Care Home: Oriel Lodge

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What the care home does well Prospective service users have detailed needs assessment using different tools before admission to the Home to ensure that the home is able to meet the individual`s need. The home stated in their Annual Quality Assurance Assessment that the pre-admission assessment is undertaken by a person trained to do so to identify those service users who have developed, or are at risk of developing, pressure sores and appropriate intervention is recorded in their plan of care. The home stated that it is not always easy to discover the wishes of a person with Dementia. The background information section of the care plan can help staff judge the wishes and preferences of the people cared for at the home. Essential to the person centred plan is putting the information on the life history and preferences and wishes of a person contained in their care plan into practice. This ensures that people cared for at the home are treated with dignity and respect at all times and in all aspects of their care. Residents receive well balanced nutritional and wholesome diet. Residents and or their families (if they are not able to communicate) are asked about their likes and dislikes to ensure that their dietary needs are met. Policies and procedures are in place in relation to protecting people from harm and abuse. There is also a whistle blowing policy to enable staff to report any bad practices without fear of reprisal. Individuals living in the home are enabled to complain through a robust complaints procedure and the home would ensure that all complaints are thoroughly investigated and all required action (if any) implemented. Staff receive on going training to enhance their knowledge and understanding in relation to caring for the category of the residents at the home. What has improved since the last inspection? The home stated in the Annual Quality Assurance Assessment that they have increased the number of Dementia friendly resources available to run activities and entertainment sessions. The home has employed an entertainment officer to work on a Saturday and Sunday afternoon to lead games, activities and one to one sessions with residents. It has improved the environment by installing a new bathroom suite and redecorated the 3rd bathroom on the landing. New suite and redecoration of the 2nd bathroom. This has a new walk-in bath. New toilet and hand basin and redecoration of the upstairs toilet. New en-suite toilet added to one resident`s room increasing the number of rooms withen-suite facilities to 10. Redecorated a further 10 bedrooms including new bedroom furniture, fixtures and fittings. Added 2 new bedrooms, both with en suite bath rooms, on the second floor increasing the number of single rooms that the home offers. This was approved by the Commission for Social Care Inspection. In relation to staff, the home has increased the number of care staff by 45.5 hours per week to ensure that extra staff are available at key times. What the care home could do better: In order to provide the residents with adequate protection, it could be better if all hand written medication on Medication Administration Records Sheets are signed and dated. Resident will further receive adequate protection if identified staff members receive extra training on medication in relation to Control drugs administration practices. The home must ensure that appropriate monitoring is in place in relation to two residents bedrooms found with unpleasant odour. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Oriel Lodge Oriel Gardens Lower Swainswick Bath Bath & N E Somerset BA1 7AS     The quality rating for this care home is:   two star good 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: Grace Agu     Date: 1 9 0 3 2 0 0 9 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. that people have said are important to them: They reflect the things 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 © (2009) 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Oriel Lodge Oriel Gardens Lower Swainswick Bath Bath & N E Somerset BA1 7AS 01225310301 01225482400 christopher@thegroveonline.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Grove Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 22 Number of places (if applicable): Under 65 Over 65 0 22 dementia old age, not falling within any other category Additional conditions: 22 0 The maximum number of service users who can be accommodated is 22. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category- Code OP Dementia- Code DE Date of last inspection Brief description of the care home Oriel Lodge is a Grade 2 Listed Building, extended and renovated to offer residential accommodation for up to twenty two older people. The Home is situated approximately one mile from the centre of Bath in Lower Swainswick. Accommodation is over three floors and consists of eighteen single rooms and two double rooms. Ten of the bedrooms have en-suite facilities and all the other rooms are fitted with wash hand Care Homes for Older People Page 4 of 32 Brief description of the care home basins. Communal facilities include three bathrooms, a large lounge and a dining room. Both the lounge and the dining room have conservatories attached, which overlook the well-tended front gardens. Car parking is available to the front of the premises. The Home has a passenger lift; however, the width of the corridors and the general layout of the Home would make it unsuitable for someone who is a permanent wheel-chair user. The cost per week to reside at the home is from £470.00 to £575.00. Fees are reviewed annually and if care needs increase. The weekly fee does not include provision for items such as hairdressing, chiropody, dental, ophthalmic, or audiology services. Prospective residents can be provided with information about the home by accessing the Service Users Guide, which will detail the services and facilities available at the home. 