Inspection on 31/01/07 for Orwell House

This inspection was carried out on 31st January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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

Similar services:

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Claremont House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Orwell House Woodlands Road Holbrook Ipswich Suffolk IP9 2PS Lead Inspector Jill Clarke Key Unannounced Inspection 10:15 31st January and 1st February 2007 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 DS0000067721.V328744.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. DS0000067721.V328744.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orwell House Address Woodlands Road Holbrook Ipswich Suffolk IP9 2PS 01473 328111 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) marian_harper@btconnect.com Carefore Homes Limited Mrs Marian Sarah Harper Care Home 59 Category(ies) of Dementia (6), Dementia - over 65 years of age registration, with number (27), Old age, not falling within any other of places category (32), Physical disability (4) DS0000067721.V328744.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. In the categories of DE and PD the home can only accommodate and provide care for persons aged 55 years and over. This is the home’s first inspection since they opened. Date of last inspection: Brief Description of the Service: Orwell House is owned by Carefore Homes Ltd, and are registered to provide residential care for up to 59 people, from 55 years of age and over. Although the home can care for up to a maximum of 59 people, they have the flexibility to take up to 32 frail older people, up to 27 older people who have a diagnosis of dementia, and up to 10 people within the age range of 55–64 years, who have a physical disability or dementia. The home opened in August 2006, and is located in the village of Holbrook. The local village amenities (3/4 mile away) include a coffee shop, Post Office, Hairdresser, Doctors Surgery and Public House. Orwell House has been decorated and furnished to a high standard throughout. All bedrooms have en-suite facilities, 6 of which include showers. Assisted and unassisted bathrooms are located close to the bedrooms. All residents have access to the landscaped gardens and courtyards. The home is divided into 2 units, Older frail/Physical disability and dementia care. Communal space consists of dining rooms in each of the units, lounges, resident’s kitchen (main unit) and specially designed sensory room (dementia care). Access to the first floor is via stairs or passenger lift. The entrances to the dementia care unit are through a ‘key pad’ coded doors, which relatives are given the number of. Call bells are located throughout the home, and are fitted to a system which records when they were answered, which supports management in monitoring their staffing levels, to ensure they are adequate. There is a well-equipped hairdressing room, and car parking is available at the front of the home. Fees per week range from £625.00 (Older frail/Physical disability) per week, to £645 (dementia) per week for residential care. The home also offers short break care at £100 to £110 per day for residential care. The homes Statement of Purpose gives full information on what is included in the fees. DS0000067721.V328744.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the homes first unannounced key inspection since it opened in August 2006, undertaken over 2 days, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to, and during the inspection. Commission for Social Care Inspection (CSCI) feedback cards were sent to the home in November 2006. This gave an opportunity for relatives, visitors and staff to give feedback on how they thought the service was run. Comments from the completed residents (5), joint relative/visitor (8), and staff (9) feedback cards have been included in this report. During the 2 days, time was spent talking in private with 4 residents to hear their views on the home, joining a group of residents taking part in a ‘musical/sing-a-long’ session, and observing the lunch time routines. Due to some residents not being able to complete the CSCI surveys on Constable unit (dementia care), the inspector spent 2 hours, over the 2 days, sitting with residents, and observing how staff were meeting their physical, social and mental health needs. The Registered Manager, and Operations manager were available throughout the 2 days, and were co-operative and helpful in supplying any records and information. Records looked at included care plans, medication, staff recruitment and training, resident’s contracts and Fire Risk Assessment. What the service does well: What has improved since the last inspection? DS0000067721.V328744.R01.S.doc Version 5.2 Page 6 Not applicable as this was the home’s first inspection since it opened in August 2006. 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. DS0000067721.V328744.R01.S.doc Version 5.2 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 DS0000067721.V328744.