Inspection on 04/10/05 for Orme House Residential Home

This inspection was carried out on 4th October 2005.

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

Orme House Residential Home 07/04/10

Orme House Residential Home 10/06/09

Orme House Residential Home 17/06/08

Orme House Residential Home 04/07/07

Orme House Residential Home 06/07/06

Orme House Residential Home 24/05/05

Orme House Residential Home 04/08/04

Orme House Residential Home 30/04/04

Orme House Residential Home 11/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Orme House Residential Home 59 Kirkley Cliff Lowestoft Suffolk NR33 0DF Lead Inspector Claire Hutton Unannounced Inspection 4th October 2005 2:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Orme House Residential Home Address 59 Kirkley Cliff Lowestoft Suffolk NR33 0DF 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) 01502 574068 01502 574068 None available Anglia Care Homes Ltd Mr Shriraj Sahadew Care Home 19 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (19) of places Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 The home may accommodate one person, whose name was made known to the commission in June 2005, who is over 65 years and requires care by reason of dementia. 24th May 2005 Date of last inspection Brief Description of the Service: Orme House is registered as a care home providing personal care for 19 older people aged over 65 years. One of whom has dementia. Care assistants staff Orme House on a 24-hour basis. One of the registered proprietors, Mr Sahdew is also the registered manager. The layout of the home is on 3 floors with level access provided in most areas by means of a shaft lift. Rooms 5, 6 and 11 are not accessible by the shaft lift. A stair lift can be used to access rooms 5 and 6, but to access room 11 the occupant needs to use stairs. Single bedrooms and shared accommodation are available. The home looks out to Kirkley Cliff, a busy one-way thoroughfare. Kensington Gardens, with its many attractions and sea front. Parking is on the road. Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one afternoon in October 2005. Several residents were met and two were spoken with in private. One relative was visiting and was spoken with privately. A tour of most of the home was undertaken and records inspected included care plans and associated records for 3 people, systems that account for residents money, records of complaints, medication records and storage and procedures on infection control and quality assurance. What the service does well: What has improved since the last inspection? What they could do better: The environment at Orme House needs to continue with the steady improvement that has been shown over the last 2 years. The management of odours is being tackled, but this is an on going matter. The home should Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 6 purchase alginate bags to transport soiled linen to the washing machine to lessen any risk of infection spreading, and should place paper towels in the staff toilet again to limit infection spread. Care plans are in the main satisfactory but attention to detail is required in matters such as monitoring weight and precise instruction to staff on manual handling as per the assessment. The home should obtain a copy of the control and administration of medicines in care homes published by the Royal Pharmaceutical Society. This will ensure that the home knows their obligations around administering medication, as some gaps were identified at this inspection. 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. Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4, and 5 People who use this service can expect to have an assessment before they move into the home and be able to visit before placement therefore, they can have some assurance that the home will meet their needs. EVIDENCE: Documentation for three current residents was examined. An assessment of care needs had been made for all three individuals before moving into the home. In two of these cases, introductory visits had been made and these were well documented as to how the new individual responded and care given. Introductory visits were seen to include families visiting and staying for a meal or entering the home on respite, then deciding to become permanent. One relative spoken with stated that the home was right for them and when they visited they were able to see that the home ‘had no airs and graces and that they could be true to themselves’. The relative spoken to felt the home did meet the needs of their relative. Two residents spoken with also felt their needs were met and that they were very settled here. One resident spoken to had been at the home some time, whereas the other person was relatively new to the home. Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, and 9 People who use this service can expect to have an individual plan of care in place, however the attention to detail for quality cannot be assured. Residents can expect to have their health and basic medication needs attended to, but cannot be certain that medication is administered as directed by a GP. EVIDENCE: An individual plan of care was in place in the three residents documents examined. These had evidence of regular review, along with evidence of assessment on dependency levels, falls assessment and pressure area assessment. From these assessments individual plans were developed. Some had good individual elements in place, that had clear instructions for staff on how to give individual care. An example being vision and communication. There was good recording of the care given along with review. The review seen in one case was with the individual resident, their relative and their social worker. Another example of accessing services and monitoring care needs was seen through the recording of regular visits with community psychiatric