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: two star good 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: This was an unannounced visit which was undertaken as a part of a key inspection over eight hours to review the care practice to ensure that it is in line with the legislation and that best practice is followed in the home. We met with Marie Rochester the home manager and the senior managers. Whilst touring the building, we spoke with a number of residents, staff, and a number of records were viewed. Care Homes for Older People Page 6 of 32 What the care home does well: What has improved since the last inspection? The home stated in the Annual Quality Assurance Assessment that they have increased the number of Dementia friendly resources available to run activities and entertainment sessions. The home has employed an entertainment officer to work on a Saturday and Sunday afternoon to lead games, activities and one to one sessions with residents. It has improved the environment by installing a new bathroom suite and redecorated the 3rd bathroom on the landing. New suite and redecoration of the 2nd bathroom. This has a new walk-in bath. New toilet and hand basin and redecoration of the upstairs toilet. New en-suite toilet added to one residents room increasing the number of rooms with Care Homes for Older People Page 7 of 32 en-suite facilities to 10. Redecorated a further 10 bedrooms including new bedroom furniture, fixtures and fittings. Added 2 new bedrooms, both with en suite bath rooms, on the second floor increasing the number of single rooms that the home offers. This was approved by the Commission for Social Care Inspection. In relation to staff, the home has increased the number of care staff by 45.5 hours per week to ensure that extra staff are available at key times. What they could do better: 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 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 9 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are properly assessed before admission to the home are and assured that their needs would be fully met. Evidence: The homes statement of purpose has recently been updated and has detailed information about services and facilities provided at the home. The Service Users guide which is a comprehensive summary of the Statement of Purpose is given or sent to the prospective resident or their representative when they visit to look round. All prospective residents and/or their families are encouraged to visit the home before admission and are informed of a one month trial to enable them to decide whether to stay. The Annual Quality Assurance Assessment (AQAA) stated that prior to admission Care Homes for Older People Page 10 of 32 Evidence: prospective residents are fully assessed by the registered manager who is fully trained to do so. The assessment documentation includes diet and weight mobility and history of falls. Included where possible are care plans and assessments obtained from either Social Services or other private organizations. The above information is looked at and care plans are written on how the assessed needs are to be met. One care file of a recently admitted resident contained pre-admission assessments and care plans completed on how the assessed needs were to be met. The care file reviewed contained information detailing the terms and conditions of stay at the Home. Care Homes for Older People Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers care and support to residents by reviewing their health, personal and social care needs, and their right to be treated with respect and privacy is upheld. However, some action is needed to ensure that hand written medication records are signed and dated and that all medicines administered are signed. Evidence: Two care plans were reviewed at this inspection There was evidence of pre-assessment before admission to the home. Following from this assessment the individuals specified needs are recorded and comprehensive person centred care plans are put in place specifying how these needs are to be met. The AQAA states that risk assessments are completed on all individuals and are regularly updated, changed and monitored. This is followed up by monthly reviews by the keyworker and intervention if needs change. Care Homes for Older People Page 12 of 32 Evidence: However, we noted that on one of the above care files there was no risk assessment in relation to the persons recent fall to ensure that further falls are minimized. The manager stated that the risk assessment will be put in place after the inspection. We received information from the home that this document had been put in place. The home is in the process of transferring residents care files to the newly purchased care planning system. We noted that this new system is comprehensive and has a section for recording risk assessments and follow ups or reviews. The home records all contacts with health professionals as a part of its care planning documentation and care files seen had evidence of visits by health professionals to include General Practitioner (GP) chiropodists Opticians and Dentists. Care staff were noted knocking on doors before going into service users rooms. One resident stated, staff treat me with respect another resident stated staff help me to have a bath and it was gorgeous. Staff were noted interacting with service users in a respectful manner. A group of residents, met in the lounge, told us that they like living at Oriel Lodge and that the staff are very good. One resident states they listen to me, they answer the bell when we call. I have a choice