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. The home does not offer intermediate care; therefore standard 6 was not assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have the information needed to choose a home, which will meet their needs. They have their needs assessed and a contract which clearly tells them about the service they will receive. EVIDENCE: The home has 2 separate information booklets, the Statement of Purpose and ‘Residents Guide’, both of which are informative. They include sufficient information to support prospective residents in identifying if the home offers the level of service they are looking for. People enquiring about the home are sent a copy of the Statement of Purpose, the residents guide is then given when the resident moves into, or visits the home. Spare copies were available in the entrance hall. Staff encourage prospective residents and their families to visit the home, and due to the home not being full, new residents currently are able to choose DS0000067721.V328744.R01.S.doc Version 5.2 Page 9 which room they prefer. Prior to residents moving in, the home also held an open day, to enable people in the local community, who had watched the home being built, and people interested in using the service, to have a good look around. Care plans looked at, showed that the manager had visited the residents prior to their admission, and undertaken their own pre-assessment. This and information obtained through (where applicable) social care assessments, supported the home in identifying if they were able to provide the level of care required. There were no separate assessments used by the home, to support them in identifying detailed information on the abilities of residents with dementia, to be able to use this as a monitoring tool, to show any improvement or mental deterioration. Time spent with residents, and feedback given both verbally during the inspection, and through CSCI resident and relatives surveys, confirmed that the home was able to meet the current residents needs, and the home lived up to their expectations. Social Care funded residents received a contract through Social Care. A copy of the Homes ‘Contract of Residence’ was also included in the Residents Brochure, to supplement the information given by Social Services. Signed copies of contracts were held on private fee paying residents, which confirmed that they had been made fully aware of the fees payable, prior to moving into the home. DS0000067721.V328744.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to be given a good level of support with their health and personal care, based on their individual needs. However, information in care plans did not always reflect the detailed knowledge, staff were able to give verbally. One mistake identified that not all staff are following the homes safe medication procedures, which could potentially put residents at risk. The principles of respect, dignity and privacy are put into practice. EVIDENCE: During the inspection 4 residents care was tracked, this included talking to the residents to hear their views on the home, looking at their care plans, preadmission paperwork and medication records. Care plans gave the basic level of information to ensure resident’s physical care needs would be met. Staff were monitoring their health appropriately and DS0000067721.V328744.R01.S.doc Version 5.2 Page 11 seeking advice from health professionals when required. Time spent with a visiting community nurse confirmed this, and they also spoke well of the home’s friendly atmosphere. Discussions with staff identified that they had a good level of knowledge on individual residents needs, and how much support they required to maintain their independence. However, this was not fully reflected in the residents care plans. For example, although staff verbally could state how much assistance they would give a resident with their personal hygiene, including information on how much the residents were able to do for themselves, the care plan simply stated ‘needs assistance’. The wording in 1 care plan included terminology such as MSU and UTI, which did not promote the good practice of using plain English. The care plans would be more informative to the reader, and in promoting independence, if they included more information on the residents preferred routines. The social care assessment for 1 resident was very informative. It gave a good pen picture of the resident’s life, what had led up to their admission and their current mental, social and physical needs. However, staff had not transferred some of this information into the main care plan read by staff, especially regarding sight and mobility problems. Time spent with the manager and operations manager, confirmed their commitment in using CSCI feedback, to look and review their paperwork, as part of their on-going development of care plans. The manual handling assessments were looked at more from a staff’s perspective, to minimise any risk of injury, rather than assessing the residents mobility needs. The assessment did not look at each task individually, for example getting in/out of a bed or armchair, moving up and down the bed. This was fed back to the manager, who showed the inspector the new manual handling assessments, which they were just going to introduce. These were far more informative, and covered the range of mobility tasks that a resident may undertake, including transfer aids to be used. Although it was acknowledged that the current residents required little support with their mobility needs, the management gave assurances that the new assessments would be introduced straight away. Time spent with residents confirmed that they felt they were receiving a good level of care, and got on well with the staff. One resident who was asked if staff ensured their privacy, replied “Staff don’t pester you – let you have privacy, which I like”. Residents completing the CSCI survey had all answered ‘always’, when asked if they received the level of support they required. All the residents introduced to, look smart and well cared for, which reflected a relative’s comment (CSCI survey) they always found their partner looking ‘clean and well cared for’. Another relative, having seen the message informing people that an inspection was being carried out, left a letter for the inspector. The letter praised all aspects of the home, including the ‘friendly, dedicated’ staff who are ‘sensitive to residents needs’. DS0000067721.V328744.R01.S.doc Version 5.2 Page 12 Good practice was seen with staff