh, no malodours were detected. However, shortfalls were identified in some areas of infection control examples being; the lack of signs in toilets and bathrooms to remind staff and residents to wash their hands. Talc and shampoo bottles in one bathroom which should have been returned to the resident’s bedrooms after use. At least six residents coats were seen hanging on a rail in a communal toilet potentially acting as an infection transmission source. If anyone was to touch them with dirty hands this could contaminate the coat. Additionally stored in a toilet they may be at risk of airborne spores settling on them. The laundry is very concerning as it is in a poor state of repair and well past it’s best. The walls are in desperate need of suitable decoration, the flooring has lost it’s sealant/ coating in a number of areas and there are gaps between tiles allowing the build up of debris and possible bacteria. There is only one sink in which a bucket was seen with numerous pieces of residents’ underclothes. There are no separate facilities for staff hand washing purposes and there was no liquid soap or paper towels to allow staff to wash their hands properly. There was a lot of clutter in the laundry allowing a build up of dust. Bearing in mind records seen in the home described one resident as being incontinent of faeces in clothing and in the bed meaning that these items would then be transferred to the laundry, it was surprising to see a freezer used for foodstuffs kept in the dirty area of the laundry. Oriel Care Home Ltd DS0000063620.V314420.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. The overall outcome for this group of standards is judged to be adequate. Night staffing levels due to the behaviour of one service user are inadequate. The home has reached the required target of over 50 of the staff achieving N.V.Q level 2 in care. Service users are supported and protected by the homes’ recruitment practices and processes. Staff are trained to do their jobs. EVIDENCE: Generally, during the day six staff provided for twenty five residents. One of these staff however, do have to undertake non-care duties for example; one carer is allocated to attend to the breakfasts. Night times two staff are provided. Generally, the manager feels assured that these night staffing levels adequate. Comments received from staff implied that due to the layout of the home someone to ‘float’ between would be an advantage at times. Due to the behaviour and wandering of one resident described earlier it is clear that two staff at night are not sufficient to supervise this individual and attend to the other residents as well. Staff observed during the inspection were seen to be kind and caring and had a good understanding of the needs of the residents’ in their care. Positive comments were received about the staff in all roles and included the following; “ The management and staff are always there for us. Nothing is too much trouble”. “ All staff are very caring, nothing is too much trouble”. Staff spoken Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 21 to were positive about their work one said; “ I love it here”. Another said; “ It is nice here, very friendly”. It is positive that over 50 of the staff have achieved N.V.Q level 2 or above in care which gives assurance to residents’ that staff are competent to do their jobs. Four staff case files were viewed. It was extremely positive to see that all of the required checks had been carried out for these staff examples being; an enhanced Criminal Records Bureau check and the required two written references. Evidence was available to confirm that staff receive formal induction training. Oriel Care Home Ltd DS0000063620.V314420.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36,38. The overall outcome for this group of standards is judged to be adequate. The Commission has assessed the manager as a fit person to be in charge of and run the home. Monitoring processes must be implemented to ensure that the home is run in the best interests of the service users. Service users financial interests are safeguarded. The area of health and safety needs development and improvement. EVIDENCE: The manager has achieved her Registered Managers Award and has been approved as a person fit to be in charge of the home by the Commission. She has had to endure major transitions in the last year as the home has been purchased by new owners and in recent months both the deputy and admin Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 23 person have left. It would be a good time for the new owners to clarify with the manager her role and responsibilities in view of the fact that they are new owners and bring with them new ways of working and a new culture. No money is held by the home for the residents. Resident records viewed showed that an inventory was in place for items such as pictures and ornaments but no other items such as clothing. Inventories seen however, were not signed or dated. The manager has carried out some quality assurance monitoring within the home for example; questionnaires to gain the views of the residents’ about the home, the results of which were positive and have been included in a summarised form in the service user guide. Questionnaires were also sent to community stakeholders, unfortunately these were not returned. The manager showed the inspection a proposed monitoring system against the National Minimum Standards for Older People. A process of this kind must be implemented as soon as possible in order for the home to be able to identify their own non-conformances and put into place corrective actions to prevent shortfalls as have been identified from this inspection. Staff records showed that staff have all received a recent appraisal. Two staff files viewed however, showed that they have not in the last 12 months received a further five one to one supervision sessions as required. West Midlands Fire Service inspected the home the same day as this inspection was carried out. The fire officers gave positive feedback in that the only shortfall found was the incorrect closing of four fire doors. A training matrix was available which confirmed that most staff have received training in the following; moving and handling, infection control and fire safety. The manager is in the process of arranging training for two new staff. Two first aid certificates seen did not state how long they were valid for. This must be explored as some first aid training is only valid for one year not three. It was noted that only a small proportion of staff have received health and safety/ risk assessment training. This must be addressed as soon as possible to ensure that staff all have a sound knowledge of health and safety and are capable and competent in undertaking risk assessments which they are expected to do. A number of products which could be’ hazardous to health’ were seen stored on the shelf in the laundry and in unlocked cupboards in residents’ toilets which could potentially place both staff and residents at risk. The kitchen was assessed. This was found to be in good order. It was clean and tidy. Evidence was available to demonstrate that temperatures of fridges, freezers and hot foods are taken and recorded. A concern was raised in that there was a hot water urn in the kitchen, although a lock was seen on the kitchen door to prevent access to risk from this hot water urn staff confirmed that the door was never locked. Oriel Care Home Ltd DS0000063620.V314420.