Care Home: Ormerod Home Trust

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What the care home does well Staff continue to maintain a high standard of support to those living at the home. Good records are maintained, making information easy to find. Communication is given a strong focus, with pictures and photographs being used to make information understandable and meaningful to those living at Warwick Rd. Decision making and independence is promoted. Staff work in person centred ways, with individualised support and activities being provided. Health monitoring and health related records are very good. Changes are responded to and professional advice sought when needed.Ormerod Home TrustDS0000010004.V374872.R01.S.docVersion 5.2Staff training is a strength of the service. Ormerod continues to provide excellent qualification training opportunities for staff and training relevant to the specific needs of those living at Warwick Rd. What has improved since the last inspection? At the last inspection the potential risks of using bed rails was highlighted. A specialist nursing bed, with integral bed rails is now being used for the person concerned and staff check the bed rails each day, as the bed is used. Containers used for taking medication out of the home are now clearly labelled, helping to reduce the chance of errors being made. The new supervision journal encourages staff to reflect upon their work performance and take more responsibility for their professional development. What the care home could do better: The arrangements for care planning and person centred planning are generally very good. However, for one person it was not clear if their care plan was being reviewed. This should be addressed, so that any changes in the support required are responded to. There is one person at the home who does not have a current person centred plan. It is important that this planning takes place to make sure that future aspirations are identified and worked towards. The use of the stair gate needs to be reviewed and a thorough risk management plan put in place. The fire and rescue service should be involved in this process. It is important that fire safety issues are fully considered within the risk management plan. Management arrangements must be formalised. Ormerod must put forward a manager to apply for registration with the commission. No application has been received and progress with this remains unacceptably slow. The Ormerod Chief Executive, who is the responsible individual registered with the commission must address this outstanding issue. Key inspection report CARE HOME ADULTS 18-65 Ormerod Home Trust 6 Warwick Road St Annes On Sea Lancashire FY8 1TX Lead Inspector Lesley Plant Unannounced Inspection 7th April 2009 2:00 Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ormerod Home Trust Address 6 Warwick Road St Annes On Sea Lancashire FY8 1TX 01253 723513 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) SSharples@ormerodtrust.org.uk Ormerod Home Trust Limited Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Ormerod Home Trust DS0000010004.V374872.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 - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 3 Date of last inspection 13th April 2007 Brief Description of the Service: Warwick Road is a semi-detached property registered to provide accommodation and support for up to three adults with a learning disability. It is situated in a residential area of St Annes, close to local shops and amenities. The home is domestic in layout and character. The service is provided by Ormerod, a trust, which operates a number of residential and community based services in the areas of Fylde and Wyre. The home is guided by the policies and procedures of Ormerod and has its own dedicated staff team. Fees vary according to the assessed needs of the individual. Ormerod Home Trust DS0000010004.V374872.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 2 star. This means the people who use this service experience good quality outcomes. This inspection took place over two days, with time being spent at the home and certain records being viewed the following day, at the organisations headquarters. All the key National Minimum Standards plus supervision arrangements for staff were assessed. At the time of this inspection there were 3 people resident at the home. Discussions took place with the three members of staff on duty during the visit. Records and documentation were viewed and a tour of the building was carried out. Time was also spent talking to and observing people living at the home. Two people living at Warwick Rd have specific communication needs; therefore some conversations were brief and limited. Surveys inviting feedback about Warwick Rd were received from one person living at the home and from three members of staff. Information was also gained from the Annual Quality Assurance Assessment completed by the Team Leader, who has management responsibility for Warwick Rd. Since the last key inspection in April 2007, a review of the service took place in April 2008. The report relating to this review is held at the CSCI office and would be made available to enquirers on request. What the service does well: Staff continue to maintain a high standard of support to those living at the home. Good records are maintained, making information easy to find. Communication is given a strong focus, with pictures and photographs being used to make information understandable and meaningful to those living at Warwick Rd. Decision making and independence is promoted. Staff work in person centred ways, with individualised support and activities being provided. Health monitoring and health related records are very good. Changes are responded to and professional advice sought when needed. Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 6 Staff training is a strength of the service. Ormerod continues to provide excellent qualification training opportunities for staff and training relevant to the specific needs of those living at Warwick Rd. What has improved since the last inspection? 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 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. Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2. People using the service experience good quality outcomes in this area. The well-established assessment and introductory procedures ensure that new people are only admitted to the home if their needs can be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Ormerod has well-established policies and procedures regarding the assessment and introduction of people new to the service. The written policy regarding admission to the service includes the giving of information, the terms and conditions of residency and a set assessment format. Information about the home is produced in a pictorial format and complimented by written material. Social work assessments are gained and Ormerod carry out their own thorough assessment. Relatives are involved as appropriate to the individual. Since the last key inspection one person has been admitted to Warwick Rd. This individual was previously living in another home provided by Ormerod and was known by staff and also by those already living at Warwick Rd. Introductory visits still took place, with compatibility within the group being given a strong focus. Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 9 The new individual has particular support needs regarding their mental health and the staff team at Warwick Rd are experienced in this area and have received specific training to enable them to meet the needs of people with dementia. A member of staff from the persons previous home, joined the Warwick Rd staff team, providing continuity for the person concerned. Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People using the service experience good quality outcomes in this area. Care planning is generally very good, with changing needs being responded to. People are supported to make decisions about their lives, promoting independence. Risks are minimised, helping to keep people from harm. Professional advice regarding certain equipment would strengthen this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Each person has a care plan detailing the support required for all aspects of day-to-day living. The care plans for the three people living at the home were viewed. Two of these were being regularly reviewed, with any changing needs being reflected in the care plan. For one person, the care plan had been changed following an accident and they needed to wear an arm sling. This care plan had also been changed to show when a nursing bed was required, when Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 11 medication was changed and when podiatry needs had changed. The regular recording of reviews and changes in the support required, help to ensure consistency of care. One of the care plans viewed did not clearly show that it was being kept under review. There was nothing to suggest that this persons needs were not being met, however recorded reviews should take place. Ormerod aims for each person to have an annual person centred plan, identifying dreams and aspirations for the future, with the individual being fully involved in this process. For two people, person centred plans were in place, with the key worker completing regular progress reports. One person had expressed a wish to go on the London Eye at her last planning meeting and this had taken place. The regular key worker updates are very useful and help to ensure that gaols, particularly those, which may require some planning and fore thought, are achieved. Person centred planning meetings are presented in ways which are meaningful to the person concerned. For one person, at their last meeting staff had presented information using flip chart and photographs displayed in a digital frame. Ormerod staff receive specific training regarding person centred planning and use creative methods to involve the person concerned. The person who moved into the home eight months ago has not yet had a person centred planning meeting. Staff explained that their only relative had not been well and it was felt that their involvement was necessary. Key worker updates were being completed, showing progress towards goals, which had been identified by the staff team, using their knowledge of the individual concerned. Although this person had previously lived in another Ormerod home the last person centred plan was not available for staff at Warwick Rd. The process of person centred planning for this person should be addressed. Files contain good information regarding the communication needs of each person, identifying how each person is able to express themselves. This focus on communication helps to promote self-determination and supports individuals with decision-making. Communication boards are used with two people at the home, with staff using photographs and pictures as prompts regarding activities and daily routines. Pictures are also used to help people to make choices regarding how they spend their time. Staff have developed good relationships with those living at the home and have a good understanding of the communication needs of each person. Risk assessments are in place and are being regularly reviewed. These address a variety of potential risks, including where restrictions have had to be made to protect the individual from harm. Good risk management guidance is in place for one person regarding evening and nighttime confusion and disorientation. Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 12 This gives clear practical guidance to staff. Staff sign all risk assessments to confirm that they have been read and understood. At the last inspection the potential risks of using bed rails was highlighted. A specialist nursing bed, with integral bed rails is now being used for the person concerned and staff check the bed rails each day, as the bed is used. At present there are two gates fitted to the stairs, one at the top and one at the bottom. Staff explained that the top stair gate is closed when one individual is upstairs/at nighttime. Although this person can usually manage the stairs without support, this ability can vary and there is concern that, as he has to pass the top of the stairs to reach the toilet, that he may fall down the stairs at night. A risk assessment is in place, which outlines the reason for the gate and says that it must be closed and bolted whenever this person is upstairs. The risk assessment does not address the risks involved in using the gate. Staff stated that all those living at the home could open the bolt, but at the time of the visit the bolt was very stiff and one person living at the home clearly had trouble opening it. There must be a thorough risk assessment regarding the use of this gate which addresses all the potential risks associated with its use, including fire safety issues. If a gate is deemed necessary, more consideration should be given to the locking mechanism, as the current bolt is very stiff. It is understood that when a stair gate was used in the past, advice was sought from the fire and rescue service. Renewed contact with this agency should be made in respect of the stair gate currently in use. Staff stated that the bottom one is not needed and therefore this should be removed. Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 and 17. People using the service experience good quality outcomes in this area. Activities are arranged according to people’s preferences and interests and family links are maintained. People are able to take part in household jobs according to their wishes and abilities, meaning that new skills can be learned and existing skills maintained. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Each person has a weekly plan of activities, which is produced using photographs and pictures to make it more meaningful to the person concerned. Ormerod provides certain activities via a day support service, which Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 14 has its own staff team. The activity programme shows that each person has some one to one support each week. The home is situated close to the centre of St Annes, providing good access to local amenities, such as shops and cafes. Regular activities include; art and crafts classes, music therapy, sensory drama, walks and meals out. Daily records kept by staff include records of activities and outings. Activity programmes are devised on an individual basis according to the interests and abilities of each person. One person at the home enjoys visiting a beautician for nail and manicure treatments, which is built into her weekly plan. This person also has her own car, via the motability scheme, meaning that staff can take her for drives or on outings further afield. Community links are supported, with local resources such as church meeting rooms and the YMCA being regularly accessed. A relative of one person at the home has a holiday home in the Peak district. All those living at the home enjoy holidays there and holidays to other destinations are also arranged. Communication boards, using photographs and pictures as prompts, are used with two people, to aid understanding and preparation for the days events. On the day of the inspection visit the planned arrangements were altered, as one person was unwell and stayed at home pottering about the house instead of going out with the day support staff. Comments from staff who completed feedback surveys for the inspection included; There is always lots of activities arranged so service users always have a range of things to do. Assessment and care planning information includes details of who individuals have close links with. Staff work hard to support contact with family and promote personal relationships. Each file contains a family contact sheet where staff record all visits and phone contact with relatives. Ormerod provides specific training for staff regarding working with families and regularly hosts events such as a recent spring open day, to which relatives are invited. Relatives are also involved in personal centred planning meetings as appropriate to the individual. Compatibility within the group and relationships with staff are given good consideration. For one person who moved to Warwick Rd from another Ormerod home, it was arranged for a member of staff who knew him well, to join the staff team at Warwick Rd. This person also has a good relationship Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 15 with another Ormerod staff member, who now works at Warwick Rd for certain shifts, in order to maintain this relationship. Daily routines are flexible, according to the planned activities for each day and as on the day of this inspection visit, may be altered if an individual is unwell or does not want to take part in what has been planned. People living at the home take part in household tasks if they wish to and the amount of involvement will vary according to their abilities. The layout of the home and large kitchen dining room, mean that people can choose to spend time alone or join in with household activities. On the day of the inspection visit a staff member supported two people to prepare the teatime meal, guiding and prompting them, working hard to encourage their involvement. Those living at the home go shopping for food with staff. Written menus are in place for the main meal of the day, which act as a guide for when shopping for food. Arrangements for meals remain flexible according to the activity plans for each day. The main meal is usually served at teatime. Although staff take the main responsibility for making meals, people are encouraged to get involved, as seen during this inspection. Some staff have completed training regarding nutrition and more of the team are due to attend this course very soon. Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the service experience good quality outcomes in this area. Good monitoring, recording, staff training and consistency, result in people receiving a high standard of personal and health care support. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Care plans provide good information regarding personal care needs and how these needs should be met. Written guidance is available regarding preferred routines, such as the nighttime routine for one person who is sometimes disorientated during the evening and through the night. Each person has a key worker and regular monthly staff meetings give opportunity for staff to discuss and agree upon how personal care support is to be provided. Staff keep daily records, which include records of providing personal care. Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 17 Health action plans are in place and staff keep good records of any contact with health care professionals, such as GPs and dentists. One person at the home has a diagnosis of dementia and the staff team are experienced in this area and have also received specific training regarding dementia. Risk assessments are in place regarding certain health care needs. For one person, there is a risk management plan addressing fluid intake, as the individual concerned may refuse or forget to drink. The speech therapist has been involved and has carried out a swallowing assessment. The plan includes recording fluid intake, and actions such as prompting, giving drinks with a straw and always providing a sports type drinks bottle for this person to carry with them. During the inspection visit staff were seen following this agreed guidance. For this same person staff keep a skills monitoring record, recording any difficulties in carrying out daily tasks, mental absences, levels of confusion and frustration. This monitoring helps to track any changes and means that significant changes can be responded to, with professional help being sought when necessary. Another person had physiotherapy exercises to do following an accident and