Inspection on 14/11/05 for Orione House

This inspection was carried out on 14th November 2005.

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

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

Other inspections for this house

Orione House 02/07/08

Orione House 18/12/07

Orione House 18/04/07

Orione House 29/08/06

Orione House 08/06/05

Orione House 11/02/05

Orione House 23/08/04

Orione House 18/12/03

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Orione House 12-14 Station Road Hampton Wick Kingston-upon-Thames Surrey KT1 4HG Lead Inspector Sharon Newman Unannounced Inspection 14th November 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orione House DS0000017385.V265512.R01.S.doc Version 5.0 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. Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Orione House Address 12-14 Station Road Hampton Wick Kingston-upon-Thames Surrey KT1 4HG 020 8977 0754 02089770105 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) The Sons of Divine Providence Ms Ursula Harrison Care Home 34 Category(ies) of Dementia - over 65 years of age (7), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2), Old age, not falling within any other category (34) Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th June 2005 Brief Description of the Service: Orione House is a purpose-built care home owned by the Sons of Divine Providence. They are a Catholic Missionary Order of Priests, Nuns and Brothers who welcome all faiths to their Homes. Personal care is provided for thirty four service users. Accommodation is provided in single rooms. The home is situated in a residential area close to Hampton Wick Station and local shops. There is a large conservatory to the front of the home which leads to a garden and car park. At the rear of the house is an enclosed garden with flower beds, mature trees and a pond. A chapel is situated in the garden which is for use by all service users at Orione House. Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Inspection Team: Sharon Newman Jeremy Howe Regulation Inspector Pharmacy Inspector One Regulation Inspector and a Pharmacy inspector conducted this inspection on 14th November 2005. The Registered Manager was present throughout the inspection and staff, service users and their relatives were also spoken to. Records examined included care planning documentation, health and safety information, and staff files. A tour was taken of the premises. The manager and staff were friendly, open and professional and the inspectors were made welcome. Nine requirements have been made including two immediate requirements which were made at the time of inspection. One immediate requirement concerned cleaning solutions (COSHH) that had been left in an unlocked room and the other concerned medication issues which are highlighted in the main body of the report. A relative commented that the ‘staff are lovely and friendly and ‘always welcoming.’ They said that they would ‘recommend this home.’ Feedback from service users was positive with many reporting that they enjoy living at this home. What the service does well: This home continues to promote a relaxed and friendly atmosphere and good care is provided to the service users. Staff were observed to have a very good rapport with service users. The staff were seen to be caring and conscientious and service users choice was respected. There is a strong emphasis on providing good spiritual care at this home. The large garden is beautifully maintained and remains an asset to the home; it also contains a chapel for the use of service users, relatives and staff. The conservatory is attractive. The manager is competent and experienced and continues to provide good support for the staff. Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 6 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. Orione House DS0000017385.V265512.R01.S.doc Version 5.0 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 Orione House DS0000017385.V265512.R01.S.doc Version 5.0 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): 1. 2. 3. 4. Service users continue to be provided with comprehensive information about the home to enable them to make decisions about their care. There are appropriate procedures for the assessment and admission of service users. Assessments are thorough and this attention to detail ensures service user needs are met EVIDENCE: As stated in the previous inspection report a comprehensive Service User Guide is in place in the home and this is presented in an organised folder. It contains a location map and information about the Sons of Divine Providence. Other information contained within this documentation includes: the philosophy of care, a standard contract, a Statement of Purpose and the complaints procedure. The Statement of Purpose contains information about: the home’s aims and objectives, facilities and services, staffing, admission criteria and social activities. Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 9 The complaints procedure and the last inspection report are displayed on notice boards around the home. Contracts were in place for three service users whose files were examined. The manager is experienced and competent and reads widely to ensure she keeps up to date with developments in care. Full assessments are carried out by the Manager prior to a prospective service user being admitted, and they are invited to visit the home or undertake a trial stay prior to choosing to live at the home. Orione House DS0000017385.V265512.R01.S.doc Version 5.0 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. The health needs of service users continue to be well met with evidence of good multi-disciplinary working taking place. Personal support in this home is offered in such a way as to promote and protect service users privacy and dignity. On the day of the visit errors in medication recording and poor arrangements for the appropriate administration of creams were found that might have an affect on the welfare of residents. The home has arrangements for the ordering, storage, recording and auditing of all other medication and has access to a pharmacist for advice. EVIDENCE: The manager reported that the home has a good relationship with their local GP surgery. She said that District Nurses visit service users at the home to provide health care. She also said that the hearing aid service/audiology at Kingston Hospital benefits the residents at the home as it is very efficient and always provides prompt service. Evidence was seen in service users files of input from healthcare professionals. Three service users files were sampled at this inspection visit. They were seen to be comprehensive and information is gathered using a systematic approach based around the activities of daily living, their likes and dislikes were also Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 11 