CARE HOMES FOR OLDER PEOPLE
Ormonde 12 Pinewood Road Branksome Park Poole Dorset BH13 6JS Lead Inspector
Amanda Porter Unannounced Inspection 10:00 28 February 2006
th 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 DS0000020506.V284985.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 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. DS0000020506.V284985.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Ormonde Address 12 Pinewood Road Branksome Park Poole Dorset BH13 6JS 01202 760838 01202 760838 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Avalon Nursing Home (Dorset) Limited Care Home 24 Category(ies) of Dementia - over 65 years of age (24) registration, with number of places DS0000020506.V284985.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. To accommodate four service users, as known to the Commission for Social Care Inspection, under the age of 65 years with mental health needs. To accommodate one service user, as known to the Commission for Social Care Inspection, under the age of 65 years with dementia. 7th July 2005 Date of last inspection Brief Description of the Service: Ormonde is registered with the Commission for Social Care Inspection to provide nursing care for a maximum of 24 service users over the age of 65 years with dementia. A condition of registration is that the home can also accommodate nine residents known to the Commission, under the age of 65 years of age. The home is owned by the Avalon Nursing Home (Dorset) Ltd and Mr A H Jaffer is the Responsible Individual. The home is situated in a residential area of Branksome Park. It is set back from the road in pleasant gardens. There is a small enclosed patio area accessible from the dining room. Accommodation is provided on the ground and first floor with access via a passenger lift. On the ground floor there is a lounge and a dining room. There are also seven bedrooms of which three are single, with two of those having ensuite facilities, and four doubles, with one having ensuite facilities. On the first floor there are seven single bedrooms, three of which have ensuite facilities and three doubles, two of which have ensuite facilities. The home has assisted bathing facilities on each floor. Some recreational activities are organised by members of staff. These include arts and crafts, gentle exercise and games. DS0000020506.V284985.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place during the morning and afternoon of the 28th February 2006 and took five and a half hours. The purpose of the inspection was to review the requirements and recommendations made in the last report and to assess key standards. Since the last inspection a new manager has been appointed, Mrs Fawsia Rust, who has been in post for two months. She has not submitted an application to be registered with the Commission for Social Care Inspection yet but expects to do so in the near future. She was on hand throughout to aid the inspection process. Four residents, one visitor and four members of staff were spoken with and asked their views on the services provided at Avalon. Comments included: “I like working here. The team work well together.” “Staff are very kind.” “The food is excellent.” “I am made very welcome when I visit.” Some documentation was reviewed, including care files, personnel and training files. A tour of the premises was undertaken. What the service does well:
The home ensures access to health care services to meet assessed needs and liaises with a variety of health care professionals. Residents say they find that staff are kind, considerate and care is given which respects personal dignity, and residents’ rights to privacy. Residents are encouraged to maintain their links with family and friends and visitors to the home are made most welcome. Residents were helped to exercise some choice and control over their lives by a caring staff. Generally the house and gardens are well maintained which provides residents with a comfortable place to live. Residents are encouraged to personalise their rooms with small items of furniture, pictures and a variety of mementos. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. Financial procedures within the home also ensure that residents’ interests are protected. DS0000020506.V284985.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
As a result of this inspection a total of ten requirements and two recommendations have been made. Work needs to be done to make sure care plans give details of how residents’ needs are to be met. Residents and their chosen representatives must be invited to participate in the drawing up and review of plans of care that affect them and their views must be considered. Social activities are limited at present and consideration should be given to addressing the individual needs of residents who do not wish to participate in group activities and make group activities more relevant to the residents undertaking them. At the time of the inspection it was apparent that staff were not following the home’s infection control policy and were not using the hand washing facilities in the sluices and the laundry. Staff should be provided with suitable training so they understand the home’s policy and procedure for responding to suspicion or evidence of abuse or neglect so that the risks of residents being exposed to harm are minimised. Recruitment records were seen to be incomplete, resulting in the management not being able to guarantee that staff were being employed appropriately. It was apparent that not all staff undertook the mandatory training required of them. All staff should undertake manual handling training when starting their employment and on a yearly basis thereafter. Fire safety training should be completed at least every six months. Common Induction training should be completed within the first twelve weeks of employment. This would ensure residents could be confident that staff are trained and competent to do their jobs. At present most of the staff have not received training in caring for people with dementia. The home has an ongoing programme for NVQ training in care but as yet has not reached the ratio of 50 of care staff needed to hold this award. The home must ensure that all care staff receive formal supervision at least six times a year so that residents can be assured that staff are supported in their
DS0000020506.V284985.R01.S.doc Version 5.1 Page 7 roles and encouraged to develop their knowledge and advance their practice to better care for them. 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. DS0000020506.V284985.R01.S.doc Version 5.1 Page 8 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 DS0000020506.V284985.R01.S.doc Version 5.1 Page 9 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 Standard 6 is not applicable as the home does not provide intermediate care. The supply of a written contract ensures that each resident is made aware of the terms and conditions of living at Ormonde. New service users move into the home having had their needs assessed and been assured that these will be met. EVIDENCE: Three service user files were seen, which contained a signed contract and a statement of terms and conditions was included in the service user guide. This included: • The room to be occupied • Overall care and services • Fees payable • Terms and conditions of occupancy • The rights and obligations of both resident and registered provider Files also showed preadmission assessments had taken place. These were thorough and contained sufficient information from which a care plan could be drawn up.