needed support to do these. Staff kept good records, detailing when the exercises had been carried out, showing that advice from health professionals is followed. Records of weight, continence and seizures are kept as appropriate to each person, meaning that any changes can be spotted and responded to. Medication is securely stored in the staff sleep in room, in individual locked cupboards. As shown on the training matrix for the team, staff undergo medication training. Additional training has been provided to staff in relation to one person at the home who has medication administered using a specific administration procedure. Clear guidance was seen on the individuals file and this has been agreed by the persons GP. This medication has to be available at all times and records are kept of it being taken out of the building and also of it being returned. Each persons file contains details of their medication and the associated patient information leaflets. Risk assessments are in place, which show the need for staff to take responsibility for administering medication to those currently living at the home. The medication administration records viewed were completed appropriately. Labelled containers are used, if the person is going out and has to have their medication outside of the home, such as on trips out. Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People using the service experience good quality outcomes in this area. People are able to raise concerns. Policies, good practice and staff training help to promote the protection of those living at the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A complaints procedure is in place with a version available, which uses pictures and symbols in order to make the process of raising a concern easier for those living at the home. People have opportunities to talk to senior managers during regular visits to the home and self-advocacy is promoted. The individual who completed a feedback survey for this inspection responded that they would know who to speak to should they be unhappy. During discussion this person named the senior manager within the organisation, who she would talk to if needed. Information within the Annual Quality Assurance Assessment (AQAA) completed by the Team Leader for Warwick Rd stated that no complaints have been received and no complaints have been received by the commission. Information within the AQAA states that, Any complaints received are acted upon immediately and are welcomed and are used positively to look at the area of concern and see where improvements can be made to the service. Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 19 This positive response to any concern raised is a strength of the provider organisation, Ormerod. Policies and procedures are in place regarding abuse, protection and whistle blowing. Staff training addresses issues of abuse and challenging behaviour, which is also covered in NVQ (national vocational qualification) programmes. The robust and well established recruitment procedures and the regular checking of peoples finances also help to protect those living at the home. Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People using the service experience good quality outcomes in this area. Warwick Road is clean, attractive and very well maintained, providing a lovely home for those who live there. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home is situated close to local shops and amenities and is just a short walk from the towns main facilities in St Annes Square. Warwick Rd is well maintained and provides lovely accommodation. All areas are decorated and furnished to a good standard. Bedrooms are individually decorated and reflect personal taste and preference. The large kitchen dining room provides good opportunities for those living at the home to get involved with or watch the meals being prepared. There is also a lounge, with patio doors to the garden. The ground floor bedroom has an ensuite facility. Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 21 The rear garden is well kept, with a patio area outside the main rooms and an enclosed garden area. Garden furniture is provided on the patio and also in the garden area. There are plans for a ground floor extension to be built, containing a further bedroom and bathroom. This accommodation has been planned to meet the needs of one person at the home who is going to need increased support and is showing deterioration in his mobility. It is also recognised that this additional ground floor bedroom, will be useful for other people in the future. The home is very clean and staff must work hard to keep this high standard as well as fulfil all other aspects of their role. The washing machine is located in the kitchen and the drier in the garage. Staff are aware of hygiene/infection control issues and have undertaken health and safety and food hygiene training. Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. People using the service experience excellent quality outcomes in this area. People are supported by qualified, capable and well-trained staff, who receive good support and supervision from managers. The robust recruitment procedures help to ensure that only suitable staff are employed. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The staff spoken to during the inspection visit all had good communication skills and appeared to have positive relationships with those living at the home. The Ormerod staff training programme addresses communication, values, individualised care and challenging behaviour, with staff at Warwick Rd also receiving training regarding epilepsy and dementia, in order to meet the specific needs of those living at the home. Records kept by staff indicate that good relationships have been built up with other professionals such as therapists and GPs. Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 23 Feedback from staff who completed surveys for the inspection included; Ormerod value people especially the people I support. At present the staff team is made up of six support workers and a senior support worker, with a Team Leader having overall management responsibility for the home. Of the seven support staff, four have achieved NVQ (national vocational qualification) level 2 or above. Two staff are soon to commence this award, with the remaining member of staff who is new to the team, currently doing induction training. Once completed, they too will register for NVQ training. Ormerod continues to provide excellent qualification training opportunities for staff. Ormerod has a thorough and well-established recruitment procedure in place. Recruitment files held at the Ormerod head office were viewed in relation to two staff, appointed within the past year. Documents include; an application form, health questionnaire, a record of the interview, which includes a written exercise and two references. Criminal records bureau disclosures, which include a check against the nationally held list of people who have been deemed unsuitable to work with vulnerable people, are obtained. These checks help to ensure that only suitable staff are appointed. A number of people supported by Ormerod, have received specific training and are involved in staff selection. The Ormerod training team based at the organisations head office continue to provide an excellent training programme for staff. A structured induction programme is in place, with training to cover working with people with a learning disability and health and safety issues such as moving and handling. The training matrix for the staff team was provided, showing all the training provided to the staff team and when refresher training is planned. The programme includes specific training relating to the needs of those living at Warwick Rd. Feedback from discussions with staff and from surveys completed by staff confirmed that training is of a high quality and is relevant to the duties performed. A new format for preparing for supervision has been introduced. Each staff member has a journal where they can record achievements, challenges and barriers, in preparation for their supervision meeting. The recording sheets for supervisions have been changed to reflect this new approach, which encourages staff to reflect upon their work performance and professional development. The journals also provide record sheets for preparing for team meetings, encouraging staff to take responsibility for agenda items. Staff supervision records for three members of the team were viewed at the organisations head office. Records show that staff receive regular supervision approximately every six weeks. Ormerod aims to conduct a formal annual Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 24 appraisal with all staff. Appraisals for the staff at Warwick Rd are due and it is advised that dates are arranged as soon as possible. Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. People using the service experience good quality outcomes in this area. Management and quality monitoring systems are in place. Staff training, policies and good practice promote the health and safety of those living and working at the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Warwick Rd has no manager registered with the commission, which is a requirement of the Care Homes Regulations 2001. The previous registered manager retired from the organisation, there then followed a series of organisational changes, resulting in the current Team Leader taking on Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 26 management responsibility for the home. The Ormerod Chief Executive, who is the responsible individual registered with the commission confirmed that this person would be submitting an application to register as manager of Warwick Rd. No application has been received and progress with this remains unacceptably slow. The Team Leader, who has management responsibility for Warwick Rd, has commenced the Registered Managers Award, the recommended qualification for managers of care homes and has completed other management courses whilst working for Ormerod. Regular staff meetings and supervision sessions take place. There are good systems in place and information is maintained in an organised manner. However two members of staff indicated that communication with managers could be improved. To the question What could the service do better? the responses were; Listen to staff worries and concerns and Communication could be improved from managers to staff as some of the time you don’t get a direct answer and you are left wondering what is happening. It is advised that communication between staff and managers is monitored and improvements made if necessary. There are internal and external quality monitoring systems in place. Ormerod has achieved the Investors in People Award, which is externally accredited. A series of internal quality audits and checks take place. Questionnaires are sent to those using the service, with responses being shared in the annual report and at the yearly general meeting. Staff and people who are supported by Ormerod are represented at learning disability and community partnership forums, where there is opportunity to contribute to wider planning and decision-making. Person centred planning is a key element of quality assurance, giving all those involved, including relatives, an opportunity to give feedback about the service and to support the individual to plan for the future. Supervisions and staff meetings also form part of quality monitoring at the home. The training matrix for the staff team shows that training in health and safety topics take place. There is a rolling programme of training which addresses moving and handling, first aid, food hygiene, health and safety and the safe administration of medication. A senior manager within the organisation carries out regular health and safety audits at the home, produces a written report and highlights any areas for improvement. Records confirming checks of fire equipment and electrical appliances were viewed. Staff check and record water temperatures and fridge temperatures, to ensure that safe temperatures are maintained. Radiator covers are in place. Any accidents are recorded and monitored. Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X Version 5.2 Page 28 Ormerod Home Trust DS0000010004.V374872.R01.S.doc YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13 Requirement Thorough risk assessment and risk management strategies regarding the use of the stair gate must be in place. An application for a manager to be registered with the commission must be submitted. (Previous timescale not met) Timescale for action 01/06/09 2. YA37 8 and 9 01/07/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA6 Good Practice Recommendations Care plans should be reviewed at least every six months. The process of annual person centred planning for each person should be addressed. The Team Leader should achieve the registers managers award. 3. YA37 Ormerod Home Trust DS0000010004.V374872.R01.S.doc Version 5.2 Page 29 Care Quality Commission Care Quality Commission Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 03000 616161 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. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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