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Inspection on 13/12/05 for Ormidale House

Also see our care home review for Ormidale House for more information

This inspection was carried out on 13th December 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 47 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is a calm and happy atmosphere within the home. The manager and staff have responded well to the change in ownership and there is a new sense of hope and optimism for positive change. The Manager and Proprietor are working together constructively to achieve change. Service users have been on holiday this year.

What has improved since the last inspection?

There have been some improvements since the last inspection. In her first month the new proprietor has been keen to make some improvements to the premises and has replaced two bedroom carpets providing a more pleasant and safer living environment for the occupants of the rooms. Flooring has also been replaced in the laundry and kitchen, which better supports infection control. Infection control is better supported now as infection control procedures based upon risk assessment have been provided in the laundry to guide staff practice. Plumbing faults have been attended to in order to ensure sufficient water temperature and the battery on the stair lift has been replaced. Water temperatures are now regularly tested and where temperatures exceed safe ranges in the kitchen and laundry risk assessments have been put in place. Inappropriate and unsafe products were not found to be stored in the laundry at this inspection. Staff are also better prepared not to deal with a fire as sufficient training has been provided and a detailed fire risk assessment is in place to reduce the likelihood of a fire. Maintenance certificates to evidence that the home is being appropriately maintained were better evidenced at this inspection too. Care plans have all been updated to the new system being used. Key holding is now better managed providing additional security. Staff meetings have also been held six times in 12 months, which represents an improvement and has helped to support staff during the period of change in ownership of the home. Training for staff has been more available this year. All staff have done medication training with staff who administer having done accredited medication training.

What the care home could do better:

The momentum for change must be maintained as a large number of outstanding requirements remain to be met before the home meets the national minimum standard expected. In addition this inspection highlighted several significant omissions requiring priority improvement. These include record keeping. Staff require support to understand the role, function and importance of accurate records. Records donot evidence significant events or demonstrate that service users needs are being met. Records did not demonstrate that a risk assessment put in place by the manager is being fully implemented. The manager must also ensure that practice in relation to the assessment of nutritional need improves to better identify intervention required to proactively support service users health. Health screening for service users is inadequate too with service users not being supported to routinely access dental and optician check ups. The premises continue to require attention to ensure service users privacy and safety. The new proprietor agreed to provide new locks on toilets, bathrooms and bedrooms to ensure compliance. There is also insufficient access to the community for service users. Ormidale House provides care and attention to young adults but presents as a care home modelled on a traditional and outdated model of care. An increase in activity levels and access to the community is essential to meet most service users needs. The manager and new proprietor both recognise that more staff hours and an increase in current staffing ratios are required to facilitate this and other outcomes and both provided assurance that this will happen. Improvement must be evidenced by the next inspection.

CARE HOME ADULTS 18-65 Ormidale House 41 Woodgreen Road Wednesbury West Midlands WS10 9QS Lead Inspector Deborah Sharman Announced Inspection 13th December 2005 08:45 Ormidale House DS0000065596.V281726.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 Ormidale House DS0000065596.V281726.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. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ormidale House Address 41 Woodgreen Road Wednesbury West Midlands WS10 9QS 0121 556 0567 0121 556 0567 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) Chuhan Limited Brian Turney Care Home 11 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (2), Physical disability (4) of places Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The outstanding requirements from previous inspections are addressed within stated timescales as detailed in the action plan provided by Mrs Freeman, signed by her and dated 10th October 2005. 7th July 2005 Date of last inspection Brief Description of the Service: Ormidale is a large detached house on the main road from Wednesbury to Walsall. It is close to local transport network and there are a number of local shops and pubs located close by. There are parking facilities for a limited number of cars at the front of building. Bedrooms are located on the ground and 1st floor. There is a bathroom on the ground floor and a shower room on the 1st floor. There is no lift available. A smoke room is provided for service users separate to other facilities. Lounge and dining facilities are sited within one main area and the dining area has views of the rear of the property. To the side of the property there is an outbuilding, which is currently used as storage space. Access to the garden is limited for service users with mobility problems. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second statutory inspection of this inspection period. But it is the first inspection to be conducted since the new proprietor has owned the home. The new proprietor took over a month before this inspection. The inspection was announced which meant that the proprietor, manager, staff and service users received prior notification and had the opportunity to prepare. The inspection was conducted by one Inspector and began at 8.45am and concluded at 6.00pm. The plan for the inspection was to assess those key national standards that were not assessed at the previous inspection. It was also planned to assess progress towards those previous requirements issued to ensure improvement that relate to the standards due for assessment. It was planned to reassess recruitment practices to see if they are now better protecting service users. However no new staff have been recruited. It is planned to recruit more staff so this will be assessed fully at following inspections. If time allowed it was planned to assess progress towards meeting other previous requirements issued and to some extent this was possible. It was felt that this was important to give the new proprietor a benchmark but the impact of this upon time meant that the Inspector was not able to interview staff or service users in detail. Some staff and service users were however spoken to briefly throughout the course of the inspection day. The Inspector case tracked the care experiences of one service user on the basis that the home has obtained a variation to their registration in order to continue to accommodate him. The purpose of the case tracking was to verify whether the home is meeting his needs. It was not possible to observe the administration of medication as none was administered during the time period of the inspection. The home is fully occupied and there have been admissions or discharges since the last inspection. No immediate requirements were issued at this inspection. Throughout the inspection day the proprietor demonstrated commitment to making radical improvements that would require expenditure. The text of this report refers to improvements required and discussed during the inspection. On this occasion not all improvements required have been made requirements. This is to ensure that the number of requirements does not become unmanageable and to give the new proprietor the opportunity to action promises made. In the event of no progress however requirements will be issued at the next inspection. What the service does well: Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 6 There is a calm and happy atmosphere within the home. The manager and staff have responded well to the change in ownership and there is a new sense of hope and optimism for positive change. The Manager and Proprietor are working together constructively to achieve change. Service users have been on holiday this year. What has improved since the last inspection? What they could do better: The momentum for change must be maintained as a large number of outstanding requirements remain to be met before the home meets the national minimum standard expected. In addition this inspection highlighted several significant omissions requiring priority improvement. These include record keeping. Staff require support to understand the role, function and importance of accurate records. Records do Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 7 not evidence significant events or demonstrate that service users needs are being met. Records did not demonstrate that a risk assessment put in place by the manager is being fully implemented. The manager must also ensure that practice in relation to the assessment of nutritional need improves to better identify intervention required to proactively support service users health. Health screening for service users is inadequate too with service users not being supported to routinely access dental and optician check ups. The premises continue to require attention to ensure service users privacy and safety. The new proprietor agreed to provide new locks on toilets, bathrooms and bedrooms to ensure compliance. There is also insufficient access to the community for service users. Ormidale House provides care and attention to young adults but presents as a care home modelled on a traditional and outdated model of care. An increase in activity levels and access to the community is essential to meet most service users needs. The manager and new proprietor both recognise that more staff hours and an increase in current staffing ratios are required to facilitate this and other outcomes and both provided assurance that this will happen. Improvement must be evidenced by the next 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. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 8 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 Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 9 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): EVIDENCE: These Standards were not assessed at this inspection. There have been no new admissions to the home. Key standard 2 was therefore not assessed and has not been assessed during this inspection period. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 10 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, 7, 9. Care plans partly reflect the assessed and changing needs of service users. Personal goals are not reflected in the plan of care. The home is generally not able to evidence how it supports less able service users to make decisions. The home is beginning to develop its risk management strategies which in part support service users. Omissions in some risk assessment systems however put service users at increased risk. EVIDENCE: All care plans have now been updated into the new system being used. Care plans include most aspects of personal and social support with some omissions such as cultural and faith needs, method of communication and the care plan in relation to the finances of a service user case tracked requires development. It referred the reader to a risk assessment for finances that is not in place. Some risk assessments however are in place for each of the service users. