Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Penwortham Grange and Lodge Martinfield Road Penwortham Preston Lancashire PR1 9HL The quality rating for this care home is:
zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marie Cordingley
Date: 1 1 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home
Name of care home: Address: Penwortham Grange and Lodge Martinfield Road Penwortham Preston Lancashire PR1 9HL 08452710796 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Orchard Care Homes.Com Limited Type of registration: Number of places registered: care home 86 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only: Care Home only - PC, to people of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 44) Dementia - Code DE (maximum number of places: 42) The maximum number of people who can be accommodated is 86. Date of last inspection Brief description of the care home Penwortham Grange and Lodge is a large residential home registered to provide care and accommodation for up to 86 people. The home is arranged in two separate units, one providing accommodation for up to 44 older people and the other providing accommodation for up to 42 people who have Dementia. The home is situated in the Penwortham area of Preston. It is located in a residential area and there are a number Care Homes for Older People
Page 4 of 32 Over 65 0 44 42 0 Brief description of the care home of transport links, facilities and amenities close by. All accommodation at the home is provided on a single room basis. Residents bedrooms are well equipped with en-suite facilities including a shower, television, DVD and a mini fridge. There are four large communal areas as well as four smaller quiet rooms and safe outdoor space for the use of residents. Care is provided on a 24 hour basis including waking watch care throughout the night. At the time of our visit we were advised weekly fees for the home range from 485 to 570. All this information and more can be found in the Service User Guide which is available from the home on request. Care Homes for Older People Page 5 of 32 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating of this service is 0 star. This means that people using this service experience poor quality outcomes. The inspection of this home included an unannounced site visit which was carried out by three inspectors. During this visit we spent time talking with residents, staff and the acting manager of the home as well as a senior manager from Orchard Care Homes. In addition, we viewed a variety of paperwork including a selection of residents care plans and staff training records. We also carried out a tour of the home viewing residents bedrooms and communal areas. As part of the inspection we carried out a case tracking exercise, which involved us Care Homes for Older People
Page 6 of 32 looking closely at the care provided to selected residents from the point of their admission to the home. Prior to our visit, we wrote to the acting manager and asked her to fill in a very detailed self assessment questionnaire. This questionnaire provided us with a lot of information about the home and its management, and was returned to us within agreed timescales. We also wrote to a selection of residents, their relatives and staff members and asked them to take part in a written survey. As part of the survey, people were asked to share their opinions about various aspects of the service provided. We received a number of completed surveys. What the care home does well: What has improved since the last inspection? Efforts have been made to plan peoples care in a more person centred way. This means valuing the person’s uniqueness and taking into account their individual personalities, as well as their own thoughts and wishes on the support they wish to receive. Following our last key inspection we made a recommendation that consideration be given as to how the environment could be made more homely. During this visit we noted the presence of pictures, ornaments and other objects of interest which had Care Homes for Older People Page 8 of 32 gone some way to achieving this. The quality of food provided was an area of concern during our last inspection and we made a requirement in relation to this. We were able to confirm during this visit that a permanent cook had been appointed and the quality of meals had improved. During our last inspection we found that some staff were not always following correct health and safety procedures in relation to the storing of cleaning fluids and the use of kettles in residents’ living accommodation. We made a requirement in relation to this and during this visit found that this had been addressed. What they could do better: It is important when carrying out pre admission assessments that all relevant information is obtained and taken into account when planning a person’s care. Gaps in assessment information can lead to gaps in the care a person receives and as such, leave them at risk. We found some examples where assessments had not been fully completed and as a result information was missing. The format used by the home for care planning is very comprehensive and if used to its full potential, would mean that carers have a detailed picture of all residents care needs and the support they require. However, in the selection of care plans we viewed, some areas had not been fully completed. Important aspects of care such as pressure care were not addressed in some examples. We found evidence that the home supports residents to access support from health care professionals such as district nurses and speech therapists. However, we found some examples where advice given by visiting professionals had not been transferred to peoples care plans. This could result in some carers not following the advice because they were not aware of it. From our discussions with staff and through case tracking residents, we found that carers had not always followed risk assessment procedures properly in areas such as pressure sores and falling. This had resulted in a failure to identify the risks to some residents in these areas. For residents who have more complex needs associated with their behaviour, a separate