CARE HOMES FOR OLDER PEOPLE
Ormonde 12 Pinewood Road Branksome Park Poole Dorset BH13 6JS Lead Inspector
Amanda Porter Key Unannounced Inspection 10:00 5 & 13th June 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.V289318.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.V289318.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 Mrs Fawzia Myrtle Patricia Rust Care Home 24 Category(ies) of Dementia - over 65 years of age (24) registration, with number of places DS0000020506.V289318.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. 28th February 2006 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 five 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 Registered Manager is Mrs F Rust. 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 the activities coordinator. These include arts and crafts, gentle exercise and games. Fees range from £450 - £475 per week. DS0000020506.V289318.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 over two days on the 5th and 13th June 2006 and took approximately seven hours. The purpose of the inspection was to review the requirements and recommendations made in the last report and to assess all the key standards. The registered manager was on hand throughout to aid the inspection process. Information gathered for this report came from several sources including: • Reports made to the Commission for Social Care Inspection by the home. • A pre-inspection questionnaire completed by the manager. • Three comment cards from visitors to the home. • Tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. • Discussion with residents and staff. Four residents and five members of staff were spoken with and asked their views on the service provided at Ormonde. Comments received included: “Very happy here, they are a great bunch of people.” “The staff know what I need.” “Staff involve residents in activities.” “A tip top home.” All the staff and residents were welcoming and helpful. What the service does well:
The service user guide gives sufficient and accurate information to prospective residents and their families so that they can decide whether living at Ormonde would suit them. The home carries out thorough assessments prior to residents moving in and assurances are given that individual needs can be met. Staff liaise with a variety of health care professionals to ensure residents have access to health care services so that assessed needs are met. Residents are encouraged to maintain their links with friends and family and all visitors are made welcome. Residents are helped to exercise some choice and control over their lives as far as possible.
DS0000020506.V289318.R01.S.doc Version 5.1 Page 6 The arrangements in the home to meet the residents’ medication needs are good and all procedures relating to this are safe. Residents are confident that staff will treat them with dignity and that their right to privacy is upheld. Meals are wholesome and nutritious and planned around the likes and dislikes of residents. The complaints procedure reassures residents that their views are important to the home and that any complaints they raise will be properly investigated. The home is well maintained and provides a comfortable, homely environment. Adequate number of staff are employed and deployed to care for the number and needs of residents accommodated. Where the home is involved in any financial transactions on behalf of a resident records are clear as to how it is spent. The health and safety of the residents and staff were protected by the policies and procedures that the staff followed at Ormonde. What has improved since the last inspection?
In the last inspection report a total of ten requirements and two recommendations were made. Since that time nine of the requirements and one of the recommendations have been met. Significant improvement has been made with care planning documentation and there is now a care planning system in place, which provides the staff with the information they need to meet the needs of the residents. The home now employs an activities coordinator who is organising some activities, which are enjoyed by the residents. She had engaged residents and their families in discussion in order to discover their preferred activities with an aim to create a monthly plan of activities, which will interest them. Further training has been provided so that staff understand how to deal with actual or suspicion of abuse of the elderly. The bathroom on the first floor has been converted into a wheel in shower, which is suitable for those residents with mobility problems. A thorough recruitment process is followed when employing staff, which ensures that residents are protected from risk.
DS0000020506.V289318.R01.S.doc Version 5.1 Page 7 The training programme has included induction and further mandatory training for care staff, which enhances the skills needed to care for residents well. Recent staff recruitment has included employing three registered nurses with the skills and qualifications to care for people with dementia, one of whom has been appointed Deputy Matron. Since the last inspection Mrs Rust has been registered with the Commission for Social Care Inspection as manager at Ormonde. There is a good rapport between staff and they work well as a team. Mrs Rust has started formal supervision with all her care staff so that there is a free exchange of ideas and any learning needs are identified. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000020506.V289318.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.V289318.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): 1 & 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families are given sufficient information to make an informed choice about whether to move to Ormonde. New residents move into the home having had their needs assessed and been assured that these needs will be met. EVIDENCE: Since the last inspection the service user guide has been updated and it gives an accurate picture of what to expect when living at Ormonde. It was readily available to anyone visiting the home and a copy was held in the reception area. Residents and their families were encouraged to visit the home prior to admission.
