Inspection on 15/07/08 for Orrell Grange

This inspection was carried out on 15th July 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Orrell Grange 05/09/07

Orrell Grange 01/12/06

Orrell Grange 23/02/06

Orrell Grange 18/11/05

Orrell Grange 18/03/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Orrell Grange 43 Cinder Lane Bootle Liverpool Merseyside L20 6DP Lead Inspector Ms Lorraine Farrar Unannounced Inspection 15 and 21 July 2008 11:25 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 Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 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. Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orrell Grange Address 43 Cinder Lane Bootle Liverpool Merseyside L20 6DP 0151 922 0391 0870 7059966 orrellgrange@orrellgrange.plus.com 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) 1st Care Ltd Sheila Victoria Harrison Care Home 36 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (36) of places Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1 2 Service users to include up to 36 (OP) and up to 6 DE(E). One named female out of category service user under pensionable age. The variation applies to the named service user only, should she leave the Home, then the variation will cease to apply. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 5 September 2007 3 Date of last inspection Brief Description of the Service: Orrell Grange is a purpose built care home designed to provide accommodation and nursing care for thirty-six older people. It is situated in a residential area of Bootle with nearby facilities including shops, pubs and public transport. Twenty-six of the bedrooms are single and there are also five double bedrooms. Four of the single rooms have en-suite facilities and all other bedrooms have washbasins. Where there are shared rooms, screens are provided for privacy. Bedrooms are on both the ground and first floor with access available to the first floor via a lift. Downstairs there is a small dining room that people can use. They can also choose to eat in their room or the lounge, as they prefer. On the ground floor there is a large lounge with different seating areas. A small separate lounge has recently been created for people who smoke. There are staff available twenty four hours a day to support people with their health and personal care and also to provide some support with leisure activities. It currently costs between £374.90 and £519.70 each week to live at Orrell Grange. Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We gathered information for this inspection in a number of different ways. We carried out an unannounced visit to the home on 15 July 2008. This took place over 6½ hours and included reading records and looking at the building. We visited the home again on 21 July 2008 for 2¾ hours to meet the manager and look at staff records. The manager completed a questionnaire, called an annual quality assurance assessment that we sent her before our visit. We used information from this to plan this inspection and in writing this report. Before our visit we sent out survey forms to the home. Two of the people living there and five members of staff completed these and their replies helped us with planning our visit and in writing this report. During our visits we spent time looking at the support the people living at Orrell Grange receive. This included looking at the support they get with their daily lives, care plans, medication, money, activities and environment. We talked with six of the people living there, and nine members of staff including the manager. We also briefly met the relatives of two people who live there. Any information the Commission for Social Care Inspection (CSCI) has received since the last big inspection of Orrell Grange is also taken into account in writing this report. What the service does well: Good systems are in place to ensure that before anyone moves into Orrell Grange they receive sufficient information about the home and sufficient information is obtained about them. This helps everyone to decide if Orrell Grange is the right place for the person to live. The people living at Orrell Grange receive good support so their health and personal care needs are met. Routines are flexible and staff have a good understanding of how to support people in a way they need and prefer. Clear complaints and adult protection procedures are in place within the home and are made readily available to the people living there and their visitors. The people living there told us that they know who to talk to if they are unhappy. Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 6 This open approach helps people to feel safe and that any concerns will be listened to and acted upon. The people living at Orrell Grange told us that there are enough staff to support them and that staff listen and act on what they say. During our visits staff were seen to offer a good level of discreet support to people with meals and personal care. They were also seen to spend time taking with people and reassuring them when needed. Good recruitment procedures are followed and staff receive training in different aspects of the care and support they provide. This helps to ensure staff are suitable and knowledgeable enough to support the people living at Orrell Grange, some of whom who may be vulnerable. Orrell Grange is a warm and clean home that has aids and adaptations to meet the mobility needs of the people living there. People can personalise their own bedrooms and choose where to send their time. Activities are arranged during the week that people can participate in if they wish to do so. Several systems are in place within the home to check the quality of the service provided. These not only help to identify any issues quickly but also help in planning future improvements to the service provided at the home. What has improved since the last inspection? Since our last big inspection systems in the home for regularly reviewing people’s care plans and assessments have been fully implemented. This means that all plans and assessments are reviewed regularly and helps to ensure that changes to the person’s support needs or choices can be quickly noted and acted upon. Practices with regards to medication have improved which lessens the risk of mistake occurring. The home has invested in new, adapted beds and chairs that are more comfortable for people and support their health needs. They have a rolling programme in place to ensure the environment is well decorated and maintained. A wheelchair accessible minibus has been purchased for the home. This means that people can get out and about more easily with staff support and that various outings can be arranged. Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 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 Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People who use this service experience good outcomes in this area. We have made this judgment using available evidence including a visit to this service. Sufficient information is provided to and obtained about people before they move into the home to enable everyone to decide if Orrell Grange is the right place for the person to live. EVIDENCE: The people living at Orrell Grange told us in their comment cards that they received enough information about the home before they moved in to help them decide if it was the right place for them. One lady told us, “I chose to come here because they were so kind. Nothing is too much trouble, you won’t find better”. Before anyone is offered a place to live at Orrell Grange they or their relatives are invited to visit and look around. Staff from the home visit the person to carry out an assessment of their support needs and their choices. They also obtain a copy of any assessments carried out by the person’s social worker. Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 10 The information given to and obtained about people helps everyone to decide if Orrell Grange can meet the persons needs and their choices and is the right place for them to live. Orrell Grange does not provide an intermediate care service. Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use this service experience good outcomes in this area. We have made this judgment using available evidence including a visit to this service. The health and personal care needs and choices of the people living at Orrell Grange are recognised and support provided to ensure they can be met. EVIDENCE: The people living at Orrell Grange told us that they get the care and support that they need and that staff listen and act on what they say. One lady explained that if she is not feeling well the nurse comes to see her and gets the doctor if needed. Records in the home showed that routines are flexible with people able to get up or go to bed when they wish and to receive support with their personal care in a way they prefer. One of the people living there told us, “its up to me” what time she gets up and “I have a bath four times a week”, as this is what she prefers. Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 12 Staff confirmed that routines are not fixed and they do not have set times to support people to go to bed or get up, explaining that this depends on how the person feels that day. Individual care plans are in place for the people living at Orrell Grange. A series of assessments are carried out to identity any areas of support the person may have. These include their mobility, their nutrition and the condition of their skin. Where the assessment identifies a need for support, a care plan is put in place with clear written guidance for staff to follow. Clear guidance is also recorded about the person’s preferences for personal care and sleeping. For example, one plan recorded that the person likes two pillows and their bedclothes to be loose. This detail is particularly good where people cannot communicate the things they prefer as easily as they used to. All care plans and assessments had been reviewed regularly. This helps to ensure that any changes to the person’s support needs or choices can be quickly noted and acted upon. Records in the home showed that staff work closely with other health professionals and seek advice when needed. For example, one assessment indicated that the person’s mental and physical health was deteriorating. Staff had sought advice from a dietician as to how best to support the person with their nutrition. Staff were seen to offer discreet support to people with their personal care and it was evident in meeting the people living there that they had received good support to maintain their appearance. Medication is stored in a locked cabinet with fridges and controlled drug storage also provided. A clear system is in place for recording medication received and given to people. A sample of medication stocks were checked and found to tally with records. Medication administration sheets in the home that we looked at were completed correctly. However some did not contain a photo of the person. This would be good practice, particularly in the event of unfamiliar staff working in the home, as it helps them to ensure they are giving the medication to the right person, particularly if that person cannot communicate verbally. Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use this service experience good outcomes in this area. We have made this judgment using available evidence including a visit to this service. The people living at Orrell Grange are supported to make choices about their everyday lives so they can lead a lifestyle of their choosing. EVIDENCE: The people living at Orrell Grange told us that there are usually activities arranged by the home that they can take part in. A recent purchase of a wheelchair accessible mini bus has meant that people can get out and about more, with recent outings including trips to Southport, the Marina and Albert Dock. Several people told us that they have enjoyed these outings whilst another explained, that she is asked if she would like to go but she chooses not to and this is respected. During our visit the people living at the home were engaged in different activities. Some were spending time reading in their room, whilst others were watching TV, listening to music or entertaining their visitors. The activity coordinator was leading a game of ‘deal or no deal’, which people appeared to be enjoying. One lady told us she had recently had a joint party arranged by the Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 14 home, which was “very good”. She explained they took part in ‘name that tune’ and a race game and that “a good buffet and drinks” were provided. Other people told us that as well as the games that are organised they also have a member of staff who does beauty treatments for them, which they enjoy. There are Catholic and Church of England services held regularly in the home that people can attend as they choose. Records in the home do not fully reflect the support offered to people with their hobbies. For example, some people have a daily