Inspection on 23/02/06 for Orrell Grange

This inspection was carried out on 23rd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Orrell Grange 15/07/08

Orrell Grange 05/09/07

Orrell Grange 01/12/06

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Orrell Grange 43 Cinder Lane Bootle Liverpool Merseyside L20 6DP Lead Inspector Ms Lorraine Farrar Unannounced Inspection 23rd February 2006 11:05 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.V285162.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. Orrell Grange DS0000061714.V285162.R01.S.doc Version 5.1 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.V285162.R01.S.doc Version 5.1 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 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.V285162.R01.S.doc Version 5.1 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 and took place over 3.45 hours. Information was gathered in a number of ways and included, talking with seven residents, three visitors and staff. Records and documents were read, including four care plans. The lounge, dining room, laundry room and four residents’ bedrooms were also visited. What the service does well: What has improved since the last inspection? Since the last inspection parts of the building have been improved, this includes decorating the lounge area which looks bright and clean. The manager has put together a training matrix for staff, so that future training can be easily planned. The home have set up a contract for the disposal of unused medication and this is now carried out in line with legislation. Orrell Grange DS0000061714.V285162.R01.S.doc Version 5.1 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.V285162.R01.S.doc Version 5.1 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.V285162.R01.S.doc Version 5.1 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): X These standards were not looked at during this inspection. EVIDENCE: Orrell Grange DS0000061714.V285162.R01.S.doc Version 5.1 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): 7,8,9, & 10 The majority of care plans in the home are up to date and clear setting out the persons care and support needs. The home work well to meet residents’ personal care needs and with other health professionals to meet their health care needs. Some care plans need updating to reflect the care provided and ensure changes to residents needs are identified and met. Medication in the home is generally well managed, however to ensure a clear audit system is in place with medication there are requirements within this report. Most, but not all of the staff working in the home are aware of and respect residents’ rights to privacy and dignity. EVIDENCE: Four care plans were looked at. Most of the care plans have recently been reformatted and were clear with easily accessible information. One of the care plans, which was read, paid particular attention to the resident’s privacy and dignity in the actions to be taken to provide personal care. Orrell Grange DS0000061714.V285162.R01.S.doc Version 5.1 Page 10 Care plans contained clear nursing and personal care plans, with reporting and review systems in place. Three of the four care plans read were up to date and had been regularly reviewed. The fourth was still in the older format, the assessment for the person’s pressure areas had not been updated since September 05 and there was no care plan in place stating how the home were meeting the persons needs in this area, this could lead to changes in the persons needs not being noted quickly. In discussion with the manager she advised that the home intend to have all plans transferred to the new format by the beginning of April 06. Although there is space in the plans for residents or their representative to sign their agreement with the plan they had not always been offered the opportunity to do so. The home should, where possible offer all residents or their representative the opportunity to read and agree with the care planned for them. All residents are registered with a G.P. and have access to paramedical services, as recorded on their care plans. Residents’ religious beliefs are also on record. A number of residents are very frail and are nursed in their bedrooms. Nursing plans for two such residents addressed areas, which include pressure care, fluid balance, peg feed, mobility and respiration. Nursing notes in the home evidenced the fact that they work well with other health professionals and seek advice quickly on any health issues that arise. Clear records are kept of health related issues and the home follow through on these to make sure the resident is receiving the care they need. Residents visited in their bedrooms, had been made comfortable, with cold drinks to hand. Attention had been paid to their personal hygiene and oral care, and records of pressure care were being maintained. Use of bedrails was referred to in care plans and those seen had bumpers fitted for safety. The home has a separate medication room for storage of medication; this was clean and well organised. Medication was generally well stored and recorded. However a box of parocetomol was being used as a ‘stock’ drug. The home must make sure that all prescribed