Care Home: Orwell House

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What the care home does well Orwell House offers individualised support to residents with a wide range of physical and health needs in an attractive and comfortable environment. The standard of catering is high with a wide choice of dishes available for each meal. Visitors are welcome to join their relatives for meals. There is a range of planned and impromptu activities organised to meet the needs of residents who wish to participate. Careforce Homes Ltd. has a commitment to staff training and encourage all staff to further their training and gain qualifications suitable for the work they perform. What has improved since the last inspection? Following the last inspection and the two requirements left then evidence was seen that both requirements had been complied with. Medication administration records (MAR sheets) were only signed after the administration of medicines. New staff had two written references before commencing employment. More emphasis has been given to offering suitable activities for people with dementia and some staff have undertaken training for that specific area. The information recorded at the pre-admission assessment has been improved so that needs are clear and the care planning process is begun as early as possible. What the care home could do better: Some policies need to be updated and expanded to give full, clear guidance to staff on managing all aspects of care. The contact details in some documents need to be amended to reflect changes in venue for some agencies. All documents relating to Orwell House should be identified as such. Some identified needs were not reflected on the care plans seen and the follow-up of some assessment scores that indicate potential risk to the resident was not present. Not all communal bathrooms and toilets had a supply of liquid soap and many had no paper towel dispenser. In one bathroom there was a cloth towel in use. A structured system of quality assurance needs to be developed to capture the views of the service from residents, staff, visitors and other stakeholders. CARE HOMES FOR OLDER PEOPLE Orwell House Woodlands Road Holbrook Ipswich Suffolk IP9 2PS Lead Inspector Jane Offord Unannounced Inspection 23rd January 2008 10:20 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 Orwell House DS0000067721.V358781.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. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orwell House Address Woodlands Road Holbrook Ipswich Suffolk IP9 2PS 01473 328111 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) marian_harper@btconnect.com Carefore Homes Limited Penelope Joy Hull Care Home 59 Category(ies) of Dementia (32), Old age, not falling within any registration, with number other category (27), Physical disability (4) of places Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st January 2007 Brief Description of the Service: Orwell House is owned by Carefore Homes Ltd, and is registered to provide residential care for up to 59 people, from 55 years of age and over. Although the home can care for up to a maximum of 59 people, they have the flexibility to take up to 32 frail older people, up to 27 older people who have a diagnosis of dementia, and up to 10 people within the age range of 55-64 years, who have a physical disability or dementia. The home opened in August 2006, and is located in the village of Holbrook. The local village amenities (3/4 mile away) include a coffee shop, Post Office, hairdresser, doctors’ surgery and public house. Orwell House has been decorated and furnished to a high standard throughout. All bedrooms have en-suite facilities, 6 of which include showers. Assisted and unassisted bathrooms are located close to the bedrooms. All residents have access to the landscaped gardens and courtyards. The home is divided into 2 units, older frail/physical disability and dementia care. Communal space consists of dining rooms in each of the units, lounges, residents’ kitchen (main unit) and specially designed sensory room (dementia care). Access to the first floor is via stairs or passenger lift. The entrances to the dementia care unit are through ‘key pad’ coded doors. Call bells are located throughout the home. There is a well-equipped hairdressing room, and car parking is available at the front of the home. Fees for accommodation in the home are £665.00 per week. They do not cover the cost of toiletries, hairdressing, newspapers, clothing and transport. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means that people who use this service experience good quality outcomes. This key unannounced inspection looking at the core standards for care of older people took place on a weekday between 10.20 and 16.00. The registered manager and area manager for Carefore Homes Ltd were present throughout the day and assisted with the inspection process by providing documents and information. This report has been compiled using information available prior to the inspection including a number of completed surveys from residents, relatives and stakeholders and the annual quality assurance assessment (AQAA) as well as evidence found on the day. A tour of the home was undertaken with the manager but all areas were revisited during the day. A number of documents and files were inspected including four residents’ files and care plans, three newly appointed staff files, the policy folder, some service and maintenance records and the duty rotas. Some residents, staff and visitors were spoken with and care practice was observed. The serving of the lunchtime meal in the dementia unit was seen and the medication round was followed. On the day residents were using all areas of the home and looked relaxed and well cared for. Interactions between staff and residents were friendly and caring. The home was clean and tidy throughout with no unpleasant odours noted. The décor is attractive and consideration has been given to the use of interesting and age appropriate pictures in the communal areas and corridors. The lunch looked and smelled appetising and residents spoken with said they had enjoyed their meal. Medication practice was safe. What the service does well: Orwell House offers individualised support to residents with a wide range of physical and health needs in an attractive and comfortable environment. The standard of catering is high with a wide choice of dishes available for each meal. Visitors are welcome to join their relatives for meals. There is a range of planned and impromptu activities organised to meet the needs of residents who wish to participate. Careforce Homes Ltd. has a commitment to staff training and encourage all staff to further their training and gain qualifications suitable for the work they perform. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6. Quality in this outcome area is good. People who use this service can expect to have sufficient information to make an informed choice about living there and an assessment of needs and assurance that the service can meet them prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a well-produced statement of purpose that is available to prospective residents and their representatives. It contains information about all the services and the accommodation provided by Orwell House. Details of the admission criteria and process are explained and include the possibility of a prospective resident visiting the home or attending day care there prior to making a final decision to live there. The first month of residency is a trial period for both parties. A pre-admission assessment of needs is undertaken for all potential residents to ensure that the service can meet the person’s needs. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 9 The home also has a service users guide that is available in large print if required and each resident receives a copy on their first day of occupancy. The two documents include copies of the home’s complaints procedure. The contact details for some agencies referred to in the documents need to be updated to give correct information. The files for four newly admitted residents were seen and they all contained a pre-admission assessment of need. Information gathered covered the ability to manage the activities of daily living (ADLs), dietary needs and any history of falls. Other areas assessed were comprehension, social interaction, whether the person had any challenging behaviour or the need to wander, their mood, co-operation with people supporting them and any level of chronic pain. The home provides respite and short term care and people using those services are also assessed prior to entry. The home does not provide intermediate care. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 10 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. People who use this service can expect to have their health needs met and a plan of care in place to help meet all their needs as they would wish. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The four residents’ files seen all contained information about the person’s past medical history and their current health status including any known allergies. Contact details for the GP and any other health professional such as community nurse, community psychiatric nurse (CPN), chiropodist and optician were recorded. The daily records noted any input from health professionals and changes in treatment. Each file contained a number of health assessments to identify any concern that needed specialist advice. There were moving and handling assessments and a Waterlow score for measuring skin integrity, a weight record and in certain cases a falls record. The care plans for the residents were developed from the original assessments and there was evidence they were reviewed with the resident and family if appropriate. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 11 Care plans had interventions for identified needs such as orientation, personal hygiene, mobility, diet, continence and night needs. Some interventions were more individual such as one care plan that had details for the management of a poor walking gait that put the resident at risk of falls. While some care plans were full there were some omissions of interventions for clearly identified health care needs. One record showed the resident had suffered fractured pubic rami and there were no instructions for care or the management of pain. Another plan showed a completed Waterlow score for the assessment of tissue viability with the outcome indicating that the resident was at risk. There was no indication that any special measures had been put in place to prevent deterioration of the resident’s skin. Daily records seen were full and gave good information about the resident and their experience during each day. Surveys received by CSCI from residents prior to the inspection were mainly positive about the care and support they received. In response to the question, ‘ do you receive the care and support you need?’ five of eight responded by ticking the ‘always’ box, one with ‘usually’, one with ‘sometimes’ and one was left blank. Comments included, ‘all this is excellent’ and ‘always very straightforward with me’. The medication round in the unit for people with dementia was followed at lunchtime. The carer said they had had refresher training for the management of medication only two weeks ago. Previously they had received a recognised training course from a pharmacy and medication was covered again during NVQ courses. These courses were confirmed in staff files and by the training matrix seen. The medication policy was inspected and needs some expansion on specific medicine management such as, the covert administration of medication and altering medicines from the format recognised by the manufacturers, in order to offer full guidance to staff. The home uses a monitored dosage system (MDS) for the management of the medicines so individual prescriptions are put in blister packs by the local pharmacist for dispensing by the home staff. The MAR sheets have identification photographs attached to them. The practice observed on the day was safe. The carer signed MAR sheets after administration of the tablets, no signature gaps were noted and codes were used appropriately if medicines were not given for any reason. Prescriptions that offered a choice of dose i.e. one tablet or two had the amount given noted to allow an audit trail. In the clinic room the controlled drugs (CDs) register and stock were checked and a random count showed the stocks tallied with the records. CDs were appropriately stored in a double locked cupboard and the signatures of two members of staff required when managing them. Records of the temperature of the drugs refrigerator indicated that it was functioning within safe limits for the storage of medicines. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 12 Care practice was observed during the day and interactions between staff and residents were caring and friendly. Staff knocked on doors prior to entering rooms and made eye contact when talking with residents. In discussion with some staff they were able to give examples of care practices they used to preserve the dignity of residents during personal care. Orwell House DS0000067721.V358781.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 excellent. People who use this service can expect to be encouraged to maintain contact with family and friends and be offered a wholesome diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the residents’ files seen contained some life and family history work supplied either by the resident or their next of kin or representative. Staff spoken with said they found the information useful to make meaningful contact particularly with the residents with a diagnosis of dementia. Contact details of the next of kin and the relationship they had to the resident were also recorded. A number of visitors were seen to come and go during the day and staff welcomed them all. During the day residents were observed using all areas of the home and meeting in small social groups for conversation and a cup of tea. They appeared relaxed and comfortable in their environment. Some people went out with relatives and others had visitors to spend time with them in their room or the communal lounges in the home. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 14 One visitor spoken with said they had a long journey to visit their friend and as the person had deteriorated in health recently the staff were very understanding of their need to spend quality time together when they could visit. They were encouraged to help with as much care as they wanted to and supported by the staff to manage care tasks. The home has a daily plan of organised activities that include ball games, ceramic painting, card games, hand massage and manicure, gentle exercises to music and skittles. Impromptu sessions of reading and chatting were observed during the day and staff were seen relaxing with residents. One resident’s survey response noted, ‘staff are very kind and interact quite naturally with residents i.e. they sit with them and talk normally not just as carers’. Entertainment is planned sometimes and the previous day there had been a pianist who had proved a great success. A number of staff and residents had commented on how enjoyable the session had been and how many people had joined in. Shopping trips are arranged either on a one to one basis or with a group of residents and trips to places such as garden centres, a concert and visit to other care homes within the Careforce group. Holy Communion is celebrated regularly within the home and residents’ birthdays are marked with a birthday tea party. One survey response said, ‘I had a lovely piece of birthday cake today’. During the inspection day a craft session was taking place in the unit for people with dementia using paint, feathers and sequins to make pictures. Staff were supporting and encouraging a number of residents with their artwork. Staff said they had recently had some training in managing activities and stimulating interest in people with dementia. They said they had found it very interesting and it had given a useful insight to help them engage with some of the residents. Sometimes baking sessions were organised and residents used the small kitchen in the unit that could have the cooker power isolated in the main kitchen and only connected if staff were working with residents. Some residents were encouraged to participate in daytime tasks such as dusting or washing up as that was what they were comfortable doing, generally having managed a household before entering residential care. The lunch time meal was served in the two dining rooms from hot trolleys and individually plated. The dining tables were laid with attention to detail and looked attractive. In the residential unit there is a pre-lunch sherry get together most days. The meal smelt appetising and residents spoken with said they had enjoyed it. Comments made by people on the day or in the surveys received seemed to be very positive about the standard of catering saying,’ the food here is excellent’, and, ‘I always enjoy what they put in front of me’. Help for people who needed it during the meal was given discreetly and sensitively. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 15 In discussion with the cook it was clear that as well as the main choices of meal such as chicken pie or haddock with parsley sauce there were a number of alternatives always available such as an omelette, a salad, fish dishes, a vegetarian option or soup. All the cakes and pastries are home cooked and there is a cooked breakfast available for any resident who wishes for one. The kitchen was visited and looked clean and tidy. There were well-stocked dry store cupboards with a wide range of ingredients. Fresh fruit and vegetables were always available with two or three deliveries a week to ensure freshness. The cleaning schedule was seen and covered all the elements needing attention in a large kitchen and recorded temperatures for the refrigerators and freezers showed they were functioning within safe limits for food storage. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 16 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. People who use this service can expect to have complaints taken seriously and be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure is found in the statement of purpose and displayed on the notice board. It is robust and offers an investigation to any complaint and a written response within a timeframe that meets the national minimum standards (NMS). Some of the contact details need to be updated for agencies referred to take account of changes of personnel and addresses. The complaints log was seen and showed there had been one complaint made since the last inspection about staffing levels. CSCI had been made aware of the complaint and had received information about the outcome of the investigation. The complaint was not upheld. Of the eight survey forms received by CSCI from residents five stated that they knew how to complain if they needed to, only one did not and the other two were left blank. Five surveys from relatives knew the procedure with only one ticking the ‘no’ box. People that answered said that if they had had to complain they felt issues were dealt with promptly and appropriately. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 17 The home has received a number of thank you letters that were very complimentary about the service. One seen said, ‘as I see it a home is only as good as its staff – I admire each of them – they are exceptional’. The policy for protecting people from abuse was seen and gives wide guidance on the recognition of different types of abuse. The information needs to be updated to include the recent changes from protection of vulnerable adults (POVA) guidelines to Safeguarding Adults and be cross-referenced to the changes in referral procedures. Abuse training is given during induction and again during any further qualification training such as NVQ level 2 or 3. The training matrix showed that there are further updates given regularly for staff who may not be following courses. Staff spoken to said they had found the training challenging and informative. They were clear about their duty of care and were able to identify incidents of potential subtle abuse that they may not have recognised before the training. The home has a whistle blowing policy to protect staff who report any concerns. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 18 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. People who use this service can expect to live in comfortable, attractive surroundings but cannot be assured that all the equipment to prevent cross infection will be available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Orwell House was purpose built and opened in 2006. The residential unit has some residents’ rooms on the ground floor and some on the first floor that can be accessed by stairs or a passenger lift. The unit for people with dementia has all the residents’ rooms on the ground floor and is accessed by a coded keypad. There are assisted bathrooms and toilets close to all the rooms but each bedroom has an en suite toilet and basin. Each unit has a lounge and dining room with a number of other quiet seating areas throughout the building. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 19 The home feels spacious and light with wide corridors for wheelchair access and large windows to take advantage of the glorious countryside views. There is ample car parking provision to the front of the building and gardens to two other sides that offer level access and the garden around the unit for people with dementia is secure. Although this inspection took place in January there was still interest in the gardens in the form of some evergreen plants and bird feeders. The décor throughout the home is attractive with co-ordinating soft furnishings and furniture. A tour of the home was undertaken with the manager but all areas were revisited later in the day. The home was clean and tidy with no unpleasant odours and plenty of fresh flowers in evidence. The pictures chosen followed different themes in corridors such as farm labours in years gone by or the replica newspaper front pages for memorable events in the early twentieth century such as the sinking of the Titanic or the assassination of John Kennedy. The laundry was visited and was fully functioning and clean. The washing machine had an automated product feed, to eliminate the carer handling potentially harmful substances, and a sluice and high temperature wash programme. The carer was able to detail the management of soiled linen, which meant it was placed in alginate bags and put directly in the machine on a hot, sluice wash. Protective clothing was available for potentially ‘dirty’ tasks. The comment in a survey from one resident about the laundry service said, ‘a very good laundry service’. The infection control policy was seen and gave good guidance on hand washing as a preventative method of passing infection. However in a number of communal bathrooms and toilets seen there were no dispensers for paper towels, which were left in piles on the cisterns of the toilets. One bathroom had a cloth towel on the towel rail, which if used by a number of people could become a potential cross infection risk. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 20 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. People who use this service can expect to be supported by adequate numbers of correctly recruited and trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rotas were seen and showed that during the morning shift there was a senior carer on duty with at least seven carers. Six carers were deployed in the unit for people with dementia. The afternoon shift had a senior carer and six carers and at night there were three waking staff. The manager was on duty most weekdays and was supernumerary. The home employs dedicated laundry workers and a cook and kitchen assistants each day. Two domestic staff a day are responsible for the cleaning in the home. The home employs in total twenty-eight care staff and of that number ten have achieved an NVQ at level 2 or above and five more are working towards it. This will give, when the courses are completed, an overall percentage of staff with the qualification of fifty-three per cent. This exceeds the national minimum standard (NMS) recommendation that the care team should have fifty per cent with the qualification. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 21 The files for three recently appointed staff members were seen and they all contained documentary evidence that the person’s identity had been checked using birth certificates, passports and/or driving licence. Each file had evidence of a full work history, a recent photograph of the person, a job description, two references and a copy of a contract of terms and conditions between the member of staff and Careforce Homes Ltd. All three files contained a POVA 1st check and two of the three had a criminal records bureau (CRB) check. In discussion with the manager it was clear that an application had been made for the third person but it was still being processed. There was evidence that new staff undertook a Skills for Care induction programme that is a nationally recognised course and covers all areas of care. Staff spoken with were able to discuss subjects covered in their induction such as fire awareness, food hygiene, infection control and care practice. Staff spoken with talked of shadow shifts that were undertaken prior to them being included in the shift numbers. Staff talked about further training they had undertaken since induction including regular updates on mandatory subjects such as moving and handling, fire, infection control, health and safety, control of substances hazardous to health (COSHH) regulation and abuse. Instruction in other areas of care practice included dementia awareness, medication management and activities to stimulate people with dementia. These training sessions were confirmed on the training matrix seen. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 22 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. People who use this service can expect to live in a well managed home and have their welfare protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager was confirmed in post in July 2007. They have many years experience working with older people and have previously managed a nursing home. They hold a management qualification and have commenced a year long diploma in dementia care that emphasises a person centred care approach. During the day friendly interaction between staff, residents, visitors and the manager was observed. People spoken with said the manager was approachable. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 23 The home is in the process of developing a questionnaire to give to residents to monitor the quality of the service they receive. The questionnaire covers the information provided by the service, the standard of meals and presentation, the cleanliness of the home, the responsiveness of the staff team and the resident’s perception of the overall service. A new system for managing residents’ personal money has been introduced using computer records centralised with Careforce Homes Ltd. It means less money is kept on the premises and requests are made for cheques to be generated if a resident needs cash or to pay a bill. Receipts of transactions are kept and the signatures of two staff members are required for any financial activity. In the staff files seen there was a supervision contract and records of supervision notes made during meetings. Items discussed included areas for development, routine changes and progress made by the person in their work role. Supervision took place every two months. Staff spoken with said they found it a supportive exercise. The general maintenance in the home is managed by Careforce Homes Ltd. but external consultants are used to service mechanical equipment such as the lift and hoists. Certificates were seen to show the lift was serviced in December 2007, hoists were serviced in November 2007 and fire extinguishers were inspected in July 2007. There was a comprehensive fire risk assessment for the home and the fire log showed that the alarms were tested weekly and emergency lighting monthly. The fire log did not have the address of the home recorded on the front page. There was evidence that a fault reported with an automatic fire door was quickly corrected. Quotes from some of the surveys received by CSCI show that people feel the home is well run. One said, ‘the carers work very hard to create a warm and caring atmosphere within the home – overall a well run home’. Another said, ‘I think Orwell House is brilliant and has maintained a standard of genteel living that my relative could not have experienced anywhere else’. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 24 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 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 Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? None. 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 OP26 Regulation 13 (3) Requirement Provision must be made for suitable hand washing equipment to be available throughout the home for staff and residents to use to prevent possible cross infection to protect people using the service. Timescale for action 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP37 Good Practice Recommendations All policies should be regularly updated with contact details of agencies referred to so that residents have the correct information available. Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Orwell House DS0000067721.V358781.R01.S.doc Version 5.2 Page 27 - 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. 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