behaviour support plan should be developed. This plan should tell carers about the behaviours a certain resident may present and how they should be supported on these occasions. Plans such as these are important because they help carers respond to challenging situations confidently and consistently and therefore provide greater protection for residents. We were aware of some residents who would have benefited from a behaviour support plan but didnt have one in place We identified some concerns in relation to the way peoples medicines were managed. We found that procedures were not always followed properly and as a result, medicines were not always given correctly. Medicines must be given to people correctly to help make sure their health and wellbeing is maintained. We also found evidence that some medicines had been stored at the wrong temperature and as such were at risk of being spoilt. Care Homes for Older People Page 9 of 32 It is important to ensure that all staff members who deal who residents medication are competent to do so. We found that the home didn’t have an effective system in place to check staff competence in handling people’s medicines which could lead to people being at risk. In response to our written survey and during conversations we held throughout the visit, people told us that they did not feel there were enough activities for residents to take part in. One resident told us There isn’t much going on but they try their best, and a staff member wrote The service needs to improve by providing more activities and more trips out for people. We were aware of some concerns that had been raised with the home by family members but could not find any evidence that these had been properly recorded. We discussed this with the acting manager during our visit. It is very important that all complaints are properly recorded so that they can be monitored and also so that the home can demonstrate that they have taken appropriate action in response to them. The home has systems in place to control the spread of infection. However, we were concerned to note that one resident who had MRSA did not have a care plan in place in relation to this condition. Individual guidelines must be in place for staff in these circumunstances as well as the general good practice guidance currently provided. A common concern raised with us by people we consulted was that of staffing levels. In general, we were told that staffing levels didn’t allow for things like activities, as staff on duty were always very busy providing personal care. One staff member who completed a survey wrote We try and do activities with people but always end up getting pulled away. A relative stated There always seems to be a shortage of staff. We discussed this with the acting manager who explained that staffing levels had been increased since our last inspection in February 08. We advised the acting manager that staffing levels should be determined in accordance with the needs of residents and as there was a high number of residents with complex needs, this needed to be taken into account. We have made a number of requirements in respect of the above matters. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Carers generally have a good understanding of people’s needs when they are admitted to the home. However, sometimes information is missed which could lead to gaps in care. Evidence: A Service User Guide is provided to people considering a move to the home to help them make a decision. The guide contains useful information about daily life there and arrangements in areas such as mealtimes and activities. In a previous inspection we found some information in the Guide which we did not feel was accurate and made a requirement that this be rectified. We were able to confirm during this visit that this had been addressed. We were advised by the acting manager that the Service User Guide is available in a
Care Homes for Older People Page 12 of 32 Evidence: number of formats including large print and audio so that everyone has equal access to the information. There are procedures in place to carry out a pre admission assessment for people before they move to the home (except in emergency circumstances). This procedure means that a prospective resident can be sure the home is right for them and that staff there will meet their needs. There are useful forms in place to help the person doing the assessment ensure they cover all areas of personal, health and social care needs and as such, not miss any important information. However, we found in some cases that assessments weren’t always fully completed. For example, one resident’s assessment missed some important information about a health related condition. We did note however, that in all the assessments we viewed, efforts had been made to find out and record people’s personal preferences and wishes. For example, each assessment had a section called ‘preferred routines of daily living’ which gave the resident a say about things that were important to them such as when and where they would like to have their meals or how they would like to spend their time during the day. The home does admit people on an unplanned basis in certain emergency circumstances. However, there are procedures in place to ensure that necessary information about the resident is obtained quickly so that their care can be planned as soon as possible. Care Homes for Older People Page 13 of 32 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and wellbeing is at risk because their health care and medication is not managed well. Evidence: We viewed a number of residents care plans as part of our case tracking exercise. Whilst the actual format for care planning was of a good standard and very comprehensive, we found that is some cases, it had not been used properly and as a result, important information about peoples daily care needs was missing. Some residents care plans lacked detail about the care they needed to help prevent them getting pressure sores for example. Another persons care plan failed to state that he had epilepsy. Care Homes for Older People Page 14 of 32 Evidence: We did note that attempts had been made to include