risk assessing the condition of resident’s skin on admission, to be able to take action to prevent the occurrence of pressure sores. Where concerns had been raised, aids such as specialist mattresses/cushion pad had been provided to give comfort, and reduce the risk of pressure sores occurring. One resident spoken with, who had been given a specialist pad to go on top of their mattress, said it was “very comfortable”. Residents weight was being recorded on admission, however there was no nutritional screening tool being used by staff, to assess resident’s dietary needs on admission. This led to discussions over the current assessment tool being promoted by the Community Hospital Nutritionist. The inspector gave details on how the information could be accessed, and the manager telephoned the Nutritionist straight away and made arrangements for the home to be sent the paperwork. This will enable staff to monitor for any signs of malnutrition on admission, and on going monitoring of residents nutritional health, which can vary inline with residents changing physical and mental health. The care plan stated that it ‘had been complied, discussed and written in collaboration with the resident’ and their family, however, it not been signed by the resident or their representative. Good practice was seen with a copy of the resident’s photograph held on both their care plan and medication records. The dispensing pharmacist currently sends the majority of residents’ medication to the home in ‘blister’ packs every 28-days. Liquid medications, and tablets that cannot be dispensed in the ‘blister’ packs are sent in the pharmacist’s, or it’s original container. The home completes a Medication Administration Record (MAR) chart for each resident. The MAR chart gave details on how much medication was received into the home, when the medication is to be taken, and the prescribed dosage. The home’s policy for safe administration is for staff to initial or enter a code, on the MAR chart to confirm that the medication has been given to the resident, at the correct time. MAR charts seen had been fully completed, to evidence that staff had given the resident their medication, or as stated by the code indicated on the chart. A sample check of 4 resident’s medication against the home’s record identified a shortfall in 1 resident’s medication. Although all the medication had been given from the ‘blister packs’, on 1 day, the resident had 1 tablet too many left. This raised concerns that a member of staff must have signed to confirm they had given the medication, but had not given it. The home was asked to look into the situation and take action to stop a reoccurrence. The manager, undertook this straight away by asking staff to keep a running record on the MAR chart of how many tablets should be left, which would then be checked DS0000067721.V328744.R01.S.doc Version 5.2 Page 13 against the actual tablets being held. The staff responsible for giving out the medication spoke of their distress to the inspector. They felt all the staff followed safe procedures, but the situation could have occurred if the carer, had got called away – or distracted. They felt the new systems instigated by the manager, would provide a double check, and resolve the problem. Staff had safe systems in place for changing the dose of a resident’s blood thinning medication. Once notified of the change, 2 staff double checked the new dosage to be given, and entered this on the MAR chart. Staff recorded the room and fridge temperatures, to ensure medication was stored correctly, and did not deteriorate. A sample check of controlled drugs held against records was correct. Discussion with the senior Staff, confirmed that they had received training in the safe dispensing of medication, by the Pharmacy firm supplying the medications. Throughout the inspection staff spoke politely to residents, addressing them by their preferred name, and when the resident was sitting - always ensuring they bent down, so they were at eye level. Residents spoken with had no concerns over staff not ensuring their privacy and dignity when supporting them with personal care. Good practice was seen in protecting residents dignity, by only using incontinent seat protectors, to support 1 individual, and not automatically used for all armchairs in the dementia unit. DS0000067721.V328744.R01.S.doc Version 5.2 Page 14 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to choose their lifestyle, and keep in contact with family and friends. Residents have the opportunity to take part in an activities programme, which is continually being developed. People can expect to receive a healthy, varied diet according to their assessed requirement and choice. EVIDENCE: Feedback from residents and relatives CSCI surveys, showed that the home is still developing their activities programme. Residents asked if there were activities arranged by the home they could take part in, 1 replied ‘always’, 2 ‘usually’ and 2 ‘sometimes’. However their comments reflected that the home had only recently opened, and was still in the developmental stage. Relatives said that they were not aware of what activities were going on. There was no daily /weekly activities listed on the residents notice boards. However the manager confirmed staff were being proactive in organising daily activities, especially for residents with dementia. This was evidenced on the afternoons on both days of the inspection. DS0000067721.V328744.R01.S.doc Version 5.2 Page 15 The inspector joined residents in Constable unit when 1 of the carer’s, who was clearly motivated and enjoying organising the music session played a range of music on the electric organ. Residents joined in and gave requests. When the carer was called away to support another resident with their care, another