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 x x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 2 x x x x x 1 1 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 2 x 2 Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 25 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 OP4 Regulation 14(1)(d) Requirement The registered persons and manager must ensure that no service users are offered a place in the home unless they are sure and can fully evidence that their full needs (behavioural/ supervision etc) can be met. The registered persons and manager must ensure that either a letter is sent to all prospective service users to acknowledge that the home can meet their needs or provision is made on the present form for them to sign to demonstrate that they have been given this written assurance that the home can meet their needs. The registered persons and manager must ensure that clear instruction is provided in each service users care plan to reflect their needs and capture any concerns. The registered persons manager must continue to seek and put into operation a care plan format which is suitable for the service DS0000063620.V314420.R01.S.doc Timescale for action 06/11/06 2 OP4 14(1)(d) 24/11/06 3 OP7 15(1) 08/11/06 4 OP7 15(1) 01/12/06 Oriel Care Home Ltd Version 5.2 Page 26 users and staff (which is easily understandable) which describes the need, how it will be met and by whom. 5 OP8 12(1)(a) The registered persons and manager must consult with MM’s doctor about findings from the blood test and whether or not she needs to be assessed by a psychiatrist. The registered persons and manager must obtain a suitable tool for tissue viability assessment, ensure that staff are trained and put this tool into operation. 06/11/06 6 OP8 12(1)(a) 13(4)(c) 24/12/06 7 OP8 12(1(a) 13(4(c) 15(1) 8 OP9 13(2) The registered persons and manager must ensure that where risks are identified from behaviours, falls , nutritional or other risk assessment processes that these are reflected fully back into the service users care plan with full instruction to staff on how to monitor/minimise these risks. The registered persons and manager must ensure that the medication keys are held by the person who is responsible for them on each shift ( not unattended in the kitchen or elsewhere). A concern letter was issued by the Commission for Social Care Inspection (CSCI) in which this requirement was included. The registered person and manager must ensure that no staff member has responsibility for or administers medication DS0000063620.V314420.R01.S.doc 24/11/06 27/10/06 9 OP9 13(2) 10/11/06 Oriel Care Home Ltd Version 5.2 Page 27 unless they have received formal training and that this instruction is given to all seniors. 10 OP9 13(2) The registered persons and manager must ensure that safe keeping procedure for the medication keys is established whereby seniors at the start/end of each shift hand over the medication keys they are signed for. 06/11/06 11 OP9 13(2) The registered persons and manager must seriously consider purchasing an approved medication trolley taking into account of and risk assessment of the following; That the present medication storage system is not fully safe and secure. That the initial administration process starts in the kitchen where the medications are kept during that time which at times leaves them unsecured. The effectiveness of the present system with the staff having to go to and fro to administer medications. The unnecessary numerous entries and exists into and out of the kitchen which present food hygiene implications. The outcome of this assessment/consideration must be forwarded to the CSCI. The CSCI pharmacist will be 15/11/06 Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 28 asked to assess the situation and give her view. 12 OP9 13(2) The registered persons and manager must ensure that no homely/ over the counter preparations are given / taken by a service user unless the y have been approved in writing by their doctor. The registered persons and manager must ensure that a photo of each service user is available on or by their medication record. The registered persons and manager must ensure that where a variable dose is prescribed for example one or two then the amount given each time is recorded. The registered persons and manager must ensure that where medication records are handwritten two staff check and sign to verify that the information transferred from medication containers/ prescriptions is correct. The registered persons and manager must ensure that a risk assessment is produced for each service user who self administers any medication. 15/11/06 13 OP9 13(2) 15/11/06 14 OP9 13(2) 15/11/06 15 OP9 13(2) 15/11/06 16 OP9 13(2) 15/11/06 17 OP9 13(2) The registered persons and 15/11/06 manager must ensure that all staff are instructed that they must stay with each service user and witness that they have taken DS0000063620.V314420.R01.S.doc Version 5.2 Page 29 Oriel Care Home Ltd 18 OP9 13(2) 19 OP9 13(2) their medication before they sign the medication chart. The registered persons and manager must ensure that all medication records have clear instructions detailed not for example; ‘To be taken as before’. The registered persons and manager must ensure that an up to date example initial list is produced concerning all staff who administer medications. The registered persons and manager must ensure that a suitable lockable box is purchased to use in the fridge in case medications are prescribed ( occasionally) which need refrigerating. The registered persons and manager must decide which of the homes’ two medication policies are to be the operational one and then ensure that this is kept near by the medications. The medication policy must have clear directions for staff on who they must contact/ inform in case of medication error- this must include the CSCI in accordance with Regulation 37. 