Inspection on 18/12/07 for Orione House

This inspection was carried out on 18th December 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 18/04/07

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 18th December 2007 07:20 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.V356320.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.V356320.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 Lydia Davis 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.V356320.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th April 2007 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 £559 per week for a single room and £592 per week for a single room with ensuite facilities. Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of this service included an unannounced visit to the home on 19th December 2007 by two regulation inspectors, a pharmacy inspector and an expert by experience. The expert by experience is a person who because of their knowledge of services visits a home with the inspection team to help us get a picture of what it is like to live in the service. The new manager, and a senior manager were available for discussions about the service. We also spoke to some staff and residents. A new manager has been appointed since the previous inspection visit and reported that she is committed to making improvements. The manager and staff were welcoming and helpful throughout the inspection. Documentation looked at included medication records, staff recruitment information, residents care plans and health and safety documentation. We also looked at the premises. We sent surveys to the home before this visit for staff and the people who live at this home to complete and return to us. Four were returned from staff and twenty-one from residents before this report was completed. Feedback at the time of inspection and from the returned surveys was largely positive about life at the home. What the service does well: What has improved since the last inspection? Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 6 A new manager and deputy manager have been appointed. The new manager is committed to making improvements in some important areas. Regular residents’ meetings have been introduced. Residents’ relatives are also invited to attend. The manager is committed to attending these meetings and to addressing any issues raised. Two lounge areas on the first floor have been combined and refurbished to create a larger, more welcoming area. Staff training has improved and there is now a training programme in place for 2008. The home now notifies us of any events which may affect the well-being of residents. All cleaning products were seen to be locked away securely. This helps to ensure the safety of the people who live here. Food hygiene standards have improved. 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. Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. 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. Residents are assessed before they come to live at the home but the assessments seen are not detailed enough to ensure that residents needs can be met. EVIDENCE: We were informed that there had been four residents admitted to the home since our previous inspection. We looked at these assessments and they did not contain much detail. One was largely written in pencil and some sections in all of them had not been completed. We could not see how effective care plans could be drawn up from these assessments. This was discussed with the manager and she reported that she had not started working at the home when these assessments were carried put. However, the manager reported that she has introduced new assessment documentation which she showed to us. She stated that she was aware that Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 9 this documentation needed to be improved upon and that this is an area that she has begun to address. She said that she is committed to ensuring that any prospective residents now have a thorough assessment before moving into the home and that the home does not admit people whose needs it cannot meet. The manager visited a prospective resident on the day of inspection to carry out a needs assessment. The home responds appropriately when residents’ needs change. The manager provided evidence that she had asked the local authority to carry out a review for one resident following a significant change in need. The manager also said that she plans to arrange assessments by occupational therapists for residents who have poor mobility. The manager reported that residents may visit the home prior to coming to live here. An information pack is given to potential residents to help them to decide if the home can meet their needs. It contains a copy of the complaints procedure and details about the fees, services offered and the philosophy of care at the home. Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. 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. Care plans do not contain enough detail to show how residents needs can be met. Residents dignity and choice is not fully respected. The storage of medication may place residents at risk. EVIDENCE: A new care planning system is being introduced but this is in the very early stages of development. New plans for four residents were checked. All but one of these contained just a ‘personal profile’. The care plans did not contain risk assessments, moving and handling assessments, daily notes or information about healthcare or individual care preferences. Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 11 The personal profile format states, “The information in this profile is to be used in such a way that carers are able to deliver the highest quality care to the residents and in a way that is tailored to his or her needs”. However the quality of information on personal profiles was brief and lacking in any meaningful detail. When asked to identify residents’ preferred activities, two of the profiles checked recorded none. In a third profile, staff had entered, “I can do any hobbies because I can see”. Later on the same page, when asked whether the resident likes to read a newspaper, staff had entered, “I can’t see I am blind”. Where profiles did identify activities that residents enjoy, there was no evidence that they have the opportunity to participate in these. For example one resident’s profile stated that they would like to go shopping in Kingston on a one-to-one basis with their keyworker and identified several places they would like to visit. Another resident’s profile identified that they would like to go shopping “with my carer”. However there was no evidence that the residents had had the opportunity to do these activities. One resident’s care plan contained a risk assessment regarding the use of bed rails. The assessment stated that the rails were in use to prevent the resident “from getting out of bed during the night to use the commode”. If the resident needs to use the toilet during the night, this should be enabled, not prevented by the use of bed rails. There are three waking night staff available to support residents at night. The inspector checked the previous care plans for four residents, as the new documentation was so brief. These did contain daily notes but the quality of recording was inconsistent and sometimes poor. Entries such as “Had a good night, no changes” and “Seems to be fine” give no meaningful information about the resident’s care. In addition care plans did not always demonstrate that residents received appropriate treatment when necessary. For example one resident’s care plan recorded that “she is awaiting admission to hospital for assessment” but there was no evidence that the hospital admission had been made. The home must be able to demonstrate that medical needs receive an appropriate response. A healthcare professional had recently made an assessment of moving and handling practice. The healthcare professional’s report concluded that the home does not employ enough staff to ensure that correct moving and handling procedures are followed by staff when transferring residents. The healthcare professional also found in his assessment that residents are made to use the commodes in their rooms rather than en suite bathrooms or communal toilets so that staff can leave them there while they attend to other Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 12 residents. This practice must cease and residents must be supported to use appropriate toilet facilities. The healthcare professional’s report indicated the necessary ratio of staff to residents at different times of day to ensure safe moving and handling procedures and that the dignity of residents is maintained. The home must ensure that these ratios are met. The medication room was found open and unattended. A medication fridge and medication storage cupboard were open in the room. This presented a potential risk to residents as the medication room is on the ground floor close to areas that are well used by residents. Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The range of activities offered needs to improve and should reflect residents choice. Residents are helped to maintain contact with relatives and friends and they are given a chance to have their say in the life of the home through relatives and residents meetings. EVIDENCE: Although the home employs an activities co-ordinator the activities on offer have not improved much since the previous inspection and this was discussed with the manager. She reported that she is aware of this and it will be addressed. There was no weekly activity rota available so residents are not aware of what activities are on offer throughout the week. Also, there was not enough evidence in the care plans of how residents’ choice in relation to activities is put into practice. The manager reported that the organisation is looking to employ another activity co-ordinator. Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 14 Residents’ meetings have been introduced every three months. Residents’ relatives are also invited to attend. The manager is committed to attending these and to addressing issues raised by residents and relatives. The expert by experience reported that they spoke to three residents in the lounge in the afternoon. One had been in the home for two weeks. They liked the home’s Catholic ethos. Another resident had been in longer. They had been very involved with their local Church and had chosen the home because of the Catholic ethos and the twice-weekly mass in the home (which had happened that morning). They usually went to church on Sunday along with other residents, some in wheelchairs and some walking as it is very near. They also went out some Sundays with relatives. The expert by experience also reported that another resident in the lounge was “staring straight ahead most of the time. The very large TV was on with no sound and music was playing on the (music) system.” The music was to one residents choice as it was their favourite singer. The expert by experience thought it rather loud but said that “perhaps it needed to be.” They also spoke to a resident who had just had their hair done. The hairdresser was collecting people regularly for this. They had made appointments beforehand. This resident was very articulate about the home, with mostly praise but some criticisms. (This was regarding a complaint which was seen by the inspection team to be well-documented in the complaint log). They also felt that some of the carers did not speak English very well and were not well-able to converse with the residents when carrying out tasks. The expert by experience pointed out that there may be local schemes of training for workers whose first language is not English which Orione House could use. The expert by experience wrote “From what I saw the interactions of the carers with the