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 11 These however are generic and where an individualised risk assessment had been previously required for a service user this has not been met to reduce the risk posed by her window. Health plans are not included in care plans and therefore there is not sufficient guidance for staff. This is evident when assessing health outcomes for service users as health screening is not sufficiently provided. A health review was however planned for the following week with a representative form the Community Learning Disability team and the local surgery practice nurse. Care plans are not providing guidance that gives staff specific and measurable targets e.g. ‘regularly’ does not inform the staff member as to how often the stated care intervention must be carried out. Six monthly reviews are not taking place with the last one for the service user case tracked unknown and possibly the manager said had last taken place prior to his becoming manager some years ago. There is also no evidence that the service user or family / representatives have been involved in drawing up the care plan as appropriate. A key worker system is in place but is to be reviewed. Written guidelines would appropriately support staff to understand the role of key working. The service user case tacked is key worked by the manager. The Inspector queried whether the manager has sufficient time to undertake this role and the outcomes assessed for this service user would suggest not. Decision-making i.e. how the service user is to be supported to make day-today and significant decisions is not included in service users care plan although the plan does indicate service users preferred routines in good detail. Records of shifts do not evidence that the care plan is being adhered to and does not at all evidence decisions made by or on behalf of service users. Records primarily indicate ‘no problem’. Activities will be referred to later in the report but as there are no community activities / outings other than attendance at Day centres and night school once per week, and few in house there appears to be little opportunity for service users to make decisions beyond their usual routine. An independent advocate has been involved with one service user but away from the home. There have been no new admissions to the home so it is not possible to assess how risk is assessed prior to admission. The manager is beginning to put risk assessments in place for service users and for the service user case tracked there are three – trip and falls, bathing and showering and a general one covering tasks in the home which are general to all service users. Risk assessments must be individualised and must provide greater clarity and direction for staff. For example the care plan for the service user case tracked states that he likes a bath or shower. There is a risk assessment in place for a bath and shower. Discussion showed that the service user always chooses to have a shower and that this is the safer option for him. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 12 The risk assessment does not address this adequately. A nutritional risk assessment tool to assess the extent of nutritional risk has not been obtained but nutritional guidelines have been put in place for the service user identified as of concern at the last inspection. Whilst the outcomes appear to be good (service user has put on weight) following this procedure there is evidence that staff have not fully followed the assessment in place. For example although records indicate that refused meals have drastically reduced there is no evidence that alternatives were offered by staff upon refusal as per risk assessment. The lack of nutritional risk assessment and Body Mass guidelines leave it unknown as to whether this and other service users are at nutritional risk. Service users engaged in a new and intimate relationship have been supported to make appropriate decisions and minimise associated risks. The manager was advised to offer additional health screening to one of the service users given that the partner had declined. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 13 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): 12, 13, 15, 16, 17 Traditionally commissioned day activities provide activity for most not all of the service users at Ormidale House. Sufficient activity is not planned or provided by the home over and above this exernally-arranged provision. There is no access to the community for the majority of service users who require support to access the community during evenings and weekends. Planned contact with family and friends is not being evidenced including when a service user leaves the premises with family. Service users routines are well known and respected. Systems to support service users rights require improvement. Service users are offered a variety of planned meals. Service users are able to choose from a menu and their choices are provided. Systems to assess nutritional need require improvement. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 14 EVIDENCE: The service user case tracked attends day centre full time and attends night school along with 5 other service users on Tuesday evenings to undertake craft activity. Ormidale House arranged this. This service users care plan states that he enjoys a range of activities and interests– dominoes, bowling, draughts, museums and steam trains. There is no evidence that the home has supported him with any of these. One service user independently accesses the community. All other service users require support to access the community. There was no evidence that this support is provided. The manager in response to this said ‘there is nobody we help to access the community who needs help to do so’. The management of voting, mail and keys must be reviewed and included in care plans as opposed to cross referencing to resident meeting minutes which do not provide clear outcomes. The home is planning to help a service user to begin work experience with the support of a Social Service’s initiative. The home continues to maintain positive relationships with neighbours, which are both similar businesses and no concerns, are known. Discussion leads the Inspector to believe that service users do have access to contact with family and friends. The care plan of the service user case tracked clearly outlined the pattern of contact enjoyed and appreciated by the service