Care Home: Ormonde

What the care home does well What has improved since the last inspection? A random inspection carried out on the 7 November 2006 looked at requirements made in the last key report and found that improvements had been made. These included staff receiving training in Dementia care and staff`s use of the hand washing facilities in the laundry area. All residents now have access to a copy of the activities programme. More than 50% of the home`s care staff now have an NVQ level 2 or equivalent in care. The home now has an effective quality assurance and monitoring system in place. What the care home could do better: As a result of this inspection a total of 1 requirement and 2 recommendations have been made. When nutritional supplements are given to residents, this should be clearly documented on the relevant care plan so that all staff are aware of this aspect of care and the reasons why. All handwritten entries made on the drug administration records must be signed by 2 competent staff members to ensure accuracy and minimise the risk of any drug errors. It is recommended that all staff who sign the complaint book also print their name to ensure legibility and that a clear audit trail is maintained. CARE HOMES FOR OLDER PEOPLE Ormonde 12 Pinewood Road Branksome Park Poole Dorset BH13 6JS Lead Inspector Jo Pasker Key Unannounced Inspection 29th August 2007 12:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ormonde Address 12 Pinewood Road Branksome Park Poole Dorset BH13 6JS 01202 760838 F/P01202 760838 ormondenursing@btconnect.com 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) The Avalon Nursing Home (Dorset) Limited Vacant Care Home 24 Category(ies) of Dementia - over 65 years of age (24) registration, with number of places Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. To accommodate four service users, as known to the Commission for Social Care Inspection, under the age of 65 years with mental health needs. To accommodate one service user, as known to the Commission for Social Care Inspection, under the age of 65 years with dementia. Mrs Rust must provide the Commission for Social Care Inspection with evidence that she has undertaken relevant training in caring for people with dementia by 31st October 2006. 5th June 2006 Date of last inspection Brief Description of the Service: Ormonde is registered with the Commission for Social Care Inspection to provide nursing care for a maximum of 24 people over the age of 65 years with dementia. The home can also provide care for people younger than 65 years of age who have dementia or mental health needs, as specified in the conditions of registration. The home is situated in a residential area of Branksome Park, with Branksome Dene chine being only a short walk away. There is a good bus route to Bournemouth outside the home. Accommodation is provided on the ground and first floor with access via a passenger lift. On the ground floor there is a lounge and a dining room, there are also seven bedrooms of which three are single, with two of those having ensuite facilities, and four doubles, with one having ensuite facilities. On the first floor there are seven single bedrooms, three of which have ensuite facilities and three doubles, two of which have ensuite facilities. The home has assisted bathing facilities on each floor. There is a small, enclosed patio area accessible from the dining room and a well maintained garden for residents use. Car parking is available to the front of the home or on the road directly outside. The home is owned by the Avalon Nursing Home (Dorset) Ltd and Mr A H Jaffer is the Responsible Individual. The home is currently without a Registered Manager but has an operations manager in place and a new manager who will be applying for the Registered Manager’s position. The fee prices in August 2007, range from £525-£575 per week for nursing care. The fee does not include hairdressing, chiropody or dry cleaning. Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 5 General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk and the following website offers further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_c hoos.aspx The home holds a copy of the most recent inspection report, which is available, on request. Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 3 days - 29 August and the 6 and 9 September 2007 and took approximately 9 hours. The purpose of the inspection was to assess all of the key standards and review the requirements and recommendations made from the random inspection carried out on the 7 November 2006. The acting manager and the operations manager were both on hand to aid the inspection process and were very helpful throughout. Information for this report was obtained from discussion with the acting manager, operations manager, discussions with 4 residents, 1 visitor and 5 members of staff on duty, a review of a variety of documentation including records provided to the Commission, care records, staff records, maintenance records, policies and procedures, surveys and a guided tour of the home. The annual quality assurance assessment (AQAA) sent before the inspection had also been completed and returned. What the service does well: The home continues to ensure that a thorough assessment of needs is carried out prior to residents moving into the home and people are assured that their needs will be met. A range of community health professionals support the home’s staff in looking after the residents. Activities and links with the local community are good and the home continues to have a varied calendar of events organised throughout the year. Residents are offered a good variety of meals and individual needs and requirements are well met. The home provides a safe and well-maintained environment for the residents, with a good standard of décor and comfort. The numbers and skill mix of staff are sufficient to meet the needs of residents. Staff receive adequate training in aspects of care work and other essential topics. Robust recruitment procedures are followed to ensure that residents are protected from the risk of unsuitable staff being employed. Management within the home is good ensuring that it is run in the best interests of the residents. Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 7 Financial procedures within the home also ensure that residents’ interests are protected. The health and safety of the residents and staff are protected by the policies and procedures that the staff follow at Ormonde. Comments received reflected that residents and relatives were very happy with the overall care provided, including: • • • “The staff are very friendly and do their best to look after residents” “Excellent care” “Mum’s very happy here”. What has improved since the last inspection? What they could do better: As a result of this inspection a total of 1 requirement and 2 recommendations have been made. When nutritional supplements are given to residents, this should be clearly documented on the relevant care plan so that all staff are aware of this aspect of care and the reasons why. All handwritten entries made on the drug administration records must be signed by 2 competent staff members to ensure accuracy and minimise the risk of any drug errors. It is recommended that all staff who sign the complaint book also print their name to ensure legibility and that a clear audit trail is maintained. Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3 (The home does not provide intermediate care so Standard 6 does not apply). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families are given sufficient information to make an informed choice about whether to move to Ormonde and new residents move into the home having had their needs assessed and been assured that these needs will be met. EVIDENCE: A comprehensive and up to date service user guide is available, which provides clear details of what a prospective resident and their relatives can expect from Ormonde. This is also available in the form of an audio guide. Pre admission documentation viewed showed that a thorough and informative assessment had taken place. This ensures that sufficient information was gained so that a comprehensive care plan could be written; to ensure that the resident’s care needs could be met appropriately. Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed care plans are in place, which provide staff with the information they need to meet residents’ needs and medicine administration and handling is generally well managed but some improvements could be made regarding aspects of recording by staff. The health needs of the residents are well met with evidence of good support from community health professionals. The home recognise the importance of treating individuals with respect and dignity and work positively to address any shortfalls. EVIDENCE: The care records of 2 residents were reviewed and found to be comprehensive, up to date and relevant and were based on the findings of appropriate assessments. Files contained a variety of assessments including ones for falls, pressure area care, mental health and nutrition. All were seen to be regularly reviewed and there was evidence of them being discussed with and signed by a resident’s representative. Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 12 Some residents were receiving nutritional supplement drinks and these were recorded on a list in the kitchen but were not documented on the care plans, with the reason why it was being given. There was clear evidence of GPs’ and other healthcare professionals’ involvement in residents’ care, documented in the care records. Medicines were properly stored, being locked away and records were kept of the receipt, administration and disposal of medication and examination of these showed that all was well recorded and there was a clear audit trail available. An up to date list of staff specimen signatures was seen and all medicines checked were in date and appropriately dated when opened, where necessary. All the medicine administration records seen for each resident clearly stated whether there were any known allergies to medicines however, not all hand written entries had been signed by 2 competent members of staff. Staff were observed to show a caring, committed attitude to the residents and their interaction was always cheerful and supportive. Staff were seen to knock on residents’ doors before entering and address them appropriately. However on the first day of inspection, some residents were observed sitting on seat covers for incontinence in the communal lounge, which does not promote their dignity but after discussion, the home acknowledged this and immediately removed the covers. Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a range of activities and social events planned by the home, which meet the residents’ social, recreational and religious needs and visits by their friends and relatives are welcomed by the home. Both relatives and staff members assist residents to make choices, enabling them to exercise control over their daily lives and the choice of meals ensure that residents receive a wholesome diet. EVIDENCE: The home employs a part time activity organiser who provides and organises a range of activities and events for all the residents, a copy of which was on display in the hall. Evidence was seen of individual residents’ interests and hobbies documented on activity profiles and also 1:1 sessions that had taken place. Trips out are arranged and the home has a mini bus for the use of residents. Different events are organised throughout the year including BBQ’s, fetes and carol singing and several community groups visit the home including the Salvation Army and the local Brownie pack and school. Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 14 Visiting is open and flexible and visitors are welcomed into the home and to participate in the home’s events. The differing needs of residents’ faiths are also well met through services or visits to the home by representatives of preferred denominations. All meals and snacks are prepared by the chef in the kitchen, next door at Avalon and delivered by a heated trolley. The small kitchen at Ormonde has facilities for washing up and making hot and cold drinks for the residents. Lunch was seen to be served during the course of the inspection and looked appetising and healthy. Residents were given assistance where needed with their meals and helped to remain as independent as possible. Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good complaints system, which ensures that complaints are managed properly and residents and relatives can be sure that their concerns will be listened to and acted upon. Adult protection is appropriately addressed in staff training and policies and practice are in place, in order to safeguard residents from potential abuse and harm. EVIDENCE: The home has a clear complaints policy and residents confirmed that they were confident to speak to the manager if they had a problem. The Commission has received no complaints since the last inspection and since the last inspection the home has investigated 1 complaint, which was found to be partially substantiated. The complaints logbook clearly stated the nature of the complaints and showed when appropriate action was taken where necessary. Some signatures in the book were not legible though and the home was advised that staff also print their name when signing the book; this had been implemented by the home on the second day of the inspection. The home has good policies and procedures in place for the protection of residents from abuse or neglect and staff spoken with confirmed that they knew the correct procedure for reporting suspicions of abuse. There has been 1 adult protection referral made since the last inspection, which is still being investigated. Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained, has a clear on going programme of maintenance and refurbishment and is clean and free from any offensive odours, ensuring that it provides a safe and pleasant place to live for residents. EVIDENCE: Since the last inspection the home has been updated and improved in several areas. The paved area outside the dining room is now being developed as a sensory area for residents, which can be shared with visitors; the lounge and dining rooms have been redecorated and some bedrooms have been refurbished. The home has a dedicated full time maintenance person who also covers Avalon and confirmed that there is a rolling programme of maintenance. During the tour of the premises, all areas seen looked clean and tidy and there were no unpleasant odours. Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 17 The laundry is shared with Avalon and sited in an outbuilding between both homes with a dedicated laundry person. The laundry was viewed and was in good order, with all equipment in working order and adequate to cope with the washing needs of the residents. The hand washing facilities were accessible to staff and appeared to be regularly used and adequate supplies of gloves and aprons were seen around the home. Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient levels of staff are employed to ensure that the needs of the residents are met and the home’s recruitment system ensures that residents are properly protected from the risks of potentially unsuitable staff being employed. Staff also receive comprehensive training which enables them to be competent in their work. EVIDENCE: The duty rota was seen during the inspection and it showed that sufficient numbers of care staff were employed to meet the needs of the residents. This was also confirmed by staff spoken to during the inspection and it was seen that the home also employs several other ancillary staff including domestics, a kitchen assistant, an activity organiser and a maintenance person. The home has an ongoing training programme, which includes NVQ level 2 in care. The manager confirmed that at the time of inspection more than 50 of care staff held this award and other health care assistants had started work on the award. The files of 2 members of staff were seen during the inspection and all relevant recruitment documentation was found to be present. Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 19 Training files demonstrated that staff were receiving regular training, including induction and this was confirmed with staff spoken with during the inspection. Recent training included fire safety, health and safety, food hygiene and first aid and there are also opportunities for external training courses. All members of staff have now received in house dementia care training following a requirement made at the last inspection. Further information on available training can be accessed through the following websites: www.picbdp.co.uk www.skillsforcare.org.uk Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home, which is run by a knowledgeable, well supported manager who possesses a good understanding of residents’ needs and will be applying to be registered with the Commission. Good quality assurance systems are in place, to ensure that the home is run in the best interests of residents and their finances are well protected. Staff are appropriately supervised ensuring that training needs are identified and met and the welfare of residents and staff are well promoted and protected, ensuring that risks to health and safety are minimised. EVIDENCE: The current manager has worked at the home since February 2007, before becoming deputy manager and now acting manager. She is a qualified Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 21 Registered Mental Health nurse with more than 23 years experience of caring for others and is currently applying to the Commission for the post of Registered Manager. She is well supported in her role by a competent staff team, experienced operations manager and a supportive Registered Provider. The homes has made great improvements in their quality assurance systems since the last inspection and now have an annual development plan in place and carry out regular audits of the service. The home also submitted a completed AQAA prior to the inspection detailing how they currently meet Care Standards and how they plan to improve. Residents’, relatives’ and healthcare professionals’ opinions are sought by the home through the use of questionnaires and relative meetings held and there are plans to provide a newsletter covering both Ormonde and Avalon. Generally residents had appointed a responsible representative to deal with financial matters if they did not want to deal with them themselves, however the home does hold some small amounts of cash or ‘pocket money’ for most of them also. A sample of records and balance of monies held were seen and checked and demonstrated that the recording was accurate. Supervision records reviewed demonstrated that it took place regularly and showed it was of an appropriate standard and staff spoken with confirmed that they received support as needed. The accident book showed that accidents were properly recorded and appropriate action was taken as necessary, with regular audits taking place. Records showed that equipment had been serviced regularly and all servicing certificates seen were in date. Appropriate risk assessments were seen to be place, including ones for the use of bed rails and all fire training and safety checks were seen to be up to date. Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement All hand written entries on MAR charts must be checked for accuracy and signed and dated by 2 competent persons. Timescale for action 12/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations All nutritional supplements given to residents, should be clearly documented on the relevant care plan so that all staff are aware of this aspect of care and the reasons why. All signatures within the complaints book should be legible or otherwise clearly state whose they are, to ensure that a clear audit trail can be followed. 2. OP16 Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ormonde DS0000020506.V350396.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!