resident took over the lead at singing, which developed into a lively conversation about “songs being much better” in the old days. When the carer returned, they brought some hand held musical percussion instruments, which the residents used to shake/rattle/hit to the beat of the music. The session ended with a ball game – and a well-earned cup of tea. Although the activity took place on the dementia care unit, a resident for the second unit joined in, and said they “enjoyed” the session. On the second afternoon, residents informed the inspector that they had just enjoyed a game of skittles, and were waiting for their afternoon tea. Although these activities took place in the afternoon, time spent in the morning sitting in Constable lounge, showed good staff interaction. No residents were left for any period of time without staff acknowledging residents and instigating conversations. Two residents were watching the large flat screen television on the wall, another was looking at their newspaper. Staff were being supportive in settling in a new resident, which was undertaken with sensitivity and patience. The home is still at the stage that they are developing their activity programme, however they are also aware of the importance of spending time on one-to-one, as well as group activities. One resident asked if they had enough to fill their day said “yes” and they preferred to spend their time, “watching TV and reading books”. Staff are also building links with the community, and were trying to arrange visits from different religious denominations, but were finding this difficult. The local Holbrook school had visited at Christmas. Relatives and visitors confirmed that they were always made to feel welcome by staff who were happy to answer any questions. During the morning the Chef came around and asked residents individually their choice from the menu. Residents interacted well with the Chef, who was patient, and happy to go several times through the choices, to ensure residents were happy with, and knew what they were ordering. Copies of the lunch and evening menus for the 2 days of the inspection showed a good range of tasty, appetising dishes, which residents said they enjoyed. The Lunchtime menu on the first day of the inspection was: Steak and Mushroom pie or Caramelised onion and Stilton flan Served with potatoes and seasonal vegetables Followed by DS0000067721.V328744.R01.S.doc Version 5.2 Page 16 Lemon and Apricot flan with ice Cream A sample of the evening menus looked at, showed that residents were offered a daily choice of ‘Soup of the day and a selection of freshly made sandwiches or light cooked meal which varied each day. For example Salmon Fishcakes with a salad Garnish. This would be followed by a sweet such as Old English Sherry Trifle or Lemon Mousse. During the 2 days, time was spent with residents in both of the dining rooms. The rooms were light and airy, and well furnished, with matching furniture and upholstered dining room chairs. Tables were laid with fresh flowers, and napkins. Some residents eating in Constable dining room, had to position themselves to ensure the sun did not shine into their eyes. Staff were polite and offered assistance as required. It was noted that on Constable unit, 1 member of staff in their willingness to give support, could have waited longer (unless it would upset the residents) before removing their empty lunch plate, and giving the dessert out – as others had not finished their main course. However, when a new resident became anxious, and refused their meal, the staff acted appropriately and sensitively, letting the resident dictate to staff what, and when, they wanted to eat. Hot and cold drinks were served regularly throughout the day, and residents or their visitors, could also make their own in the residents kitchen. Discussions with residents confirmed that they did not feel restricted living at the home, and were able to make their own decisions. DS0000067721.V328744.R01.S.doc Version 5.2 Page 17 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home, can expect any concerns they have to be listened to, and acted on in an appropriate manner. EVIDENCE: The home’s complaint procedure is displayed in the entrance hall, and contained within the Statement of Purpose and Residents Guide. The procedure informs people how to make a complaint, who will deal with it, and action to be taken if they are not satisfied with the outcome of the complaint investigation. The policy also states that ‘all complaints are dealt with within 28 days’. Relatives and residents completing the CSCI surveys confirmed that they were aware of the complaints policy and knew who to complain to. One relative wrote ‘I can’t think of any reason (however trivial) for complaint’. Discussion with residents confirmed that they felt comfortable to speak to staff if they have any concerns. The home’s complaint book showed that no complaints had been received. Eight out of the 9 staff completing the CSCI surveys, said that they were aware of the homes complaint policy. The home’s Statement of Purpose, informs the reader that they also have a compliments and concerns book, which residents, relatives and visitors are encouraged to write in. Where concerns are raised, the home will write what action has been taken to address it, to demonstrate that the home is proactive in dealing with all concerns. DS0000067721.V328744.R01.S.doc Version 5.2 Page 18 Some staff have undertaken vulnerable adult training prior to working at Orwell House, as part of their NVQ module. From those surveyed, 7 out of 9 staff said that they had received training in the home’s abuse policy. To ensure staff have the same level of understanding, the manager had booked abuse awareness training for all staff during February 2007. The manager