Care Home: Orford House

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What the care home does well People feel that they will be able to live the life they choose in the home. This is because the assessment is person centred and shows an understanding and respect for diversity. The home has a settled staff group and has the numbers and skill mix of staff sufficient to meet residents` needs. Residents were observed to be treated with respect by staff and to have their privacy and dignity respected. Residents are actively encouraged to keep in contact with family and friends living in the community. Visitors are welcome at any time and facilities are available for them. The home has a training plan and intends to train its staff in health care to achieve accreditation. The home is pleasantly designed and furnished, providing communal living, recreational and dining space that meets individual and collective needs. Comments from residents were generally positive, with indication that staff is kind and helpful in meeting their care needs. What has improved since the last inspection? Following discussion with residents the flower beds have been raised for residents to participate in planting flowers. The activities programme has also been increased according to the residents` wishes. A number of flooring has been replaced in the corridors and residents` bedrooms. Part of the courtyard has been paved and there is new garden furniture. The home has achieved "Investors in people" award since the last inspection. What the care home could do better: The residents` care plans need to be reviewed at least once a month, updated to reflect changing needs and current objectives for health and personal care, and actioned. This will ensure that all their needs are being met. All staff must be up to date with their mandatory training to ensure residents continue to receive care as is reasonable to meet their needs. CARE HOMES FOR OLDER PEOPLE Orford House Meadow Hill Woodcote Park Coulsdon Surrey CR5 2XN Lead Inspector Mohammad Peerbux Unannounced Inspection 9th September 2008 09:25 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orford House DS0000007136.V368592.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orford House DS0000007136.V368592.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orford House Address Meadow Hill Woodcote Park Coulsdon Surrey CR5 2XN 020 8660 2875 020 8645 0762 manager@orford.fote.org.uk www.fote.org.uk Friends of the Elderly Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Susan Eastwood Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Orford House DS0000007136.V368592.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 29 10th September 2007 Date of last inspection Brief Description of the Service: Orford House is situated in Coulsdon and owned by Friends of the Elderly, a registered charity. The home is registered to provide care for up to 29 elderly persons. It is detached property with an internal courtyard and set in secluded well-maintained grounds, surrounded by paddocks and woods. The grounds are over 45 acres and also accommodate a formal Chinese ornamental garden, an arboretum, lawn areas, flowerbeds and patios. The home is accessed by it’s own and shared private roads that contain speed bumps, and ample parking is provided. Two other Friends of the Elderly homes, Woodcote Grove House and Selkirk Wing, which provides nursing care, are also within the grounds. Accommodation in the home includes bedrooms on the ground and first floor. There is a lift serving all residents floors. The communal facilities include one dining room, one drawing room, an activities/ hairdressing room, an indoor gardening room, kitchenettes for the residents own use, and a chapel. The chapel is attached to Woodcote Grove House. The weekly fee is £555.00. Orford House DS0000007136.V368592.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. This unannounced visit to the home was undertaken as a part of the inspection process for the year 2008/2009.The inspection was facilitated by the registered manager and deputy manager. Some of the residents were spoken to and they commented positively on the care they are receiving. They are all thanked for their time and all of those who provided feedback for their support in the inspection process. A tour of the building was also carried out. All registered adult services are now required to fill in an annual quality assurance assessment (AQAA) .It is a self-assessment that the provider (owner) must complete every year. The completed assessment is used to show how well the service is delivering good outcomes for the people using it. Some information from this AQAA is included in the report. What the service does well: People feel that they will be able to live the life they choose in the home. This is because the assessment is person centred and shows an understanding and respect for diversity. The home has a settled staff group and has the numbers and skill mix of staff sufficient to meet residents’ needs. Residents were observed to be treated with respect by staff and to have their privacy and dignity respected. Residents are actively encouraged to keep in contact with family and friends living in the community. Visitors are welcome at any time and facilities are available for them. The home has a training plan and intends to train its staff in health care to achieve accreditation. The home is pleasantly designed and furnished, providing communal living, recreational and dining space that meets individual and collective needs. Comments from residents were generally positive, with indication that staff is kind and helpful in meeting their care needs. Orford House DS0000007136.V368592.