of when I get up and when I retire. Another resident said, I always get the help I need, the girls are very respectful. A local pharmacy provides medication using a monthly monitored dosage system. A check of the blister packs indicated that medication had been administered as recorded. To ensure safety at the home, a statutory warning notice is needed for the door of the residents rooms with oxygen cylinder as noted at the entrance of the home. A policy is available to enable residents to look after their own medicines. All medication is ordered and received by staff. Controlled drugs were stored correctly and recorded in a register. The pharmacy supply printed medicine administration record sheets each month. Records of administration of medicines were clear. However, two records were seen indicating that medicines had been hand written but were not signed and or dated to make sure that it was authorized by the residents doctor or the dispensing pharmacist. We also noted that three residents drugs that required extra security were stored correctly, however, an error was noted between the recording of the drugs and the balance in the Controlled Drug Book. The manager stated that this was a one off incident and that staff involved would Care Homes for Older People Page 13 of 32 Evidence: undertake medication administration training update and continuous monitoring through supervision to ensure that this incident is prevented in future. We received an action plan from the home. We have required that the home contact the Commission for Social Care Inspection regularly to tell us the progress of the monitoring programme that they have put in place. All medication seen was stored securely. Medicines trolleys are used to transport medication around the home. Records are kept of medicines received into the home. Waste medication is recorded and now disposed of via the dispensing pharmacy. The homes admission documentation form has a space for staff to document a persons wishes in the event of death. The home encourages residents or their families to discuss this very sensitive issue as soon as possible in order to reduce the difficulties that may be caused when the individual has passed away. The homes recently developed confidentiality policy states that at induction staff are made aware of the importance of maintaining a clients confidentiality at all times. Care Homes for Older People Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home enables the residents to maintain contact with families, friends and the local community. It provides meaningful activities and choice in respect of meals and meal times. Evidence: We noted at this inspection that the home has an entertainment schedule, which was displayed at the entrance of the building and included in that schedule, is an activity session in relation to the visit from the Museum of East Asian Arts. There are other scheduled activities to include, hairdressing and Ball games on Mondays, General knowledge quiz on Tuesdays, Occupational Therapist (Reminiscence Session) on Wednesdays, Games on Thursdays and Musical entertainment on Fridays. The home told us in the AQAA that it has employed an entertainment officer to work on Saturday and Sunday afternoons to lead games, activities and one-to-one sessions for the residents. We were unable to verify this at this visit. The home is registered for people with Dementia and the home told us in the AQAA that residents have a choice where they wish to spend their time and whether or not Care Homes for Older People Page 15 of 32 Evidence: to join in with the entertainment or activities. It also recognizes the importance of giving people with dementia as much choice as possible, and explain clearly and warmly what those choices are. It also ensures that if residents choose not to join in with an activity that their decision is respected and other suggestions are offered. A resident s decision to decline to join in an activity was recorded along with the reason for decline. This is good practice and evidence that the residents are given the opportunity to exercise choice over their lives. The manager stated that the individual is supported by staff on a one-to -one basis and sometimes joins in a musical entertainment. The AQAA also states that the home recognizes that some people find it difficult and frustrating to communicate their wishes. Because of this it developed individualized care plans to enable staff to see what hobbies and other daily life the person had before the person developed Dementia and then try to organize activities, which the person might enjoy. The home has a monthly newsletter, which is located on the notice board, which gives all information and dates of all the events, and activities that has been organized for the month.The senior manager told us that it had increased the staffing level with an extra 45.5 hours to provide more time for activities for the residents. Discussion with the manager, staff members and evidence from the visitors book showed that the residents maintain good contact with families and representatives. The level of contact varies for each resident living at the home, some receive regular visitors and go out with family, and others do not. The home would contact individuals next of kin should they need to be informed of issues, which affect the well being of an individual living at the home. During a walk around the building residents were seen spending time in their bedrooms and the communal lounges. The home stated in the AQAA that visitors are always warmly welcome where they are offered welcome drinks and cakes. Residents are able to see their relatives in private if they wish to do so. All residents have a right to refuse any visitor. Residents spoken with stated that they have a choice of when to get up