Inspection on 04/09/07 for Oriel Care Home Ltd

This inspection was carried out on 4th September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Oriel Care Home Ltd 24/10/06

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 Jean Edwards Key Unannounced Inspection 04th September 2007 08:40 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.V333136.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.V333136.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.V333136.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 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. Information relating to the weekly fees for Oriel Care Home range from £420£440, with individual top up fees paid on an individual basis, has been provided from the home. It should be noted that fee information included in the report applied at the time of this inspection and people may wish to obtain more up to date information from the care home. Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the key inspection visit for 2007 - 8, undertaken by an inspector from the Commission for Social Care Inspection (CSCI). The inspector has spent nine hours on a weekday at the home. All Key National Minimum Standards have been assessed at this visit. The range of inspection methods to obtain evidence and make judgements includes: discussions with the senior care supervisor and staff on duty during the visits, discussions with residents and examination of a number of records. Other information was gathered before this inspection visit from the pre inspection questionnaire, notification of incidents, accidents and events submitted from the home. Twenty service user surveys, ten relatives surveys and five GP / professional surveys were sent to the home by the CSCI. An analysis of the 11 survey forms from service users, 2 from relatives and 3 GP responses is contained throughout this report. Responses are very positive. There are currently 24 residents living at the home. During the visit the inspector spoke to the majority of residents. Longer discussions have taken place with the residents whose care was looked at in depth. The inspection has included a tour of the premises, including the grounds, communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and residents’ bedrooms, with their permission. What the service does well: The home provides comprehensive information for prospective residents and their representatives, assisting people to make decisions, which are right for them. The residents are very complimentary about the care and support they receive with comment such as: The staff are excellent, very kind and helpful, if they are a little rushed at busy times, and the activities are also excellent The home has a key worker system, which means that there is a closer relationship between staff and individual residents, whose preferences and needs receive more detailed attention. There is a wide range of organised and spontaneous activities for residents, with outings advertised on a notice board in the communal areas. The home has a supply of communal newspapers, which are valued by residents and used by staff to discuss local and world events with residents. The home has its own ‘people carrier’ transport, which is used for residents’ to go out regularly on trips and outings. Residents spiritual needs are met with communion services, which take place at the home and arrangements can be made to take any resident who wishes to go to church. The home has an Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 6 Aroma therapist, associated with the home for more than seven years, who visits weekly to offer residents back, hand and arm massages. She is very complimentary about the staff, meals, the way the home is run and the warm friendly feel of the home. Staff are aware of each persons dietary needs and food intake is recorded as required with residents weight monitored and action taken as needed. There are excellent relationships between the home and health care professionals. One of the district nurses visiting during the inspection, comments that Oriel Care Home is one of the best homes the nurses visit and joked they have their names down as prospective residents, a sentiment echoed in a GP survey form. She says that staff are welcoming and approachable, always following instructions regarding residents care and asked questions if they are unsure. The manager has taken advantage of a Government grant for funds to develop block paved waking areas around the very attractive, colourful gardens, completed on the day of this inspection visit and used with great interest by some of the residents. There are a number of residents who enjoy the gardens and will have great pleasure from their daily strolls. The gardens have been entered for the Stourbridge Gardens in Bloom. Although results will be announced soon the pictures taken are going to be used in the Stourbridge Tourist Information. Redecoration of the entrance hall, and stairs has been completed, and new carpets have been provided for these areas. The staff are caring, knowledgeable about the residents needs and they are welcoming and friendly. Comments from the relatives survey about what the home does well are, some very nice carers, extremely clean, encourages residents to participate in activities and Oriel house is very well run. The staff are excellent, much better than other care homes that I have visited, and the cleanliness and general activities are also excellent There is lots of conversation and informal activity between residents who freely move around the home to chat to their friends in other parts of the home and they also make good use of the gardens to walk, meet and chat. The management of this home show a strong commitment to training and developing staff, which means that the residents benefit from their skills and knowledge. The registered persons, manager, and senior care team, have put in place quality and monitoring systems, which actively involve residents, relatives and staff across a number of areas of the home, including how care is provided, menus, activities, and the environment. This inspection was conducted with full co-operation of the senior care supervisor, staff and residents. The atmosphere through out the inspection was relaxed and friendly. The Inspector would like to thank staff, and residents for their hospitality during this inspection visit. Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? The majority of the previous 40 requirements are met or partly met and 1 good practice recommendation has also been met. Each person or their representative now receives written confirmation that the home is able to meet all of their needs. Everyone is offered the opportunity to make introductory visits, with outcomes and decisions about visits fully recorded on residents individual case files. This demonstrates that people have good information and opportunities, to make decisions about where they will live. The way the home plans each persons care has improved with very detailed and specific written information providing staff with clear guidance about each persons needs and preferences. At this visit additional areas needing fuller detail have been discussed. Health care assessments are good, with detailed measures in place to minimise risks of falls and risks involved in moving and handling people. There are also records on each persons file, showing that there is good access to specialist medical, chiropody and dental care. The results from all three GP surveys are very positive about the way this home meets residents healthcare needs, which indicates the good relationships between the staff and health care professionals. The homes system for the management and administration of residents medication has been improved in a number of areas, though as a result of this visit there are additional minor improvements needed, so that residents are safeguarded as far as possible. The registered manager has taken action to explore the comments made by some residents and relatives in the homes own quality assurance surveys and residents meetings, relating to minor problems with the laundering of residents clothing. The registered manager and staff have created an environment, where comments and concerns are welcomed as an opportunity for the home to improve and a comment from a relative states, the manager and her staff are always helpful and answer any concerns I have. The registered manager, as part of the monitoring systems in the home has started to put in place audits of all areas the premises. As a result improvements to the internal décor, fixtures and fittings and the exterior of the home continue to be made. For example new carpets and flooring have been installed in the Hagley unit, making a safer and attractive environment for residents. The manager also prioritises the decoration and refurbishment of residents bedrooms. The laundry area has been reorganised and has improved infection control measures in place, though the home has been advised to contact the Health Protection Agency for their opinion as to whether further work is needed. Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is good. The home has an up-to-date statement of purpose and service user guide. This has the effect that residents and their advocates have good information regarding their rights and entitlements, any agreed restrictions and how care will be provided. The home uses comprehensive assessment tools, which means that residents’ needs are thoroughly assessed to ensure that care needs will be met. The home actively encourages introductory visits and there is evidence to demonstrate that people have been given the opportunity and time to make decisions, which are right for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is evidence from the service user surveys and sample of residents case files assessed that all residents have a clear contract, with fees and rights and responsibilities documented. However the contracts contain some terminology, Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 11 which is out of date, for example referring to the National Care Standards Commission instead of the Commission for Social Care Inspection. The registered persons should also take account of the Office of Fair Trading publication relating to contracts in care homes and the revised Care Homes Regulations when reviewing the homes contracts and terms and conditions of residency. From discussions and observations there is evidence that all prospective residents and families have an invitation to visit before coming to live at the home. There is documented evidence that three new residents admitted in March, April and June 2007 have been offered the opportunity to visit the home. The dates of visits made to the home by them or their relatives are recorded, together with additional information in each persons file. The sample of residents case files examined demonstrates that the registered manager records for each resident and their family confirmation that the home can meet their assessed and identified needs. There are currently 24 residents accommodated at the home. Discussions with the senior care supervisor and assessment of the pre inspection information supplied by the home, indicates an awareness that if and when residents deteriorate and they may need care, which the home is not able and not registered to provide, they are supported to access a more appropriate placement. The staff show that they are aware of residents needs, and there are improved records of each residents preferences such as rising, retiring, likes and dislikes, which reduces risks posed by reliance on verbal communication between staff. Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, Quality in this outcome area is good. The improved care planning, risk assessments and monitoring provides staff with the information they need to satisfactorily meet residents needs. There is good multi disciplinary working taking place on a regular basis, which results in the health needs of residents being well met. The home has made good progress to improve the arrangements for administration of medication, which safeguards residents health and well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident has a comprehensive care plan, with evidence of the involvement of residents and their families where appropriate, in the development and review of the plan, which demonstrates good practice. Residents and relatives confirm their involvement in developing the plan and receive feedback on decisions made during reviews. The sample of three care plans examined during the inspection include all essential information necessary to plan the individuals care and there are a range of risk assessments in place. All care plans generally include beliefs, contact with Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 13 relatives, physical abilities, healthcare & personal care needs, mental health and communication. Two plans contain photographs of the person and good information about preferred daily routines. The senior care supervisor explained the omissions from the third residents plan stating that she had originally come to the home for respite short stays, and the home does not complete the care plans, risk assessments and health screening tools in the same way as permanent residents. Information must be robust for the care of any resident accommodated by the home. Generally care plans include information about how care needs will be met for example, level of assistance, prompts, and monitoring. There is generally satisfactory evidence that information and changing actions appear on care plans. However one of the residents notes indicated that diabetes has recently been diagnosed, and guidance about care for this condition is insufficient in the care plan, which should, for example, include fuller information about this persons skin, eye and foot care. In addition, though there is good evidence of GP involvement, from notes indicating on 2/8/07 GP visited regarding the recent diagnosis, requires no further action at present and states she may continue to exercise choice relating to her liking for sweet foods, there is no action to discuss the risks with her. It is recommended that the home puts in place a disclaimer to show she understands and wishes to take the risks, with this managed as part of care plan. Another residents case file has comprehensive pre admission information completed, and includes, medical history, sight, hearing, communication and dietary needs, including the need for a 1000mls fluid restriction each day because of low sodium levels. Staff state that this is now not required, however there is no documentary evidence to show how or when this decision was made and this residents needs are not reflected in her care plan in sufficient detail. Although there is good observational evidence that there are a wide range of activities available the information in pre-assessment notes is not always translated into the care plan. For example it is indicated that a resident recently admitted would like to continue attendance at the Age Concern day centre, there is no reflection of activities in the care plan. Similarly it is recorded in pre-admission information that a recently admitted residents likes to go out to lunch twice weekly, which is not reflected in the social section of the care. All three care plans sampled contain evidence that they are audited monthly, signed & dated by key worker. One contains comments from the family, son is very happy with care his mother is receiving and has no concerns or issues regarding his mothers care. Two residents files have good written evidence of a range of risk assessments, dependency levels, for falls, for moving and handling, Waterlow tissue viability Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 14 and nutritional assessment, one person has a history of falls, 2 prior to admission, and the falls risk assessment and moving & handling assessments are recorded as low. These have been discussed with the senior care supervisor on duty and they have reviewed and updated during the visit, to more accurately reflect the residents needs. The manager and staff are proactive in seeking professional advice on health care issues, always acting upon it and generally able to access the aids and equipment recommended. The comments from the GP surveys and from visiting district nurses are very positive about relationships with staff at this home. There is documentary evidence that all residents have appropriate access to dentists, opticians, chiropodists and other community services. A relative states, the home strives to find anything that helps my mother to be comfortable. The home has a comprehensive medication policy, accessible for staff guidance, which has been assessed as satisfactory by the CSCI Pharmacy Inspector since the last inspection visit. Staff involved in medication administration have received accredited medication training and demonstrate a good awareness of the use and effects of medications in the home. Medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. There are just 3 gaps on MAR sheets where there is no signature or code to indicate whether medication has been administered or not. There are currently five residents who wish to administer some or all of their own medication. The home now has systems in place to support this to happen safely, including risk assessments. Where medication systems are in need of improvement action, there is confidence that the registered person is working to achieve the improvements. For example minor improvements are required as a result of this inspection, for example, as previously indicated records of medication administered need to be fully recorded on MAR sheets, whether it has been given or not with a code to denote the reason. The home has a new pharmacy provider and while it is positive there has been a meeting to resolve initial issues, there are no records of the pharmacy support or reports of audits undertaken. It is recommended that a request be made to the supplying pharmacy for a copy of the contract it holds with the home and for regular audit visits and reports. The staff must also record carried forward balances of medication on MAR sheets to enable accurate audits of stocks to take place. From observations and discussions there is evidence that staff are aware of the need to treat residents with respect and they consider personal dignity when delivering personal care. The home arranges for residents to enjoy the privacy of their own rooms any time they wish. The residents say that are happy with the way that the staff deliver their care and show them respect. Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. There are planned and spontaneous activities available on a which give residents opportunities to take advantage of and stimulating activities. Residents cultural and spiritual needs majority of residents are able to maintain good contact with regular basis, develop socially are well met. The family and friends. Dietary needs of residents are well catered for with a balanced and varied selection of food that meets residents tastes and choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is evidence that the residents and relatives are able to discuss what makes them happy and make comments if they feel improvements can be made. Evidence from the CSCI residents and relatives survey forms and from discussions during the inspection visit indicates that staff listen and make genuine efforts to enable residents to enjoy a good quality of life. The home has a key worker system, which enables closer relationships between residents and staff, where likes, dislikes and needs are understood. There is improved evidence that Key workers use information to plan activities, Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 16 which residents will enjoy. There is a good level of activities, especially relating to residents with dementia or sensory difficulties. The activities and events are well advertised with imaginative pictorial images. Separate activities take place simultaneously each morning and afternoon on the Ibstock and Hagley units, each session and geared to the needs and preferences of the residents living in each area. The home provides a supply of communal newspapers, and this is obviously valued by the number of residents living at the home and members of staff use the news items as opportunities for discussion of local and world events. A member of care staff conducted a general knowledge quiz during the morning of the inspection, the residents really enjoyed participating in what is obviously a regular event, commenting that they could remember having a question before even if they could not remember the answer. The subjects of the quiz questions also generated lots of more general discussion. The home has an Aroma therapist who visits weekly to offer neck, back, hand and arm massages to those residents wishing to avail themselves of this service, in addition the home offers good opportunities for socialisation in the local community. Some residents had enjoyed a day trip to Weston-super-Mare in the week preceding this inspection visit. A number of residents enjoy outings, including holidays and weekends stays with members of their family. During discussions some people say that they prefer to spend their time on their own in their own bedrooms, with individual interests. The staff are well aware of individual residents decisions, which are respected and supported. There is evidence that family and friends of the residents feel welcome and know they can visit the home at any time. Visitors say that staff always make time to talk to them and share information. This is done with the agreement of the resident. During the tour of the premises it is evident that residents are able to have personal possessions in their room, though there may be some restrictions, for example larger items of furniture, which may be due to space restrictions or health and safety considerations relating to the residents bedroom. A number of residents have their own telephones, with large buttons, in their bedrooms. The home has menus, which are displayed. It is recommended that the home considers providing them in large print and pictorial formats to help residents with limited understanding to make meaningful meal choices. Residents are able to enjoy the flexibility of meal arrangements and can eat in their own room, or at a small table in one of the sitting rooms, if they wish. There are plentiful supplies of cool drinks, with easy access for residents, around the communal areas of the home and it is evident that staff willingly make drinks for residents at any time. The food is good quality, well presented and Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 17 generally meets the dietary needs of residents. The home generally does not offer a cooked breakfast and it is stated that there are no residents at present who wish to have a cooked breakfast and have generally refused eggs, which are offered on a Sunday mornings. On the day of this inspection visit the midday; cooked meal was braised lamb, mint sauce, potatoes, carrots and dark green cabbage, with fish in sauce as an alternative; and homemade pear and hazelnut flan and custard as a dessert. The meal appeared attractive and appetising and residents have been extremely complimentary, with enjoyment evident by the generally well cleared plates. The staff on duty during the inspection asked residents about their food preferences, before each meal time and are sensitive in their approach to help those residents who need help when eating. Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. Complaints are listened to and action is taken to look into them, and there are systems to record investigations and outcomes. Arrangements for protecting residents are generally satisfactory. Policies, procedures, guidance and staff training are in the process of implementation, which will provide residents with safeguards from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has complaints procedure displayed in the reception area and contained in the service user guide, which is also available in each residents bedroom. Information supplied as part of the pre-inspection questionnaire indicates that the home has not received any complaints in the previous 12 months. There are no complaints in the homes complaints log, however there is reference to a complaint, which it is stated has been investigated by the manager with satisfactory outcomes in the homes quality assurance file. There is evidence from the homes own surveys and residents meetings that concerns are raised and responded to effectively. It is positive that the registered persons strive to create the environment where people are able to raise small issues and have a satisfactory resolution, which then improves the care of the residents. Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 19 The results of the CSCI service users survey and discussions during the visit indicate that the majority of residents and all relatives are aware of how to raise concerns or use the homes complaints procedure. The home has not received any allegations relating to abuse of vulnerable residents in the past 12 months. Although the senior care supervisor states that the home has a copy of the multi-agency procedures for the protection of vulnerable adults, Safeguard and Protect at the home, not all staff are aware of it and there is no evidence to show that they have been given the opportunity and instruction to make themselves familiar with its contents. The registered persons must make sure that the homes policies and procedures to safeguard residents have been reviewed and updated to be generally in line with regulations and other external guidance. There is some evidence that training is being made available for all staff to be provided with appropriate adult protection training, however though some staff spoken to are able to discuss their awareness and knowledge of any action, which may be needed, at least 2 staff on the day of this inspection visit have not received the training required. Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,24,25,26 Quality in this outcome area is good. The significant and positive changes to the décor and furnishings are continuing. The incremental improvements contribute to creating a pleasing and pleasant environment for residents to live in. The grounds are very well maintained to provide a safe, pleasant and stimulating outdoor environment for residents to enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Oriel Care Home has a bright and cheerful interior, creating a warm and homely environment. The improvements to the exterior of the premises are continuing and include redecoration of the ground floor corridors on the Ibstock unit and rolling programme of residents bedrooms. The majority of requirements for repairs and redecoration issued at the last inspection have been acted upon and the home has a written redecoration and maintenance programme. A copy was given to the inspector during this inspection visit. Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 21 The tour of the building identified a small number of improvements needed, such as the compromised double-glazing units in the first floor bathroom, which is not yet included the program of redecoration and refurbishment. The senior care supervisor removed a bar of soap and nail brush from the first floor bathroom, following discussions highlighting that these items potentially harbouring bacteria, could be used communally by any resident and be a source infection. The senior care supervisor states that action will be taken so that bathrooms will be monitored to ensure they remain free from clutter or items, which may be used communally. A sample of bedrooms has been viewed, with the residents consent. Many are very pleasing, especially those recently refurbished with attractive decor, carpet, matching bed linen, curtains and thick, fluffy towels. Most residents have treasured personal possessions and many family photos displayed in their bedrooms. The garden project, of a block paved walk-way round the perimeter of the home, for which government funding was obtained, has been completed on the day of this inspection visit. The residents have shown great interest and are eager to try it out, with some residents taking advantage of the warm sunshine to stroll around the newly laid block paved path to enjoy a very colourful, well maintained garden. The overall cleanliness of the home if of a high standard and cleaning schedules are in place for bedrooms, bathrooms, and kitchen and laundry areas. The kitchen is well organised, clean and tidy. There are a number of improvements to the laundry, with redecorated walls, new flooring, a new sink for staff to wash their hands, and additional cupboards for secure storage. There is a new more efficient and environmentally friendly tumble dryer, and two new commercial washing machines, each with a sluice cycle. The senior care supervisor states that no sluicing by hand is now undertaken by staff. The homes main laundry, located in the basement has obviously been improved, however it is strongly recommended that opinion be sought from the Health Protection Agency as to the effectiveness of the homes infection control measures. During discussion residents indicate that they are comfortable, and the home is always clean, and well lit. The residents move freely around the home, using all communal areas as they wish, visiting between the Hagley and Ibstock units and make good use of the seating in the gardens. Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. Staff morale and confidence is good. The staffing levels mean that there are generally sufficient care staff and ancillary staff, ensuring that residents have care, support and needs for stimulation met. The staff recruitment processes are satisfactory, which provide residents with safeguards. The registered persons, manager and senior staff demonstrate a strong commitment to staff training, support and development. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are currently 24 residents accommodated, with a variety of dependency levels and diverse needs. From assessment of staffing rotas, observations and discussions indicate that the current staffing levels is adequate. The home is staffed with 6 carers on the early shift, 4 carers on the late shift and 2 wakeful night carers. There is a designated senior carer on all shifts and the registered manager is supernumerary to the care hours. There are a small number of comments from the CSCI questionnaires indicating that there may be occasions when there are not enough staff or that staff are busy or rushed, which should be explored during residents meetings. Assessment of the pre-inspection questionnaire submitted, staff files and staffing rotas during the visit show that 11 staff have left the homes employ, since the last inspection visit in October 2006 and all positions have been filled. Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 23 Generally staff have left for valid reasons, such as university, nurse training, relocating, though the senior care supervisor states some new staff have only stayed a short time after recruitment, not realising what the job entailed or how much training and responsibility is involved. The home does have a core of very loyal, long serving staff. One person has worked at the home for 21 years, another 15 years and others with more than 10 years service. There is evidence that 18 of the 30 care staff have achieved an NVQ level 2 or above care award, with 4 candidates registered and commenced on NVQ 2 training and 2 senior carers have commenced NVQ 3 at Dudley College. This means that the home is able to demonstrate that it meets the ratio of 55 of care staff with an NVQ 2 (or equivalent) award, which enhances the care and support for the residents. A sample of staff files and recruitment processes have been examined. The documentation and management of staff personnel files is satisfactory to the credit of the homes administrator and manager and generally robust recruitment processes are in place, which provide safeguards for residents living at the home. The registered persons and management team demonstrate a strong commitment to staff training and development, together with support measures such as structured supervision. From the sample of staff files examined there is documented evidence that they have participated in recorded supervision sessions. During discussions staff say that they find the sessions useful and helpful. The manager is in the process of implementing the homes an annual training plan and individual staff training profiles. There are some gaps in the required training, particularly for some new staff and staff working irregular patterns. The senior care indicated that a few staff are reluctant to attend planned training, even when allocated a place on the course, notably training relating to safeguarding residents. She states that the management will be writing to staff and ensuring action is taken to make staff are suitably trained in all areas and able to provide residents care needs safely. Staff spoken to demonstrate that they are knowledgeable about residents needs and how to meet them. There is a warm and genuine rapport with both residents and visitors. Staff spoken to say they feel that morale is good and that they feel supported, valued and are aware of their responsibilities, what is expected of them. Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 37, 38 Quality in this outcome area is good. The home has effective management systems providing good leadership and direction, which ensures continuity and consistency. There are systems for resident consultation at Oriel Care Home, and there is evidence that efforts are made to ensure that residents’ views are continually sought and acted upon. The improvement in the standards of record keeping and health and safety compliance at this home now provides protection for residents from risks of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager, Jane Linford, was off duty for the day of this inspection, though she called in during the morning. She has NVQ 2, 3, 4 and Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 25 the Registered Managers Award (RMA). Kerry Hipkiss, the senior care supervisor has on duty throughout the inspection and has been efficient, knowledgeable and helpful. The registered provider has also visited the home during the inspection. The registered manager has started to implement a quality assurance system, which includes feedback from residents and relatives, stakeholders in the community, and in which staff feel they have ownership. The commissioning of Dudley MBC has monitored progress and the home reports that they are satisfied with the homes efforts. The collated results of the annual residents, relatives questionnaires are used to make improvements to the services provided. Staff and residents meetings take place regularly, with minutes posted on notice boards. The home has an annual development plan and the registered providers make the required Regulation 26 visits to the home and reports of monthly unannounced visits relating to the conduct of the home are made available to the home, registered proprietors and the CSCI office, Halesowen. Discussions have taken place relating to the new Regulation requiring the home to submit an annual AQAA on request by the CSCI and it is recommended that the registered manager proactively obtain a copy in advance to become familiar with the contents. The home generally recognises that it is particularly important to receive monitoring, feedback and support for its continued improvement to achieve satisfactory compliance with required standards and to be able to provide evidence to the CSCI. The homes administrator states that the home does not have any dealing with residents finances. There are significant improvements to records keeping, which include comprehensive pre-admission proformas, personal profiles, care plans, risk assessments, tissue viability assessments, falls risk assessments, nutritional assessments, and medication records. The West Midland Fire Service has inspected the home on 2 November 2006 and the report shows one requirement to review and update the homes fire risk assessment annually. The home has also recently been inspected by Dudley MBC health & safety / food safety officers. There was only one requirement for the chef to evidence his completion of intermediate food safety training, which has been provided. Food safety is maintained to high standards at this home. The random assessment of a sample of health and safety and service maintenance records examined shows that they are generally satisfactory. Though the testing of portable electrical equipment is overdue and there is no evidence on site of a documented asbestos risk assessment. The documents to provide evidence of compliance should be forwarded to the CSCI office. Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 26 Mandatory training is provided for the majority of staff commensurate with their roles in a rolling training programme. There are some gaps where new staff do not have all required training, including a recently appointed senior night care supervisor, who has also only had one recorded supervision session. It is particularly important that staff with overall responsibilities are adequately trained, supported and supervised to ensure residents are safeguarded. There have been 7 recorded accidents involving residents, however there are a number of incidents, which have been logged relating to residents in their case files, these should be included in an effective system for auditing, analysing and evaluating accidents / events involving residents, to highlight risks and trends, with effective measures implemented. Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X 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 2 3 X 2 X X 3 3 2 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 2 2 Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement The registered persons and manager must ensure that care plans are expanded and developed to provide more specific guidance for conditions such as diabetes, hypertension, and heart failure. It is the home’s responsibility to notify the CSCI when this requirement is met. 2. OP7 15(1) The registered persons and manager ensure that comprehensive care plans, risk assessments and health screening tools are in place for all residents, including those people the home accepts for short stay respite care. It is the home’s responsibility to notify the CSCI when this requirement is met. 3. OP15 17(2) Sch4 (13) The registered persons and manager must clarify with the medical advisers whether the need identified in the DS0000063620.V333136.R01.S.doc Timescale for action 01/11/07 01/11/07 01/11/07 Oriel Care Home Ltd Version 5.2 Page 29 assessment notes for a fluid restricted diet of 1000 mls daily is still required for one resident, and update the care plan accordingly. It is the home’s responsibility to notify the CSCI when this requirement is met. 4. OP18 13(6) The registered persons and manager must ensure that all staff have attended training and have a good awareness regarding the protection of vulnerable adults and it is strongly recommended that all staff are given time supported within the supervisory framework to read and sign Dudleys multi-agency procedure Safeguard and Protect and other policies such as whistle blowing It is the home’s responsibility to notify the CSCI when this requirement is met. 5. OP26 13(3) The registered persons and manager must contact a health protection agency and seek the opinion of the infection control nurse specialist regarding the suitability the refurbishment carried out in the laundry. It is the home’s responsibility to notify the CSCI when this requirement is met. 6. OP38 13(4)(c) 18(1)(a) The registered persons and manager must ensure that all staff receive health and safety/ risk assessment training to deem them competent in dealing with DS0000063620.V333136.R01.S.doc 01/12/07 01/12/07 01/12/07 Oriel Care Home Ltd Version 5.2 Page 30 and ensuring compliance with health and safety and to undertake risk assessments. It is the home’s responsibility to notify the CSCI when this requirement is met. 7. OP38 23(4)(a) The registered persons and manager must ensure that the radio, TV and lamp in bedroom 8 are PAT tested. (Timescale of 03/11/06 is Not Met) The registered persons and manager must ensure that the overdue checks of all portable electrical equipment are completed, together with any remedial action, as priority It is the home’s responsibility to notify the CSCI when this requirement is met. 8. OP38 13 (4) The registered persons and manager must ensure that risk assessment for the use of bedrails is expanded to include the provision of bumpers, the risks of entrapment, and the need for regular recorded checks on the bedrails It is the home’s responsibility to notify the CSCI when this requirement is met. 01/10/07 14/09/07 Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 31 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 OP2 Good Practice Recommendations That consideration should be given to reviewing and updating the contracts and terms & conditions of residence to include up to date terminology, for example Commission for Social Care Inspection, and take account of the guidance issued from the Office of Fair Trading regarding Care Homes Contracts It is recommended that the pre-admission information is also signed by the resident/relative as well as the manager to demonstrate their involvement and agreement That carried forward balances of medication stocks should be recorded on the MAR sheets That a request is made to the pharmacy provider to carry out regular medication audits and provide written reports to the home That the record have complaint in the homes quality assurance file be relocated to the homes complaints log and that in future all complaints be logged with details of a complaint, investigation, and action That replacement of the compromised double glazed windows in the Ibstock first floor bathroom are included in the homes refurbishment programme, with an estimated cost and timescale That any outstanding mandatory training is prioritised for supervisory and new staff, within the homes training programme The registered persons and manager should ensure that all staff, especially supervisory staff are up to dated with all policies and procedures, and in receipt of formal supervision meetings with a minimum of six sessions in any 12 month period. DS0000063620.V333136.R01.S.doc Version 5.2 Page 32 2. OP3 3. 4. OP9 OP9 5. OP16 6. OP19 7. OP30 8. OP36 Oriel Care Home Ltd 9. OP38 That monitoring arrangements are implemented to maintain effective infection control measures throughout the home, including checks that bathrooms do not have communal bars of soap and nails brushes, which may be a source of bacteria The registered persons and the manager should ensure that there is documentary evidence within the home that the homes fire risk assessment has been updated and satisfactory to the West Midlands Fire Service It is strongly recommended that all incidents, which have been logged relating to residents are collated together with accident records and a documented accident analysis should be undertaken on a regular basis to highlight risks and trends 10. OP38 11. OP38 Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-56 Stephenson Street Birmingham B2 4UZ 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 Oriel Care Home Ltd DS0000063620.V333136.R01.S.doc Version 5.2 Page 34 - 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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