Inspection on 31/10/08 for Lake & Orchard Care Centre

This is the latest available inspection report for this service, carried out on 31st October 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lake & Orchard Care Centre 14/03/06

Lake & Orchard Care Centre 30/09/05

Lake & Orchard Care Centre 26/01/05

Lake & Orchard Care Centre 10/08/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Orchard House Nursing Home Orchard House Nursing Home Kelfield York North Yorkshire YO19 6RE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jean Dobbin     Date: 3 1 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Orchard House Nursing Home Orchard House Nursing Home Kelfield York North Yorkshire YO19 6RE 01757248868 01757249446 lakehousehome@btopenworld.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Vikki Sara Hamblin Type of registration: Number of places registered: European Care (SW) Ltd care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 1. The registered person may provide the following category of service only: Care home with nursing: Code N, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories, Dementia: Code DE, Mental disorder, excluding learning disability; Code MD, Old age, not falling within any other category: Code OP, Physical disability: Code PD. 2. The maximum number of service users who can be accommodated is 50. Date of last inspection 30 30 20 20 Over 65 0 0 0 0 Care Homes for Older People Page 4 of 33 Brief description of the care home Orchard House is a care home providing nursing care for people over the age of 55 years who may have dementia or a mental health illness. The home is situated in a rural area between Kelfield and Riccall, villages between Selby and York. There are village amenities, particularly at Riccall, which is on a bus route between York and Selby. It is set in large private grounds alongside its sister home Lake House and other property owned by the company. Visitor and staff parking are available on the site. Building work has just been completed in Autumn 2008 to form a link between the two homes, which will increase the communal and private rooms.The accommodation is provided both in single and shared bedrooms over two floors and there is a passenger lift for access to the first floor.There is ramped and level access to the home, ample parking for visitors and staff and a large garden area, including a safe area for people living there to enjoy. The home has a Statement of Purpose, service user guide and recent inspection reports written by the Commission for Social Care Inspection displayed in the reception area. Weekly fees to live at Orchard House on 31st October 2008 are between £450 and £625. Additional charges are made for chiropody, hairdressing and personal items and newspapers. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is what was used to write this report. Information about the home kept by the Commission for Social Care Inspection. Information asked for, before the inspection, which the manager provides. This is called an Annual Quality Assurance Assessment or AQAA. Information from surveys, which were sent to people who live at Orchard House, to staff and to other professional people who visit the home. 15 were sent to people at the home, and 5 were returned. 10 were sent to healthcare and social care professionals and 4 were completed and returned. 5 were sent to staff at the home and Care Homes for Older People Page 6 of 33 2 were returned. A visit to the home by one inspector, which lasted about 8 hours from 9.15 to 5.15. This visit included talking to people who live there, to staff and the manager about their work and training they had completed. It also included checking some of the records, policies and procedures that the home has to keep. Some time was also spent watching the general activity to get an idea about what it is like to live at Orchard House. Information about what was found during the inspection was given to the registered manager and the deputy manager at the end of the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: The way risk is managed in the home could be looked at to make sure that the manager and staff are doing all they could be to keep people safe. These include. Care Homes for Older People Page 8 of 33 The manager could make sure that medication audits are completed in a consistent way, to show that people are getting their drugs according to their prescriptions. Those drugs taken when necessary and rarely, if ever needed, could be discussed with the doctor and removed from the medication record sheets. The registered person could make sure all staff at the home are very clear of their responsibilities, should they hear or see something which could be abusive. This knowledge can help to protect people from harm. Record keeping could be improved, so that it is easily available for authorised people to look at, so that they can satisfy themselves that the home is well run. Prepared foods could be labelled to show when they are prepared. This would make it easier to check the age of the food, and whether it needs to be thrown out. This would prevent it being served to people when it may not be fit to eat. Hot water temperature monitoring could be carried out more often so that the risk of people being scalded by water that is too hot is minimised. Staff at the home could continue to seek out the views of people living there, and other people with an interest in how the home runs. This information could be put together so that it is easy to see what changes are going to be made as a result of these changes. People who have told the home what they think about it, also need to know what changes are going to be made, so that they know that they have been listened to. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are assessed properly before they move to the home so that the home can be sure they can provide the right care if they choose to move there, but also to satisfy the person and their family that they will be cared for appropriately. Evidence: Peoples care plans looked at showed that a detailed assessment had been completed and these were dated prior to the date the individual moved to the home. This assessment looked at peoples total needs, such as their personal care needs, social care needs and their abilities to communicate and understand what is going on around them. This information helps the senior staff at the home to determine whether staff have the skills and knowledge to support that person if they choose to move there. These assessments are always completed by a senior nurse, who talks with other professionals involved in the individuals care to make sure that as much information Care Homes for Older People Page 11 of 33 Evidence: as possible is gained about the individual. People are encouraged to look around and spend a day at the home so that they can see if they like it. A Statement of Purpose and service user guide describing the facilities and services the home provides is given to people thinking about moving to the home. It is also displayed in the reception area. The manager could consider producing a much simpler version, or in another format like DVD, for those people with impaired understanding so that they can have an alternative way of learning about the home. Intermediate care is not provided at Orchard House, however after discussions with the local authorities a bed is now made available for respite care, to provide short breaks for people as necessary. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are well met and there is detailed documentation to help make sure care is given in a safe and consistent manner. Evidence: Three care plans were looked at as part of the inspection process. These describe the help and support people need to stay in control of their lives as much as possible. Those looked at were well written and clearly described a very person centred approach, where it was easy to identify how one person had very different needs to the next. They were written in a way that supported people in maintaining small life skills and recognised that people could still be provided with small choices despite sometimes very impaired understanding. Examples of person centred care included how many pillows one person likes to sleep with, and the specific time of day that someone likes their bath. There was information about what support and aids people need in order to manage Care Homes for Older People Page 13 of 33 Evidence: their meals independently or with minimal help. These records demonstrate good attention to detail, and by writing the information down care staff can refer to the plan and be sure they are providing the right care. These care plans are reviewed regularly to make sure they are still relevant and daily records are kept of peoples day-to-day routines. There was also a good understanding of managing risk. Assessments in the care plans were completed as to whether people were at risk of, for example, developing pressure sores, becoming malnourished because of a poor appetite or a health problem or of falling. Those identified as at risk had a care plan in place, describing what needs to be done to minimise the risk of that happening. Those people needing help to mobilise had a detailed plan describing how this task was to be managed in a safe and consistent way. These assessments were reviewed monthly to make sure they were still appropriate, however it would be good practice to review a falls risk assessment each time someone has a fall, to make sure there nothing more could be done to prevent a future fall. People are weighed monthly and staff are very alert to the need to provide adequate calories for people with dementia and to take any weight loss seriously. Pressure relieving equipment is widely used on chairs and beds, according to peoples assessed risk. One person has been provided with a special bed that lowers right to the floor, because this was assessed as the best way of keeping them safe at night. The home has good links with health care professionals, like the doctor, speech therapist and chiropodist. Comments from completed surveys are positive and include if I have raised any issues I have felt the home have dealt with things properly. And I feel people are managed with skill and this applies especially to people with behaviours that challenge the service. I feel they know each person’s potential. Another professional wrote you provide professional and kindly care to people and their families. You are getting it just about spot on. Medication systems were looked at and these were generally satisfactory, with the nurse having a good knowledge of how medication is managed in the home. Checks on several boxes showed that the actual number of tablets was the same as the number written on the record sheet. Although a thorough medication check is carried out each week, at other times the changing number of tablets is written down at each medicine round, without nurses actually checking whether the number is right. The way these checks are completed needs to be clarified by the manager, so that she can be satisfied that the records are accurate. The quantities of those drugs that are prescribed as required need to be carried forward on to each new record sheet every month so that checks can be completed to make sure that the calculated number is Care Homes for Older People Page 14 of 33 Evidence: the same as the actual number. One persons record sheet had a drug prescribed, which the home didnt keep any longer because the person hadnt needed it for a long time. These prescriptions need to be removed from the record sheet, when checks have been made with the doctor that this can be done. Staff were observed interacting in a gentle and sensitive manner. They explained to people what they were doing before carrying out the task. And they listened to what people said to them. There was lots of banter and gentle humour and the atmosphere was generally calm and relaxed. People were observed knocking on peoples doors before entering the room and care was provided in private. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are helped and supported to make choices, wherever possible, and their independence is promoted, enabling them to stay in charge of their own lives as much as possible. Evidence: The atmosphere in the home is happy and friendly. People are able to walk around parts of the home as they choose, and keypads to the outside and a lock on the lift help to keep people safe. There is evidence of activities having taken place in the past, including a large painting incorporating a number of hand prints, and photographs of the Summer Fayre. An activities programme is displayed, listing events like dominoes, cards and hand massage. However this is in the entrance area, where people who live there generally do not have access. A programme, where people can look forward to specific events is good practice, however this needs to be where people can look at it and in a format (like pictorial) that more people could understand. An activities person is employed to work in both homes on the site and people can Care Homes for Older People Page 16 of 33 Evidence: attend events at either home. A Halloween party had taken place at the other home the day before the visit, and a few people from Orchard House attended. The home has a minibus and trips to York and Selby were advertised. One person spoken to said they were very happy at the home. They have a newspaper delivered and talked about the headlines that day. Many of the people living there though are unable to talk about how they spend their time. However although the surveys provided few comments people responded always or usually to questions relating to whether staff listen to what they say, or whether the staff treat them well. One person wrote they (the staff) are lovely. Care staff were observed talking with people even though they couldnt always talk back to them and there was a lot of smiles and non-verbal communication. The home uses doll therapy and several ladies clearly drew great comfort and pleasure from nursing and talking to these baby-like dolls. Staff supported this activity in a sensitive and caring manner. People were dressed tidily and some ladies wore make-up, nail varnish and jewellery. The local vicar visits to give communion as requested and a catholic sister also visits the home regularly. People who have different cultural or spiritual needs because of their background or nationality need to have very clear records in their care plan about how those needs are to be met, so that care staff recognise and understand those differences. This was discussed with the manager and deputy. A catering assistant is employed to help with the main meals of the day, as well as offering snacks and drinks as necessary. People were offered small choices, like choosing their own biscuits or cakes. One person asked the staff for more biscuits and the care staff willingly provided more snacks to keep them going until dinnertime. Staff are very alert to the fact that people with dementia need a high calorie diet. Chocolates and crisps are available in the lounge for people to help themselves, and staff also offer these regularly to people who cant get them themselves. Chocolate bars are also given to people regularly, although these are paid for either by the individual or their family. Hot meals come over from the main kitchen in a heated trolley and are served by the catering assistant. There is a dining area within the large lounge, but many people have their meals sat in their lounge chair, which can provide more support for impaired balance. The trolley came over very early though, so the food was being kept warm for a long Care Homes for Older People Page 17 of 33 Evidence: time before it was served. This was discussed with a staff member, who had also noticed that it had arrived particularly early that day. The manager needs to monitor this to make sure food isnt being prepared too early. Peoples meal preferences are recorded in their care plans and staff also have learned more about what people do and dont like. There is a choice of meals and desserts each day. There was fish and chips with mushy peas on the day of the site visit and one person said it was very nice and very hot. Carers must always remember to offer salt and pepper and sauces to those people who cannot choose to help themselves. One person was offered vinegar with their fish, but this was not widely offered. Many of the people living at Orchard House need assistance with their meals. This was provided in a respectful and unhurried manner, though the numbers needing help mean that the mealtime period can be quite lengthy. The manager is aware of this but thinks a relaxed atmosphere enables people to enjoy their meal and enjoy the interactions with the person helping them. This time was very relaxed and calm. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples complaints are looked into properly and whist staff have some knowledge about what abuse means, they are less clear about what they should do and how they should behave if they have concerns about a potential safeguarding incident in the home. Evidence: The complaints policy is displayed in the entrance area and is included in the information given to people and their families when they are thinking of moving to the home. Many of the people living at Orchard House would not be able to say if they were unhappy about something, and the surveys confirmed this. Whilst two people said they would tell somebody, the others said they would not know what to do. The records, completed as part of the assessment process, describe how people communicate and what different gestures and behaviours may mean. Staff are very alert to these changes, which could indicate that something is wrong, which requires looking at. The staff at the home should continue to remind people, in everyday conversations, of the importance of telling people if something is wrong, so that it can be put right. Care Homes for Older People Page 19 of 33 Evidence: The home has received two complaints in the past year, one of which was upheld. These related to a lost item, which was subsequently found, and dissatisfaction with some furnishings in an individuals bedroom. The manager should consider also keeping a niggles book, where negative comments, made in conversation can be recorded so that these comments can be identified and looked into. Staff attend training in Safeguarding adults, both when they start working at the home and as part of their National Vocational Qualification study. The manager has completed extra training so that she has up-to-date knowledge and can provide training in safeguarding adults precedures. The training records though are poorly recorded, so evidence of this could not be seen. Two members of staff were spoken with and both said they would promptly report to the senior person, anything they saw or heard, which may be abusive. One person though was unsure whether they would interrupt any suspicious behaviour, before telling the manager. The other person said it would be difficult to report something if a person living at the home had expressly asked them not to tell anyone. The manager needs to make sure staff know what to do in various situations, in order to help to keep people safe. One safeguarding referral has been made in the last year. This was reported promptly to the local authority, and dealt with appropriately. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, warm and comfortable, though parts need some refurbishment to make them more pleasant for the people who live there. Evidence: Orchard House is in the midst of major refurbishment. A new building has been built, which will mean that the home is joined to its sister home, Lake House, and the owners will then apply to the commission to register the building as one large care home. This new build is due to be opened in the weeks following this visit. Orchard House itself will then undergo major refurbishment, which will include renewing the plumbing, bathroom fittings and a total redecoration. This should be complete by late Spring 2009, when there are plans to divide the home into smaller units, which will provide more homely environments, rather than being a larger institution. Whilst the home was noted to be clean, warm, tidy and comfortable some areas of the home are ready for redecoration and refurbishment. There are two large communal rooms, which both have dining areas. One had a large television, though this was not on loudly. There were a number of occasional tables for people to use for their drinks and personal belongings. Settees were also available, and these were popular. Care Homes for Older People Page 21 of 33 Evidence: A small quiet room is available on the first floor, though this is not often used by people living there. Bedrooms are on both floors and those looked at contained personal items, which help to make the room seem more like home. The corridors are decorated with collages and there are lots of photographs and posters displaying people and places from the past, which help to promote conversation and recall things that happened years ago. There is a large safe garden, with ramped access, with large raised garden beds, a pergola and bird feeding station. People are encouraged to help with maintaining these if they wish to. One person had photographs in their room, showing them clearly enjoying this activity. At the last inspection in January 2007 the manager was required to address the shortage of assisted baths in the home. Since then two rooms have been combined to create a large bathroom with specialist bath and separate sit in shower, to provide more choice for people when bathing. The manager makes sure that appropriate aids are available and used, to make sure that people living in the home are protected against infection. One carer said that there was a ready supply of these. They were also available for use in the laundry room. The home has robust ways of dealing with soiled laundry. All these systems are used to reduce the risk of a spread of infection in the home. However one carer was observed lifting the lid of a pedal bin by hand, during lunch, to throw something away. She then returned to help someone with their lunch without washing her hands first. This poor practice was discussed with the manager. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive good quality care from an experienced staff team, however improved record keeping would better evidence that training and recruitment processes are robust. Evidence: There is always one trained nurse on duty at Orchard House and during office hours the deputy manager, a trained nurse, is also available. The care staffing levels are one nurse and four carers on the early shift, one plus three carers on the late shift and one plus two carers through the night. There is also a catering assistant who helps people with their breakfasts, as they get up each day, as well as supervising the three main meals, drinks and snacks. Her role enables the care staff to concentrate on providing the care and support people need. Other ancillary staff include laundry and domestic staff, as well as an activities person. There appears to be generally enough staff on duty to meet peoples needs, and staff were observed talking with people in a pleasant and respectful manner. The staff team seemed to work well together and showed a good understanding of peoples needs. One survey from a healthcare professional commented that the staff seem very good. Whenever you ring up or visit they always answer well. Another healthcare Care Homes for Older People Page 23 of 33 Evidence: professional commented I believe the care staff are well supervised by the trained nurses. There seems to be a core group of carers who have been at Orchard House for a long time and the team is mature. A baby monitoring alarm was noted in the lounge and one of the staff said the sensor was used on the upstairs corridor at night to alert staff when somebody came out of their room. The manager needs to make sure that this is not being used to reduce the need for a regular staff presence in that part of the home. The survey responses and peoples responses to questions on the day of the visit suggested that staff almost always listen and act on what people say to them and they are almost always available whenever help is needed. One person said in their survey the girls are lovely. Eight care staff are currently working towards their National Vocational Qualification Level 2 Award in Care. When they have completed this study more than 50 of the care staff will have achieved that award. This core training helps staff to have a good understanding of their role and so people are more likely to receive safe, consistent care. Two recruitment files were looked at. Both recruits had started work following a PovaFirst check which makes sure an individual is not barred from working in a care setting because of a previous offence. But before the complete police check was available to look at. The work carried out by new staff needs to be supervised by a named senior person and the manager should keep evidence to show that this supervision takes place. This would help to demonstrate her commitment to keeping people safe. One file contained only one reference. The manager contacted the commission in the week following the site visit to say she had located the missing reference, which had been in another persons file. Similarly the evidence to show that checks had been made to show that a nurse was still registered to practice was also missing, but found at a later date. Records need to be well kept, so that authorised people can check to make sure procedures are being followed properly. Good record keeping can also help the manager to be sure that she has completed all her checks properly before someone starts working at the home. New staff have a planned induction programme, where they learn about care practices and the policies and procedures that they are expected to follow. This makes sure that all new staff follow the same learning pathway so that all gain the same knowledge. One person spoken with confirmed that process. Care Homes for Older People Page 24 of 33 Evidence: The reception area has a number of certificates displayed, showing the training that staff have attended. The deputy manager is a trainer for a dementia care programme called Yesterday, Today and Tomorrow, which is being provided for all staff at the home, including all the ancillary staff, like the cook and handyman. This is good practice as it means that all employees will have some understanding of the specialist needs of people with dementia. Training is provided in-house by trainers employed by the owners of the home, or by the manager. There is no record though to show that staff are receiving compulsory refresher training in a timely way. One person spoken with said that they had attended fire safety training and health and safety updates in the last year. The manager says she knows when training is due and requests input from the companys trainer. This though does not demonstrate that people are receiving these updates promptly and relies on her continued presence to organise this. There needs to be a more transparent system in place that can be checked on by other senior staff at the home. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst observation of the general activity shows that the home is being run in the best interests of the people, some of the record keeping and health and safety processes need improving to confirm that the home is being well managed. Evidence: The day to day running of the home is managed by a deputy manager, who is a nurse and has undertaken extra training in dementia care, so that she has in depth knowledge about the challenges this illness can present. The registered manager has been in post for a number of years and showed in discussion that she had a good understanding of the needs of people with dementia. She is described as approachable and easy to talk to. The home has an open style of management, where people can speak with senior staff at any time. The registered manager has overall responsibility for the two homes on site, with Care Homes for Older People Page 26 of 33 Evidence: offices in both buildings. She has also been keeping an eye on the new build, which is almost complete. This may explain why some of the record keeping is not as organised as it might be. The views of people who live at the home are difficult to obtain, because of their disability. However carers generally know the people well, and can recognise pleasure or dissatisfaction by peoples behaviours or gestures. Small changes can then be made. Surveys are sent out periodically