CARE HOMES FOR OLDER PEOPLE
Otterbourne Grange Pitmore Road Otterbourne Winchester SO21 2HZ Lead Inspector
Peter J McNeillie Unannounced 9th May 2005 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. Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Otterbourne Grange Address Pitmore Road Otterbourne Winchester Hampshire SO21 2HZ 02380 253 519 02380 253 519 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 S Hennessy Mrs S Shine CRH 25 Category(ies) of DE(E) Dementia - over 65 - 5 registration, with number MD(E) Mental Disorder -over 65 - 5 of places OP Old age - 25 Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: A total of five service users in the category MD(E) and DE(E) may be accommodated at any one time None Date of last inspection 1st September 2004 Brief Description of the Service: Otterbourne Grange is a privately owned and managed home set in a large Victorian manor house registered to accommodate up to twenty-five older people, including up to five with an age related mental health problem, (DE[E] dementia and MD[E] mental disorder. The home which is set in five acres of its own accesible grounds and gardens accomodates residents in nine single and eight double bedrooms, five of which are equipped with en suite toilet facilities. The home is located within easy accesss eg the M3 motorway and urban areas of Chandlers Ford and Eastleigh. The cities of Southampton and Winchester are within thirty minutes travelling time. Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the first of two annual inspections for 2005/2006. During this inspection which took place between 9:00am and 12:30pm the inspector who was assisted by the registered manager and the owner spoke with twenty residents and the majority of staff on duty. Evidence was also gathered from a tour of the building, reading records (including care plans), the previous reports, observations and a talk with the homes visiting pharmacist. What the service does well: What has improved since the last inspection?
The previous high standard commented on in previous reports has been maintained for both new and more established residents. Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 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. Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.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 Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.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 The home has a well developed system of assessing and identifying residents needs which ensures residents safety and assessed needs can be met. EVIDENCE: Records seen and information from the manager care staff and residents confirmed all potential service users are visited prior to admission. A detailed assessment of their needs and risks is compiled by the manager and the allocated primary carer / key worker. The same records and residents confirmed they were consulted and were involved in the assessment process. Records viewed also confirmed consultation with a wide range of health care professionals including GPs, geriatricians, continence advisors, physiotherapists, occupational therapists and care managers. Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 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 standard(s) 7,8,9,and 10 The arrangements for planning care are clear ensuring that the health and personal care needs of resident are met were satisfactory and thaeir privacy and rights respected. The home has adequate policies and procedures in place ensuring the medication needs of residents are met. EVIDENCE: All of the residents when spoken with, expressed total satisfaction with the care they were receiving and the manner in which it was delivered. They also confirmed they were consulted about the contents of their individual care plan and the assessments on which the plan was based. All were aware they could view their plan at any time. A sample of six care plans were viewed. Care plans which were reviewed monthly included information on how identified needs were to be met. Residents confirmed any personal care was given in private, staff always knocked and waited before entering their bedroom, they were able to make / receive telephone calls and receive and converse with visitors in private. Files seen and comments made by staff confirmed consultation with a range of
Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 Page 10 external health care professionals eg doctors, district nurses, community phychiatric nurses, geriatricians, continence advisors take place. Other specialists would be consulted on a needs basis. Residents and staff confirmed all were free to choose their own GP and the source of other personal services eg chiropodists, dentists optician etc. Any restriction on choice with regard to a GP was outside the control of the resident or the home’s management. From records seen, and comments made by the homes staff, management and a visiting pharmacist the inspector confirmed all drugs which are dispensed by the pharmacist in a unit dosage system are securely stored, administered and recorded in accordance with the homes drugs policy and procedure by trained staff. Following written risk assessments no residents are self medicating. Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 Page 11 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 and 15 The social activities family contacts and the provision of varied and nutritious meals were well managed and reflected service users interests and choices. EVIDENCE: A list of in house and community based activities for the month was displayed in the main lounge. Activities available included scrabble, boat trips, birthday celebrations, reminiscence, walks shopping, music and movement and a keyboard entertainer. Records seen confirmed members of staff had attended courses run by Age Concern on games and activities. All of the residents spoken with praised the efforts of the staff for ensuring they were well cared for comments such as “its lovely here” ”The best” ”We could not ask for more” were a sample of the remarks made. Residents also confirmed they were fully consulted and were able to exercise choice in all aspects of their lives ie, when to get up and go to bed, mealtimes (meals at a later time would be provided if they were out at usual meal times). As previously commented in this report residents confirmed any personal care was given in privateand their rights and privacy respected.
Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 Page 12 The quality, quantity, and choice of food served came in for particular praise from the residents. A full and varied menu based on individual likes, dislikes and choices produced by a professional cook was available. The inspector who joined the residents for their mid day meal from his personal observations and experiences would confirm the residents comments regarding, the choice, quality and excellent presentation of the main mid day meal. The inspector commented the assessment and recording of nutritional needs could be improved include more details apart from regular weight checks. A verbal undertaking was given by the manager this would be attended to and be more detailed Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 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 standard(s) 16 and 18 The home has clear policies and procedures in place which ensures residents are protected from abuse .The complaints procedure was satisfactory with evidence that residents feel their views will be acted upon. EVIDENCE: The homes a policy and procedure which operates in tandem with the Hampshire County Council policy and procedure designed to protect vulnerable residents from abuse was available as were records to confirm all staff had received training in the procedures to follow should they suspect abuse has occurred. Staff spoken with confirmed they were fully aware of the procedure to follow should they witness or suspect the abuse of any resident. The complaints procedure which was also included in the service users guide gave information on how to contact The Commission for Social Care Inspection (C.S.C.I) was seen as was a record of complaints that indicated no complaints had been received since the last inspection. Residents spoken to stated they felt comfortable in raising any concerns they had with the homes management and confident any matters raised would be dealt with fairly and promptly but made it clear to the inspector “They never had concerns”. Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 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 standard(s) 19 and 26 A safe, well maintained, clean and suitably furnished home and accessible garden is provided for service users which meets their needs. EVIDENCE: A tour of the building indicated that the building was fit for its stated purpose, accessible, safe, well maintained meeting service users individual and collective needs. Furniture was comfortable and homely and in keeping with the décor. Residents commentes how satisfied they were with the accommodation. All of the rooms were fully furnished. Aids to assist service currently include, handrails, ramps, bath hoists, raised toilets and a stair lift. Doors from the large lounge lead onto a large patio which overlooks lawns and countryside in which frequently wild life such as rabbits, foxes and deer can be seen.
Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 Page 15 The home was clean, hygienic and free from adverse odours. An infection control policy and procedure was in place. All wash hand basins were equipped with soap and towels. Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 Page 16 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) 27,29 and 30 Residents needs are met by sufficient numbers of well trained and supported staff who are recruited and selected using a procedure designed to protect all service users. EVIDENCE: At the time of the inspection 5 carers the manager a cleaner and a cook were on duty.The staffing level was adequate to meet the needs of the residents an opinion shared by the residents who were full of praise for their carers. Care staff confirmed the level of staffing allowed them to deal with residents in an unhurried manner, putting the residents needs and wishes first. Records seen confirmed a very low turnover of staff who are recruited in accordance with the home’s selection and recruitment procedure which includes the completion of an application form, an interview and satisfactory Criminal Bureau, Protection of Vulnerable Adults (CRB, POVA) and reference checks. On commencement of employment all staff are subject to induction training (records seen),a period of probation and extra supervision before a final permanent position is offered. CRB checks for all existing staff have been carried out. Following induction and a probationary period all staff are expected to participate in an NVQ training programme. Currently 100 of staff have either been trained, are training or about to commence training courses leading to
Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 Page 17 NVQ level 2. Five staff have been trained to NVQ level 3 with a further three on level 3 courses. Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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) 33 and 38 The management of the home seeks the views and opinions of residents, visiting health care professionals and safeguards the health and safety of staff and residents through the implementation of safe working practices. EVIDENCE: Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 Page 19 The inspector was shown the results of quality monitoring questionnaires sent out to visiting professionals and service users. All of the returns confirmed the positive comments made in this report. A health and safety policy , controll of substances hazardous to health (COSH) assessments, equipment servicing and accident records were available .A programme and records to confirm and ensure all staff receive training in the techniques of moving and handling first aid health and safety and the procedures to follow in the event of fire (including evacuation) were available. All of the hot water supplies to baths were fitted with thermostatic controls set at 43 degrees centigrade and all radiators and hot pipes covered. Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x x x 3 Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Otterbourne Grange H54 S12155 Otterbourne Grange V225943 090505.doc Version 1.30 Page 22 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton Hampshire, SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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