nurse and their psycho geriatrician. This level of detail was in place for several aspects of care plans but there were also some gaps where care plans had not been fully developed. Examples of Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 10 this included monitoring weight, which is a key indicator in many aspects of care, and a key element of a manual handling assessment and use of a hoist. One manual handling assessment for staff to follow did not give specific instruction on which particular hoist and sling to use based on the person size and care needs. At the last inspection it was reported that ‘one person had 23 falls recorded. The risk assessment in place stated they were at a high risk of falling and there was no strategy in place to prevent falls’. It was recommended that the local falls prevention officer be contacted for those assessed at high risk to help develop a prevention strategy of injury from falls if possible. Upon reviewing the manager stated that the local support on this was not yet up and running. Residents were all said to be registered with a local GP and documentation of three files confirmed this. A chiropodist visited the home regularly. One resident met and spoken with was hard of hearing. The manager agreed, given the person was newly admitted, to seek health advice on this matter to see if this could be improved. Medication administration records were examined. These were well kept. At the last inspection evidence was seen that staff were trained to administer medication, except for one person. It was requested that this person be trained as soon as possible. This was still outstanding and had not been addressed. Also at the last inspection it was stated that ‘the home have some medication that is administered as and when required (PRN). The instructions from the chemist and GP must be explicit for care staff to follow and not have any ambiguity, as was the case on more than one record’. At this inspection this was still the case and had not been addressed. In one case the direction on the medication for staff to follow stated that a resident should have ½ a Lorazepam tablet 3 times a day, but staff were administering it on an as and when required basis. Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Residents can expect to have their choices respected and have a degree of control over their lives. EVIDENCE: Two residents and one visitor spoken with confirmed that the lifestyle individually chosen could be followed at this home. Discussion with the manager showed his understanding of residents choosing to make decisions even though on occasions these may be unwise. This was specifically in relation to one individual choosing to use the telephone. Two residents had chosen to have additional storage for clothes in their rooms, even though this would make it difficult to have arm chairs. Residents are encouraged to maintain their own finances with the home holding small amounts of personal money for use as determined by the residents. Access to records by the residents would be possible if they requested and all information is recorded individually with no communal recording in place. The three other standards in this section were assessed as met at the last inspection from May this year. Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service will find an owner/manager who does take complaints and protection of residents seriously and will resolve matters. EVIDENCE: The home have an appropriate complaints procedure in place and this can be found in both the service users guide and the statement of purpose. Reference to this is displayed at the home on the wall. The record of complaints was examined and was appropriate in terms of a log of every complaint and evidence that it had been investigated. One resident was confident that they could speak to the manager about any concerns they may have. The home have a copy of the Protection Of Vulnerable Adults (POVA) policy (June 2004). The manager was aware of the national POVA listing. Both the key standards 16 and 18 were assessed as met in May this year. Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 23, 24 and 26 The residents who use this service can be assured that there is a programme of redecoration and improvement taking place, but some areas require improvement to offer a safe environment in which to live. EVIDENCE: The layout of the home is on 3 floors with level access provided in most areas by means of a shaft lift. Rooms 5, 6 and 11 are not accessible by the shaft lift. A stair lift can be used to access rooms 5 and 6, but to access room 11 the occupant needs to use stairs. Single bedrooms and shared accommodation are available. The management of odours is being tackled, but this is an on going matter. Two bedrooms that had an odour previously were improved, but an odour was detected near the bottom of the stair lift. The stair lift was in full working order. The senior carer on duty was measuring up a window to purchase a net curtain for room 3 to ensure the privacy of the resident who used the room. Room 4 which is on the ground floor, does not have an entrance door wide enough to allow access to a standard wheelchair. The over door glass panel in room 6 is Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 14 obscured, at the request of the resident, but only with some hardboard and tacks. It was agreed with the manager that a black out blind would be purchased to ensure darkness at night if the resident wished, but to use the borrowed light of the window on the stairs by day. Communal space comprises of a large lounge and conservatory/dining room. Both areas have a television and music provided. There are bathing/shower facilities. A hoist was available for assisted bathing. Paper towels and liquid soap were provided in some toilets. In the staff toilet, staff provided their own liquid soap, but paper towels were not provided. The silicone bath seal in the bathroom on the first floor needs replacing. The home has installed a new industrial washing machine that will deal with soiled linen. The home should purchase alginate bags to transport soiled linen to the washing machine to lessen any risk of infection spreading. This would be in line with the homes policy on infection control. The home looks out to Kirkley Cliff, a busy one-way thoroughfare. Kensington Gardens, with its many attractions and sea front, is just across the road from the home and easily accessible. Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 29 People who use this service can expect to find sufficient staff that are appropriately recruited. EVIDENCE: The Manager of the home is Mr Sahdew, he is also one of the owners. He works at the home each day, Monday to Friday from 09.000 until 15.00. He is usually there in addition to care staff. Each day there are two care staff on duty and one senior carer. The care staff are supported by a cook who works each day and two cleaning staff. One senior is always on call. At night there are two awake care staff. The roster from the previous week was examined. The home had difficulty on one occasion when 4 staff were off sick. This was covered by the use of agency and the manager working a care shift. Staff had or were expected to return to work. Sufficient staff were deployed to care for the 16 older people resident. At the previous inspection required checks for recruitment were in place to ensure the safety of residents except for one CRB on one member of staff in housekeeping. At this inspection these were in place. Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38 People who use this service can expect to find a competent approachable manager who understands aspects of health and safety. EVIDENCE: The registered manager of the home is Mr Sahdew, he and his wife are joint owners and have another home in Essex. Mr Sahdew is a qualified nurse and he is currently undertaking the care management award NVQ 4. Both Mr and Mrs Sahdew have recently become trainers in first aid and manual handling. Staff spoken with, two residents and one relative all said that Mr Sahdew was approachable and that they were confident that he would resolve issues for them. Mr Sahdew was very helpful throughout the inspection process. In relation to quality assurance Mr Sahdew showed a file containing questionnaires he had undertaken with residents and relatives. These were undertaken in May 2005 and asked questions about the catering, housekeeping Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 17 and care. Where feedback on how to improve had been obtained action was taken. Mrs Sahdew was responsible for these audits. Residents or their relatives manage finances, but the home does keep a small amount of personal money for residents. The system of receipts and signatures was in place to create an audit trail. The money and records were kept in a secure place. Mr Sahdew was aware of his responsibility in health and safety matters and had actioned two points from the last inspection relating to the stairlift and the washing machine. He also agreed to action the matter relating to the transporting of laundry using alginate bags, in line with the homes policy. In addition he spoke of training planned through Otley College for staff to undertake training in Health and Safety, Infection Control, Food Hygiene and medication. Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 18 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 X 3 2 3 3 X 2 STAFFING Standard No Score 27 3 28 X 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 2 Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 19 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 OP7 Regulation 15(1) Requirement Individual care planning approach must be further developed and give explicit instruction for staff for: - Detailed manual handling assessments - Falls prevention strategy. (Repeat requirement from 24/05/05) The registered person must promote and maintain residents’ health and ensures access to health care services to meet assessed needs. This is specifically related to hearing loss. A protocol for individual as and when required (PRN) medication must be in each persons medication documentation. The one untrained person must be trained. (Repeat requirement from 24/05/05) Residents must live in a safe and well maintained environment therefore: DS0000049444.V256465.R01.S.doc Timescale for action 01/01/06 2 OP8 12(1)(a) 31/01/06 3 OP9 13(2) 31/01/06 4 OP19 13 (3) 23 (2) b d 31/01/06 Orme House Residential Home Version 5.0 Page 20 5 OP22 23 (2) (a) (n) 6 OP26 13 (3) 23(2)( K) - the door panel in room 6 must be fitted with a blackout blind for use at night. - the silicone bath seal around the upstairs bath must be renewed. (Repeat requirement from 24/05/05) - Room 7 must be decorated. The environment must meet the needs of residents who live there therefore the door to room 4 must be made accessible to a wheel chair, this should be a 800mm clear opening. (Repeat requirement from 24/05/05) The home must be hygienic, free from odour and control the spread of infection therefore: - Paper towels and liquid soap must be provided in all toilets. - Alginate bags must be used to transport and process soiled linen. This is then in line with the homes policy on infection control. 31/01/06 31/01/06 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 2 Refer to Standard OP9 OP8 Good Practice Recommendations The home should obtain a copy of the control and administration of medicines in care homes published by the Royal Pharmaceutical Society. Advice on falls prevention should be sought from a health professional. Orme House Residential Home DS0000049444.V256465.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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