medication for individual residents is only given from a container with their name on, this will help to provide a clear audit trail and prevent mistakes being made. A requirement was made regarding the use of ‘stock’ parocetomol at the last inspection, which the home has failed to meet. Records of medication given and medication received into the home were in order. The home has recently introduced a new system for returning medication not used as required by legislation. However some of the medication to be returned was not recorded. The home need to introduce a clear system so that they can audit medications returned. Orrell Grange DS0000061714.V285162.R01.S.doc Version 5.1 Page 11 Time was spent in the main lounge and a recently admitted resident spoke about moving into Orrell Grange, “It was a bit strange at first but I come into the lounge now and have met a lady I like to talk to.” She said she was being well cared for, and was having bed rest during the day. Another resident said, “The meals are very nice here, there is plenty to eat.” Staff were observed moving residents in wheelchairs and by hoist without interacting with them. One lady was wheeled into the lounge and was waiting for a toilet to become free. A member of staff approached the wheelchair from behind and moved her without warning. There were no footrests on the wheelchair and this lady’s feet were nearly touching the floor. Two members of staff were later using a hoist to move this lady from the wheelchair to an armchair. They were engaged in conversation with each other throughout the process without acknowledging her. A member of staff, (later said to work for an agency), approached a gentleman who was asleep in the lounge. She tapped him on the arm to wake him and stood over him spooning food into his mouth without greeting/speaking with him, or offering him a drink. When the meal was finished, she passed his glass to another member of staff wearing the same uniform who was passing. This person also stood over him and put the glass to his lips without speaking. There was no interaction or eye contact, from either of these staff, to a gentleman who is very frail and needs assistance with his meals. Later, the cook came into the lounge and spoke to this gentleman with respect and affection, she left a drink of stout for him. She gave crisps and sweets to residents and was pleasant and respectful towards them. There is a residents’ forum and minutes from the meeting of 30/03/05 were read. The home has policies on Equal Opportunities and Residents’ Rights are set out in large print in the Residents’ Charter. Orrell Grange DS0000061714.V285162.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Some parties and outings are arranged by the home, however there is a lack of planned activates on a day-to-day basis. EVIDENCE: A recommendation was given at the last inspection that the home consults with residents about their preferences regarding leisure activities and maintain an activity diary. This recommendation had not been met and the activities diary was not available. There appears to be an emphasis on outings and larger events for residents, but few activities arranged on a daily basis. A relative said, “They have nice parties but nothing happens regularly during the daytime. The days are long………….goes to bed early. Luckily she like reading and is fairly independent.” Orrell Grange DS0000061714.V285162.R01.S.doc Version 5.1 Page 13 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 The home has an appropriate procedure in place for dealing with complaints and this information is easily available to residents and visitors. Staff receive training in adult protection issues, however a copy of the latest adult protection procedure was not available. EVIDENCE: The home has an appropriate policy in place for the investigation of any complaints. This information is made available to residents and relatives via the homes service user guide and a large print version is displayed in the foyer. The home has a record of complaints made, however none had been received recently. Staff in the home have received training in adult protection and the manager has an understanding of these issues. A copy of the latest adult protection policy from the local authority was not available in the home, which could lead to inappropriate action being taken in the event of an allegation. The Manager must ensure a copy of this procedure is available and all staff are aware of how to access this. The home have worked hard on the support they offer to residents in managing their monies. They no longer act as appointee for new residents and where possible have ceased to act as appointee for existing residents. Records of monies kept were in order and amounts held were correct. Orrell Grange DS0000061714.V285162.R01.S.doc Version 5.1 Page 14 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): 26 The home is clean, pleasant and hygienically maintained. EVIDENCE: The home has a separate laundry room equipped with, 2 industrial washers, an industrial dryer and sluice. A member of staff is employed to work in there 4 days a week and it was noted that residents clothing is well cared for and bedding ironed