is aware of the local protocols of reporting any concerns that someone may be being abused, and signs to watch out for. DS0000067721.V328744.R01.S.doc Version 5.2 Page 19 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, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe, clean, well-maintained and comfortable homely environment, which encourages independence. EVIDENCE: A site visit was undertaken on the 28 July 2006, prior to Orwell House being registered. The visit confirmed that the home had been built and furnished to a high standard, met the environmental requirements of the National Minimum Standards, and suitable for wheelchair users. Bedrooms, all of which have ensuite facilities, are located on 2 floors which can be accessed by stairwell or passenger lift. Bedrooms range in size from 12 to 17 square metres. They have been tastefully decorated, with coordinating soft furnishings, and have sufficient furniture to meet resident’s needs. This includes, wardrobe, chest of drawers with lockable facilities, bed, over-bed table and upholstered armchair. DS0000067721.V328744.R01.S.doc Version 5.2 Page 20 Although bedrooms come fully furnished, residents can bring their furniture if they prefer; taking into account the size of the bedroom. The home has a self-contained dementia care unit (Constable) located on the ground floor, which has its own enclosed garden, courtyard, dining room, lounge, activities and sensory room. Time spent with 2 residents in their bedrooms, showed that their room had been personalised and met their needs. One resident said they had “a nice room” and liked the fact that their room opened out to the internal courtyards. The courtyards, complete with water features and seating areas, provide a pleasant area for residents to sit, and enjoy the planted flowerbeds. At the time of the inspection, contractors were completing the hard landscaping to the rear gardens. Some setting down of grass, planting and laying of patios and footpaths had been delayed due to the very hot dry weather conditions, when the home was opened. However, observation during the inspection showed that this was now close to completion. Residents throughout the 2-day inspection were seen to move freely around the home, making full use of the communal, and small seating areas. The signage used around the home, was shown to be more suitable for the frail older person unit, than a resident whose has dementia. When the inspector asked a resident on Constable if they could look at their bedroom, the resident took them to the wrong room. Currently the home uses a big number, and small resident nameplate to distinguish individual bedrooms. Although in keeping with the décor, the nameplates are at waist level, and can be missed by someone walking past. The home was asked to look at residents individual needs, to identify ways that would support them in finding their bedrooms, and other rooms such as toilets and bathrooms. Bathrooms are a mixture of assisted and unassisted, to enable residents who do not require mechanical assistance (hoists) to get into a bath, and wish to maintain their independence. Hot water systems have been fitted with thermostat controls, to ensure the hot water remains at a safe, comfortable, temperature. Records kept in the bathroom, showed that staff check the temperature of the hot water, before residents get into the bath, as an extra safety measure. Call bells were seen throughout the home, including resident’s bedrooms, bathrooms and toilets. Lighting was domestic in nature, and residents were seen to have sufficient light to be able to read papers and magazines. The design of the dementia suite (Constable) made good use of natural light. The lounge at the front of the home overlooked the car park and street, giving a point of interest. Comfortable armchairs were of different height, catering for all residents needs. Large glass windows enabled residents to see into the dining room from the small seating area in the corridor. This comfortable DS0000067721.V328744.R01.S.doc Version 5.2 Page 21 seating area also acted as a point of interest for residents to sit and watch staff and visitors, coming and going. The plans for the home were passed by the Fire Service department as meeting all safety requirements. Since opening, the Fire Safety Officer has also inspected the home and raised no concerns with the CSCI. The Environmental Health Officer visited the home in September, shortly after opening to look at the food safety systems in place. Comments in their report to the CSCI included that they found ‘high standards in operation’ and their overall comment was ‘excellent’. As befitting a new build, the environment looked well maintained. To ensure that standards do not slip, staff are made aware through their job descriptions of ‘their responsibility for reporting any equipment failures or repairs’. It was noted that the controlled medication cabinet had not been fixed to the wall, however, before returning on the second day of the inspection, this had been undertaken. Residents completing the CSCI survey confirmed that they ‘always’ found the home to be kept fresh and clean. This reflected the findings during the inspection. There are systems in place to ensure staff use correct infection control procedures. This included using disposable gloves when coming in contact with bodily fluids, and liquid soap/paper soap dispensers located around the home for staff use. DS0000067721.V328744.R01.S.doc Version 5.2 Page 22 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service can expect to be cared for by trained staff, who have the skills to meet their needs. However, it cannot be assured, that staffing levels are being increased at the appropriate time, to ensure that the aims of the home are being fully met. The home