user. In spite of previous requirement however there is no recorded evidence of contact including visits by family on the service users birthday. The manager pointed out that prior to the service users birthday his family had taken him to visit steam trains. This is evidence of the family rather than the home intervening to meet expressed need. However there is no record in shift records or in the handover book that this outing happened, had been enjoyed or indeed that the service user had left or returned to the home. This is of concern as he went out during the afternoon shift and returned after the start of the night shift. There is no evidence that night staff had been informed that at the start of their shift a resident was out of the building and no evidence that he had subsequently returned. Records singularly recorded ‘no problems’. Discussion in relation to a second service user showed that intimate relationships chosen by service users are respected and appropriate advice and action taken. Records in relation to this however were not verified on this occasion. Preferred forms of address are noted and used and questionnaires undertaken with some service users by the home indicate that service users are satisfied that staff talk to them rather than exclusively with each other. Keys are available in the locks of service users doors but have become ‘invisible’, as service users need information, support and training to know that they are there and how they can use them. Locks also require priority review as they Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 15 cannot be locked from inside to maintain privacy and cannot all be over ridden in the event of an emergency. Housekeeping tasks and independent living skills or goals are not included in care plans and there is not a proactive response by the home to identify and meet these needs of service users. None of the service users have or have requested a pet. There is not a policy but the homes attitude to pets is outlined in the Statement of Purpose and service user contract. The contract still does not include reference to house rules in respect of drugs and alcohol as previously required. The menu is varied and offers choices. The meal provided looked appetising and sufficient in quantity. Mealtime was calm and service users were seen to be enjoying their meal. It was pleasing to see a staff member asking each service user their preferred choice for tea in accordance with the menu. Action taken since the last inspection has resulted in a service user who was frequently refusing meals refusing far fewer meals and putting on 6 pound in weight as opposed to losing weight. There is no indication however as to whether this and other service users are at nutritional risk as this is not being assessed. On the recorded occasions where the service user had refused his meal e.g. once in December and three times in November there was no evidence that the risk assessment undertaken by the manager had been followed by staff and no evidence that performance had been monitored by the manager. The service user case tracked who is elderly has lost weight steadily throughout 2005 (although records did not indicate the year). The manager explained that an effort had been made to encourage the service user to eat less chocolate which accounted for the weight loss which he said was needed. However there is not a clinical rational provided to justify the need to lose weight and no plan of care to support an objective to lose weight. None of the service users have any special dietary requirements (e.g. for religious or personal beliefs). There are no diabetic service users and none need aids or support to eat. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 16 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): 18, 19, 20, 21 Staff are provided with detailed information with regards to the provision of personal care. The privacy and dignity of service users is considered and assured during the provision of personal care. Service users health needs are not being fully met. Medication is generally well managed. Ageing of service users is handled with respect. Wishes upon death are not known for most service users but information is being gathered to work towards handling the death of a service user as the individual would wish. EVIDENCE: Care plans generally contain good detail about how service users prefer to receive personal care. Records however contradicted the outcomes found from discussion in relation to whether a service user prefers to have a shower or bath. The care plans and risk assessment must be clarified in this instance. Service users routines are well known and well documented providing good guidance for staff. This includes consideration of gender issues. For example a male carer attends to one service user’s personal needs in recognition of his preference and dignity. The home has a bath chair and a stair lift. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 17 Health outcomes for service users continue to require improvement. Care plans are not sufficiently guiding staff particularly with respect to routine health screening that service users are entitled and need to receive or in relation to specific health treatments or needs of individual service users. For example the care plan for the service user case tracked indicates that 6 monthly chiropody appointments are required and there is evidence of three appointments since September 2005. Care plans do not set the standard of care required in respect of dental, optical or other screening required. Subsequently the service user case tracked has not received dental or optical screening. There was evidence however that he had received an annual influenza vaccination. He had not needed to see a GP as there had been no changes in his health. A service user for whom it was identified at the last inspection required 6 monthly blood pressure checks has received two checks and there is recorded evidence of this but as required the care plan does not guide staff to ensure that this screening continues to be provided. The home has purchased its own blood pressure monitor but this must not replace the screening