and retire, choice of having meals and a choice of participating in any leisure activities at the home. A record of activities was noted in the activities book. The home has a four-week menu, which contained varied nutritional meals. The meal Care Homes for Older People Page 16 of 32 Evidence: at lunchtime was Beef Casserole, boiled potatoes and vegetables with other options and was well attended. Staff were noted assisting residents their meals and those who were unable to feed themselves were assisted in a sensitive and dignified manner while staff interacted with them. Residents spoken with said they enjoyed the meal. We noted that the home has a picture card available to show the residents the dish available for the day, especially useful for the residents with a communication difficulty. The kitchen was found to be clean and tidy. It was pleasing to note that the home was recently inspected by the Bath and North East Somerset (BANES) Council Environmental Services and was awarded a five star rating on food safety. The chef stated that staff working in the kitchen have attended basic food hygiene training. Fridge and freezer temperatures and food probing temperatures were recorded regularly, the cooked foods noted in the fridge were also labelled. The senior manager stated that all staff attend the laundry and that this has no detrimental effect on the care of the residents. There was one industrial machines and a tumble dryer to provide better laundry services for the residents at the home. The manager told us that risk assessments of both laundry and kitchen would be undertaken along with the rest of the home where there might be potential hazards in other to protect the residents staff and visitors. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are enabled to complain and are confident that the home is able to protect them from harm and abuse. Evidence: The home complaints policy and procedure is displayed at the entrance of the building. The complaint procedure is also included in the Statement of Purpose and the Service Users Guide. This document has information about the Commission for Social Care Inspection (CSCI) to enable the residents and their relatives to contact the Commission if they were not satisfied with the outcome of their complaint to the organization. We looked at the complaint logbook maintained by the manager and noted that there were no recorded complaints and no complaint had been received by the Commission since the last inspection. The AQAA stated that day to day complaints are often resolved through informal discussions, meetings and during reviews. Residents we spoke with were aware of whom to complain to. One resident stated I have no reason to complain I am very happy here. Staff spoken with were aware of the Whistle Blowing policy and would report any bad Care Homes for Older People Page 18 of 32 Evidence: practices to the Manager without fear of reprisal. The home has ongoing training on the Protection of Vulnerable Adults from Abuse. There is a copy of the BANES Council policy on The Protection of Vulnerable Adults from Abuse at the Home to ensure that the Home is aware of the protocol to be followed if incidents of abuse occur. The Senior manager attends the local providers forum where safeguarding adults is a standing agenda item, this ensures that the home is up to date with changes to guidelines and policy. A new staff file viewed contained personal information, record of identity, Enhanced Criminal Record Bureau Disclosure and two suitable references obtained before the member of staff commenced employment. Care Homes for Older People Page 19 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. The home has a safe, clean, hygienic and well maintained environment, and it also provides equipment suitable for residents needs. Evidence: Oriel Lodge is a Grade 2 Listed Building, extended and renovated to offer residential accommodation for up to twenty two older people. The Home is situated approximately one mile from the centre of Bath in Lower Swainswick. Accommodation is over three floors and consists of eighteen single rooms and two double rooms. 10 of the bedrooms have en-suite facilities and all the other rooms are fitted with wash hand basins. Communal facilities include three bathrooms, a large lounge and a dining room. Both the lounge and the dining room have conservatories attached, which overlook the well-tended front gardens. Car parking is available to the front of the premises. The Home has a passenger lift: however, the width of the corridors and the general layout of the Home would make it unsuitable for someone who is a permanent wheel-chair user. The home was found clean and tidy however, two rooms were noted with a slight unpleasant odour. The senior manager stated that the housekeeper was aware of the Care Homes for Older People Page 20 of 32 Evidence: issue and would be giving those rooms a deep clean to minimize odour. This was dealt with before the inspectionn was completed. The senior manager also told us that the home will monitor the rooms daily and if the problem persists, appropriate measures will be put in place to diminish the issue. Some residents were noted walking about and some were noted sitting in the lounges and enjoying each others company. Staff were noted to be well presented in uniform and were wearing disposable aprons when serving and assisting residents with their meals, this demonstrated that infection control and hygiene principles are well maintained at the home. Whilst walking around we noted that the home is comfortable, suitable for its purpose and well maintained. The home was noted to be generally light, bright with a well maintained front garden used by residents at summer time when the weather is good. There are two sun rooms at the front of the