CARE HOMES FOR OLDER PEOPLE
Orrell Grange 43 Cinder Lane Bootle Liverpool Merseyside L20 6DP Lead Inspector
Ms Lorraine Farrar Unannounced Inspection 18th November 2005 11.30 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.V269672.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Orrell Grange Address 43 Cinder Lane Bootle Liverpool Merseyside L20 6DP 0151 922 0391 0870 7059966 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 Mrs Shiela Victoria Harrison Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 36 (OP). 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 Staffing Notice, dated 22/7/04, is to be adhered to at all times. The Manager to work a minimum of 8 hours supernumerary per week where service user numbers are below 25. The Manager to be supernumerary at all times where service user numbers exceed 25. The service should, at all times, employ a suitably qualified and experienced Manager who is registered with the CSCI. 3. 4. 5. 6. Date of last inspection 18th March 05 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. 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. Accommodation is on two floors with a lift available to access the top floor. Shared space consists of one large lounge and a dining room. The lounge provides a TV area and quieter area with a smoking area designated next to the patio doors, the dining room is not large enough to accommodate all Residents, therefore meals are served in two sittings. Outside there are pleasant gardens, which Residents, can make use of during warmer months. The home is situated in a residential area of Bootle, nearby facilities include shops, pubs and public transport. Twenty-four hour nursing and personal care is provided by the home, in addition to which a member of staff is employed on a part time basis to coordinate leisure activities for Residents. Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out by two inspectors, Lorraine Farrar and Trish Thomas. The Inspection lasted 3hrs and 45 minutes during which time, the Inspectors spoke with residents, relatives and staff, read care plans, files and documents in the home and looked around parts of the building. What the service does well: What has improved since the last inspection?
Residents’ social histories are being compiled, (in partnership with their families), to be included in their care plans. A new hoist has been purchased. The dining room has been decorated with new seating provided. Two reclining chairs, a DVD and video have been purchased, from funds raised by residents and staff. The home and organisation have worked hard to make sure their management of residents monies is clear and well recorded and that wherever possible they do not act as appointee for residents benefits. Care plans have been reviewed and a new format is being introduced which is clear and comprehensive. Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 Page 6 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. Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 The home carries out their own pre-admission assessment and use this to decide if they can meet the persons needs. They do not always obtain a copy of the Local Authority assessment to make sure they are aware of all of the persons identified needs. EVIDENCE: Care plans contained copies of assessments completed by Nurses in the home that had been carried out before offering a place to the residents. Not all new residents had a copy of an assessment completed by the Social Worker from their local authority. The home manager explained that a pre-admission assessment is carried out by either herself or one of the Registered Nurses, this is then discussed to make sure the home can meet the person’s needs. She confirmed that if the home are unable to meet the needs identified they refuse a place. Before offering a placement the home needs to obtain a copy of the person’s local authority assessment, this will help them to make sure they are aware of all of the persons identified needs and whether they can offer the support needed. Orrell Grange does not offer an intermediate care service.
Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10 Six care plans, which were read, had planned for the identified needs of the Residents concerned. Residents were benefiting from the care provided in the home and the condition of more frail residents is monitored throughout the day and night. Residents are registered with a G.P. and were receiving medical treatment in accordance with their recorded need. The home generally stores and manages resident’s medication well, however they are not currently disposing of unused medication in accordance with legislation. Residents’ privacy and dignity was seen to be respected in the home, other than in one instance witnessed in the lounge. EVIDENCE: Six care plans were tracked and contained comprehensive nursing assessments, action plans, reviews and risk assessments. Action plans included attention to residents’ care and comfort, and to their mobility requirements and health needs. Some of the residents whose care plans were tracked, were visited in their bedrooms, and attention had been given to their care, comfort and personal grooming, pressure care and fluid intake. One gentleman was very poorly, and he nodded when asked if he was comfortable, there was a cold drink on his bedside table. One lady was dozing with the radio on low.
Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 Page 10 It had been stated in the care plan that she liked listening to the radio. Obvious attention had been paid to her personal care and grooming. The bedding in all rooms visited, was clean and had been carefully ironed. It was noted on some care plans that social histories had not been completed. The manager is taking action to obtain background knowledge of residents who are unable to respond, by providing family representatives with a “getting to know you” document, to be completed on their behalf. Care plans have a section for the resident or relative to sign but those read had not been signed. As identified at previous inspections the home should offer all residents or with their permission their relatives the opportunity to read and sign their care plan. A member of staff spoken with had a good level of knowledge of residents’ care needs and said that the condition of the more frail residents is monitored regularly, and that turns, treatment, drinks and meals are given throughout the day and night. All residents are registered with a G.P. and care files had the G.P names and contact details recorded. There was also evidence on care plans of treatment by specialist and paramedical services. One visitor and five residents who commented said that the care provided in the home is good. They said there are always nurses on duty, and the doctor will visit if necessary. No concerns were expressed. Care plans contained detailed information about the person’s healthcare needs and thorough recording of the actions taken by staff to monitor these. The home has a room set aside for storing medication and have recently provided a second drug trolley on the 1st floor, the RGN on duty explained that this was working well and enabled staff to be more efficient when giving out medications. The medication room was clean and well organised with records and storage of medication completed correctly. Several of the residents are prescribed parocetomol and this was being given from a stock, the home need to make sure that if a medication is prescribed then it is stored and given from individual containers, this will provide a clear audit trail. The home are currently returning unused medication to their pharmacist. The manager is aware that legislation states this should be disposed of to a company who hold a licence. She explained that they had contacted a suitable company and were awaiting the storage equipment needed. The home must advise the CSCI of the date they expect this contract to start. Residents’ privacy was respected in care giving, bedroom and bathroom doors were kept closed and double bedrooms had screening provided. Residents looked well cared for and staff were available in the lounge and dining room to support them. One member of staff was observed speaking harshly to a resident in the main lounge. The member of staff was identified to the manager by the Inspector, during feedback. A requirement is made regarding support and training for the member of staff concerned. In general, residents said that staff were very good and work hard.
Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 Page 11 The majority of staff were respectful towards staff and their visitors. A resident who commented said she chooses the time she goes to bed and gets up in the morning. She said that staff are always available to help her. Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 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): Standards 12,13 & 15 A member of care staff is the designated activities co-ordinator. Outings and parties had been arranged in recent months but a shortfall was noted regarding day-to-day leisure activities in the home. Visitors are made welcome in the home and community links encouraged, in accordance with residents’ preferences and abilities. Improvements were seen in the condition of the dining room and Residents are also served meals in the lounge, or in their bedrooms. EVIDENCE: Five residents were asked about social events in the home. One lady said that not much happens during the day but “My family take me out.” Another resident said she would not be interested if there were more organised activities, she would prefer to not get involved. One gentleman said he prefers to stay in his room and watch sport on television. Another resident said the home had held a garden fete in August and others said they had been on an outing. She said a group of residents and staff went to the Floral Hall in Southport for a sing along, they took a packed lunch and had a really wonderful day. Recommendations are made regarding consultation with residents as to their preferences for leisure activities and for the home to keep a social activities diary. Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 Page 13 A number of residents of the home were very poorly at the time of inspection and remained in their bedrooms. A member of staff said their family and friends visit regularly and staff respect their privacy during the visits. One lady said that her daughter visits daily. Her visitor said that she had no concerns or complaints and that her mother is well cared for. One resident was going out with his visitor, the nurse on duty was helpful and provided him with a wheelchair and his warm jacket. Another lady was entertaining three members of her family in the lounge. In general, there was a pleasant and friendly atmosphere in the home (other than the incident referred to in standard 10). One lady explained, “We get lovely meals here.” This was the opinion of all of the residents who commented. There is a four weekly rotating menu, with the menu of the day written on a board in the dining room. Residents are offered a cooked breakfast, light lunch with dessert and a main evening meal. Conditions in the dining room had improved since the last inspection. The room has been decorated with new seating provided. A number of residents remain in their wheelchairs for meals. Surplus dining chairs are now stored in a corridor and are not stacked in the dining room, as previously, where they caused a hazard. Residents choose where to have their meals, a number being served in the lounge or in their bedrooms. Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 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 looked at during this inspection. EVIDENCE: Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 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): Standards 19 & 21 The home provides suitable, safe premises to meet residents’ needs. There are sufficient lavatories including some en-suite to meet resident’s needs however some bathing and toilet facilities require upgrading and decorating. EVIDENCE: Orrell Grange is a purpose built care home with accommodation over 2 floors, a passenger lift is available to the first floor and there are ramps to access the garden area. Since the last inspection the dinging room gas been decorated with new carpet and unused furniture stored elsewhere, the room is now less hazardous and provides a pleasant area for residents to eat their meals. Overall the home appears clean and safe with the environment suitable for residents with mobility problems. Some of the rooms have been decorated with others beginning to look shabby, the manager explained there are plans for more decor, however the home does not employ a handyman and uses local tradesmen a day or two a week. Given the size and age of the home they should consider employing a part time handyman to carry out routine maintenance and decorating. Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 Page 16 As identified at previous inspections the home must provide a detailed maintenance and renewal plan for the home to make sure all identified works are planned for and carried out. The home has an enclosed garden area, which is safe and pleasant for residents to use in warmer months. Some of the bathrooms and equipment are in need of upgrading, this includes, toilet 6 – lighting is very dim and needs decorating, toilet 7 – toilet frame is rusting and needs replacing, toilet 1- there are hols in the flooring, paint is peeling and tiles are cracked, bathroom 3 walls are scuffed. The home must forward a plan to the CSCI stating how they intend to upgrade bathroom and toilet areas. The home provides four bathrooms and several additional toilets, however the Nurse on duty explained there are plans to change on bathroom into a second medication room, this will mean that the home are providing less than the minimum required number of baths for the 36 residents they are registered for. The organisation must inform the CSCI of their plans for this room and how they intend to ensure there are enough bathing facilities available. It was recommended at the last inspection that the home consider a walk in shower for residents use, it was also recommended that they should designated a member of staff each month to check bathrooms and ensure they are well maintained, this would help prevent bathrooms becoming shabby as identified above. Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 Page 17 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): Standard 29 The homes recruitment policy is thorough and includes all required checks and references. EVIDENCE: Two staff files were read and contained identification, application form, two references and medical and police clearances and there is a clear recruitment policy in place, which the home follows. Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 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): Standards 31, 35 & 38 The home is managed by an experienced manager who holds both nursing and management qualifications. Residents’ monies are well managed by the home with good accounting and recording systems in place. The home generally operates safely with health and safety checks carried out, a risk to residents safety was identified in the dining area. EVIDENCE: Mrs Sheila Harrison is the registered manager of the home. She is a registered general nurse with many years experience of working with older people. Mrs Harrison holds a management qualification and is an experience care home manager. Lines of accountability within the home and within the organisation are clear. The homes administrator is responsible along with the registered manager for managing and dealing with residents’ monies. Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 Page 19 The home has worked with residents and their relatives to help them take over the management of resident’s monies and wherever possible the home no longer act as appointee for residents benefits. The Commission for Social Care Inspection (CSCI) made a series of visits to the home earlier in the year to check on the management of monies. During this inspection it was evident that the home have worked hard to meet requirements in this area and ensure their practices are in line with legislation and good practice. Records of residents monies checked during the inspection were clear and in order. Records and certificates relating to health and safety were checked and were in date and satisfactory, this included, gas and electrics, fire and small appliances and the lift and equipment. A dining table is placed next to the radiator, which was very hot to touch, this could cause burns to residents seated at the table. A requirement is given that a guard is fitted to the radiator. Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 Page 20 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X 2 X X X X X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1)(a) (b) Requirement The home must obtain a copy of the local authority assessment prior to admitting a new resident. The home must inform the CSCI of the date they intend to commence a contract for the safe disposable of unused medications. The home must use individual containers for all prescribed medication including parocetomol and not use a stock supply. The manager must ensure that staff treat residents respectfully at all times, to be addressed (with the member of staff concerned) through training and one to one supervision. Timescale for action 23/01/06 2 OP9 13(2) 23/01/06 3 OP9 13(2) 30/12/06 4 OP10 12 (4) 23/01/06 5 OP21 23(2)(b) The home must provide the CSCI 23/01/06 with a plan stating how they intend to upgrade / decorate bathrooms and replace equipment where needed.
DS0000061714.V269672.R01.S.doc Version 5.0 Page 22 Orrell Grange 6 OP21 23(2)(j) 7 8 OP38 OP19 13(4)(a) 23(2) The home must inform the CSCI of their plans for altering the use of an upstairs bathroom and how they intend to ensure there are sufficient bathing facilities available. The manager must arrange for a guard to be fitted to the radiator in the dining room. The home must formulate maintenance programme. This requirement is outstanding from previous inspections 23/01/06 16/01/06 a 23/01/06 9 OP36 18(2) The home must introduce a 27/02/06 formal system for the supervision and appraisal of staff. This requirement is outstanding from previous inspections 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 OP12 Good Practice Recommendations The manager should arrange for consultation with residents as to their preferences regarding leisure activities. The manager should arrange for a social activities diary to be maintained in the home. The home should consider employing a permanent handyman. 50 percent of staff should obtain NVQ level 2 in care by 2005.
DS0000061714.V269672.R01.S.doc Version 5.0 Page 23 2 3 4 OP12 OP19 OP28 Orrell Grange 5 OP7 This is a previous inspection recommendation The home should provide Service Users and / or their relatives with the opportunity to sign their care plan. This is a previous inspection recommendation The home should consider providing a walk in shower to aid Service Users. This is a previous inspection recommendation The home should put a system into place to ensure bathrooms and toilets are inspected monthly by a designated member of staff and that any damage or repair work observed is recorded in the maintenance book for time limited action. This is a previous inspection recommendation 6 OP21 7 OP21 Orrell Grange DS0000061714.V269672.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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