DS0000020506.V289318.R01.S.doc Version 5.1 Page 10 Three pre-admission assessments were reviewed and showed that prior to people moving to the home their needs are fully assessed by the manager. She gives written assurance that needs can be met. DS0000020506.V289318.R01.S.doc Version 5.1 Page 11 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, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear, consistent care planning system in place, which provides staff with the information they need to meet residents’ needs. The systems for the administration of medication are good with clear and comprehensive arrangements being in place to ensure that residents’ medication needs are met. Residents felt that staff were kind and caring, treated them with respect and upheld their right to privacy. EVIDENCE: Since the last inspection the system of care planning had much improved. Three care files were reviewed. They contained care plans, which accurately reflected the care given to the individual residents. There was evidence that residents and/or their chosen representatives were involved in the development and review of the care plans.
DS0000020506.V289318.R01.S.doc Version 5.1 Page 12 Relevant assessments such as mental health, moving and handling and risk of falls were held on file and reviewed regularly. Where risk assessments identified a need for specialist equipment this was provided. Visits from health care professionals such as GP, optician and chiropodist were recorded in the care files. The home has a well-written and informative medicines policy and procedure including reference to self-administration and associated risk assessment and arrangements for ordering, administration and disposal. Medicines were stored securely. Records were kept of the receipt, administration and disposal of medicines. Examination of records indicated that medicines are properly administered in accordance with the prescriber’s instructions. Residents spoken with confirmed that staff were kind in their approach. Comments included: “They’re a great bunch.” “They look after me well.” “They know my routine and how I like things done.” DS0000020506.V289318.R01.S.doc Version 5.1 Page 13 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 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are offered opportunities to enjoy social and recreational activities although a monthly plan of events is not yet available. Residents are helped to exercise choice and control in their daily lives within their capabilities and desire to do so. The dietary needs of residents are well catered for with a balanced and varied selection of food available that meets their tastes and choices. EVIDENCE: Since the last inspection the provider has employed an activities coordinator to work at Ormonde and Avalon, another home owned by the same provider. The organised activities take place between 10am – 2pm Monday to Friday. Effectively each home has activities for two hours in the morning one day and one hour in the afternoon the following day. The activities coordinator was in the process of auditing the activities within the home. She had involved the residents and their families in this and was
DS0000020506.V289318.R01.S.doc Version 5.1 Page 14 gaining a much clearer picture of the social needs of each individual. From this information she intends to produce a monthly programme of events, which will be given to each resident. This will be reviewed again at the next inspection. Activities at the time of inspection included: • Gardening. • Hand massage. • Soft ball games. Residents confirmed that they could meet privately with their visitors if they wanted to and generally they were free to make decisions about what they did each day. Members of the local clergy were made welcome and visited regularly. Most residents were not able to, or chose not to, deal with their own financial affairs. In most instances family members dealt with this. Residents were able to bring personal possessions in with them to personalise their rooms. The furniture in the dining room has been rearranged and now provides a more comfortable environment for residents to take their meals in. Generally residents liked the food provided and comments included: “The food is very good.” “Not bad on the whole.” “The staff make sure my meal is hot enough.” The menu, which offered choice, was displayed in the dining room. There was a supply of fresh fruit at all times which residents were encouraged to eat during the day. Meals are prepared in the kitchen at Avalon, next door, and delivered in a heated trolley. DS0000020506.V289318.R01.S.doc Version 5.1 Page 15 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 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A written complaints procedure leaves residents in no doubt that steps will be taken to deal with any complaint or concern they may have. Staff’s knowledge and understanding of Adult Protection issues provides a safe environment to protect service users from abuse. EVIDENCE: The home has a clear complaints procedure available to everyone. No complaints have been received by the home or the Commission for Social Care Inspection since the last inspection. Ormonde has a robust policy and procedure to respond to suspicion or evidence of abuse or neglect. Since the last inspection many of the staff had received training on abuse. Through discussion the management and staff demonstrated knowledge of the Department of Health guidance “No Secrets” and local protection of vulnerable adults procedures. DS0000020506.V289318.R01.S.doc Version 5.1 Page 16 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment at Ormonde is good providing residents with an attractive, homely and safe place to live. There are sufficient lavatories and bathing facilities for residents, which are in good working order. Not all staff follow the home’s infection control policy, which exposes the residents to the risk of cross infection. EVIDENCE: Ormonde has an ongoing programme of refurbishment and maintenance. Since the last inspection the downstairs small shower room, which was not useable for residents with mobility problems, has been removed and turned
DS0000020506.V289318.R01.S.doc Version 5.1 Page 17 into a much needed storage area. There is a hoist bath in the general bathroom downstairs. The general bathroom upstairs has been updated and the bath removed and replaced with a wheel in shower. The manager confirmed in the completed pre-inspection questionnaire that a variety of outside agencies have attended the home to undertake the routine maintenance of: • Fire safety equipment. • Gas installation. • Check for compliance with Legionella. • Lift. • Hoists. The layout of the home ensures that all communal areas are accessible. The grounds were tidy and attractive but residents rarely have the opportunity to sit out in them. One comment received stated: “It would be nicer for staff and residents if they could be sat outside in the fresh air – nicer for visitors too.” The house is free from any unpleasant odours. The laundry, which services both Ormonde and Avalon, is situated in an outbuilding between both homes. There is a designated member of staff to undertake the laundry duties. At this inspection and at the previous one it was noted that the hand washing facilities in the laundry were not being used. This lack of effective hand washing does put residents and the staff member at risk of cross infection/contamination. DS0000020506.V289318.R01.S.doc Version 5.1 Page 18 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient staff are employed and deployed to ensure that the needs of the residents can be met. The recruitment procedures in place are sufficiently robust and ensure that residents are protected. There are still some shortfalls in training, which may result in some staff not having the necessary skills and confidence to provide care in a competent way. EVIDENCE: Staff rosters demonstrated that there were sufficient staff on duty at all times. Since the last inspection the home’s training programme has been reviewed. 13 of care staff hold the NVQ level 2 award in care, which is below the 50 recommended. Five • • • • staff recruitment files were seen and they contained: Completed application forms. Two written references. Enhanced CRB and POVA first checks. Terms and conditions of employment.