peoples personal wishes and preferences on their care plans. However, a number of staff we spoke with and some who responded to our written survey told us that they did not refer to care plans on a daily basis as they didnt have sufficient time. We found evidence that the home supports people to access advice from community health care professionals such as occupational therapists and speech therapists. However, we also found a number of occasions where professionals had visited the home and given advice which had not been transferred to the persons care plan. This means that carers could fail to follow the advice because they were not aware of it. We noted that there were a number of residents at the home with quite complex health care needs. After discussion with staff and reading some peoples care plans, we found that carers didnt always have a full understanding of the importance of careful monitoring to ensure that peoples changing health care needs continue to be met. As part of the visit a CSCI pharmacist inspector checked how medicines were being handled because previous visits had found some medicines were not being recorded and given to people correctly. We checked the medicines stock against the records for several people and found some serious mistakes. One person had received an overdose of a painkiller for three weeks because staff had read the instructions wrong. Giving medicines at a higher dose than the recommended maximum can seriously affect the health and wellbeing of a person. Another resident was prescribed two different liquid medicines but checks showed that both had been missed at least once in the last four days. Further checks showed medicines used for blood pressure, sleeping and antibiotics had all been missed even though the records were signed as if they had been given. A medicine used to prevent blood clots had also been given at the wrong dose on two occasions in the previous week because staff were not checking the records carefully. Giving medicines at the wrong dose or missing them completely can seriously affect the health and wellbeing of people who live in the home. We looked at how controlled drugs (medicines that can be misused) were handled. They were safely kept in a secure cupboard to help prevent them being misused or stolen. However, we found several mistakes that showed not all staff were following the correct procedures. The special register used to record controlled drug handling still showed some medicines in stock but staff said that they had been sent with a person that had recently gone into hospital. This is poor practice because a record of where they had gone should have been made to help make sure they were not mishandled. One carer had forgotten to give a person a strong painkiller so the next
Care Homes for Older People Page 15 of 32 Evidence: day they tried to back sign the register to look like they had given it, this made the stock records wrong and is also dishonest. Several records had not been completed correctly and on speaking with a carer it was clear that not all staff were fully witnessing the handling of controlled drugs throughout the whole process. Failing to witness the giving of controlled drugs can lead to them being misused and to people not getting them correctly. We checked the storage arrangements for medicines. The storage rooms were at the right temperature because air conditioning had been installed. However, one of the fridges was too cold and had been for several weeks. This same issue was pointed out on our last visit but had not been adressed. Storing medicines at the wrong temperature can spoil them and affect the way they work. No arrangements were in place for people to have homely remedies such as Paracetamol for headaches because Orchard Care Homes do not do this as part of their own policy. The acting manager said that this was now being considered and advice was being taken from a Primary Care Trust pharmacist. Keeping a stock of homely remedies in the home is good practice because it helps people receive prompt treatment for minor ailments. Care Homes for Older People Page 16 of 32 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Carers understand that residents benefit from the chance to take part in enjoyable and stimulating activities but they don’t always have the opportunity to provide them. Evidence: People we spoke with and those who responded to our written survey told us that they didn’t think there were enough activities available for people living in the home. This was also confirmed when we looked at records of the activities that individual residents had taken part in over recent months. Some records had very few entries and in some cases there were gaps of several weeks with no activities recorded. When we looked at residents’ care plans we found that staff had made attempts to record people’s individual preferences and hobbies and had also obtained important social history about residents such as previous employment, significant life events and previous hobbies. In discussion, carers demonstrated that they were aware of the importance of providing residents with regular opportunities to take part in enjoyable and stimulating activities but several told us that they rarely had the time to do so. One carer said We try and make things happen every day but often you just don’t get the time. Another carer said We start things with residents but end up getting pulled
