Inspection on 18/04/07 for Orione House

This inspection was carried out on 18th April 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

Orione House 02/07/08

Orione House 18/12/07

Orione House 29/08/06

Orione House 14/11/05

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 09:30 18th April 2007 and 1st May 2007 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.V335307.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. Orione House DS0000017385.V335307.R01.S.doc Version 5.2 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 020 8977 0105 manager.orione@sonsofdivine.org 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 (8), 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.V335307.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th August 2006 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. Fees range from £452 per week for a single room and £483 per week for a single room with ensuite facilities. Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit was carried out over two days. Two regulation inspectors visited the home on the first day and one regulation inspector returned to the home for a second day. A pharmacy inspector also visited the home and will send out a separate report with their findings. The manager was present on the first day of the inspection and was spoken to at length. Records examined included care planning documentation, staff records, medication records and health and safety information. A tour was also taken of the premises. Two members of the senior management team were also spoken to during the course of the inspection. The manager also completed an Annual Quality Assessment Assessment (AQAA) which is a self assessment survey. Staff members, residents and visitors were spoken to during the inspection. Surveys were left for residents, relatives and health professionals to complete and return. Four were returned from relatives and three from residents before this report was completed. A letter was also received from a relative this was very positive about the home and praised the manager and the care given. Some concerning issues arose during this inspection visit and these were discussed with the management team at the time of inspection. One issue was that staffing levels may be insufficient to meet the needs of the residents. There are also many issues relating to poor recording of information in the residents care plans. These concerns are discussed in the main body of this report. Some positive comments about the home were received from relatives. One commented that they ‘feel so much happier now’ that their relative ‘is settled and content again.’ What the service does well: All residents and visitors spoken to spoke highly of the manager. She is also well respected by staff. The garden is beautiful and is well maintained. It also contains a chapel for the use of residents, relatives and staff. The conservatory is attractive and remains an asset to the home. There is a strong emphasis on providing good spiritual care at this home. Some residents said that they liked the food. Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Recording of information in assessments and care plans needs to be improved to ensure that residents are not placed at risk and that their needs can be met. Residents should be encouraged to exercise choice in their lives and their wishes should be recorded and respected. Where residents choose to smoke or to remain in wheelchairs then their wishes must be documented and appropriate risk assessments need to be in place. Activity provision for the residents must be increased and their likes and dislikes need to be taken into account and fully recorded in their care plans. These need to be more person centred and relate more to each individuals needs. Staff training needs to improve and staff need to be up-to-date in areas including moving and handling, first aid, infection control and abuse awareness to ensure that residents are not paced at risk of harm. Staff also need training in the area of continence care to ensure that residents needs are properly assessed. The home must ensure that appropriate permanent staffing levels are maintained this is to ensure that residents are not placed at risk and their needs can be met. Communication between staff at the home needs to improve to ensure that the home is run in the best interests of the residents. The home must improve in the area of health and safety. Staff need to be aware of safe food and kitchen hygiene practice and all staff involved in the handling of food must have training in this area. Also, cleaning materials must not be left unattended. When they are not in direct use they must be kept locked away securely to ensure that residents are not placed at risk of harm The home needs to ensure that it informs the Commission for Social Care Inspection of any events affecting the health and well being of the resident. Hot water temperatures must remain below 43 degrees centigrade to ensure the safety of the residents. Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 7 There are still areas within the home that require redecoration and this is discussed in the environment section of the report. 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. Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments are carried out but are not detailed enough to ensure that a residents needs can be fully met. EVIDENCE: There is a ‘Service Users Guide’ in place to help residents and relatives decide if this home can meet their needs. It contains a location map and information about the home. Other information contained within this documentation includes: the philosophy of care, a standard contract, a copy of the home’s Statement of Purpose and the complaints procedure. As stated in the previous inspection report the ‘Statement of Purpose’ contains information about: the home’s aims and objectives, facilities and services, staffing, admission criteria and social activities. A discussion took place with one of the management team regarding an issue raised by residents spoken to during the inspection. This was regarding a lack Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 10 of choice at mealtimes. They reported that this was due to the type of religious home this is and waste would not be tolerated. If this is the case this needs to be stated in the Statement of Purpose to ensure that prospective residents are fully aware of this when deciding whether to come to the home. Residents admission information did not contain much detail. Areas of the assessment sheets had been not been completed for some residents. Where information had been completed it was often not detailed enough to ensure that residents needs can be met. For example for one resident in the orientation section it stated ‘normal.’ Information seen for a new resident on their assessment form was incomplete. The risk assessments had not been completed and there was no assessment of their continence or a falls assessment. This individual was spoken to during the inspection visit and it was noted that much information about their interests and previous life was not included in their assessment. This does not allow staff to draw up an individual care plan that can meet their needs. The home is aware of the shortcomings in the recording of information at the home. The self assessment survey about the home that was completed by the manager stated that ‘there is a lot of room for improvement in many aspects of our record keeping’. Feed back received about the home was largely positive. A relative wrote that their family member ‘had improved immensely’ since coming to this home. They also reported that they are given the opportunity to speak to their relative whenever they telephone the home. A resident wrote ‘ that they had received enough information’ prior to moving into the home. They also commented that they receive the support and care that they need. A relative wrote that the home ‘maintains the dignity of the residents’ and that their relative was ‘always clean and well-dressed.’ Another relative stated that ‘If I mention something they will act upon it.’ Another relative commented ‘I am generally happy with the home and would raise any concerns with the manager and CSCI (Commission for Social Care Inspection) if required. One wrote that staff deal with ‘a variety of situations with kindness plus practicality’. They also commented that they and their friends are ‘amazed’ at how their relatives ‘state of mind has improved’ since being at this home. Many residents spoken to at the time of inspection also commented about how busy the staff are. Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service have access to healthcare services, however poor recording of information in the care plans may affect the health care of the residents. Staff do not deliver person centred care. EVIDENCE: The care plans seen at the home during this inspection contained only basic information about the needs of the residents. Some terminology used in the care plans was found to be inappropriate. For example: ‘can be difficult’ and ‘very practical about clothing.’ Another entry read: ‘hard to please’ and another stated: ‘complains a lot about not eating but we monitor’. These are subjective and could be seen as offensive in some cases. Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 12 On the front sheet of each care plan there is a ‘description of resident’ section. It is unclear what this section is for as it contains varying information depending on which member of staff has completed it. The descriptions are sometimes inappropriate and sometimes don’t make sense. This section needs to be completed consistently by all members of staff to help ensure that residents needs can be met. From observations at the time of inspection and from the information contained within the care plans it was noted that care at the home is not person centred and is very task orientated. The care plans are often not completed with the resident. Staff need to ensure that they sit down with the residents when completing their care plans to ensure that their individual needs, interests and likes and dislikes are documented. One daily entry stated that an individual was upset because a friend had died. There was no further information about how this person was supported nor anything to acknowledge how difficult this might be for the person. Another daily entry stated that a resident was lonely and the only support offered was to offer them a radio. There was no other detail about how this resident might be supported. An entry in another resident’s notes reported that they had to remind staff about their birthday – the following day. It is concerning that information important to the residents is not know to the staff. A care plan for one individual stated ‘assist and support’ them ‘at all times.’ However this was not observed to happen at the inspection visit. It was also unclear what assistance and support they required, no action plan had been written to suggest how to meet their needs. Although some of this documentation was seen to be updated on a monthly basis some had not been. All care plans must be updated monthly to ensure that any change in need is documented and appropriate action taken. One resident’s daily notes record a headache on several consecutive days. There was no evidence of follow up or action other than administration of painkillers. There was also no evidence of GP involvement. The self assessment survey completed by the manager indicated that nineteen residents have issues with continence. However, there was a lack of information regarding the continence of residents in the care plans seen. More detailed assessment is needed in this area and evidence of liaison with continence specialists needs to be recorded. The minutes seen from the staff meeting minutes also suggests that staff require training in this area. This document indicates ‘high levels of urinary infection’ at the home. All staff must observe strict hygiene practices to help prevent infection and observe for signs of urinary tract infection. The appropriate medical advice must be sought for each individual and this must be recorded clearly in their care plans. Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 13 A relative wrote that staff deal with personal care needs ‘with tact and sensitivity.’ Where residents choose to remain in their wheelchairs a detailed risk assessment must be in place to show that this is the resident’s choice. These must demonstrate the involvement of the resident and health and social care professionals. Staff reported that one individual was sitting in a wheelchair that they have not been assessed for. All residents who wish to remain in wheelchairs should have an appropriate assessment by an occupational therapist to ensure that they are not placed at risk of harm from the use of an unsuitable wheelchair. Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Little consideration is given to supporting people’s individuality or social preferences. Many staff do not talk or interact with individual residents or respect their rights. EVIDENCE: The activities co-ordinator was not on duty during the first day of inspection and no activities were organised by the staff on duty. The chairs in the main lounge were positioned around the walls which does not help to create a homely atmosphere. There were no snacks or fruit available. Also it was a warm day and no one was offered a drink apart from during the tea round. There were no planned activities and the staff did not spend time with residents. The TV was left on although most residents were not watching this. No one was offered a choice of a different channel or music or to watch a DVD. No one was consulted about the channel the TV was on and it remained on the same channel at throughout. One resident was reading a book and one person was reading a newspaper. No one else was doing anything and there Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 15 was only very limited conversation. For most of the morning there were no staff present in the room although they would occasionally walk in. At one point a staff member sat next to a resident. They did not engage in conversation or offer any support to any residents. Many residents spent most of the morning with their eyes closed or looking out into the centre of the room. On the second day of inspection the activities co-ordinator was present and organised a bingo game for some of the residents. No other activities were organised for the other residents. The activities co-ordinator spoke of the difficulty in trying to arrange activities for all of the residents some of whom do not wish to participate. Whilst residents choice to not participate must always be respected, the home should look at more creative ways of encouraging residents to participate in activities that they enjoy. All staff need to see it as part of their role to sit down and speak to residents and to take part in activities with them. One resident spoken to commented that ‘there should be staff in the lounge to look after the residents’ they said that staff are ‘too busy.’ Another said ‘staff do their best but they are too busy.’ One individual who kept trying to get up from their chair was told to ‘sit down’ by passing staff members. Where interests have been identified in the care plans there is little detail and no evidence in the daily reports that staff have supported people to pursue interests or discuss them. The self assessment survey completed by the manager acknowledges that there is room for improvement in the area of activity provision at the home. A relative wrote ‘I would like to see more activities and for residents to spend time out of the home.’ They also said ‘I believe residents are somewhat isolated from the outside world.’ One resident wrote ‘I do not want to join in any activities – I am not that sort of person.’ And that this is respected at the home. One resident said ‘I have no choice when to get up – I have to get up when the carers come around in the morning.’ They also said ‘I do what I am told.’ All residents must be given the opportunity to rise at a time more convenient to them. As stated in the previous inspection report there is a strong emphasis on religion at this home, weekly and evening Mass takes place and residents may choose to participate. Some residents spoken to said that they enjoy attending Mass. A hairdresser visits the home weekly and was observed to be visiting during the inspection visit. Some residents choose to visit hairdressing salons outside the home. Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 16 One resident reported that they had enjoyed a recent concert that had been performed by a visiting theatre company. Another reported that they ‘would like more outings – particularly in the summer.’ They said ‘we have a minibus but I never go out in it.’ One resident said that they had attended an exercise session at the home recently and had enjoyed this. Many residents commented that they can have visitors when they like. One visitor said he is not restricted in the time they wished to visit the home. Another also reported that they visit their friend whenever they wish. One individual’s care plan states that they does not wish to transfer into a dining chair at meal times. On the day of the inspection a staff member told them that they had to sit in a dining chair. Other residents were told the same thing. It is best practice to allow people to sit in dining chairs and not stay in their wheelchair. However if residents chose to remain in their wheelchairs their wishes should be respected. The appropriate risk assessment be completed and consultation with health professionals, such as an Occupational Therapist should take place and be documented. There were no menus displayed on the tables and although the menu was recorded on the white board at the entrance to the dining room, a large number of people were heard asking what was for lunch. Also, some of the staff did not know the answer when residents asked. The home should look at other ways of making this information more accessible to residents so that they are aware of what is available at mealtimes. Some residents reported that they ‘liked the food’. However many commented on the lack of choice of food. One said ‘what they call a choice I wouldn’t like.’ Another stated ‘the food is edible but there is a lack of choice.’ Another said ‘the food is good but there is not a lot of choice.’ However one reported that their vegetarian choice is respected and ‘the food is good.’ Staff brought a metal jug of drink around to the resident’s tables. Some residents had a choice between two different drinks although they could not see what these were because of the metal jugs. Others did not get a choice and were just poured a drink. Jugs were not left on the tables for people to help themselves. People were only offered squash and not water or an alternative drink. Staff topped up some drinks without speaking to residents and in one case filled the glass so full that it would have been difficult for anyone to pick it up without spilling it. The staff leaned across residents to pour other people’s drinks. On one table drinks were poured for residents before they arrived at their places. This does not demonstrate individual and person centred care. Residents should be offered a choice of drinks when they sit down at the table. Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 17 All food was plated up by kitchen staff and residents were not given a choice of portion sizes or vegetables. Gravy was poured on at the kitchen and residents were not given a choice. All residents must be given a choice so that their wishes are respected. Their likes and dislikes must be taken into consideration. There was salt and pepper on the tables but no other condiments. One table was given a dish of vegetables for people to help themselves. No other tables were given vegetables. On the table with the vegetables one resident helped themselves. The other resident was having soup and the vegetables were left on the table with no lid on whilst they were having their soup so that they were cold by the time their main course arrived. The resident was told to hurry their soup by a member of staff because the vegetables were getting cold. A relative commented on the positive interaction between staff and residents at mealtimes. ‘I love to sit and watch the interaction at mealtimes. So many warm smiles, touches and friendly banter…’ However interaction seen between staff and residents during the inspection was poor. The staff stood around watching people eating and did not engage in conversation with residents. No members of staff sat with residents to offer support. Several different members of staff walked up to residents and cut up their food and then walked away with no consultation. One person was very slow at eating. Throughout the meal different members of staff walked up to this person and placed food on their fork then put it in their hand. They did not speak to them and stood behind them so that the resident couldn’t see them and then walked away again afterwards. The staff seemed impatient with them and did not seem to accept that they were just eating their dinner very slowly. If this resident needs additional support this must be documented in their care plan guidelines should be in place to demonstrate how to support them at meal times. Plates were taken away without consultation with residents. One person looked as if they had not finished but had just put their fork down, they were still chewing a mouthful of food. This is not acceptable, residents must be given time to finish their food and shown respect. Residents meetings are held three monthly and the activities co-ordinator reported that most do not attend. The frequency of these meetings must be increased to ensure that residents wishes are taken into consideration regarding the running of the home. Orione House DS0000017385.V335307.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 poor. This judgement has been made using available evidence including a visit to this service. Residents may be placed at risk due to poor recording of important information in the care plans. A lack of staff may also place residents at risk of harm and prevent their needs being met. Poor moving and handling techniques could place residents and staff at risk. Not all staff are up-to-date with training in the protection of vulnerable adults. EVIDENCE: The manager reported that no complaints have been made since the previous inspection visit. She reported that the home tries to prevent small issues becoming complaints by dealing with anything raised immediately. A relative wrote that ‘I have raised some minor concerns and they have been dealt with.’ Another wrote ‘Most queries are dealt with quickly and staff are ready to listen and respond.’ One resident raised a complaint during the inspection. The issues raised were regarding their choice not being respected. The home has been asked to investigate these matters using their complaints procedure. Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 19 During the inspection visit it was noticed that one resident had visible bruising. A staff member reported that this resident had fallen and they believed this had caused the bruising. However although a fall was documented in the ‘falls log’ it stated that the resident ‘was unhurt’. No bruising relating to this incident was documented in their care plan or daily notes. All bruising and injuries must be fully documented and the appropriate advice must be sought from a healthcare/medical professional. There was also no evidence that protection of vulnerable adult procedures had been followed in this instance. On at least four occasions during the inspection visit residents were observed to be calling out for help and there were no staff available to see to their needs. The inspectors had to alert staff on each occasion. All residents spoken to during the visit reported that staff are very busy. One resident commented that they did not like it when there were no staff in the lounge area as they were worried about other residents falling over. It was also logged in the residents meeting minutes that this issue had been raised by a resident and was supported by other residents. However, there was no evidence of any follow up to suggest that any action had been taken. There must be sufficient numbers of staff on duty at all times to ensure that residents needs can be met. Poor moving and handling of residents was observed during the inspection. At one point a staff member took a resident, who appeared unsteady on her feet, by the hand and led them by walking in front of them and pulling. The staff member did not communicate with the resident. Also, staff supporting people to move and to use a wheelchair did not speak to the residents either for conversation or to tell them what they were doing. Staff must use appropriate moving and handling techniques to ensure that residents are not placed at risk of harm. A training log indicates that many care staff have attended training in the protection of vulnerable adults. However it indicates that some staff have still not attended training in this area and that some staff attended training up to three years ago. All staff must receive training in the protection of vulnerable adults to ensure that residents are not placed at risk. Orione House DS0000017385.V335307.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, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The large mature garden is beautifully maintained and the attractive conservatory remains an asset to the home. Areas within the home need redecoration. There are areas including the toilets and bathrooms which do not look homely or attractive. EVIDENCE: The lounge area has a homely atmosphere and contains a fish tank, book cases, plants and ornaments. It leads into a spacious and attractive conservatory which is situated to the front of the building and contains a small feature fountain. There is attractive furniture in the conservatory area and it also contains a cold water dispenser. A relative commented on the ‘spacious environment’ at the home. They also felt the garden and conservatory were good. Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 21 The home has a large, well maintained garden and many residents commented what an asset it is to the home. Residents were observed to sit out in the garden. On the first day of inspection the floors in the bathrooms and toilets were found to be marked and stained. Sealant around several sinks was blackened and two toilet cisterns were stained and marked. All of these areas require repair and redecoration. Some of the bedrooms were also seen to require redecorating. In one room the wallpaper was peeling away from the wall, there were scuff marks to the walls, stains on the floor and metal showing through the wall. This did not look homely or attractive and must be redecorated. On the second day of inspection it was noted that work had begun to address some of these outstanding issues. However the requirements remain outstanding and will be checked at the next inspection to ensure that they have been met satisfactorily. In one residents’ bedroom there was a broken set of drawers which must be replaced. In the home self-assessment survey completed by the manager she commented ‘our home is in need of lot of improvements at the time of this report.’ Also, a relative wrote ‘ The décor and fixtures (furniture) are rather dated.’ Although the general hygiene of the home was satisfactory, kitchen hygiene needs to be addressed and this is discussed in the management section of this report. Orione House DS0000017385.V335307.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 poor. This judgement has been made using available evidence including a visit to this service. Insufficient staffing levels are impacting upon the care of the residents and do not allow staff to provide person centred care. Good staff pre-employment checks are in place to help protect the residents from harm. There is not enough evidence of up-to-date staff training which could have an affect on the care of the residents. EVIDENCE: An issue raised with the manager and senior management during this visit was staffing levels. This was because on some occasions it was observed that there were no staff available to supervise residents. Also residents commented upon staff being too busy. The manager reported that there are staff vacancies at the home and they are trying to cover these vacancies with agency staff at present. She said the home is recruiting more staff. One senior manager showed me two prospective staff files to demonstrate that the recruitment process is under way and said that these members of staff are due to start Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 23 soon. The home needs to ensure that there are sufficient numbers of trained staff on duty to meet the needs of the residents. Staff members spoken to reported that they did not have enough time to complete the care plans and carry out other duties due to ‘lack of staff.’ One said ‘there is a lack of staff all the time.’ A relative did comment positively on the ‘staff consistency’ at the home in relation to management and key workers. In the self assessment survey completed by the manager she acknowledge that the home ‘could improve upon levels of permanent staff and training.’ A discussion took place during the inspection with members of senior management who reported that they were recruiting new staff members. Four staff files were looked at and contained the necessary pre-employment checks and evidence of criminal record checks. CRB checks were also seen to have been carried out on two prospective staff members. Staff reported that training ‘was good’ at the home. However there was insufficient evidence at the time of inspection to demonstrate that staff are upto-date in mandatory areas such as food hygiene, first aid or moving and handling. Training records must be kept up-to-date to ensure that there is evidence that all care staff are up-to-date in these important areas. One relative wrote about the staff that ‘there is a warmth and affection evident in the relationships and understanding of the problems related to old age.’ Orione House DS0000017385.V335307.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, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is well respected but there is poor communication between management and staff which is affecting the running of the home. Staff supervision has improved, this helps to make sure that staff have the support they need to carry out their roles. EVIDENCE: The Manager reported that they will be leaving the home this year. Senior management reported that interviews were being held that week for the post of the new manager. They reported that they would involve residents and relatives in this process. Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 25 The manager said that she felt there was ‘poor communication between senior management, management and staff.’ The issues of poor communication between staff was seen to be recorded in the staff meeting minutes. The manager and senior manager were very open and honest about the communication and staff issues at the home. However these need to be addressed so that the care of the residents is not affected. The manager also reported that the home has tried to address further issues with staff through staff training. Many residents spoke highly of the manager. One said ‘she does well in adverse circumstances.’ Another said ‘she is lovely if I was worried I would go to her’ A visitor commented ‘she is down to earth and approachable.’ One relative wrote ‘that the manager ‘is responsible for the positive impact Orione House’ has had on their family member. The manager reported she was not consulted about the government grants being offered to older people services and feels that any proposal regarding spending the money should be in consultation with residents. Although the home has now started to hold relatives meetings there was no evidence of recent quality assurance measures such as sending surveys out to relatives and health professionals for their comments about the home. Also residents meetings are not held regularly enough. The views of the residents need to be sought regarding the running of the home. Staff reported that all the residents’ finances/ monies are kept separately and that they do not look after any of their individual finances. Records seen in staff files indicated that one-to-one staff supervision is taking place regularly and staff reported that they felt supported. Regular supervision helps to ensure that staff have the support and direction that they need to carry out their roles. Hot water checks are being carried out weekly, however as found at the previous inspection visit temperatures were seen to be variable with some recorded up to 47 degrees centigrade. Hot water temperatures must not rise above 43 degrees centigrade. Some temperatures were also recorded as being low at 35 degrees centigrade. Also it was not clear from the records which temperatures relate to which baths. These records must be clearly labelled to ensure that the records relate directly to the individual bath/water outlet that has been checked. Checks were seen to be in up-to-date relating to portable appliance testing, gas safety, legionella testing and electrical installations. This helps to ensure the safety of the residents and staff. Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 26 Staff serving food in the kitchens were not wearing hats or aprons. One member of kitchen staff (man clearing tables) was wearing a dirty apron. This is unacceptable, all staff going into the kitchen or serving food must wear the appropriate clothing to ensure that food hygiene standards are met and the health and safety of the residents is not placed at risk. Also the self assessment completed by the manager indicates that a policy is not in place for ‘Hygiene and Food Safety.’ Several instances were recorded in the home’s ‘Falls log’ where the Commission for Social Care Inspection (CSCI) had not been informed of events that affected the well being of residents. The Commission for Social Care Inspection (CSCI) must be notified of all events that affect the well-being and safety of the residents. A bottle of toilet cleaner was found in an unlocked sluice. This was brought to the manager and domestic staff managers attention and was removed immediately. Bottles of cleaning substances must not be left unattended and must be locked away securely when not in use to help to ensure the safety of the residents. All staff must be aware of Coshh (Control of Substances Hazardous to Health) procedures. Orione House DS0000017385.V335307.