CARE HOME ADULTS 18-65
Orla House Care Home Orla House 317 Mapperley Plains Mapperley Nottingham NG3 5RG Lead Inspector
Joanna Carrington Unannounced Inspection 16 February 2006 10:00
th Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 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 Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 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 Adults 18-65. 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. Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Orla House Care Home Address Orla House 317 Mapperley Plains Mapperley Nottingham NG3 5RG 0115 920 3754 0115 9267325 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) Mr J & Mrs M Dobbin & Mr S & Ms S Dobbin Mr Seamus Dobbin Miss Sinead Maire Aine Dobbin Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: Orla House is a care home registered to provide support and accommodation for up to thirteen adults with a learning disability. The home is a large detached property on Mapperley Plains, down the road from Mapperley and all its amenities. The communal space in the home is very comfortable and homely. As well as a separate lounge and dining room there is also a very pleasant smaller quiet room where residents can meet their family and friends in private. There are well kept gardens and parking to the front of the house and an attractive garden to the rear, which residents have access to. There is a small supermarket close by and the home has its own vehicle. Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over three and a half hours on the 16th February 2006. This was the home’s second of two statutory unannounced inspections for this financial / inspection year. The focus of the inspection was to follow up any requirements made at the last inspection and to assess the remaining key standards that must be assessed at least once over a one-year period. Therefore, it is recommended that this report be read in conjunction with the previous report. The main method of inspection was ‘case tracking’ which meant selecting three residents and tracking the care and support they receive through checking their records, discussion with staff and observation of care practices. No residents were spoken with at this inspection as all but one were out. Three staff files were also looked at in order to assess recruitment practices at the home. The manager / owner of the home plus another one of the four owners were available for discussion and feedback throughout the inspection. What the service does well: What has improved since the last inspection?
There have been some general improvements to records, which are important for promoting and protecting the health and welfare of residents. Further to
Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 6 the Social Services Adult Protection Investigation, the care plan for managing the named resident’s challenging behaviour has now been amended and updated. All residents now have care plans in place outlining how they are supported with their finances and safeguarded from financial abuse. All residents now have care plans on Promoting their health, which cross reference to other records that are used to monitor health, weight and record outcomes of appointments. In order to respect a named resident’s right to privacy it is now stated on their care plan for the use of a sound monitor for seizure activity when this sound monitor should and should not be used. 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. Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Prospective residents needs are assessed before they move to the home. EVIDENCE: There have not been any new admissions to the home for a while now. However, there was evidence seen that the placing authority’s community care assessment is obtained prior to any admission, in order to be sure that the home is appropriate in meeting an individual’s needs. For one resident case tracked an up to date community care assessment was also present on their file and the placing authority are involved in a multidisciplinary annual review of each resident, to ensure that the home remains as suitable in meeting their needs. Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 Care plans reflect individual residents needs and how these needs are to be met however to ensure that changing needs are identified care plans must be kept under review. EVIDENCE: As noted at the last inspection existing care plans provide useful and detailed information on how to meet individual residents’ needs and also give good insight into the individual personalities and the likes / dislikes of residents. The manager reported that a new format is going to be used for the presentation of care plans, which will enable the reviewing process and any amendments to care plans that are necessary. The review of some care plans is now overdue, as this should take place at least every six months, in order to identify any increases in needs and changes to how support is given and even, to identify where there are no changes and support plans remain the same. Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 16 and 17 There is a commitment to respecting residents’ rights and enabling them to access and be a part of the local community. Residents are offered a healthy and varied diet but improvements to recording will provide better evidence of this. EVIDENCE: The home has an activities book for recording what’s been on offer and daily notes also refer to what activities individuals have enjoyed participating in. There have been holidays to Centre Parks and to Wales. There are regular nights out to the local pub and residents are members of the local miners welfare club. At the end of January residents enjoyed a day out in Loughborough and two residents have also recently been to Derbyshire. There are also opportunities to go to concerts and to the festive pantomime. Residents are involved in domestic tasks in the home and domestic skills are identified in relevant care plans. Maintaining individuals’ dignity and respect is referred to in care plans. One resident has a sound monitor in his bedroom so that staff can monitor any seizure activity he may have. In response to a requirement made at the last inspection this care plan now elaborates when
Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 11 this monitor should only be in use, in order to fully respect the resident’s right to privacy. There is a four-week rolling menu for the home, which shows that a variety of healthy balanced meals are offered. The menu record details the variety of fresh vegetables that are served with meals, which is good practice. A member of staff spoken with explained that alternatives are provided to residents that do not want the meal on offer that particular day. Staff must remember to record when residents have had an alternative meal, as this indicates that there is a choice but is also important in case there is an outbreak of food poisoning. Currently only evening meal times are being recorded. Records are also required for breakfast and lunchtimes. Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Residents’ healthcare needs are met. EVIDENCE: This standard was not fully assessed, but the requirement set at the last inspection was followed up. There has not been any seizure activity in the last couple of months. However, the form that is to be used for recording the named resident’s seizures now prompts staff to not only record when there has been a seizure but also the length of time the seizure was. As recommended at the last inspection there is now a care plan in place for promoting health of residents, which cross references to the location of other necessary records such as doctors appointments, correspondence relating to other specialist healthcare professionals and medication and charts for monitoring weight. Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Residents’ are protected from abuse. EVIDENCE: There have been no allegations or incidents of abuse since the last inspection. All of the identified action as a result of the Social Services Investigation and Case Conference that took place prior to the last inspection has now been addressed. The relevant staff have attended refresher training in managing challenging behaviour and there is now an updated care plan in place for appropriately managing the challenging behaviour of the resident concerned. There was evidence seen on staff files that training in adult protection has been provided to all staff and all staff have access to the folder for the Nottinghamshire Committee for Protection of Vulnerable Adults (NCPVA) Policy and Procedures. All residents now have a support plan in place specifying what the arrangements are for them accessing and saving their own money. The support plan identifies who is appointee and what safeguards are in place for protecting residents from financial abuse. Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X None of these standards were assessed on this occasion. EVIDENCE: Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Staffing levels are appropriate to meeting the needs of residents. There are training opportunities but further progress is required on staff achieving the necessary social care qualification. Improvements to recruitment practices are required to ensure the protection of residents. EVIDENCE: The staff rota was looked at and showed that there are always three staff on at as a minimum but at busy periods, for example, in the morning before residents go to day centre, or in the evenings or on Saturday afternoons, for activities, there are usually four or five staff on shift. The rota showed that there is flexibility depending on what trips have been organised etc and takes into account both the personal circumstances of staff and needs of residents. The staff files seen show that training courses relevant to the needs of residents such as ‘Promotion of Continence’, Asthma, Managing Challenging Behaviour are accessed as well as all the necessary mandatory health and safety courses such as First Aid, Food Hygiene and Fire training. There is evidence that a structured induction takes place however as part of induction, within six months of their appointment it is recommended that staff receive Learning Disability Award Framework (LDAF) accredited Foundation training, which provides underpinning knowledge for progress towards achieving the National Vocational Qualification Level 2. The target of at least 50 of the staff team achieving NVQ Level 2 by 2005 has not been successful as currently
Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 16 there are no staff members that have completed this qualification. There are four staff members currently doing the course. Four staff files were looked at. All of the necessary checks have been carried out for all four staff. However, it was noted that for the recently recruited member of staff their POVA First check and Criminal Record Bureau check was returned after their employment had commenced. This practice must stop immediately as under no circumstances should new staff commence employment until the return of two satisfactory references and at least the return of a POVA First check. If a new staff member commence employment on return of a POVA First Check, then they must be supervised by an appropriately skilled and experienced staff member (with evidence of this), until their full CRB has come back. Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 Implementing a quality assurance system based on the views of residents and their relatives is required. Overall, the health and safety of residents is promoted and protected. EVIDENCE: There appears to be no system in place for quality assurance, which is required in order to inform any developments or improvements to the service. There have not been any internal quality audits and although a copy of a quality assurance questionnaire that goes to relatives of residents was seen, this exercise has not been undertaken since 2004. All necessary fire safety tests are carried out, in accordance with Fire Precautions in the Workplace legislation. All the necessary electrical and gas systems have been serviced as required. Water temperatures at taps are being checked to make sure that the temperature is maintained to 43 degrees Celsius. In order for this check to mean something rather than just initialling when a check has been carried out the actual temperature needs to be recorded so that this can be monitored. A written risk assessment is required for specifying the necessary measures in place for the prevention of Legionella. Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 X 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 X X X X 1 X X 2 X Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 19 no Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 15 Requirement Ensure that care plans are kept under review; and in line with standards, that reviewing takes place at least every six months. In accordance with Schedule 4 ensure there is a detailed record of food provided to service users, in order to determine whether the diet is satisfactory. This refers to keeping a record of all meals, as opposed to just the evening meal. Ensure that staff are not employed at the home until the return of a satisfactory CRB disclosure, and that if staff commence employment before the return of a CRB then this is only on return of a POVA First check, and that the new member of staff is supervised by an appropriately skilled and experienced staff member. Ensure that are suitably qualified. This refers to continuing staff with their NVQ training. Implement quality assurance system that includes seeking the views of residents and their
DS0000008730.V279728.R01.S.doc Timescale for action 30/04/06 2. YA17 16 30/04/06 3. YA34 19 28/02/06 4. YA32 18 31/08/06 5. YA39 24 30/05/06 Orla House Care Home Version 5.1 Page 20 representatives. 6. YA42 13 Devise a written risk assessment for measures in place for the prevention of Legionella. 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA35 Good Practice Recommendations As part of induction, within six months of appointment staff must attend LDAF-accredited Foundation training. Orla House Care Home DS0000008730.V279728.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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