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Orford House DS0000007136.V368592.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orford House DS0000007136.V368592.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home undertakes an assessment of the healthcare needs of residents prior to their admission to ensure that their needs would be met. EVIDENCE: The home considers the needs assessment for each prospective resident before agreeing admission to the home. Three residents’ files were sampled at random and they all had a pre-admission assessment carried out. Intermediate care for rehabilitation and return to the community is not provided by this home. Orford House DS0000007136.V368592.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally, residents’ care plans include detailed information about their needs and personal goals. This helps staff to know the residents’ needs and how to meet them. EVIDENCE: The service has a strong belief that it is essential to involve residents in the planning of care that affects their lifestyle and quality of life. Each resident has a plan that where possible has been agreed with them. This is written in plain language, is easy to understand and considers all areas of the individual’s life including health, personal and social care needs. This is in line with a requirement made at the last inspection. The plan also includes a risk assessment where applicable. Areas have been identified where staff are willing to support residents to take some risks, which may have an impact on their rights. Orford House DS0000007136.V368592.R01.S.doc Version 5.2 Page 10 From the three care plans, which were sampled at random, it was noted that two of them had not been reviewed recently. Residents’ care plans must be reviewed by care staff in the home at least once a month, updated to reflect changing needs and current objectives for health and personal care, and actioned. This will ensure that all their needs are being met. In the absence of the named key worker, another staff must be delegated that responsibility. The home actively promotes the residents’ right of access to the health and remedial services that they need, both within the home and in the community. Records show that the home arranges for health professionals to visit residents in the home and provides facilities to carry out treatment. The home has a medication policy which is accessible to staff, medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. However the manager must ensure that the medication is monitored regularly so that residents do not run out as it was identified that one resident did not have one of her medication for three and half days as it was out of stock. It was positively noted that items of medication sampled at random were within their use by date. This is in line with a requirement made at the last inspection. Staff are aware of the need to treat residents with respect and to consider dignity when delivering personal care. The home arranges for residents to enjoy the privacy of their own rooms. Observation of the staff team interacting with the residents showed that the carers were mindful how they addressed residents, and they were seen to be polite and friendly. The hairdresser visits the house three days a week and works a rota with each and every resident to ensure they have their hair washed set to suit the person to maintain their identity. Orford House DS0000007136.V368592.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are being provided with a range of opportunities for recreational and social activity that is in accord with their social and cultural needs. Dietary needs are well catered for and a well balanced diet is provided, to ensure health and enjoyment of food. EVIDENCE: Staff are aware of the need to plan the routines and activities of the home in a way, which meets the choice, and wishes of residents. The home tries to be flexible and attempts to provide a service, which is as individual as possible by using its staff and resources effectively. As far as possible, the residents are consulted on how the home can work to provide them with a flexible lifestyle, and to achieve their wishes. The activities co-ordinator has made a list of activities and/or outings which is displayed it on the residents notice board to enable each individual resident to take part in group activities if they so wish. Orford House DS0000007136.V368592.R01.S.doc Version 5.2 Page 12 There are small group outings to places like the lavender fields, garden centre, shopping trips to local shops for coffee or lunch and/or places of the residents’ choice. The home has open visiting arrangements and residents know they can entertain their family and friends in their own room. If they prefer they can use communal areas of the home to talk to visitors. Maintaining independence and enabling residents to make their own decisions about how they wish to live is a key objective of the home. Residents have the choice to bring personal possessions with them on admission to the home and are encouraged to keep personal items, which are important to them in their own room. It was clear from the menus that a wide variety of different food options were available in the home with a lot of consideration given to the nutritional value of the meals provided. Staff are ready to offer assistance in eating where necessary, discreetly, sensitively and individually, while independent eating is encouraged for as long as possible. The chef consults with residents and tries to meet the preferences and suggested dishes when preparing the menu. This is also discussed during the monthly residents meeting. There is a choice of hot or cold food three times a day. At meal times there is a choice of menu including vegetarian. Orford House DS0000007136.V368592.