DS0000020506.V284985.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 10. There is no clear or consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet resident’s needs. However the health needs of residents are well met with evidence of good support from community professionals such as GPs, occupational therapists, opticians and dentists. Residents and their families felt that staff were kind and caring, treated them with respect and upheld their right to privacy. EVIDENCE: Three care files were reviewed and two contained care plans. Although it was apparent that residents were receiving adequate care, evidence of this was not clearly given in the care documentation. Two • • • • files contained a variety of assessments such as: Moving and handling Nutrition Use of bed rails The risk of pressure sore development
DS0000020506.V284985.R01.S.doc Version 5.1 Page 11 Dietary preferences were recorded and client weights were recorded appropriately. Visits from GP, chiropodist and optician were seen in the records. Care records showed that each service user was assessed for the risk of developing pressure sores. Where the risk was high action was taken and the equipment necessary for the promotion of tissue viability and prevention or treatment of pressure sores was provided. In most cases only some of the information gained through assessment had been used in the care plans. One resident had a thorough pre-admission assessment but no care plan had been drawn up as a result. Generally the care plans were not written until some days after admission and did not involve consultation with the resident and/or relative. Therefore care staff would not have the information they needed to ensure that residents’ needs were met. Residents said that they were treated with respect and kindness and their right to privacy was upheld. Comments from residents included: “ They are very kind.” “Staff are very good.” DS0000020506.V284985.R01.S.doc Version 5.1 Page 12 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): 12, 13 &14. The social and recreational needs of the service users are not wholly satisfied, which results in some service users being bored and under stimulated. The residents are supported in maintaining contact with their friends, family and the narrow community and in making decisions about their lives in the home. EVIDENCE: Each afternoon the care staff was allocated to organised a group activity. On the day of inspection this was music and playing musical instruments. There appeared to be no structure to this session and very little meaningful interaction between staff and residents. The lack of meaningful activities is unlikely to improve until there is some understanding of person centred care, matched to individual’s lifestyle preferences. Generally residents said that they were very appreciative of the efforts of staff. However the activities were not based on the assessed needs of individuals. For those service users who did not wish to take part in the organised activities no plan was evident for how their social needs were to be met. Residents and visitors confirmed that their visitors were made very welcome in the home and they could receive their visitors in private if they so wish.
DS0000020506.V284985.R01.S.doc Version 5.1 Page 13 Some residents spoken with said that they were free to make decisions about how they spent their days. Most preferred to allow family members to handle financial affairs. They were able to bring personal possessions in with them to make their rooms more homely. DS0000020506.V284985.R01.S.doc Version 5.1 Page 14 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): These standards were not assessed during this inspection. EVIDENCE: The recommendation that staff have training in the protection of vulnerable adults, made under standard 18 in the last report, has been brought forward into this one. DS0000020506.V284985.R01.S.doc Version 5.1 Page 15 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 & 26. The standard of the environment at Ormonde is good providing residents with an attractive, homely and safe place to live. However there is only one usable bath within the home. Staff do not follow the home’s infection control policy, which exposes the residents to the risk of cross infection. EVIDENCE: Since the last inspection the home has appointed a member of staff to undertake routine maintenance at Ormonde and Avalon, the home next door. A programme of refurbishment and redecoration was underway. However the Parker bath in the upstairs bathroom was out of action, which reduced the number of baths available in the home to one. The space in both sluices is cramped and as a result staff were not using the hand washing facilities. Since the last inspection hand washing facilities had been provided in the laundry but it was evident that they were not being used. The general lack of effective hand washing by staff does put residents at risk of cross infection.