DS0000020506.V289318.R01.S.doc Version 5.1 Page 19 • • • Documentary evidence of any relevant qualifications. Proof of identity. Work permits where necessary. Staff training has included protection of vulnerable adults; health and safety; first aid; fire safety; moving and handling. Although dementia care training had not started four members of staff are due to attend a course at the end of June and in house training will start soon after. This training will be reviewed at the next inspection. The home has recruited three registered nurses who have relevant experience and qualifications for caring for people with dementia. Training records showed that staff were receiving induction training and staff spoken with confirmed this. Further information on available training can be accessed through the following websites: www.picbdp.co.uk www.skillsforcare.org.uk DS0000020506.V289318.R01.S.doc Version 5.1 Page 20 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, 33, 35, 36 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is run by a committed and competent manager, who creates an open and positive atmosphere, which supports good care practices for residents. Although the views of residents and visitors has been sought the information gained has not yet been used to formulate an annual development plan. Residents are assured of sound management of their financial interests. There is adequate provision for formal and informal staff supervision, which promotes good practise within the home. Generally the health and safety of the service users and staff are protected by the policies and procedures followed at Ormonde.
DS0000020506.V289318.R01.S.doc Version 5.1 Page 21 EVIDENCE: Since the last inspection Mrs Rust has been registered with the Commission for Social Care Inspection as manager of Ormonde. There is a good rapport between all the staff, who work well together as a team. The home has recently appointed a deputy matron to support Mrs Rust in the management of the home. Mrs Rust confirmed that she had sent out satisfaction questionnaires to relatives but as yet had not used the information gained through them to formulate an annual development plan for Ormonde, nor were regular audits of the service provided undertaken. Feedback from residents and relatives had also been sought through a recent “Relatives Association” meeting, which had been well attended. Most residents choose not to deal with their own finances but they all had someone to act on their behalf. The home does hold some “pocket money” for some residents at their request. All monetary transactions were recorded and seen to be accurate. Records showed that all care staff had formal supervision and staff spoken with said that they felt well supported in their roles. Ormonde currently meets the requirements of the Dorset Fire and Rescue Service and the environmental health standards. Records relating to the maintenance and servicing of equipment, including fire safety equipment were seen to be up to date. Generally staff follow sound procedures to reduce the risk of cross infection and there is a plentiful supply of gloves and aprons. Accidents records were seen. They are recorded promptly and reviewed by the manager on a regular basis and action taken appropriately. Training records showed that staff were receiving fire safety and moving and handling training at appropriate intervals. DS0000020506.V289318.R01.S.doc Version 5.1 Page 22 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X X X 1 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 DS0000020506.V289318.R01.S.doc Version 5.1 Page 23 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 OP26 Regulation 13(3) & 16(2)(j) 18(1) Requirement Timescale for action 13/09/06 2. OP30 3. OP33 24 Hand washing facilities must be used in the laundry. (This requirement was first made on 28/02/06.) All care staff must have an 13/09/06 understanding of caring for people with dementia. (This requirement was first made on 28/02/06) The home must have an effective 13/09/06 quality assurance and monitoring system in place. 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 OP12 OP28 Good Practice Recommendations A programme of activities should be circulated to all residents. A minimum ratio of 50 care staff should have the NVQ level 2 award in care, or equivalent. DS0000020506.V289318.R01.S.doc Version 5.1 Page 24 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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