property that allows the residents to access the sunlight and enjoy the magnificent views of Bath. Bedrooms were personalized, colour-coordinated clean and were pleasantly furnished. One service user met in their room stated that they felt comfortable in their room. The manager stated that a risk assessment was in place in relation to steps leading to one residents bedroom in order to minimize falls, though the resident is very mobile. The home told us that risk assessment would be put in place in relation to the slope noted outside a residents room and a clear warning sign displayed to warn residents staff and visitors of potential hazard that could lead to a fall. The corridors had handrails to aid residents mobility. The senior manager told us that all the floorings on the corridors would be changed and the wall painted to reflect the needs of people living in a Dementia setting following consultation with a company specialised in Dementia care. We noted that all the toilets and bathrooms have extra large signs with symbols, pictures and words to ensure that they are easily recognized by people with Dementia and/or dual sensory impairment or learning disabilities. Various manual handling equipment and Aids to assist staff with meeting the residents needs were also noted. Kitchen and laundry facilities have been discussed previously. Care Homes for Older People Page 21 of 32 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment procedure of the home is robust and offers protection to residents at the home. There are adequate numbers of staff that are competent to meet the needs of the residents. Evidence: Oriel Lodge is an organisation committed to ensuring that appropriate training is given to its staff in order to provide a high standard of care. All staff have training goals with dates for the training booked, date started and completed. This is then signed off at supervision. Evidence from staff records and discussion with the managers and staff showed that staff have attended training on Protection of Vulnerable Adults (POVA). New staff have been booked for POVA training on 11/05/09. Other training attended includes First Aid, Food Hygiene, Medication training and Manual Handling The manager stated that two senior staff members have been booked to attend training on Dementia Awareness on 25/03/09 and that its aim is that all staff would attend this training by the end of the year. The manager also told us that three staff have undertaken specialist training (ASET) in medication for people with dementia and three staff are currently undertaking this training. When completed it is Care Homes for Older People Page 23 of 32 Evidence: expected that a further six staff would undertake ASET training in dementia. It was agreed that staff attend training on challenging behavior to enable them to gain knowledge and confident to support residents with challenging needs. The home told us in the AQAA that the quality of staff communication for people with Dementia has direct impact on their sense of well-being and quality of care. For this reason the home focus heavily on effective communication training. This was evident in way in which staff were interacting with the residents on the day of the inspection. Health and Safety training was undertaken on 18/03/09. In addition to the above training the AQAA stated that more than 50 of care staff have completed National Vocational Qualification (NVQ) at Level 2.The manager is an NVQ Assessor and the home is committed to ensuring that all staff undertake this qualification. The manger recently attended an update on Manual Handling for Trainers specialising in people with Dementia and would update staff on this training. One Senior staff also attended full Manual Handling training session at St Martins Hospital on 17/03/09. The AQAA also stated that staff have an area where they can watch DVDs to enhance their knowledge and understanding of all aspects of care, for example Dementia care. The homes induction training is robust. The AQAA stated that the home has adopted the Skills for Care Induction and foundation training programme to ensure that new staff are well equipped with their responsibilities of meeting needs before working with service users in an older peoples setting. The staff supervision is essential to the quality of care that the residents receive at the home. Discussion with Manager and staff along with records viewed evidenced that staff are receiving regular supervision. One staff member spoken with stated, all staff work as a team, this has contributed to the good atmosphere in the home and residents being well cared for. The home has a recruitment procedure to ensure that appropriate, competent and experienced staff are recruited. Recent staff recruitment showed that all statutory requirements in relation to protection of residents were met. All staff working at the Home had satisfactory Criminal Records Bureau disclosures. On the day of the inspection there were twenty two residents at the Home. The rota showed that there was one senior carer 7am-2pm and two carers 8am-2pm. There Care Homes for Older People Page 24 of 32 Evidence: was also one senior carer and two carers 2pm-8pm. One senior carer and one carer from 8pm-8am. The Manager stated that this is regularly monitored to ensure that residents needs are adequately met. Also noted on the rota was one housekeeper and one chef. The Senior Manager and the Manager were also on duty. The senior manager stated that care hours had been increased by 45.5 hours per week in other to meet the demanding needs of the residents. Residents spoken with stated that staff attended to them when they rang the bell and provided time for them to talk. The Home operates a key working system to enhance the resident/staff relationship. Care Homes for