CARE HOME ADULTS 18-65
Orla House Care Home 317 Mapperley Plains Nottingham Nottinghamshire NG3 5RG Lead Inspector
Joanna Carrington Unannounced 16 September 2005 10.00 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 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 Stationary 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 C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Orla House Care Home Address 317 Mapperley Plains Nottingham NG3 5RG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0115 9203754 0115 9267325 Mr J, Mr S, Mrs M & Ms S Dobbin Ms S M A Dobbin Care Home 13 Category(ies) of Learning Disability 13 registration, with number of places Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: none Date of last inspection 16/11/04 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 with well kept gardens and parking to the front and an attractive garden to the rear, which residents have access to. The home has its own vehicle and there is small supermarket very closeby. Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over four and a half hours on the 16th September 2005. This was the home’s first inspection for this financial / inspection year. The main method of inspection was called ‘case tracking’ which involved selecting three residents and tracking the care and support they receive through the checking of their records, discussion with them, and observation of care practices. The focus of the inspection was to assess ten of the twenty key standards. No staff were spoken with on this occasion therefore this will be necessary at the next inspection. What the service does well: What has improved since the last inspection?
There are no improvements arising from the last inspection as no issues were raised. However, following an adult protection investigation, which took place after the last inspection the manager has already began to action requirements that were made as a result of this investigation, in order to protect residents from abuse. Staff involved have been booked on appropriate training for managing challenging behaviour and those staff have been receiving the necessary support. The manager has now been fully informed of the Nottinghamshire Adult Protection Policy and Procedures, which will ensure that the correct procedures are followed following any allegation of abuse. Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 6 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 C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 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 standard(s) X None of these standards were assessed on this occasion. EVIDENCE: Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 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 standard(s) 6, 7 and 9 Care plans reflect individual residents needs and how these are to be met however, evidence of consultation over the development and review of care plans is required. Residents are supported to make decisions about their lives and to take acceptable risks as part of promoting independence. EVIDENCE: For the three residents that were case tracked all the existing care plans provide useful and detailed information on how to meet their individual needs and gave good insight into the individual personalities and the likes / dislikes of residents. As part of these care plans adequate risk assessments are incorporated. There was evidence seen that these care plans are reviewed six monthly. Even though two of the residents spoken with know of their care plans and what they are for there is no evidence on these plans that they have seen them or been involved in their development. Where residents have limited or no understanding of these plans then consultation with their relatives or representatives is required.
Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 10 It was apparent from talking with residents that they are supported to make decisions and informed choices about their lives. Individuals are encouraged to follow their own interests. Care plans refer to the preferences of residents and how residents with limited communication express choices. Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12, 14, 15 and 16 Residents have opportunities to participate in appropriate activities and relationships with family and friends are promoted. Residents’ rights and responsibilities are generally promoted however further elaboration on one resident’s care plan will ensure that his right to privacy is acknowledged and upheld. EVIDENCE: Residents spoken with talked about the day centres that they attend and the activities that they enjoy doing there. During the week of the inspection residents were off from the day centre and were going out with staff on day trips throughout the week. Residents spoken with reported that they enjoyed a holiday to Wales earlier in the year and there are regular evenings out to the Welfare Club. All activities that residents participate in are recorded in their daily notes. Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 12 Contact with relatives and friends is also recorded in daily notes and this showed that the residents case tracked have regular contact either at the home or by visiting their families and having overnight stays. Residents spoken with confirmed that their visitors are always made to feel welcome. Residents have responsibilities for domestic tasks in the home and these responsibilities are identified in individuals’ care plans. Care plans make reference to promoting dignity and respect and residents spoken with confirmed that they are treated with respect. For one of the residents case tracked there is a care plan stating that a sound monitor is used in their bedroom to monitor any seizure activity. It is required that this care plan elaborates exactly when this monitor is to be used so to respect their right to privacy. Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 13 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 standard(s) 18, 19 and 20 Personal support is given in the way that is preferred and required. Residents’ health care needs are generally met but improvements to monitoring health conditions and recording would ensure this. The medication system assures that medication is handled appropriately and that residents are safe. EVIDENCE: Residents spoken with explained what their preferences are regarding how their personal care is given, for example whether they prefer shower or baths and when they like to get up and these preferences were reflected in their respective care plans. It was evident from talking with residents and from reading daily notes that times for getting up, going to bed etc are flexible and that choice is always promoted. Care files seen demonstrate that residents have access to the necessary and relevant health care professionals and that residents have regular health care checks for dentist, opticians, chiropodist etc. Each resident has an NHS card for recording all health care appointments and contact with GP and community nurses. Some appointments attended by the residents case tracked had not been filled in on this record and with correspondence from hospital held on a different file to care plans, and with no specific care plan for promoting health it was not always easy to follow what input and support residents have received. It is therefore, recommended that a general health care plan is
Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 14 introduced, which cross references to relevant NHS card and correspondence. For the promotion and protection of health as well as recording when there has been any seizure activity staff must ensure that they record approximately how long each seizure is. A monitored dosage system (MDS) is used for the administration of the majority of medication. The storage of medication was appropriate and the medication administration records gave clear instructions and no errors were found. Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 15 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 standard(s) 22 and 23 There is an appropriate complaints procedure, which assures residents and their relatives / representatives concerns and complaints are listened to. The manager must ensure that for all allegations concerning adult protection the Nottinghamshire Protection of Vulnerable Adults Policy and Procedures are correctly followed. EVIDENCE: Residents spoken with are aware of the complaints procedure and all residents and their relatives are supplied with a copy of this. There is a compliments, concerns and complaints book held at the home with basic information written here, including the dates of any complaints etc. All other documentation and correspondence relating to a specific complaint is held securely to respect confidentiality and is cross-referenced with the complaints book. Since the last inspection there has been a Protection of Vulnerable Adults (POVA) investigation conducted by Social Services. The allegation made was against two staff at the home, which meant that in accordance with the local Nottinghamshire Policy and Procedures, Social Services should have been initially notified in order to negotiate whether the investigation is conducted internally or Social Services take the lead in the investigation. The Policy and Procedures were not followed correctly as instead the manager of the home informed Social Services that she was carrying out her own investigation. Subsequently, Social Services also conducted an investigation and then a case conference was held identifying outcomes and any necessary action to be taken: Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 16 Further training on managing challenging behaviour has been booked for the relevant staff and the manager explained how she is in the process of amending the concerned resident’s care plan on how to appropriately respond to his challenging behaviour, which was identified as a requirement at the case conference. Currently there is no actual care plan for managing challenging behaviour but guidance to staff is recorded under the risk assessment for maintaining a safe environment. In order to ensure that an appropriate and consistent approach then a more specific care plan is required and it was recommended at the case conference that the relevant professionals are consulted over the appropriate strategies and wording of this care plan. It is recommended that training run by the Nottinghamshire Committee for the Protection of Vulnerable Adults (NCPVA) is accessed to ensure staff are aware of their roles and responsibilities in accordance with the local policy and procedures. One of the owners of the home is the appointee for residents. Care plans for managing finances need to also include who the appointee is, what arrangements are in place for safeguarding residents from financial abuse and how this arrangement is in the best interest of each resident. Evidence of consultation is also required and this was already evident for one of the resident’s case tracked with a signed form held on file. Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 17 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 standard(s) 24 and 30 Residents live in a clean, safe and homely environment. EVIDENCE: On a partial tour of the premises it was evident that the home is kept clean and hygienic. There is a separate laundry room with industrial driers and washing machines with a sluicing facility available. The home is well decorated and furnished and there is a homely feel throughout. The environment is bright and cheerful and free from offensive odours. There is a separate lounge and dining room plus a smaller quieter room ideal for residents to meet with their friends and family in private. Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 Staff are well supported and supervised, which ultimately benefits the residents. EVIDENCE: Supervision records indicate that formal supervision sessions take place regularly for all staff, at least every two months. The level of support is based on the needs of each individual member of staff. Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) X None of these standards were assessed on this occasion. EVIDENCE: Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23
ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 4 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 x 3 3 2 x Standard No 31 32 33 34 35 36 Score x x x x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Orla House Care Home Score 3 2 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 21 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 6 Regulation 15 Requirement Ensure that service users and / or their relatives / representatives are consulted over the development and review of their care plans, and that there is evidence of this consultation. To promote named service users right to privacy elaborate on care plan when and when not the sound monitor is is to be used in his bedroom. When recording seizure activity include how long the seisure is. For the named service user ensure that there is an appropriate care plan specifically for managing his challenging behaviour (which reflects current best practice on meeting the needs of residents that present significant challenges). This requirement was set following POVA investigation. Ensure that all residents have a care plan for how their individual finances are managed, identifying when support is needed, that consultaion has taken place with regards to appointeeship, and what Timescale for action 30/11/05 2. 16 12(4)(a) 30/11/05 3. 4. 19 23 12(1)(a) 15(1) 31/10/05 31/10/05 5. 23 15(1) 31/10/05 Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 22 arrangements are in place for safeguarding residents from financial abuse, eg independent auditing. 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. 2. Refer to Standard 19 23 Good Practice Recommendations It is recommended that a care plan for Promoting Health is devised for each resident, that cross references with relevant records and correspondence. It is recommended that Nottinghamshire Committee for Protection of Vulnerable Adults (NCPVA) Adult Protection Training is also accessed (as it provides essential information on the roles and responsibilities in accordance with the local policy and procedures). It is recommended that there is joint working with the relevant agencies and specialist professionals in the development of the named service user’s care plans for managing aggression and challenging behaviour. 3. 23 Orla House Care Home C03 C53 S8730 Orla V248067 160905 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Edgeley House 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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