paper delivered, others take part in small household tasks and staff were seen to sit and chat with people. Better recording would help staff to ensure they are supporting everyone in this area. Visitors were seen to come and go throughout the day and relatives told us that they are always made welcome and there are no restrictions on their visiting. People are able to personalise their bedroom with their own possessions and are able to make choices about how they spend their time, decide where to see visitors and to manage or have their family manage their money. Information about local advice agencies is made readily available to people via the home’s notice board and statement of purpose. This all helps people to retain as much of their independence as possible and supports them to live their life as they choose. One lady we spoke with told us, “It’s very friendly here, very homely the meals are lovely”. Another said the food is “all right, they give me what suits me”. Menus and records showed that a choice of meals is offered daily and alternatives are always available. One person told us she did not like the teatime choices and staff were making her an alternative, explaining, “They always offer me something”. Menus showed that a good variety of meals are provided and we saw there were sufficient food stores including fruit and vegetables available. We observed part of the lunch and evening meals. Tables were nicely laid and people offered crockery and cutlery to meet their individual needs. Staff provided discreet support to people where needed to eat their meal. Drinks were provided throughout the day and a jug of juice was left in the lounge for people to help themselves if they wished. Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience good outcomes in this area. We have made this judgment using available evidence including a visit to this service. Clear polices and procedures are in place at Orrell Grange for dealing with any concerns or complaints that arise and the people living there are fully aware of these. There are also procedures to make sure that people are safeguarded from abuse and harm. This helps people to feel safe and confident that they will be listened to. EVIDENCE: The people living at Orrell Grange told us that they know who they can talk to if they have any concerns or complaints. Information about how to make a complaint and how it will be dealt with is readily available on the notice board in the foyer. There has been one complaint received about the service since the last big inspection. This was investigated by the organisation and responded to appropriately. There is a policy in place within the home for dealing with any adult protection issues that arise. Staff receive regular training in how to identify potential issues and deal with them appropriately. Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 16 Clear procedures are in place for managing any money held in the home that belongs to the people living there. This helps to ensure that people’s money is managed safely and well. The clear information provided to people about how to raise concerns helps to ensure that people can feel safe and that their concerns will be taken seriously and acted upon. Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26 People who use this service experience adequate outcomes in this area. We have made this judgment using available evidence including a visit to this service. Orrell Grange is well maintained so it provides a safe, comfortable environment for the people who live there. Further adaptations need to be made so people with dementia living there can understand their environment more easily. EVIDENCE: The people living at Orrell Grange said in their comment cards that the home is always fresh and clean. We saw this during our visit when all areas we looked at were clean, tidy and warm. Bedrooms are personalised with people’s own possessions and equipment is provided to meet their needs. This includes adapted baths and toilets, a lift, hoists, bed rails and specialised beds and chairs. Call bells are located throughout the home. However in one shared room the bed had been moved Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 18 and the call bell was not within reach, which could lead to the person not being able to summon help when needed. The manager was aware of this and told us that arrangements were in hand to move the bell near to the bed very shortly. Several of the people who live at Orrell Grange have dementia. A member of staff we spoke with was aware of how environments can be adapted to help people find their way around and make sense of their environment more easily. However at present there are very few environmental adaptations to Orrell Grange that could support people to understand their environment more. The majority of bedrooms do not have en-suite facilities. However all are provided with washbasins and there are bathrooms available on both floors. Bathrooms are quite clinical in appearance and would benefit from some homely decorations and storage. At present open storage trolleys and urine bottles are stored in bathrooms, which adds to the clinical appearance of these rooms. Shared space includes a small dining room and large lounge. The lounge has been arranged into separate seating areas so that people can choose whether to watch TV, join in activities or entertain their visitors. At the back of the lounge a separate, enclosed room has been created to be used by residents who smoke. The information form completed by the manager showed that there is a continuous programme for maintaining the home, including redecoration and refurbishment where needed. The areas of the home we visited during our visit were all well maintained, with bedrooms appearing as homely as possible. Where rooms are shared, screens are provided for privacy. There is a separate laundry room equipped with industrial washers, an industrial dryer and sluice. A member of staff is employed to work in there and it was noted that people’s clothing looked well cared for. Bedding was ironed and in good condition. A system is in place to prevent cross infection and equipment to help with this is provided, including disposable gloves and aprons and colour coded bags for potentially infected waste or laundry. Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use this service experience good outcomes in this area. We have made this judgment using available evidence including a visit to this service. There are enough staff on duty so that people’s needs are met. There are thorough recruitment procedures used and staff receive training so the people living at Orrell Grange are supported by staff who are able to identity and meet their needs and choices. EVIDENCE: The people living at Orrell Grange told us that there are enough staff to offer them support when needed. The staff rota shows that there are always two registered nurses working during the day and one at night. The number of carers alters according to the times of the day that the people living there have more support needs. In addition staff are employed to work in the kitchen and laundry and to clean the home. Records showed that before anyone is appointed to work at Orrell Grange a series of checks are carried out. These include obtaining written references and checking with the Criminal Records Bureau (CRB) and register of people unsuited to work with vulnerable adults. These checks help to ensure that staff are suitable to work with people who may be vulnerable. A newer member of staff explained that when she started work in the home she was given an induction and also assigned to shadow an experienced carer Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 20 so that she could learn how the home works. This is good practice as it helps to ensure staff do not support people until they have the knowledge in how to do so safely and well. Records showed that staff undertake basic training such as moving and handling people, fire safety and protection of vulnerable adults. They also undertake more specialist training such as courses in caring for people with dementia and palliative care. Over 50 of the care staff working in the home have obtained a qualification in care (NVQ). The training staff receive helps them to remain up to date with current good practices in how to support people safely and well. A member of staff we spoke with was very enthusiastic about the training she had in dementia care and in supporting people who can be challenging, describing it as, “fascinating, really good”. She was able to explain how she applies this training in her everyday work and in understanding the people she supports. All staff we spoke with had a good understanding of the support needs of the people living at Orrell Grange and their role in meeting these. Throughout our visit staff were seen to spend time chatting with and reassuring people as well as offering discreet support to them with their meals and personal care. Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use this service experience good outcomes in this area. We have made this judgment using available evidence including a visit to this service. Orrell Grange is well managed so it is run for the benefit of the people who live there. EVIDENCE: Sheila Harrison is the registered Manager of Orrell Grange. She is a registered nurse with many years experience of supporting and managing care services for older people. She keeps herself up to date by attending training relevant to the support provided at Orrell Grange. Orrell Grange arranges for a quality audit to be carried out each year by an external company. This was last carried out in April 2008 and the home received a 4.4 star rating out of a possible 5 stars, which was an improvement Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 22 on their rating the previous year. The audit involves, amongst other things, the auditor spending time with the people living there, their relatives and staff and sending out questionnaires seeking their opinion of the service offered. In addition a manager from the organisation that runs the home visits it regularly to carry out visits and audits of the service. This includes talking with the people living there and staff and examining a selection of records. Care plans are reviewed regularly and systems are in place to audit the environment and medication management regularly. These audits and quality assurance systems help to ensure that Orrell Grange is providing a good quality service for people and that any areas for improvement can be quickly noted and acted upon. The service encourages the people living there to manage their own money with support from relatives or friends of needed. They do act as appointee for some people’s benefit money but are clear that they will not undertake this role for anyone new moving into the home. A safe is provided for storing small amounts of people’s money and written records are kept of their balances. A check was made on some of the records and money held for people and these were found to be in order. Records and certificates showed that regular checks are carried out on the building and equipment. This includes checking electrical appliances, the gas supply, lift and lifting equipment as well as regular checks of fire safety equipment. These checks help to ensure that the home is a safe place to live and work in. Care plans state that regular checks of bedrails should be carried out. However no formal record of these checks is maintained. Although the rails we looked at during inspection were well fitted and appeared safe it would be good practice to maintain a record so that any issues that occur can be quickly noted and acted upon. Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 23 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 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 25 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 Timescale for action 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 Refer to Standard OP9 Good Practice Recommendations A photograph of the person should be attached to their medication administration sheets. This will help to ensure that unfamiliar staff can easily identity the person when dealing with their medication. Records relating to the support people receive with activities, hobbies and their lifestyle should be more in depth. This will help to ensure everyone is getting the support they need and to plan future activities. The environment should be assessed to establish what if any changes or additions would help to support the people living there who have dementia to orientate themselves more easily. A record should be maintained of checks carried out on bedrails. This will help to ensure that any potential risks can be quickly noted and acted upon. 2 OP12 3 OP22 4 OP38 Orrell Grange DS0000061714.V363861.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North West Region CSCI Preston Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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