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 X X 2 X X 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 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 3 X 2 Orione House DS0000017385.V335307.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 OP3 Regulation 14 (1) Requirement Full assessments of need must be completed by a suitably qualified person for all residents. This is to ensure that all needs are fully assessed and a clear care plan can be drawn up from this information. All care plans must be kept under regular monthly review. This will help to make sure that the residents needs are regularly reviewed and any change in need is documented Previous timescale of 01/10/06 not met. Residents’ care plans must include information on social, health and personal care and all identified needs. It must state how these are to be met. All care staff must receive training in continence care. This will help to ensure that staff can meet the needs of residents in this area. Advice about continence issues must be sought from a suitably trained individual such as a continence nurse specialist. DS0000017385.V335307.R01.S.doc Timescale for action 01/07/07 2 OP7 15 (2) 01/06/07 3 OP7 15 (1) 01/07/07 4 OP8 12 (1) 18 (1) (c) 01/08/07 5 OP8 13 (1) (b) 01/07/07 Orione House Version 5.2 Page 29 6 OP12 16 (m) (n) 7 OP14 12 (2) (3) 8 OP14 12(1)(2)( 3)(4)13(7 ) 9 OP18 13 (6) 10 OP18 13 (4) Individual residents must be referred for assessment when needed. This is to make sure that residents needs in this area are properly assessed and they receive the most suitable treatment or intervention. A full activity programme must be put in place to meet the needs of the residents. Residents must be consulted regarding their preferred activities. This is to ensure that their wishes are taken into consideration and are respected. Residents must be allowed to exercise choice and control in their daily lives in relation to all their health and social care needs. Residents must be 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 their wishes and should be subject to advice from relevant health care professionals. (Previous timescales of 01/05/05 and 01/12/05 and 01/10/06 not met) All staff must receive up-to-date training in abuse awareness and adult protection procedures. This is to ensure that staff are aware of the correct procedures to follow and what constitutes abuse. (Previous timescale of 01/11/06 not met) Where residents have sustained injuries or bruising these must be fully documented and the appropriate health and social care professionals must be informed. Appropriate medical DS0000017385.V335307.R01.S.doc 01/07/07 01/06/07 01/06/07 01/07/07 01/05/07 Orione House Version 5.2 Page 30 11 OP18 13 (5) 12 OP19 23(2)(b) & (d) 13 OP27 18 (1) (a) 14 OP30 18 (1) 15 OP31 12 (a) (b) 16 OP33 37 17 OP33 24 (3) advice must be sought immediately and fully documented. The home must make suitable arrangements for the safe moving and handling of residents and ensure that training in this area is put into practice. This is to ensure that residents are not put at risk from poor practice. All maintenance issues outlined in Standard 19 of this report are addressed. (Previous timescale of 01/12/06 not met). Sufficient numbers of trained and experienced staff must be on duty at all times to meet the needs of the service users. This is to make sure that residents are not placed at risk of harm and their health and social needs can be met. (Previous timescale of 01/10/06 not met). All care staff must receive up-todate training in areas including first aid, moving and handling. This is to ensure that residents are not placed at risk due to out dated practice. (Previous timescale of 01/02/06 and 01/01/07 not met). Communication between all staff and management within the home must improve. This is to ensure that important information is shared to help meet residents needs. The Commission for Social Care Inspection must be notified of all events that affect the well being and safety of the residents. A full quality assurance system needs to be implemented. The views of residents and relatives must be taken into consideration. This will help to DS0000017385.V335307.R01.S.doc 01/06/07 01/10/07 01/06/07 01/08/07 01/06/07 18/04/07 01/10/07 Orione House Version 5.2 Page 31 18 OP38 13 (4) 19 OP38 13 (4) 20 OP38 13 (4) 21 OP38 13 (4) ensure that they contribute to the running of the home. Hot water temperatures must not exceed 43 degrees centigrade. This is for the safety of the residents. (Previous timescale of 01/12/05, 01/09/06 not met). Cleaning products must not be left unattended. All materials hazardous to health under COSHH guidelines must be locked securely away. This is to ensure the safety of the residents. All staff must receive up-to-date training in food hygiene. This is to ensure that hygiene standards are maintained and people who use the service are not placed at risk. All staff entering the kitchen or handling food must observe satisfactory standards of kitchen hygiene. To help make sure that people who use the service are not placed at risk from poor hygiene practice. 18/04/07 18/04/07 01/06/07 18/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP14 Good Practice Recommendations The home should consider consulting residents with regard to meal choice at the home. Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Orione House DS0000017385.V335307.R01.S.doc Version 5.2 Page 33 - 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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