residents was good and those I observed seemed to talk about what they were going to do.” One inspector shared lunch with three residents. All the residents enjoyed their meals and said that the food provided by the home is good. Some residents needed support with eating and drinking during the meal. This was provided by staff but the practice observed should be improved. Staff communicated very little with the resident they were supporting and the interaction was therefore entirely task-oriented. The expert by experience also shared lunch with the residents and wrote that they “enjoyed the lunch, liver and bacon with carrots, broccoli and roast potatoes, not an easy dish to serve to large numbers. The vegetables were not overcooked and neither was the liver. There was a choice of fried cod. (One resident) asked for a small portion and got it. The residents were asked to choose once they were seated at the table. There was a choice of Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 15 blackcurrant or orange squash. I asked for water and a jug was brought. The jugs were glass, not metal, as previously, and I noted the tumblers were rather full, as last time. This was a problem for a resident who had shaky hands.” Comments received from residents in response to our survey were positive about the food at the home. One responded that the food was “good.” Another said “ I eat anything, I love my food,” another resident wrote “very good.” Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home takes complaints seriously and responds to issues raised. The home follows the local SOVA procedures to help ensure that issues raised are properly investigated. EVIDENCE: There is a complaints procedure in place which is pinned up at the home for relatives and residents to see and it is also included in the information sent out to potential residents. We looked at the complaints log which contained five complaints since the previous inspection and these all contained details of the action taken. The home follows the London Borough of Richmond’s Safeguarding Vulnerable Adults procedures (SOVA). It has referred some SOVA issues to the London Borough of Richmond this year using these procedures. The manager reported that the home takes any allegations very seriously and always contact the local authority for advice if they suspect and SOVA issues. Some issues were concerning unexplained injuries and poor use of equipment. The manager reported that the home has taken action to address these issues through their training programme and disciplinary procedures and evidence of Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 17 this was provided to us. An adaptations and equipment assessment has also been carried out by an external agency on 31st October 2007. The manager reported that the home is working to address the recommendations made in this assessment. We were also informed by a senior management representative that issues regarding the low numbers of permanent staff was being addressed as they were actively interviewing with a view to recruiting more permanent staff to help ensure that residents are not put at risk by insufficient numbers of permanent staff at the home. We have also received notifications of a significant number of falls and unexplained injuries to residents from the home since the previous inspection visit. In view of this and the healthcare professional’s report which concluded that the home does not employ enough staff to ensure that correct moving and handling procedures are followed by staff when transferring residents this requirement remains outstanding from the previous inspection. Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. 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 area is bright and remains an asset to the home. A programme of redecoration is needed throughout the home as some areas such as the corridors do not look homely. EVIDENCE: As stated in the previous inspection report 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. Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 19 There have been improvements in some areas of the home since the last inspection. The first floor lounge was in the process of being totally refurbished during this inspection visit and this is very positive. However one issue was highlighted concerning the new windows in this area. We were shown that they have the potential to open fully in one direction which could be a risk to the people who live here. They have window restrictors fitted to prevent them opening fully in another direction, however these can be unlatched which again may be hazardous. These must be assessed by a qualified individual to ensure that they are safe prior to the room being used by any residents. Some work has been undertaken to address the requirements set in the previous inspection report as the dining area has been redecorated and some of the bathrooms have had new flooring. However overall some of the building such as the corridors and some of the bathrooms and toilets have an outdated feel and the dark woodwork throughout the building does not look homely. Painting this in a lighter colour would improve the appearance of these areas. The organisation needs to ensure that it continues with a programme of redecoration to help ensure that the home provides a homely and pleasant home for the residents. Hot pipework was exposed in several bathrooms. Insulating foam had been used to cover pipework in other bathrooms, which was unsightly. There are double doors at the entrance to both the lounge and the dining room from the entrance lobby. Many residents were unable to open these doors and had to wait for staff assistance before they could enter either of the rooms. If these doors need to be kept shut when not in use for reasons of fire safety, they should be automatic so that residents have better access to the communal rooms of the home. The expert by experience found that “The rooms were all attractive and wellcared-for. They were all individually decorated with wallpaper, carpets and curtains chosen to match. Some of the rooms also had individual light fittings chosen by the resident. Most of the rooms had at least one piece of furniture, and some had most pieces, brought by the resident. All rooms had pictures and photographs, and some many, belonging to the resident. Some rooms were ensuite and the rest had a wash-hand basin and a commode, which was well-disguised as a chair. There were red call strings above the bed and in the en suite facilities where provided. All of these had knots in them presumably to get them to the right size but it would have looked tidier to cut them to the right size.” They also reported that “There were baths with chair hoists in each wing but only one wing had a shower room, with a chair for use under the shower.” We also noted the lack of shower facilities and this is another area that the home should look into as part of it’s programme of refurbishment. Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 20 They also wrote that they “walked across the garden to the chapel and looked in. It was lit and warm and someone was playing the organ so it was welcoming. The garden also is well-kept and had a number of plants with flowers.” The home was generally clean and hygienic at the time of inspection. Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There are insufficient permanent staffing levels which may impact upon the care of the residents and also does not allow staff to provide person centred care. Staff training has improved and a full programme is now in place. EVIDENCE: A member of senior management reported that they are aware that permanent staffing levels need to be improved and they are actively trying to recruit staff. They also told us that they would like to increase the number of night staff to three waking staff as opposed to the current rota of two waking night staff and one sleep-in member of staff. One member of staff stated during the inspection that they would not be able to complete their paperwork during their shift. A resident wrote “ The staff are good to me and they try to give me enough support although they are short staffed.” Another responded “the night staff are not available most of the time when you need them.” Four recruitment files were looked at for new members of staff. They contained most of the information required by law to help to ensure that the residents safety is protected. However none of them contained up-to-date colour photographs of the staff members and one did not contain evidence that the Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 22 staff member had not started work until their Criminal Record Bureau check (CRB) or POVA First check had returned. The manager reported that a POVA First check had been obtained prior to their start date at the home, however there was no evidence of this in their recruitment file. The manager and deputy manager have improved the recording of staff training. A review of all training is carried out each quarter and the impact of each session is assessed. The most recent quarterly review demonstrated that training provided in the last three months included communication, medication, first aid and the Protection of Vulnerable Adults. There is a training plan for 2008/9, which identifies the home’s training and development needs. The home’s training policy was reviewed in December 2007. The policy outlines the home’s commitment to supporting staff to undertake training, including National Vocational Qualifications. However the organisation expects staff to repay the cost of National Vocational Qualifications if they leave the home within a year of achieving them. There is a staff training record, but this needs updating as it currently does not provide an accurate record of which staff are still employed and which of those need refresher training. We discussed with the manager the need for staff to attend training in care planning and person centred care. This is to help improve the quality of the information in the care plans and for staff to realise the importance of person centred care. The manager said that many staff have attended training provided without charge by the London Borough of Richmond in the last six months, including the Protection of Vulnerable Adults, health and safety and moving and handling. Regular staff meetings are held to try to ensure that staff are up-to-date with current issues at the home and have a chance to air their views. Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 23 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 enthusiastic and committed. There are still many areas in this home that need to improve. However, the manager is working hard to make improvements. Financial procedures at the home need to be more organised. A quality assurance system that takes into account the views for residents and relatives is not yet in place. EVIDENCE: Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 24 The manager is relatively new in post and is committed to improving the service provided to residents. The manager aims to monitor standards of care practice and makes ‘spot checks’ at different times of day. A deputy manager has been appointed, with whom the manager said she has developed a positive working relationship. Some management responsibilities have been delegated to the deputy manager, such as managing the staff rota and staff training. Some residents manage their own finances. The home holds small amounts of cash for other residents for items such as hairdressing and toiletries. The manager said that clearer procedures have been introduced around residents’ finances. However further improvements must be made to practice in this area. For example there was no evidence that staff check residents’ cash balances against the expenditure recorded. Cash balances for three residents were checked. These demonstrated that each resident’s expenditure is recorded in a book and that receipts are kept. However two of the three cash balances did not match the balances recorded in the book. One resident’s actual balance was £20 less than that recorded in the book and another resident’s money was £10 less than that recorded in the book. This was discussed with the manager and she reported that money had been taken to purchase items for the residents, however this needs to be recorded to ensure that this is clear to anyone auditing or reading the accounts. The monthly self-audit which is sent to us each month is very detailed and gives an impression of an open culture as it includes details about areas that need to improve. 