CARE HOMES FOR OLDER PEOPLE
Osborn Manor 38 Osborn Road Fareham Hampshire PO16 7DS Lead Inspector
Annie Billings Unannounced 29.04.05 11:00 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 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. Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Osborn Manor Address 38 Osborn Road Fareham Hampshire PO16 7DS 01329 823216 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr J Allen Jean-Anne Allen CRH 14 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (14), Old age, not falling within any other of places category (14)14 Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: No person under 55 years of age to be admitted in DE category A maximum of two service users may be accomodated in the DE category Date of last inspection 09.12.2004 Brief Description of the Service: Osborn Manor is situated on the outskirts of Fareham town centre, opposite Fernham Hall. The home benefits from being on a main bus route, and is directly opposite a variety of shops, library and a local medical practice. Set in immaculately kept grounds of nearly three quarters of an acre, the home is well screened from the road, and provides accommodation over three floors, within single and double rooms. Communal areas are well maintained, homely and comfortable, and provide a large, comfortable sitting room, a conservatory providing views over the gardens, a dining room and kitchen. Osborn Manor is registered to provide accommodation to fourteen older people, including those with dementia. Two residents may be admitted with dementia over the age of 55. Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 5.25 hours as part of the normal regulation and inspection programme. No requirements were made at the last inspection. During the inspection a tour of the premises was undertaken, lunch was observed and care plans and other records examined. Ten of the 13 current residents were spoken to, three members of staff on duty plus a further two attending a training course, as well as the registered manager, Mrs Allen. What the service does well:
The home provides a comfortable and homely environment, set within large, immaculately kept grounds. Individual rooms viewed provide spacious accommodation, both in single and double rooms. All areas of the home were particularly clean, and residents confirmed that: “it is always spotless”. Management continually seek to improve facilities for residents. With this in mind, plans are being considered to replace an old bath facility with a walk-in shower, following further consultation to ensure its’ suitability. A good variety of activities are organised for residents. These include outside entertainers, trips out to places of interest, pubs, barbeques, clothes shows, theatre trips and exercise classes. Staff also advised they regularly provide one to one activities with residents, as well as organising quizzes, bowls and reminiscence sessions. Three residents were keen to discuss a forthcoming trip to Bird world. Meals are plentiful, varied and attractively presented in an attractively decorated dining room. One resident said: “the food is excellent”, and discussion with other diners confirmed this opinion. Staffing levels are provided in sufficient numbers, and one resident said that there is always staff around. Other comments received included: “They are very kind and caring”, “they look after us very well”, and of the manager: “you only have to ask for something and you get it”. Members of staff confirmed they work well together as a team, and are well supported by the manager. One staff member described the manager as wonderful. Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 Page 6 What has improved since the last inspection? 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. Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 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 standard(s) 3, 5, 6 The needs assessment systems are comprehensive, and ensure that all needs are identified. Prospective service users have opportunities to visit the home, in order to make an informed choice about living at the home permanently. EVIDENCE: Three resident’s files were sampled. Two of three contained full and detailed pre-admission assessments, including risk assessments, although several assessments were not signed or dated. One assessment for a resident admitted in March was not fully completed, and identified the resident at risk of falls and wandering. No risk assessments had been completed. The home’s assessment identified this resident as a non-smoker, yet the pre-admission profile states they are a smoker. On discussion with the manager, it was confirmed that pre-admission information was supplied by the residents’ family, as the prospective service user lived abroad. The assessment needs to reflect the current need. This was discussed with the manager, who gave assurances that these matters would be addressed. Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 Page 9 Three residents were able to confirm they had been encouraged to visit the home prior to admission, although one said their family had visited as they lived abroad. The home does not offer an intermediate care service. Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 10 The care planning process is comprehensive, and provides staff with detailed guidance on how to meet the needs of residents. EVIDENCE: Two of three care plans sampled are comprehensive and provide staff with detailed guidance on the support needed to meet the objectives of the plan. The third was incomplete and lacked detail, e.g. assist with personal care. The well-organised files inspected provided evidence of consultation with residents, and records seen confirm that health care needs are well managed, with prompt and efficient referral to the local health care team and specialist professionals when required. Residents confirmed they are able to see their GP either in their own room or visit the surgery across the road, and that regular visits are made by the chiropodist, dentist and optician. Assessments and care plans are reviewed monthly with an annual assessment introduced recently to provide an opportunity for family members to be involved in the process. Observation of care practices in the home, and from discussion with residents, confirmed that privacy and dignity of residents is upheld. Residents advised
Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 Page 11 that friends and family could visit the home at any reasonable time, with their permission. A notice in the reception area clearly states that visitors will be permitted into the home only with the resident’s permission. Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 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 standard(s) 12, 13, 14, 15 Social activities, social contacts and the provision of a balanced diet are well managed, and reflect variation and preference of residents. EVIDENCE: Residents discussed a variety of activities provided both inside and outside of the home, with a forthcoming trip to Bird world a keen subject for discussion. A few activities described included exercise classes to assist with mobility, quizzes, visits to places of interest and outside entertainers coming into the home. One resident described the activities as plentiful and appropriate. Another advised that a church group visit the home regularly, although a number of residents are able to access the local churches. Several residents advised that they determine their own daily routines. Visitors were seen to come and go, and a number of residents are able to access the community as they wish. A telephone is provided for resident’s use, although the manager advised that several have their own mobile telephones. A four-week rotational menu is available, which has been developed from preferences of residents, as detailed within their files. Meals are varied and provide a roast meal twice a week. The main course does not offer a choice, but residents spoken with confirmed they could have an alternative if they requested it. The lunch observed had been cooked by a member of the care
Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 Page 13 staff, and was served hot, and attractively presented. When asked their opinion two residents put their thumbs up. Other comments received were: “very good meals, we eat very well”, “food is excellent, with lots of fresh vegetables, I’m putting on weight”. The meal was served in very pleasant surroundings, with staff on hand to give support if necessary. Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 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 standard(s) 16, 17, 18 Systems for complaints and the protection of service users are robust. EVIDENCE: No complaints have been received by the home or the Commission since the last inspection. Five service users advised of their awareness of the complaints procedure, and one said: “we only have to say something and it’s put right”. A discussion with residents around the forthcoming general election confirmed they have been registered for a postal vote. Records within files sampled demonstrate that advocacy and legal services have been obtained for a number of residents to ensure they retain control over their lives. Discussion with five staff members demonstrated an awareness of abuse, and of the appropriate reporting procedures. Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 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 standard(s) 19, 20, 21, 22, 23, 24, 25, 26 The home is tastefully decorated, clean and provides service users with comfortable furnishings within a friendly environment. The safety of residents is being compromised by a number of health and safety issues. EVIDENCE: The home was completely decorated last year, although the manager advised that programmed decoration continues when a room becomes vacant. A tour of the premises identified that generally the home is well maintained and kept particularly clean, with attention to detail. One resident commented that: “it’s always spotless”. Several internal doors are chipped and scuffed, and will require decoration in the near future. Communal rooms are comfortably furnished, and provide a homely environment with views of the surrounding garden. Two first floor windows were observed as wide open. These areas have not been risk assessed and no restrictors were in place. A requirement has been made to risk assess these areas for potential risk to residents, and to take action to minimise the risk. The boiler is housed within an unlocked
Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 Page 16 cupboard on the ground floor. This area also has uncovered hot water pipes, and presented a potential risk area to residents who have a tendency to wander. No lock was fitted to this door, and an immediate requirement was issued to ensure this area is locked when not in use. Bedrooms were inspected and found to be spacious and comfortably furnished. All had been personalised with the occupant’s possessions, and in some cases furniture. One corner of the ceiling in room 3 has been damaged by a leak, and needed decoration. One room on the lower ground floor was found to contain cleaning products, which may potentially cause harm to residents. The bedroom door was unlocked and therefore accessible to other residents. The manager has agreed to speak to the resident, and following a risk assessment may need to provide a lockable area for storage of these products. Another bedroom occupied by a retired electrician had additional wiring supplied by the occupant. This included trailing wires across the floor, and no risk assessment was in place. The manager has previously discussed this health and safety issue with the resident, but no risk assessment was in place. The manager agreed to speak to the resident again, having put a risk assessment in place. Bathrooms and WC’s are appropriate to meet the needs of service users, although the manager advised consideration was being given to provide a walk-in shower, to enhance the facilities. Water temperatures on hot water outlets are regulated to ensure the safety of residents. A lift is available to provide access between the ground and first floor, and grab rails and other equipment has been made available to residents. A sloped walkway has been provided outside to improve access to wheelchairs. New locker facilities have recently been provided for staff to store their personal belongings. Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 30 Residents needs are well supported by a stable, well-trained workforce. EVIDENCE: From observation during the day, discussion with staff and service users, and inspection of duty rotas, there are adequate staff on duty at all times of the day. In addition to the manager or deputy manager there are generally three care staff on morning duty, with two on afternoon/ evening shift. One resident commented that: “there is always someone around”. All other comments received in respect of the staff team were positive, including “they’re very kind and caring”, “they’re all lovely”. Discussion with staff identified a good team spirit. All those spoken with said they enjoyed their work at Osborn Manor, and felt competent to meet the needs of residents. Two members of staff advised they had recently been put under pressure by the increased needs of one resident, waiting for a more appropriate placement elsewhere. This situation was well managed, and staffing levels had been increased once this was identified to the manager. The resident has since left the home. The manager advised that the staff rota had recently been adapted, to ensure that the skill mix of staff on duty were adequate to meet the resident’s needs. Discussion with the manager, and training records viewed confirmed that a programme of training has been developed. This is currently being updated on computer, to allow for early identification of training updates. Promotion of
Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 Page 18 continence training was being undertaken on the day of inspection. Records seen identified a need for manual handling updates for a few staff members. This had been previously booked, but the course was subsequently cancelled. The manager gave assurances this was to be re-booked urgently, as well as sourcing training courses in infection control and dementia awareness. This will be followed up at the next inspection. All staff members, with one exception, have either completed their National Vocational Qualification level 2 or 3, or are nearing completion. Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 The home is run by an experienced manager whose leadership and management approach ensures staff are supported, and residents’ interests are promoted. EVIDENCE: Mrs Allen has been registered manager since 1990, as well as being one of the registered providers, and is well supported by a deputy manager, and an administrative assistant four days per week. Discussion with staff confirmed they are well supported by management, and an open door policy for discussion is encouraged. Staff meetings are held on a regular basis, and it was noted that a crime prevention officer had attended the last meeting to discuss security issues within the home. Residents spoken with said they felt able to discuss any problems with staff and management, and gave assurances that they would “speak their minds” in
Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 Page 20 the event they felt anything was wrong. Questionnaires are distributed to residents and relatives, to ensure they are consulted on how the home is run and to demonstrate satisfaction with the service provided. Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 3 3 3 2 2 3 STAFFING Standard No Score 27 4 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x x x x x Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 Page 22 NO 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 19 Regulation 13[4]a Requirement The registered manager must undertake a risk assessment in respect of the boiler room, and take action to minimise any risk to service users. The registered manager must undertake risk assessments in respect of trailing wires, unrestricted first floor windows and cleaning products identified within service users bedrooms, and take action to minimise any risk. Timescale for action 29.4.05 2. 24, 25 13[4]a 30.6.05 3. 4. 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 Good Practice Recommendations Osborn Manor H54 S11768 Osborn Manor V223364 29.04.05.doc Version 1.30 Page 23 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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