by the Doctor. There are few accidents in the accident records most of which are minor and relate to the effects of seizures experienced by one service user. This service user has fallen out of bed twice and knocked her head. The space around her bed has been modified to promote safety and reduce risk. The manager feels that the provision of a double bed would reduce the likelihood of her falling out of bed but this has not been purchased. Medication appears to be managed satisfactorily. Records do not indicate any gaps in the administration of medication. Stocks are limited to medications required. This is helped by medications being delivered weekly by the supplying pharmacist. This helps to keep storage down and minimises risk. Medications are stored in a locked box in a locked room and key management has improved since the last inspection. The medication policy has been slightly but not fully improved to include all that was previously required. Receipts and returns of medication are being accounted for on the medication administration record and in the homes returns book. Photographs on administration records are now in place to help to identify service users during the administration of medication which helps to reduce the risk of error. Care plans do not indicate current prescribed medications. The home does not have any controlled drugs. Only senior staff administer medication and they have this year received accredited training. Other staff observe medications being administered and they have all received training in medication awareness. The manager will consider implementing a system to assess the ongoing competency of staff to administer medication. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 18 The Manager and proprietor said that they are beginning to approach service users and relatives about their wishes in the event of death and are beginning to make slow progress. This had not been achieved for the service user case tracked. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 19 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): EVIDENCE: These Standards were not assessed at this inspection. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 20 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): EVIDENCE: These Standards were not assessed at this inspection although it was found that a service user at risk of falling from bed requires a double bed as assessed by the manager to reduce the risk of falling. Some previous requirements have been met in relation to the provision of new flooring in 2 bedrooms, the laundry and kitchen. New carpet has been laid in a service users bedroom that is incontinent to remove the odour as required and provide her with a more pleasant living environment. This flooring will have to be kept under review as an alternative, more readily washable type with an impervious seal may have been more appropriate. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 21 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 Staff require further guidance, support, training and supervision to assure competence with all aspects of their role to maximise effectiveness. The home is not currently demonstrating that it is providing staff in sufficient numbers to support service users assessed needs at all times. EVIDENCE: Staff require further guidance, support, training and supervision to assure competence with all aspects of their role to maximise effectiveness. The home is not currently demonstrating that it is providing staff in sufficient numbers to support service users assessed needs at all times. Sixty six percent of staff have achieved an appropriate NVQ qualification and this exceeds the national minimum standard. Staff are to be congratulated. Induction training has not been provided for new staff to date to the required standard. However progress has been made. The manager has identified a provider and assessor of Learning Disability Award Framework training who have capacity and who have assured the Manager that with two weeks notice this can be provided for the next new starter. The home does not use agency staff. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 22 Quality assurance systems do not yet seek the views of professional visitors or contacts with the home and it is therefore not possible to assess the quality of the relationship the home has with its professional contacts. No complaints however have been made to the Commission for Social Care Inspection. The home is not currently evidencing that it is providing sufficient staff hours or ratios per shift and at peak times. One service user has high support needs at peak times (needing two staff) but this had not been considered in the calculation of hours undertaken using the RSF tool giving a misleading outcome. Consideration of this service users needs took the estimate of hours required from 303 per week to 337. The home is providing 301 but budgeting for 315. Commissioners, the Manager said have agreed to fund an extra 50 hours for the service user with high support needs. The proprietor and manager proposed to provide an extra 22 care hours from week beginning 19 December, to recruit more staff to provide 365 care hours following the promised increase in funding, to review the sleeping in function with a view to providing two waking night staff instead and to ensure that the manager is totally supernumerary without having to provide 14 care hours and a key working function per week. This will give him more time to meet requirements and improve the performance of the home. The proprietor and manager also undertook to review the hours that care staff are distracted from caring tasks by undertaking domestic and catering tasks and to either replace these calculated hours with additional care hours or to employ a cook and cleaner. Current staffing ratios (3 staff 8am – 10.00am, 2 staff 10am – 3pm, 2 staff 3pm – 6pm and 3 staff 6pm – 10pm) do not fully meet the needs of residents at peak times. Activities in the evening and at weekends are compromised and are not happening and at meal times for example one carer is in the kitchen leaving only one carer to care for 11 service users. At peak times 2 of three staff are required to attend to one service user leaving one staff member for the remaining 10. The manager explained that as the service user stays in bed morning staffing levels are not seriously compromised. The Inspector’s concern is that current staffing ratios rely on this expected routine and do not allow for safe deviation from it compromising the choice and or safety of the service user/s. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 23 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): 37, 39, 42 The Manager is working towards the required qualification and requires support to ensure that the home can meet its stated purpose and objectives. Service users cannot be assured that their views underpin self-monitoring as self-monitoring is not sufficient. Steps have been taken and accordingly the safety of service users is better promoted. EVIDENCE: The Registered Manager said that he is half way through completing the required managers qualification – NVQ4. Records show that he has undertaken training regularly in 2003, 2004 and 2005 to update his knowledge and skills. In addition he is currently undertaking a course in dementia. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 24 The new proprietor has agreed to pay a management consultant for one day per month beginning in the New Year to ensure that the manager receives appropriate supervision. This consultant will also undertake the regulation 26 visits. In turn the manager must ensure that staff are appropriately supported and performance outcomes monitored. The manager has a job description. Certificates of registration are appropriately displayed. The manager spoke positively about the future. He is optimistic that the new proprietor will support him to carry out the required improvements and feels that the first month of working together has been positive. The manager together with the proprietor and staff must now ensure that improvements are made quickly and effectively. Outstanding requirements must be met without ongoing delay. Some steps have been taken to develop a system to seek service user views about the quality of the service provided but this has not been completed (3 completed), is not sufficiently independent nor has a conclusion yet been drawn. Third parties have not been included. The quality assurance system is not all encompassing or sufficiently robust. The proprietor and manager said they will consider purchasing a system. The safety of service users is being better met and some improvements have been better evidenced since the last inspection including maintenance, COSHH storage, some new risk assessments (e.g. hot surfaces) and improved core training for staff this year (Medication, First Aid and Infection control training being carried out and achieved in 2005). Most staff have first aid and infection control training. All staff who administer medication have accredited training with witnesses having been trained in medication awareness. Only half the staff have food hygiene training but those without do not prepare food the manager said. This restricts the deployment of staff throughout the shift. The proprietor is to review whether to train all staff or whether to cease the multi tasking present arrangement and employ domestic and catering staff. The Fire Service visited and assessed the home in June 2005 with no recommendations the manager said. A fire risk assessment required following the last inspection has been provided. Environmental Health last undertook a safety compliance visit 12 months ago with minor improvements required. The fire alarm system is regularly tested and there was good evidence of regular fire drills. Fire training is due to be provided again. In house training had been provided following the last input by a trainer in November 2004 but this will be reserved for new starters. The new proprietor said that she will ensure that a competent individual provides staff with sufficiently regular training. Appropriate induction training is planned for the next new staff member to start. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 25 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 X 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 X 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 2 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 1 14 X 15 1 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 2 2 2 X 1 X X 2 X Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 26 Yes 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 YA1YA1 Regulation 4, 16 Requirement The Statement of Purpose must explicitly detail which rooms do and do not meet the minimum space requirements. Requirement first made and not met since September 2004. Not assessed at December 2005. 2 YA1 5 A copy of the home’s service user guide must be made available to each resident. This requirement was first made and not met since November 2004. Not assessed at December 2005. 3 YA3 14(i)(d) A letter must be sent to each resident and /or their representative to state that the home can meet the resident’s individually assessed needs. A letter stating needs can be met must be sent in future prior to any new admission. At July 05 no new admissions. 31/03/05 31/03/05 Timescale for action 31/03/05 Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 27 This requirement was first made and not met since November 2004 Not assessed at December 2005. 4 YA6 15 The Home needs to: • Consider how person centred planning can be incorporated into the care planning system in order to demonstrate involvement from service users and their families/advocates. Consideration must also be given regarding producing care plans in a format suitable for service users at Ormidale House. 31/03/05 • Requirements first made and not met since October 2003. 5 YA6 17(1)(a) Sch 3(2) Review meetings must be evidenced 30/06/06 i.e. through the provision of minutes. This requirement was first made and not met since November 2004 Reviews of care must take place every six months with the service user, family and other appropriate third parties Multi disciplinary review meetings must be held for each service user within the next six months. New Requirement at December 2005. 