DS0000020506.V284985.R01.S.doc Version 5.1 Page 16 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, 28, 29 & 30. Sufficient staff are employed and deployed to ensure that the needs of the residents can be met. Shortfalls in the recruitment procedure do not protect residents from risk. The shortfalls in training, results in care staff not being fully competent to do their jobs properly. This means that residents cannot be assured they are in safe hands at all times. EVIDENCE: Staff rosters demonstrated that there are sufficient staff on duty at all times. The home has an ongoing training programme, which includes NVQ level 2 in care but at the time of inspection none of the care staff held this award. It is recommended that 50 of care staff should hold this award to ensure that residents are in safe hands at all times. Five • • • • • • • staff recruitment files were seen and four contained: Completed application forms Two written references Enhanced CRB checks Terms and conditions of employments Documentary evidence of any relevant qualifications Proof of identity A record of the interview
DS0000020506.V284985.R01.S.doc Version 5.1 Page 17 However a new member of staff had recently started and there was no personnel information held at all within the home. This member of staff was included in staffing numbers and was not given any supernumerary hours to help with a constructive induction. Training files did not demonstrate that healthcare assistants were receiving the common induction training, which meets National Training Organisation workforce training targets. Most of the staff had not received training in caring for people with dementia. Records also demonstrated that not all staff had received manual handling or fire safety training on a regular basis thus putting residents at risk. DS0000020506.V284985.R01.S.doc Version 5.1 Page 18 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): 35 & 36. Residents are assured of sound management of their financial interests. The lack of formal supervision for staff does hinder the standards of care given. EVIDENCE: The manager confirmed that generally residents in the home were unable to deal with their own finances and many had a family member to act on their behalf. The home does hold ‘pocket money’ for some service users at their request. Monetary transactions were recorded and seen to be accurate. The manager also confirmed that not all staff were receiving formal supervision on a regular basis. A requirement to rectify this shortfall has been made.
DS0000020506.V284985.R01.S.doc Version 5.1 Page 19 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X 1 X X X X 1 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 1 X X DS0000020506.V284985.R01.S.doc Version 5.1 Page 20 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. Standard Regulation Requirement The plan of care for each resident must be drawn up with the involvement of the resident and/or their chosen representative unless it is impracticable to carry out such consultation. (Timescale of 07/10/05 was not met.) Each care plan must set out in detail the care required to ensure that assessed needs in respect of the residents health and welfare are to be met. Residents must be consulted about a programme of activities and the home must provide facilities for recreation. (Timescale of 07/10/05 was not met.) The general bathroom on the first floor must be in good repair and usable by residents. Hand washing facilities must be used in the laundry and sluices. All care staff must have an understanding of caring for people with dementia. The registered person must ensure that care staff receive
DS0000020506.V284985.R01.S.doc Timescale for action 1. OP7 15(1) 28/05/06 2. OP7 15(1) 28/05/06 3. OP12 16(2)(n) 28/05/06 4. 5. 6. 7. OP21 OP26 OP30 OP30 23(2)(j) 13(3) & 16(2)(j) 18(1) 18(1) 28/05/06 28/05/06 28/05/06 28/05/06 Version 5.1 Page 21 8. 9. 10. OP30 OP30 OP36 13(5) 23(4) 18(2) common induction training to National Training Organisation specification. All staff must have manual handling training on a yearly basis. All staff must have fire safety training as recommended by the Dorset Fire and Rescue Service. All care staff must receive formal supervision at least six times a year. 28/05/06 28/05/06 28/05/06 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 OP18 OP28 Good Practice Recommendations Staff should receive training in the procedures for responding to suspicion or evidence of abuse or neglect A minimum ratio of 50 care staff should have the NVQ level 2 award in care, or equivalent. DS0000020506.V284985.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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