and in good condition. The laundry assistant was able to explain the system for dealing with any potentially infected linen to prevent cross infection. The home supplies protective equipment, including disposable gloves, aprons, clinical waste and water-soluble bags. Orrell Grange DS0000061714.V285162.R01.S.doc Version 5.1 Page 15 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 The home has sufficient numbers of staff on duty to meet residents’ needs. Not all staff have up to date training in areas of health and safety although the home are aware of this and planning further training sessions. EVIDENCE: The nursing and care rotas were satisfactory with agreed staffing levels being maintained. A training matrix has been devised for ease of reference in checking staff training needs. The manager said further training has been arranged from April 06. A member of staff who commented said she had undertaken Patient Handling, Emergency Aid, fire drill, and has NVQ 2. She does serve food to residents and had not received Basic Food Hygiene training. National minimum standards for care homes state that at least 50 of staff should hold a care qualification (NVQ) at level 2 or above by 2005. Although many of the care staff working in the home are experienced carers the home are not meeting this standard. It is a recommendation of this report and previous inspections, that the home offer staff the opportunity to undertake this qualification, which should increase their knowledge of working within the field of care. Orrell Grange DS0000061714.V285162.R01.S.doc Version 5.1 Page 16 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): 33 The home has good procedures in place for checking the quality of the service offered. EVIDENCE: The home arranges for a quality audit to be carried out each year by an external company. This was last carried out in April 05 and the home received a 4 star rating out of a possible 5 stars. The manager advised that the audit had been booked to take place again in April 06 and involves the auditor spending time with residents, relatives and staff and sending out questionnaires. In addition the manager maintains a quality audit file with appropriate polices etc and carries out regular checks of the building. Orrell Grange DS0000061714.V285162.R01.S.doc Version 5.1 Page 17 The standard around health and safety was not fully looked at during this inspection. However it was noted that fire doors throughout the building had been propped open with furniture. A wheelchair had no footrests, which was placing the resident at risk of injury. Orrell Grange DS0000061714.V285162.R01.S.doc Version 5.1 Page 18 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X X Orrell Grange DS0000061714.V285162.R01.S.doc Version 5.1 Page 19 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 OP9 Regulation 13(2) Requirement The home must use individual containers for all prescribed medication including parocetomol and not use a stock supply. This is a previous inspection requirement that has not been met. Timescale for action 31/03/06 2. OP21 23(2)(b) The home must provide the CSCI 24/04/06 with a plan stating how they intend to upgrade / decorate bathrooms and replace equipment where needed. This is a previous inspection requirement that has not been met. The home must ensure that all parts of care plans, including health related assessments are reviewed at least once a month. The home must put a system into place for clear recording and auditing of medications to be returned. 30/04/06 3. OP7 15(2)(b) 4. OP9 13(2) 30/04/06 Orrell Grange DS0000061714.V285162.R01.S.doc Version 5.1 Page 20 5. OP10 16(m)(n) The manager must make suitable arrangement to ensure that the home is conducted in a manner, which respects the dignity of residents. The home must obtain and make clearly available a copy of the latest local authority adult protection procedure. The manager must instruct staff that all wheelchairs must have footrests in place when moving residents. The manager must instruct staff that fire doors must not be wedged open with furniture. 31/03/06 6. OP18 13(6) 24/04/06 7. OP38 13(4) 07/04/06 8. OP38 23(4) 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP12 Good Practice Recommendations The manager should arrange for consultation with residents as to their preferences regarding leisure activities. This is a previous inspection recommendation The manager should arrange for a social activities diary to be maintained in the home. This is a previous inspection recommendation 50 percent of staff should obtain NVQ level 2 in care by 2005. This is a previous inspection recommendation 2. OP12 3. OP28 Orrell Grange DS0000061714.V285162.R01.S.doc Version 5.1 Page 21 4. OP7 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 manager should arrange for care staff who serve or handle food to receive Basic Food Hygiene training. 5. OP21 6. OP27 Orrell Grange DS0000061714.V285162.R01.S.doc Version 5.1 Page 22 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 © 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 Orrell Grange DS0000061714.V285162.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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