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are generally managed well, which should ensure that residents’ and relatives’ concerns are listened to. EVIDENCE: The service has a complaints procedure that generally meets the national minimum standards and regulations. The complaints procedure is available within the home. Residents’ relatives/representatives and others associated with the provision understand how to make a complaint. The home is clear when an incident needs to be referred to the Local Authority as part of the local Safeguarding procedures in place. The manager stated that most of the staff working within the home are fully trained in Safeguarding Adults and know how to respond in the event of an alert. Orford House DS0000007136.V368592.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally hygienic and clean, homely and comfortable; this environment therefore facilitates the residents’ health and emotional wellbeing. EVIDENCE: The home is suitable for its stated purpose. It is accessible, meet residents’ individual and collective needs in a comfortable and homely way. Residents’ bedrooms are personalised to reflect their individual needs, and personalities. Overall the home was decorated to a good standard throughout and appeared to be very comfortable, bright and warm. The home has a rolling maintenance programme in place. Orford House DS0000007136.V368592.R01.S.doc Version 5.2 Page 15 The home is kept clean and hygienic and free from offensive odours throughout. Systems are in place to control infection in accordance with relevant legislation and published professional guidance. Orford House DS0000007136.V368592.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People using the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has the numbers and skill mix of staff sufficient to meet residents’ needs and ensure their safety however there are some gaps in the training programme. EVIDENCE: People have confidence in the staff who care for them. Copies of staff rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the residents. The registered manager informed that more than 50 of staff have an NVQ level qualification at level 2. Recruitment procedures seemed appropriate. Three staff files were examined at random and found to contain all the information required by the Care Homes Regulations 2001 including a completed job application, terms and conditions of employment, an enhanced CRB check and proof of their identity. Orford House DS0000007136.V368592.R01.S.doc Version 5.2 Page 17 The home ensures that all staff within its organisation receives relevant training that is targeted and focussed on improving outcomes for residents. The manager is aware that there are some gaps in the training programme. These are being addressed and further training sessions have been arranged. All staff must be up to date with their mandatory training to ensure residents continue to receive care as is reasonable to meet their needs. According to the service annual quality assurance assessment (AQAA), all staff are undertaking training in dementia awareness. Orford House DS0000007136.V368592.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People using the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home generally provides guidance and direction to staff to ensure residents receive consistent quality care. There is a quality monitoring system and this ensures the home is run in a way that is in the best interests of the residents. EVIDENCE: The manager is qualified and has the necessary experience to run the home. She is aware of and works to the basic processes set out in the NMS. She works to continuously improve services and provide an increased quality of life for residents. Orford House DS0000007136.V368592.R01.S.doc Version 5.2 Page 19 Effective quality assurance and quality monitoring systems, based on seeking the views of residents, are in place to measure success in meeting the aims, objectives and statement of purpose of the home. The manager informed that small amounts of money are kept in separate envelopes for each resident with a running balance sheet appropriately maintained for sundries, such as hairdressing costs. A sample of these was seen and was accurate and well maintained. Records with regards to health and safety are of a good standard and are routinely completed. Certificates relating to health and safety were up to date servicing certificates. Orford House DS0000007136.V368592.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Orford House DS0000007136.V368592.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No. 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 OP7 Regulation 15 (2)(b)(c) Requirement Residents’ care plans must be reviewed by care staff in the home at least once a month, updated to reflect changing needs and current objectives for health and personal care, and actioned. This will ensure that all their needs are being met. All staff must be up to date with their mandatory training to ensure residents continue to receive care as is reasonable to meet their needs. Timescale for action 09/12/08 2. OP30 18(1) 09/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Orford House DS0000007136.V368592.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Orford House DS0000007136.V368592.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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