is not always following safe recruitment procedures by obtaining two written references prior to staff starting work. EVIDENCE: The staffing levels at the time of the inspection were 3 carers on shift during the daytime, and 2 at night caring for 21 residents. Feedback from resident /relative/staff surveys and discussions during the inspection, identified that they felt their care needs were being met, but would like to see more staff. One resident was asked if staff answered the calls bells quickly? replied “yes – but sometimes a bit busy and it takes a bit longer”. No one spoken with, or surveyed, raised concerns that they were not receiving the care they wanted. Time spent sitting with the residents on the dementia care unit, showed that staff were constantly interacting, and residents enjoyed the activities in the afternoon. On the second afternoon, there was a short period, when 3 residents were showing signs of agitation, walking around the corridors. However, at a time they could have benefited from some staff interaction, there was only 1 carer DS0000067721.V328744.R01.S.doc Version 5.2 Page 23 seen on the unit at that time, who was busy putting away laundry. Further discussion identified that care staff had been covering the laundry, during the laundry assistants days off. Before the inspector fed back their concerns, the management had also identified there was a problem, and had sent another member of staff to help. Further discussion with the manager, identified that new staff were starting the following week, and the staffing levels were to be increased by 1 carer during the daytime. The manager was aware of their responsibility to increase staffing levels to match occupancy. Information held in minutes of the Operational/Managers meeting, showed that the manager was monitoring staffing levels, and putting in requests to increase these, to enable staff ‘to meet the residents needs’. New care staff are put on a work based 12-week ‘Skills for care’ common induction programme, which supports staff in gaining knowledge in the work place. Staff keep their own ‘progress log’ of the standards they have covered, which includes feedback and on-going support from the management. On successful completion of the course a certificate is issued. Currently 5 staff are being inducted. All staff surveyed said that they felt the home had a good training and development programme, to support them with their different roles. A senior carer is trained as a manual handling co-ordinator, which benefit staff from having on-going support with their manual handling techniques. Taking into account that 14 care staff were employed at the time of the inspection, the home has already achieved having over 50 of their staff, qualified to National Vocational Qualification (NVQ) level 2 certificate, or equivalent. As the staffing levels increase management are completing an overall training record sheet, to help them gain an overview of all the staff’s training needs. Where any shortfalls are identified, arrangements will be made for staff to receive training (dementia care, First Aid), or re-fresher training (manual handling, food hygiene). To ensure the home was following safe recruitment policies, and were obtaining all required paperwork, prior to staff starting work, 2 staff records were looked at. Copies of letters on file showed that the applicants had been sent confirmation of their appointment, contract and job description. Criminal Record Bureau (CRB) checks, and paperwork to validate identity had been obtained. Completed application forms included a medical questionnaire. Both written references had been obtained for the first member of staff, before they commenced work at the home. However for the second applicant, records showed that although they had received a verbal reference, they had started the person before being in receipt of the second written reference. The management shared their frustrations in trying to obtain the second reference, from the workers previous care establishment. Records kept, DS0000067721.V328744.R01.S.doc Version 5.2 Page 24 backed up the work they had undertaken in contacting the previous employer to chase up the reference. DS0000067721.V328744.R01.S.doc Version 5.2 Page 25 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, 32, 33, 34, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect a well-managed service, run by staff that are committed to working in the best interests of the residents. EVIDENCE: The Registered Manager, Mrs Marian Harper, who previously managed a 73 bedded home in Essex, is committed to providing a good level of care. With over 25 years working in care (11 at management level), Mrs Harper has the skills and knowledge to ensure the home is well run. Mrs Harper holds a NVQ level 3 in Management, and has commenced her Registered Managers Award training. To increase her knowledge of dementia care, the manager has also been attending dementia care courses. DS0000067721.V328744.R01.S.doc Version 5.2 Page 26 Discussions with residents, staff and Mrs Harper, identified that the manager keeps a good presence around the home, so she is fully updated on what is happening. Residents confirmed this, saying it is a good way to ensure the high standards are maintained. Eight of the 9 staff surveyed, said they felt the home was ‘well run’, no further information was given by the person who felt it was not. Six out of the 9 staff asked said that they were not receiving regular 1 to 1 supervision, with records kept of their meeting. The manager confirmed that this was an area they were currently organising. They gave assurances that although this may not be fully happening at the present time, staff are receiving regular support and day to day supervision, of their working practices. This reflected