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. Checks were seen to be in up-to-date relating to gas safety, legionella testing and electrical installations. However there was no record of up-to-date portable appliance testing taking place this year and this needs to be carried out to help ensure the safety of residents and staff. Although there was evidence that fire drills take place there was not record to show how night staff are included in these drills. The home must include night staff in these practice sessions to ensure that they are aware of the action to take in the event of a fire at the home. Hot water temperatures are checked weekly and temperatures have improved. Only two were observed to be above 43 degrees centigrade. The manager reported that when this occurs the maintenance team immediately adjust the Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 25 temperature to that outlet. However there is no record of this – the entry just stated “too hot”. A clear log must be kept of the action taken and outcome. Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 26 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 27 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 to ensure that their needs can be met. Previous timescale of 01/07/07 not met. Residents care plans must contain sufficient detail to ensure that their needs can be met. This includes risk assessments and moving and handling assessments. The daily notes must be more detailed. 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. Previous timescale of 01/07/07 not met. The care plans must demonstrate how the identified needs or goals are being met. Residents care plans must demonstrate the action that has been taken in response to a medical need. If residents wish to get out of DS0000017385.V356320.R01.S.doc Timescale for action 01/03/08 2 OP7 15 (2) 01/03/08 3 OP7 15 (1) 01/03/08 4 5 OP7 OP8 15 (1) 15 (1) 01/03/08 01/03/08 6 OP8 12 (4) (a) 01/02/08 Page 28 Orione House Version 5.2 7 8 9 OP9 OP10 OP12 13 (2) 12 (4) (a) 16 (m) (n) 10 OP15 12 (4) (a) 11 OP18 13 (5) 12 OP19 23(2)(b) & (d) 13 (4) 12 (1) (a) 13 (4) 13 14 OP19 OP19 15 OP27 18 (1) (a) bed to use the toilet during the night they must be supported to carry out this activity and not prevented from doing so. The medication cupboards and fridges must be kept locked securely. Residents must be supported to use appropriate toilet facilities 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. Previous timescale of 01/07/07 not met. Staff must try to ensure that mealtimes are not task orientated and improve communication with the residents during this time. The organisation must ensure that there are sufficient numbers of trained staff to ensure the safe moving and handling of residents and make sure that training in this area is put into practice. This is to ensure that residents are not put at risk from poor practice and low staffing levels. The organisation must ensure that a programme of refurbishment and decoration continues throughout the home. The exposed pipework must be covered and the unsightly foam foam lagging must be replaced. The windows in the newly refurbished lounge must be assessed by an appropriately qualified individual to ensure that they do not present a risk to the residents. Sufficient numbers of permanent DS0000017385.V356320.R01.S.doc 01/02/08 01/02/08 01/03/08 01/02/08 01/02/08 01/04/08 01/02/08 01/02/08 01/02/08 Page 29 Orione House Version 5.2 16 OP29 19 (4) (b) Schedule 2 18 (1) (c) 24 (3) 17 18 OP30 OP33 19 OP35 13 (6) 20 OP35 13 (6) 21 OP38 13 (4) 22 23 OP38 OP38 13 (4) 23 (d) (e) staff must be recruited 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. Staff files must contain all the information required in Schedule 4 of the Care Homes Regulations 2001. Staff must receive training in care planning and person centred care A full quality assurance system needs to be implemented. The views of residents and relatives must be taken into consideration. This will help to ensure that they contribute to the running of the home. Previous timescale of 01/10/07 not met. The organisation must investigate the shortfall in residents monies and send a copy of the report to the CSCI. The organisation must introduce tighter procedures demonstrating regular checks on finances. Where hot water temperatures have risen higher than 43 degrees centigrade the action taken must be clearly documented. Portable appliance testing must take place and the certificate must be available for inspection. The fire drills must include night staff. 01/02/08 01/04/08 01/04/08 01/02/08 01/02/08 01/02/08 01/02/08 01/02/08 Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 30 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 OP19 Good Practice Recommendations The home should consider the use of magnetic door openers for the heavy fire doors at the home. This will enable the residents to travel independently around the home. Orione House DS0000017385.V356320.R01.S.doc Version 5.2 Page 31 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.V356320.R01.S.doc Version 5.2 Page 32 - 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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