recorded. This documentation was seen to be updated on a monthly basis. Risk assessments were in place for issues including risk of falling. However, where a service user had been identified as using their wheelchair for most of the time there was no risk assessment in place to support this. The written medication policies and procedures were not reviewed on this visit. All medications administered by staff along with the records relating to receipt, storage, administration and disposal of medication were examined. The person in charge was interviewed, fourteen resident’s rooms checked and all medication not supplied in the monitored dosage system was counted and compared with the record of receipt and administration. From these observations and discussions in nine instances creams were found in residents’ rooms that were not written on the administration record. In one of these instances two creams were found with no label and it was not clear the cream was for that particular resident. In two instances there was no record of administration of creams written on the administration record. In one instance cream for one resident was found in the room of another. In one instance the recording of the administration of medication did not indicate whether the correct dose of medication had been given. The amount of medication agreed with the amount that should be in stock for all instances except for one service user where the quantity of medication carried over from one month to the next had not been recorded making it difficult to check if all the medication had been given correctly. Five other items were found in the cupboard in the medicines room that were no longer prescribed. One of these had expired. The manager stated that they conduct audits of medication and records following an earlier incident. No records are made of these audits. All other records had been completed accurately and provided evidence that all medication had been administered correctly, medication was stored and administered safely. Only appropriately trained and designated staff administer medication. Service users were seen to be treated with dignity and respect by the staff during this inspection visit. Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 12 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 Service users are supported to pursue a range of activities and are encouraged to maintain contact with friends and family. They are offered a choice of wellprepared, wholesome food and are supported by staff to exercise choice and control over their daily life. EVIDENCE: A designated activities officer works at the home from Monday to Fridays for five hours each day. She said she has completed two activity training courses and found them very helpful to her role. She displayed a very good knowledge of the service users and their likes and dislikes. Activities on offer include: painting, crosswords, bingo, reminiscence therapy and craftwork. The activities officer stated that they sometimes work with service users in groups and also undertake individual activities with them. She reported that, weather permitting; outings to the local park are arranged the home has a minibus that can be used for these occasions. Service users can also watch films, which she said a group of them enjoy doing. She stated that she arranges service user meetings at which they may discuss any issues or put forward suggestions. One lady spoken to said they ‘like reading and playing bingo.’ She was seen to be reading a magazine at the time of inspection and said she found the contents very interesting. Another was observed drawing pictures. A relative spoken to said that there are now ‘more activities’ on offer at the home. The Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 13 activities officer reported that a Christmas party was being planned to which relatives are also invited. As reported in the previous inspection report a hairdresser visits the home weekly and some service users choose to visit hairdressing salons outside the home. Weekly and evening Mass takes place and service users may choose to participate. Three service users were observed to remain in their wheelchairs during the inspection visit. The inspector discussed this with the manager who said that this was the service users choice. However, detailed risk assessments must be in place and these must demonstrate the involvement of the service user and health and social care professionals. The menu was seen to be displayed on a large menu board in the dining room. The lunch looked nutritious and good-sized portions were offered to service users. Lunch was seen to be taken in a relaxed atmosphere and staff were observed sitting with service users and tactfully helping those who needed assistance. Tables were attractively laid and service users chatted to each other and to staff members. Food was seen to be served at the tables enabling service users to choose their portion sizes. One relative commented there is ‘always plenty of food’ and a service user reported that ‘the food is good.’ Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 14 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. There is an appropriate complaints procedure and this is accessible to service users. Complaints are investigated fully in accordance with this procedure. Service users rights are protected and systems are in place to protect service users from abuse. EVIDENCE: The home has adopted the Local London Borough of Richmond Protection of Vulnerable Adults Policy and also has it’s own organisational abuse policy. There is a whistle blowing policy in place. A complaints procedure is in place at the home and there is a well organised complaints log available. Details of complaints and the outcomes were seen to have been fully recorded. There have been no complaints since the previous inspection. As stated in the previous section on Daily Life the issue of risk assessments was discussed with the manager at the time of inspection. These must be put in place. Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 15 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. 20. 21. 24. 25. 26. The environment at this home is comfortable and homely. However, attention needs to be paid to ensuring standards of cleanliness are addressed. The large mature garden is beautifully maintained and the attractive conservatory is an asset to the home. Service users live in a safe, well-maintained environment. Their bedrooms are comfortable and they have their personal possessions around them. EVIDENCE: Standards of cleanliness have declined since the previous inspection visit. This was brought to the attention of the manager at the time of the inspection visit. Areas within the home were seen to require cleaning including: dusty extractor fans in WC areas, some surfaces and window ledges were again very dusty, a bath did not appear to have been cleaned and contained grubby marks. Linoleum flooring in several bathrooms and WC’s throughout the home was seen to be marked and stained and should be replaced. A broken chest of drawers was observed to be stored in a bathroom and these must be removed. Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 16 As reported in the previous inspection report there is a spacious and attractive conservatory which is situated to the front of the building, it contains a small feature fountain and leads into the lounge area which has a homely atmosphere and contains a fish tank, book cases, plants and ornaments. A cold water dispenser can be found in the conservatory. There is a large and bright dining room that is situated next to the kitchen and leads out to the garden. A relative spoken to at the inspection visit commented that ‘the dining room is a lovely room.’ The large garden is well maintained and contains a pond and mature shrubs and trees. A secluded area to the side of the garden contains a grotto shaded by trees where open air Mass can take place. A chapel for the use of staff, service users and their families is situated across the garden. Relatives spoken to at the time of inspection complimented the home on the garden and how well it is maintained. Bedrooms were seen to be clean, comfortable and well personalised to individual taste on the day of inspection. Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 17 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 Staff are enthusiastic and committed to delivering high standards of care and they demonstrated a good knowledge of service users needs and displayed a conscientious attitude to their work EVIDENCE: A relative stated that the staff do not regard working at the home as ‘just a job’ and were ‘a dedicated group of carers.’ Another relative stated that the staff are ‘lovely and friendly’ and ‘kind and caring.’ Many staff were seen to have a good rapport with service users and to interact positively with them. Monthly staff meetings are taking place and are fully recorded. Issues discussed include: issues at the home, care of the service users, staff duties and computer training. Four staff files were examined and contained most of the information required by Care Homes Regulations however all four files did not contain contracts of employment. All staff files must contain contracts. Evidence was seen to suggest that not all staff are up-to-date with mandatory training such as moving and handling or food hygiene. All staff must be up-todate with this training. Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 18 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. 32. 33. 36. 37. 38. The manager is experienced, enthusiastic and suitably qualified, her management style is open, inclusive and positive. She provides clear direction and leadership within this home and continues to demonstrate a good understanding of any areas needing improvement. EVIDENCE: As reported in the previous inspection report the manager is experienced and has been at the home for over 12 years. She achieved the NVQ Level 4, is an NVQ assessor and works closely with the local college. She keeps herself upto-date by reading on a wide range of care and social issues. A service user spoken to said that ‘the manager is lovely.’ Another service user commented that they ‘like the manager’ who ‘is very good.’ The manager said that having a computer, fax and photocopying facilities is of enormous benefit to her in her role. Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 19 The manager said that the first aid box checks were not being carried out regularly and she would address this issue. Hot water checks are being carried out weekly, however temperatures were seen to be variable with some recorded at 47 to 49 degrees centigrade. Hot water temperatures must not rise above 43 degrees centigrade. Fridge and freezer temperatures were seen to be recorded daily and checks for gas safety, five yearly electrical installation, portable appliance testing and water disinfection were in order. Fire drills are being held regularly. Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 20 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 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 x x 3 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x 3 3 2 Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 21 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 OP9 Regulation 13 (2) Requirement The Registered Person must ensure that: 1. Appropriate arrangements are in place for the safe administration of creams. Immediate Requirement 2. The registered person must ensure that the administration of all medication is recorded accurately. Immediate Requirement 2 OP9 13 (2) The Registered Person must ensure that arrangements are in place for removing items that are no longer prescribed or have expired. 15/11/05 Timescale for action 15/12/05 3 OP14 12(1) The Registered Person must (2)(3)(4)1 ensure that service users are 3(7) given the opportunity to be seated in chairs rather than wheelchairs. Wheelchairs must not be used as a form of restraint. Any decision for a service user to remain in their wheelchair must be based on DS0000017385.V265512.R01.S.doc 01/12/05 Orione House Version 5.0 Page 22 4 OP19 23(2)(b) & (d) 19 (4) Schedule 4 5 OP29 6 OP30 18 (1) 7 OP38 13 (4) 8 OP38 13 (4) 9 OP38 13 (4) their wishes and should be subject to advice from relevant health care professionals. (Previous timescale of 01/05/05 not met) The Registered Person must ensure that all maintenance issues outlined in Standard 19 of this report are addressed. The Registered Person must ensure that staff files contain all the information required in Schedule 4 of the Care Homes Regulations 2001. (Previous timescale of 30/04/05 not met) The Registered Person should ensure that staff training is upto-date. Refresher training must be provided for staff as required with regard to Manual Handling, First Aid and Food Hygiene. The Registered Person must ensure that all COSHH items are kept locked away securely and do not present a hazard to service users. Immediate Requirement issued at the time of inspection. The Registered Person must ensure that hot water temperatures do not exceed 43 degrees centigrade. The Registered Person must ensure that the first aid box is checked monthly. 01/02/06 01/01/06 01/02/06 14/11/05 01/12/05 01/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000017385.V265512.R01.S.doc Version 5.0 Page 23 Orione House 1 2 Standard OP9 OP9 It is recommended that the quantity of medication carried over from one month to the next be recorded on the administration record. It is recommended that all records of all audits by the manager be recorded. Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Orione House DS0000017385.V265512.R01.S.doc Version 5.0 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!