6 YA6 15 Care plans must include guidance as to how all service users needs in respect of health and welfare are to be met. Guidance must be specific and must outline the frequencies of care to be provided. New Requirement at December 2005. Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 28 31/01/06 7 YA7 12(2) The Home should: • Ensure that care plans contain specific details as to what type of support and tuition are needed to assist individual service users with managing their finances as required by the NMS 7.5. 31/01/06 Requirement first made and not met since October 2003. 8 YA11 14(i)(d) 16(2)(b) The following needs / requests made 31/01/06 by TY must be met: • • The provision of a key to the bedroom A telephone point in her bedroom or access to a cordless telephone for use in her bedroom when required. To attend church. To go to the library to borrow books. To do sewing / cross stitch at home. To maintain independent living skills such as vacuuming. To access the community at weekends. • • • • • These requirements were first made November 2004 and were not assessed at July or December 2005. 9 YA13 12, 15 Residents must be supported to execute their right to vote. (Residents not offered opportunity to vote at general election 5.5.05) Requirement first made and not met since September 2004 31/03/06 Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 29 10 YA14 17(2) Sch 4(8) 25 The proprietor must confirm in writing providing evidence, the arrangements for funding residents’ annual holidays including arrangements for funding staff accommodation and expenses. Requirement first made September 2004 and not assessed at July 2005. Not known at December 2005 – evidence not provided. Not met in previous proprietors action plan. New proprietor must confirm her intention in writing re the above. 31/01/06 11 YA14 12(1)(a)(2)(3 ) 15 Independent living skills must be included in plans of care and implemented. Plans of care must reflect service users individual interests and outcomes must be monitored. More regular community access must be facilitated and evidenced in line with individual service users specific interests. The proprietor must meet residents’ 7-day holiday costs. This requirement was first made and not met since November 2004 31/01/06 12 YA15 12 Residents’ contact with friends and family must be evidenced. This requirement was first made and has not been met since November 2004. 31/12/05 Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 30 13 YA16 5 The home’s rules re alcohol and drugs must be included in the residents terms and conditions document. This requirement was first made and not met since November 2004 31/03/06 14 YA16 13(4) 23(4)(b) Locks on bedrooms, bathrooms 31/01/06 and toilets must be reviewed in consultation with the West Midlands Fire Service and as per risk assessment. Action taken must be on a prioritised basis and works fully completed by the date set. Requirement first made and not met since September 2004. 15 YA17 Sch 3(3)(m) Sch 3 (13) Nutritional risk assessments must be regularly reviewed and action taken without delay when risk is highlighted e.g. seek medical advice, put nutritional care plan in place ensuring that all staff adhere to it. New Requirement at July 2005 and not fully met at December 2005. 31/01/06 16 YA19 12(1) 13(1)(b) Annual sight, hearing tests must be provided for all residents. The manager must ensure that advice is sought from medical authorities about sexual health screening for residents and included in care plans. This requirement was first made November 2004 and not met at December 2005. 31/03/06 Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 31 17 YA19 13 All service users must be with sufficient regularity offered all health screening including dental checks. New Requirement at December 2005. 31/03/06 18 YA20 13(2) Residents or their representative where appropriate must give written consent for the administration of medication to them by the home. The medication policy must include arrangements for the transportation of medication and must state that medication must not be double dispensed. This requirement was first made and not met since November 2004 31/03/06 19 YA21 12 Service users wishes in the event of death must be assessed and recorded. New Requirement at December 2005. 30/06/06 20 YA22 22 The complaints policy must be in an accessible format for service users and must be readily available to them. New Requirement at July 2005. Not assessed at December 2005. 31/03/06 21 YA23 13(6) The manager must obtain for the home a copy of the Department of Health’s ‘No Secrets’ New Requirement at July 2005. Not assessed at December 2005. 31/01/06 22 YA23 13(6) The Physical Intervention Policy must be reviewed ensuring that it complies with the Department of Health’s Guidelines and guidelines issued by the British Institute of Learning Disabilities. 31/03/06 Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 32 New Requirement at July 2005. Not assessed at December 2005. A policy to guide the management of service user finances must be written and be made familiar to staff. New Requirement at July 2005.Not assessed at December 2005. The management of service users finances must be completely reviewed. This is to include: There must be a clear audit trail of service users finances available for inspection within the home. Service users monies must not be paid into the home’s business account. Purchase receipts must be retained to evidence service users spending. Service users money must be managed so that service users are not left short of money as a result of administrative error. Key holding arrangements to access service user monies must be reviewed upon seeking the advice of the Police Crime Prevention Unit. Requirements made at July 2005 and not assessed at December 2005. 25 YA24 13(3) 13(4) Chlorination test certificates must be obtained. Requirements first made and not met since September 2004 31/12/05 23 YA23 13(6) 31/01/06 24 YA23 13(6) 31/01/06 Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 33 26 YA24 23 The proprietor in conjunction with the manager must audit the furniture and implement a written renewal programme with target dates and a copy submitted to the Commission for Social care Inspection. Requirements made at July 2005 and not met at December 2005. 