the findings during the inspection, and positive comments from staff who enjoyed working at the home, and what they felt had a good team spirit. One relative said that they have been “thoroughly impressed by the management and staff, and could not sing their praises highly enough”. Comments received from residents included that the manager was “nice” and “approachable”. Residents, relatives and staff confirmed that the home has a warm, relaxed atmosphere and “friendly staff”. Minutes of meetings looked at showed that regular management and senior staff meetings are held. The home has only been open 5 months, therefore with less then 50 occupancy most of the homes quality assurance has been undertaken by verbal feedback and observation. The home’s Statement of Purpose gives information on their ‘Quality Assurance programme’, including a copy of their quality assurance surveys. Taking into account the rising occupancy level, the home will be sending out surveys for residents and relatives to complete. This will give the owners and management more formal, structured feedback to identify what they are doing well, and any areas they need to work on. Once completed a copy of the results will be made into a report and made available for residents and visitors to read. As part of quality monitoring, the Operations Manager, undertakes monthly unannounced visits, looking at all areas of the service, and writes a report of the findings. Copies of which have been sent to the CSCI. When Carefore Homes applied to register Orwell House, as part of their application, they were asked to submit a business plan, and give financial references. No concerns were raised from the information obtained over the Registered Providers (home owners) accounting and financial procedures. DS0000067721.V328744.R01.S.doc Version 5.2 Page 27 The Business liabilities insurance (£5 million) certificate was displayed in entrance hall, which is valid until 30/8/07. Visitors are asked to sign in as part of their fire safety, regulatory requirements. The home has systems in place for residents to hold money in safekeeping. A record is kept for each resident, which gives information on the amount paid in/out, and gives a running total. All entries are double signed, and receipts kept, as part of their security controls. The money held for one resident was counted, and the total agreed with the home’s records. Care plans are held in a lockable office and residents can ask to see their records at any time. The home generally had a good standard of record keeping, however, 1 shortfall was identified in the completing of a MAR chart, (see Health and personal care). Prior to the home being registered the home supplied the CSCI with copies of installation and servicing agreements to ensure all work has/will be carried out by competent, trained contractors. Since the opening the home has been visited both by the Fire Safety officer and the Environmental Officer, who raised no concerns. Staff training programmes showed that staff had or are booked to receive training in Health and Safety subjects, for example Manual handling and Food Hygiene. The management is aware of the importance as they recruit new staff that they monitor to ensure staff receive the appropriate health and safety training. DS0000067721.V328744.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 4 4 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 2 2 3 DS0000067721.V328744.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Not applicable 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 OP37 Regulation 13 (2) Requirement Medication must be given, as prescribed by the residents General Practitioner, and MAR sheets are not signed until this has been undertaken. Timescale for action 01/02/07 2. OP29 19 (1) Schedule 2 (3) The home must be in receipt of 01/02/07 two written references, prior to the applicant starting work at the home. 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 OP3 Good Practice Recommendations The home should look at what gauge/assessment tool they can use to monitor residents with dementia differing levels of physical and emotional support needed on admission, and at regular monthly intervals. This would also support the home in assessing the residents behavioural, physical care support required, and how they will interact with the current residents, prior to admission. DS0000067721.V328744.R01.S.doc Version 5.2 Page 30 2. OP7 The home should review the level of information in the care plans, to ensure it matches staff’s knowledge of the residents, and fully reflects residents preferences and choices. Staff should try not to use abbreviations in residents care plans, to support residents (or if appropriate their representative) in being able to understand everything that is written about them. Once the home has received information on how to use the new nutritional screening tool, this should be instigated straight away. The home should look at ways of preventing sun getting into residents eyes (Constable unit) to ensure they can enjoy their meal in comfort. The home should review their signage in Constable unit, to ensure residents are able to find their bedrooms, toilets and bathrooms easily. The home should continue monitoring staffing levels, as they increase occupancy, to ensure they have sufficient staff on duty across the 24-hour period. To support staff, the management should ensure that staff receive regularly 1 to 1 supervision, with records of discussions and outcomes, at least 6 times a month. 3. OP7 4. OP8 5. OP15 6. OP22 7. OP27 8. OP36 DS0000067721.V328744.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000067721.V328744.R01.S.doc Version 5.2 Page 32 - 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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