to people with an interest in how the home runs though the manager says many are not returned. The home needs to look at any other ways of getting peoples views about how the home operates, so that they can have the opportunity to influence how the home runs. Results from surveys need to be displayed, so that people know their views have been acknowledged. A displayed action plan would inform people what the manager is going to do as a result of the survey responses. A newsletter has been published this autumn and making this a regular issue could help to keep people informed about whats going on at the home. The manager carries out checks each month to satisfy herself and her organisation that the home is running well. And a senior manager from the organisation visits each month to speak with people and spot check some records, again to make sure the home is running properly. The home keeps some personal monies. These are securely stored in named purses. Two peoples financial records were looked at. Invoices and receipts are kept and the actual money agreed with the paper records. These systems help to make sure peoples finances are safeguarded. Staff spoken with confirmed that they attended regular compulsory updates so that they could provide safe, consistent support to people. The manager though does not keep a training record to show when these are due to take place, but organises key training sessions at different times of the year relying on her learned knowledge from working at the home for a number of years. This information needs to be written down, both to demonstrate that training is being provided in a timely way, and so that if she were absent, other senior staff could make sure that staff still attended the training. A sample of health and safety certificates was looked at. The gas certificate, bath hoist and small electrical item checks were all in date, although not easily located. Although hot water temperature checks are carried out, only a small number of taps are sampled each month. The manager needs to assess whether that level of sampling is Care Homes for Older People Page 27 of 33 Evidence: sufficient to satisfy her that people throughout the home are not being put at risk of scalding, by water that may be too hot. Fire safety checks are routinely carried out and staff have attended fire safety training earlier this year. The small kitchen in Orchard House was looked at, followed by the main kitchen in Lake House where all the food for both homes is prepared. There were some fresh fruit and vegetables seen in the main kitchen, but there was a variety of cooked food in both the fridge and pantry, which was not labelled to say when it was prepared. These foods must be clearly labelled so that any staff that use the kitchen will know when the food was prepared and also older food can be promptly discarded. This will minimise the risk of people from coming to harm. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 There must be a robust system of checking that the actual number of tablets is the same as the expected number. This should include counting the number of as required drugs and carrying forward the running totals, from one month’s medication record sheet to the next. This would help to show that people are receiving their drugs according to their prescription. 30/11/2008 2 18 13 The registered person must make sure all staff know their immediate responsibilities, should they hear about something that may constitute abusive behaviour. Good staff knowledge and awareness helps to protect people from harm. 31/12/2008 Care Homes for Older People Page 30 of 33 3 38 13 All prepared foods must be accurately labelled to show when they were prepared. This will help to indicate when foods should be discarded, in order to protect people from harm. 30/11/2008 4 38 13 The registered person must be satisfied that hot water temperature monitoring is carried out at sufficiently frequent time intervals that people are not being put at risk from scalding. This will contribute to keeping people safe. 30/11/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Medication records, which highlight prescriptions that are no longer required and no longer kept at the home could be reviewed with the doctor to see if they could be removed from the chart. This is so that these charts provide an accurate record of what drugs the person is currently receiving. The registered person could monitor hot food delivery to the home, to make sure this isnt being prepared too early meaning it has to be kept warm for a long time before it is served. The registered person should ensure good recruitment records are kept so that a robust process can be demonstrated. Good records should also be kept to show that an individual working at the home before their full police check is back is being properly supervised by a named senior person. This would show that peoples safety is being protected. A written record of when people are due compulsory training, and whether they have attended or not, should be kept, to show this training is being provided in a timely way. This could also demonstrate attendance dates of other Page 31 of 33 2 15 3 29 4 30 Care Homes for Older People training events and would help with future planning. 5 33 There should be continued effort to get the views and comments of people who use the service so that they can influence how the home runs. This information needs to be collated and displayed and people need to be notified what changes are to be made as a result of their comments. Care Homes for Older People Page 32 of 33 Helpline: 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 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - 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!