Older People Page 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is supported by the registered provider and staff to provide clear leadership at the home. All staff demonstrate understanding and awareness of their roles and responsibilities to the needs of the service users. People living at the home are protected by satisfactory health and safety measures. Evidence: Marie Rochester was appointed in November 2008 as the new manager for Oriel Lodge. Ms Rochester has many years management experience in a care setting. She has NVQ 4 qualification in care as well as the Registered Managers Award. Marie had undertaken other statutory training to include, Manual Handling and Protection of Vulnerable Adults from Abuse, Safe Handling of medicines, Emergency First Aid, Health and Safety at work and Dementia care. Marie stated that her registration with the Commission for Social Care Inspection is in progress. She told us Care Homes for Older People Page 26 of 32 Evidence: that her CRB Disclosure has been returned and all the forms had been completed and to be sent to the Commission. The manager stated that she is supernumerary but helps out regularly and when needed on the floors to enable her to see and to discuss issues with the residents. Staff and residents spoken with were complimentary about the managers ability to manage the home. One staff member spoken with, stated, Marie is good, very caring, approachable and will listen to your concerns. Staff work as a team. There was evidence of regular staff meetings. Records evidenced that the last staff meeting was on 16/01/09. Issues discussed includes supervision, training, care plans, key workers, daily diary, dignity and privacy and medication. The fire logbook was found up to date and well maintained. There is evidence that staff have attended regular fire drills. The Maintenance book was also up to date. In relation to other health and safety measures, the senior manager stated that two new boilers had been installed and were last services in October 2008. Portable Appliance checks were undertaken in November 2008. The Liability Insurance is current and is due to expire in on 14/01/2010. The service record in relation to the Stairlift, passenger lift, bath hoists and the foldable handling hoist were all in date. The senior manager told us that the home consulted a Health and Safety expert on 12/12/08 in relation to risk assessment of the home and Control of Substances Hazardous to Health (COSHH). An action plan had been drawn up on how to undertake the risk assessment and it is expected that staff would be involved. The risk assessment will include, stairs, windows, kitchen, laundry, bedrooms, lounge, hallways, bathrooms and toilets. The senior manager told us that the Five yearly periodic inspection of the electrical installation safety certificate will be undertaken when the the work at The Grove (a sister home) is completed. It was agreed that a copy of the certificate is sent to the Commission for confirmation. Accidents to residents were recorded in the newly implemented accident record. Each resident has an accident profile and this is regularly audited to enable the manager to find out if there is a pattern and to refer the individual to the Falls Clinic if necessary. It was agreed that all accidents need to be reviewed following falls and where appropriate care plans and risk assessments reviewed to ensure that the individuals are adequately protected and to prevent further occurrences. This issue had been Care Homes for Older People Page 27 of 32 Evidence: covered under Standard 7. We received information from the home on action they have taken regarding a recent fall to one resident. The home regularly sends us Regulation 37 notifications on any serious injuries to the residents. The homes Quality Assurance systems were reviewed. The manager stated that the home assesses the quality of its services through annual questionnaires to residents and relatives and that the questions are based on Key Lines of Regulatory Assessment (KLORA) from the Commission for Social Care Inspection. The result is published and made available to residents, relatives and visitors. The residents care reviews from Social Services enables the home to receive feedback on the care provided to individuals living in the home. The home also has a newsletter to inform residents and relatives of things happening at the home. There is also a suggestion box located at the entrance of the building. The home has policies and procedures to include admission, complaints, death in the home, medication and missing service user, whistle blowing and equal opportunities. It was agreed that the home develop a confidentiality policy to ensure that the residents are adequately protected. This document had been put in place and the copy sent to the Commission was found satisfactory. All residents information was securely locked away. Care Homes for Older People Page 28 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 29 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 9 13 All hand written medication 03/04/2009 on Medication Administration Record Sheets(MARS) must be signed and dated. To protect the residents from drug error. 2 9 18 Ensure that the identified staff member receive training update on medication administration. This must be followed with regular monitoring. To prevent further medication errors. 30/04/2009 3 26 23 Ensure that the two identified rooms are free from unpleasant odour at all times. To provide the residents with comfortable rooms. 20/04/2009 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 Care Homes for Older People Page 30 of 32 improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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. 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