Care Homes for Older People Page 17 of 32 Evidence: away. There have been no trips or outings arranged for residents since the home opened in September 07. We discussed this with the acting manager who told us that there were no plans to provide any outings in the future due to the fact that they were difficult to arrange. This was disappointing. In discussion we recommended that consideration be given to recruiting a dedicated activities coordinator which would help ensure more regular activities are available. All the people we spoke with told us that they were satisfied with the meals provided at the home. One resident said The food is always very nice, I have never had any complaints. We viewed menus which showed that people are offered a varied and appealing diet. In addition, we were able to confirm that there are always a number of choices available at each meal time. We observed residents having their lunch during our visit. The lunchtime was a relaxed and social occasion and staff were observed telling residents the various choices available. People who needed assistance were supported in a discrete manner and one resident who wanted to eat with her meal on her lap, sitting on an easy chair was enabled to do so. The food served was nicely presented and appeared to be of a good standard. Portion sizes were of a good size and residents seemed to enjoy their meals. Care Homes for Older People Page 18 of 32 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are not always properly recorded so there is a danger they won’t be dealt with effectively. Evidence: The home provides a guide to making a complaint which is clearly written and easy to understand. This procedure is included in the Service User Guide and also posted at various points around the home. The acting manager advised us that the complaints procedure is available in a number of formats including large print and audio. Records should be made of all complaints and kept within the home. However, we were aware of two sets of relatives who had raised concerns about various aspects of their family members’ care and could find no evidence that these had been recorded. One set of relatives had attended a meeting with senior staff at the home but no record had been made of the meeting. We discussed this with the acting manager and advised her of the importance of keeping thorough records of all complaints raised, their investigation and any action taken as a result. All homes are required to have comprehensive procedures in place that are to be followed if it is suspected that a resident has been the victim of any type of abuse. These are generally referred to as safeguarding procedures. Care Homes for Older People Page 19 of 32 Evidence: All the staff members we spoke to showed a good understanding of safeguarding procedures and told us that they had confidence in managers of the home to deal with any such issues quickly and effectively. Staff training records confirmed that all staff have been provided with training in safeguarding as part of their induction. Care Homes for Older People Page 20 of 32 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at this home are provided with a good standard of accommodation. Evidence: The home opened in September 2007 and was purpose built in accordance with the needs of older people. It is a very spacious home with a variety of communal areas for people to access including safe outdoor space. All the bedrooms are single and very well equipped. Each resident has their own en– suite shower, flat screen television, DVD and mini fridge. The home is very well maintained and decorated and furnished to a high standard. We noted that since our last visit efforts had been made to provide a more homely environment by adding pictures and ornaments, for example. At the time of our visit we found all areas of the home to be clean and comfortable. However some people we consulted told us that they had at times noticed some unclean areas within the home. This was discussed with the acting manager. There is guidance for staff in infection control and all staff do training in this area at the start of their employment. However, whilst it is important to follow general good
Care Homes for Older People Page 21 of 32 Evidence: practice, it is also important to ensure that individual residents care plans contain guidance where necessary. We tracked the care of one resident who had MRSA and found that there was no written care plan in place in relation to the residents condition. Care Homes for Older People Page 22 of 32 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The careful recruitment procedures that are followed at the home help to protect residents from harm however current staffing levels at the home do not enable carers to regularly provide support in areas such as social activities. Evidence: We viewed a number of staff members personnel files which confirmed that managers follow careful processes when recruiting new employees. Each file we viewed contained a completed application form, employment history, three references and a Criminal Records Bureau check. We were also able to confirm that in each case, all this information had been received prior to the candidate being offered employment. We did however advise that a full employment history should be obtained as opposed to the current five years. At the start of their employment carers are provided with induction training which is in line with Skills for Care standards. We spoke to several carers who told us that they found their induction training very useful. One carer said It covered everything I needed. There is a comprehensive core training programme in place, which covers all areas of mandatory training such as moving and handling and also includes additional training
Care Homes for Older People Page 23 of 32 Evidence: in areas such as caring for people who have dementia. However, some cares who work in the unit for people who have dementia told us that they had not done dementia training despite being in post for several months. This was discussed with the manager during our visit. The acting manager told us that all care staff are encouraged to do National Vocational training in care. This was also evidenced by viewing training records that showed over half the homes carers hold National Vocational Qualifications at level 2 or above. People we consulted and those who responded to our written survey told us that they felt staffing levels needed to be increased. One staff member said We are a good team and work very hard, there just isn’t enough of us. We looked at staff rotas and noted that staffing levels had been increased since our last inspection. However people we talked with said that because there were a number of residents who needed a lot of care, there were rarely enough staff to carry out activities or spend time with residents on a one to one basis. All staff members are provided with