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Archived: Orton Manor Nursing Home

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All reports

Inspection report

Date of Inspection: 5 August 2011
Date of Publication: 18 October 2011
Inspection Report published 18 October 2011 PDF

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Not met this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

How this check was done

Our judgement

Care plans are not consistently available for each of the identified needs of people. Improvements are needed in the way the service identifies risks to people’s health and in taking appropriate action to minimise any risks that are identified.

User experience

We observed that people looked clean and appropriately dressed for the time of year. Those people that were in bed had been made as comfortable as possible with pillows, blankets and call bells close to hand. Hospital beds were in use as well as other specialist equipment including pressure relieving mattresses, cushions, hoists and bath chairs.

We observed several interventions when staff used equipment such as a hoist to assist people to move safely. Staff explained what they were doing and gave sensitive assistance at a pace appropriate for each person.

We saw that staff were knowledgeable people’s needs and their likes and dislikes and were kind, caring and attentive towards them.

People spoken with told us they were generally satisfied with the care they received. Their comments included, ‘I am very well looked after.’

Staff told us it was usual practice for a senior member of the nursing staff to visit people who are considering moving into the home to undertake an assessment of their needs and abilities.

We observed safe practice during the administration of medicines at lunchtime.

Other evidence

Concerns about the welfare of people using this service were raised by a relative and social worker in June 2011. The concerns were investigated under safeguarding procedures led by the local authority. This involved a review of the care needed by many of the people using the service and looked at how the home was meeting their needs.

The reviews identified shortfalls in the way the service monitors people's nutritional needs. Staff did not always keep adequate records of what people ate and drank.

Staff did not always take appropriate action when people lost weight. For example, it was discovered during a review by a social worker that a person had a significant weight loss over a period of several weeks, along with some symptoms of difficulty in swallowing. Staff did not make referrals to the GP, dietician and Speech and language therapist until the social worker suggested it was necessary.

We saw evidence that the manager has begun to audit care plans and undertake clinical supervision of nursing staff in response to the shortfalls identified during the safeguarding investigation.

We looked at the care records of two people using the service.

Both care records we looked at each contained a pre admission assessment of the person's needs and abilities. For example, staff identified that a person with mobility needs required the assistance of two staff to assist them to move using a hoist.

In the records of one person, care plans were available for each identified need and supplied staff with the information needed to make sure the person's needs were met safely and appropriately. For example a care plan was available describing the person’S wound care regime. It included evidence of referral and advice from a tissue viability nurse and recorded the progress of the wound to show improvement.

We saw evidence of the use of risk assessment tools in this person's care records for falls, nutrition, mobility and pressure sores. For example, we saw a care plan for a person identified as having a high risk of developing pressure sores. The actions included the use of a pressure relieving mattress, which we saw in use.

When we looked at the second person’s care records we saw that care plans had not been developed to address the complex health and personal care of this person, who had diabetes. For example, there were no care plans describing the person’S diet or monitoring their blood sugar levels. There were no care plans in place for wound care for a recent amputation related to unstable diabetes. The risk assessment tools had not been completed to identify any further risks to this person's health.

The nursing and care staff we spoke with were aware of this person’S needs and the person told us they were satisfied with the care they received. However the absence of written care plans means staff have no written instruction about how to meet the needs. Staff told us the care plans had not been written because the person was a recent admission. We noted the admission was 10 days previously.