31/01/06 27 YA24 23(2)(n) The Manager has identified that a double bed would serve to better protect an epileptic service user who falls from bed. This must be provided by the home to meet assessed safety needs. New Requirement at December 2005. 31/01/06 28 YA30 13(3) 23(4)(a) 13(4) The manager must seek the advice of the Infection Control Nurse and / or the Environmental Health Department. Requirements first made and not met since September 2004. 31/03/06 29 YA30 13(3) The home must devise and adhere to an Infection Control Policy. New Requirements made at this inspection, July 2005. Not assessed at December 2005. 31/03/06 30 YA33 18 Care staffing hours provided per week must be reviewed: Consideration must be given to: • • Assessed dependencies of service users. Updated recommended outcomes of a recognised staffing tool. Ratios of staff required on each shift to meet need, safety and promote activities and choice. Care hours lost to domestic 31/12/05 • • Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 34 and catering tasks. • • Needs/ safety at peak times. Care hours (14) currently provided by the manager, which detract from his management role. Assessed outcomes and action taken must be confirmed in writing to the Commission for Social care Inspection by the date set. New Requirement at December 2005. 31 YA34 13(4) 19 The volunteer policy must be expanded to state that full checks and references, support and training will be undertaken in line with the recruitment policy for staff. Requirement first made and not met since September 2004. Not assessed at December 2005. The home must ensure that: • All gaps in employment history are explored 31/03/06 32 YA34 19 31/12/05 Requirement first made and not met since October 2003. Not assessed at December 2005 All recruitment checks and 31/12/05 documentation as per Schedule 2 must be obtained and must held on file prior to the appointment of new staff. New requirement at inspection July 2005. Not assessed at December 2005 34 YA35 23(4)(d) The manager must develop a training needs assessment for the team as a whole and each individual staff member. DS0000065596.V281726.R01.S.doc 33 YA34 19 31/03/06 Ormidale House Version 5.1 Page 35 Each staff member must receive at least 5 paid days training per year. All staff must receive training in recognising and reporting abuse. All staff must receive training in equal opportunities including disability and anti racism training. An action plan outlining dates for the provision of appropriate training for all staff must be provided to the Commission for Social Care Inspection. This requirement was first made and not met / evidenced since November 2004 Not assessed at December 2005 All documentation required by regulation including staff training certificates must be retained on the premises, must be up to date and must be available for inspection at all times. New Requirement at inspection, July 2005. Not assessed at December 2005 New staff must be provided 31/12/05 with induction training to the required standard and within the required time scale. New Requirement at inspection, July 2005 At December 2005 trainer identified for next new staff member. The homes to further enhance 31/03/05 the supervision sessions to cover care practices and the individual’s strength’s and weaknesses. DS0000065596.V281726.R01.S.doc Version 5.1 Page 36 35 YA35 18 31/12/05 36 YA35 18 37 YA36 18 Ormidale House Requirement first made and not met since October 2003. Not assessed at December 2005. Develop an effective quality assurance system. Requirement first made and not met since Prior to October 2003 The home to produce and implement an annual development plan for the home, this to be made available for inspection. Requirement first made and not met since March 2004. 40 YA41 17 Ensure that records required by regulation and those identified within this report are available for inspection. Requirement first made and not met since September 2004. Not fully assessed at December 2005. 41 YA42 23 The home to forward • The service contract for the chair lift. (Due to commence February 2005) 31/03/06 31/12/05 38 YA39 24 31/03/06 39 YA39 24 31/03/06 Requirement first made and not met since March 2004. 42 YA42 23, 13 The home to ensure that risk assessments are carried out for all safe working practice topics and that significant findings of risk assessments are recorded. Requirements first made and not met since March 2004. 43 YA42 13(4) 23 A written risk assessment must be carried out in respect of the bedroom window, which is internally climbed on to by the 31/12/05 31/03/05 Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 37 occupying service user. Advice must be sought from the Environmental Health Department. New Requirements made at inspection, July 2005 and not met at December 2005. 44 YA42 13(3) 23 The following must be carried out and kept up to date, with copies supplied to the Commission for Social Care Inspection. • A bacteriological water test certificate 31/12/05 New Requirements made at inspection, July 2005 and not met at December 2005. 45 YA43 17 , 25 The manager must receive formal and recorded supervision. Requirement first made and not met since September 2004. 46 YA43 13, 25 Ensure that financial and business plans are available for the purposes of inspection. Not assessed at December 2005 31/03/06 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 YA8 YA40 Good Practice Recommendations The home to consider how the service user’s can be involved in the selection of new staff to the home. The manager to consider signing and dating all policies and procedures Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 38 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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. Extracts may not be used or reproduced without the express permission of CSCI Ormidale House DS0000065596.V281726.R01.S.doc Version 5.1 Page 39 - 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. 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