15/11/06 20/11/06 20 OP9 13(2) 20/11/06 21 OP9 13(2) 20/11/06 22 OP12 Sch 1 4(1)(c) 23 OP15 17(2) Sch4 (13) The registered persons and 01/12/06 manager must ensure that any restrictions on TV usage in the lounges during the day be clearly documented in the homes’ statement of purpose/ service user guide. ( This can be documented as a positive in that the restriction is to encourage social interaction/ activity participation). The registered persons and 06/11/06 manager must ensure that a full DS0000063620.V314420.R01.S.doc Version 5.2 Page 30 Oriel Care Home Ltd 24 OP15 5(1) record is made of each service users food/ fluid intake daily where concerns have been raised about their physical health, outcome of their nutritional assessment , weight, risk of dehydration. The registered persons and 01/12/06 manager must include in the service user guide reference to the fact that the home does not provide a cooked breakfast. Consideration must be made to the choices and wishes of existing residents on whether or not they would like a cooked breakfast. 25 OP18 13(6) The registered person must ensure that a documented risk assessment is undertaken to determine what processes/ methods can be put in place to safeguard MM and other service users health, safety, well being and ensure the prevention of another concerning incident. A copy of the risk assessment, it’s outcomes and actions taken are to be forwarded to the CSCI. A concern letter was issued by the CSCI in which this requirement was included. 30/10/06 26 OP19 13(4)(a) 13(4)(c) The registered persons and manager must ensure that the carpet on ‘Hagley’ landing is repaired so that it completely safe or replace it. In the interim period risk assessments must be carried out to reduce the risks of tripping, falls or accidents. 15/11/06 Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 31 27 OP25 13(4)(a) 13(4)(c) A concern letter was issued by the CSCI in which this requirement was included. The registered persons and manager must suitably guard all radiators (that are not of a low surface temperature model or already guarded) and hot pipe work throughout the home. In the interim period risk assessments must be carried out to reduce the risk of burning. A concern letter was issued by the CSCI in which this requirement was included. 27/11/06 28 OP26 13(3) The registered persons and manager must store the freezer in an appropriate part of the home where it will not be at risk from infection/ bacteria transmission/contamination. A concern letter was issued by the CSCI in which this requirement was included. 31/10/06 29 OP26 13(3) The registered persons and manager must provide the CSCI with a written proposal and timescale for the refurbishment of the laundry. A concern letter was issued by the CSCI in which this requirement was included. 10/11/06 30 OP26 13(3) The registered persons and manager must ensure that; Signs to remind service users and staff to wash their hands are placed in all high risk areas examples being; toilets, 06/11/06 Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 32 bathrooms and the laundry. Liquid soap and paper towels are provided in the laundry. The laundry is cleared of all extraneous items. Personal care items and products (examples being; talc and shampoo) are used for individual Service users only and are returned to their rooms after use. That rubber bath mats are audited regularly to ensure that they are in a good state of repair. 31 OP26 13(3) 32 OP27 18(1)(a) The registered persons and manager must find an alternative safe storage/hanging facility for putting residents coats on. They are not to be hung in a communal toilet where they could be contaminated by infection/ bacteria. The registered persons and manager ( on receipt of the concern letter issued by the CSCI) must increase night staff by at least one to safeguard MM’s and other service users’ health, and well being and prevention of incidents of concern. You must provide evidence to the CSCI to demonstrate that this has been done. A concern letter was issued by the CSCI in which this requirement was included. 10/11/06 30/10/06 Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 33 33 OP33 24(1)(a) (b) The registered persons and manager must implement a auditing/ monitoring process against all of the National Minimum Standards for Older People (and secondary legislation) to ensure that shortfalls as identified during the inspection do not re-occur. 01/12/06 34 OP35 17(2) Sch 4 10 35 OP36 18(2) 36 OP38 13(4)(a) (c) The registered persons and manager must ensure that all resident inventories are fully completed and are signed and dated. The registered persons and manager must ensure that processes are implemented to ensure that all staff receive one to one formal supervision six times in any 12 month period. The registered persons and manager must ensure that products which could be hazardous to health ( COSHH) are not stored in communal toilets or on the laundry shelf. All COSHH products must be stored in a locked cupboard. 24/11/06 01/12/06 10/11/06 37 OP38 13(4)(c) The registered persons and DS0000063620.V314420.R01.S.doc 24/01/07 Version 5.2 Page 34 Oriel Care Home Ltd 18(1)(a) 38 OP38 13(4)(c) 18(1)(a) manager must ensure that all staff receive health and safety/ risk assessment training to deem them competent in dealing with and ensuring compliance with health and safety and to undertake risk assessments. The registered persons and manager must confirm with the first aid trainer how long the staff certificates are valid for and request in future for this to be detailed on the staff first aid certificates. The registered persons and manager must ensure that the radio, TV and lamp in bedroom 8 are PAT tested. The registered persons must sure that the kitchen door is locked at all times when it is not in use. 24/11/06 39 OP38 23(4)(a) 03/11/06 40 OP38 13(4)(a) (c) 10/11/06 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 OP38 Good Practice Recommendations The registered persons and manager should seriously consider purchasing a suitable, hoist for the home to use if a service user fell or if a service user were unwell for any period of time. Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 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 Oriel Care Home Ltd DS0000063620.V314420.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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