supervision, during which they can meet with their line manager on a regular basis and discuss areas such as training, work performance and general practice. In general, we found that staff were provided with supervision quite regularly although not as often as we would recommend (six times per year). Care Homes for Older People Page 24 of 32 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management systems in this home do not always ensure good outcomes for people. Evidence: Since the home opened in September 2007 there has been a number of changes in the management, and the home is currently without a registered manager. At the present time there is an acting manager in place who has made some positive changes, particularly on the unit for people who have dementia. However, it is important that a manager is appointed for the whole home who is registered with the Commission. We were advised during our visit that a manager had been appointed and was due to start employment at the home in the coming weeks. We discussed the quality monitoring systems used within the home with the acting
Care Homes for Older People Page 25 of 32 Evidence: manager and area manager from Orchard. We made a recommendation that these be reviewed in light of the fact that we found the home was not meeting some standards. An effective quality monitoring system should have highlighted this to the management before we did. Staff at the home help some residents look after small amounts of money for every day expenses. Records are kept and we viewed these and found them to be in good order. The system for holding residents’ money is well organised and ensures that residents’ money is not pooled and is kept separately. There is a health and safety policy in place which is supported by a number of separate policies and procedures for example fire safety and COSHH (control of substances hazardous to health). Training records confirmed that all staff have carried out mandatory health and safety training such as moving and handling and fire safety. In addition, there are systems in place to alert the manager automatically when a staff member is due to take refresher training. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 32 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 3 14 All information gathered at assessment must be taken into account when planning people’s care. This is so that people are provided with the care they need. 22/10/2008 2 7 15 Residents’ care plans must contain all the relevant information about their individual needs. This is so that staff are aware of the support they should provide. 22/10/2008 3 8 13 When carrying out risk 22/10/2008 assessments in relation to individual residents, it must be ensured that all the relevant information is taken into account. This is so that risks to people’s health or wellbeing can be reduced or eliminated. Care Homes for Older People Page 28 of 32 4 9 18 There should be an effective system in place to check staff competence when handling medicines. This is to help make sure people who live in the home are kept safe. 22/10/2008 5 9 13 Medicines must be stored at the correct temperature. This is to ensure they are not spoilt. Medicines must be given to people correctly. This is to help ensure their health and wellbeing is maintained. 22/10/2008 6 9 13 22/10/2008 7 12 16 Residents must be provided 22/10/2008 with regular opportunities to take part in activities that are in line with their individual needs and wishes. This is so that they can spend their time in an enjoyable and fulfilling way. 8 16 22 All complaints made must be 22/10/2008 properly recorded. This is so that they can be monitored and so that the home can demonstrate that they have dealt with them appropriately. In the event that a resident has a relevant condition, staff must be provided with individual infection control guidelines in relation to that person. 31/12/2008 9 26 13 Care Homes for Older People Page 29 of 32 This is so that the spread of infectious diseases is reduced. 10 27 18 Staffing levels must be adequate to meet the needs of residents at all times. This is so that their health and wellbeing is protected. 11 31 8 A suitably qualified and experienced manager must be appointed and proposed for registration with the Commission. This is so that there are suitable management arrangements in the home. 31/01/2009 22/10/2008 Recommendations
These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Behaviour support plans should be in place for people with complex behavioural needs so that staff have the guidance they need to approach challenging situations consistently and confidently. Information on how medicines should be used should form part of the residents care plans, particularly for medicines prescribed as when require, to help ensure they are administered correctly. A dedicated activities organiser should be appointed to improve the quality and variety of activities offered to residents. Residents should be offered the chance to take part in trips outside of the home on a regular basis so they can spend their time in an enjoyable way. All managers and staff should have training in The Mental 2 9 3 12 4 12 5 18 Care Homes for Older People Page 30 of 32 Capacity Act so that people’s rights are protected. 6 29 A full employment history should be obtained from all future candidates to help ensure the safety and wellbeing of residents. All staff working with people who have dementia should be provided with training in this area so that they are competent to carry out their roles. Staff should be provided with training in working with people with complex needs so that they can deal with situations confidently and consistently. The homes quality monitoring systems should be reviewed to ensure that they are effective in highlighting areas that need to be developed. All staff should be provided with supervision at least six times each year. Where there are concerns about a staff members’ performance supervision should be increased to ensure that they are receiving regular monitoring and support. 7 30 8 30 9 33 10 36 Care Homes for Older People Page 31 of 32 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
