Inspection on 11/03/10 for Orchard House

This is the latest available inspection report for this service, carried out on 11th March 2010.

CQC found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orchard House 17/09/09

Orchard House 09/06/08

Orchard House 16/01/07

Orchard House 05/02/06

Orchard House 22/06/05

Orchard House 06/10/04

Orchard House 01/06/04

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Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: Orchard House Orchard House Kinnersley Severn Stoke Worcestershire WR8 9JR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Andrew Spearing-Brown     Date: 1 1 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Orchard House Orchard House Kinnersley Severn Stoke Worcestershire WR8 9JR 01905371445 01905371017 lrwilliams.orchard@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Anthony Gordon Williams,Mrs Susan Harris Name of registered manager (if applicable) Mrs Lavinia Rachel Williams Type of registration: Number of places registered: care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Age: Physical disability (PD) age 55 and above. The maximum number of service users who can be accommodated is: 39 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 39, Old age, not falling within any other category (OP) 39, Physical disability (PD) 39 Date of last inspection 0 6 1 1 2 0 0 9 39 0 39 Over 65 0 39 0 Care Homes for Older People Page 4 of 31 Brief description of the care home Orchard House is registered to provide residential care for up to 39 older people who may have a physical disability or a dementia type illness. The home is an adapted country house with a purpose built extension situated in a rural setting. The home is about six miles from Worcester city. There is a local pub but no other amenities within walking distance. There is a regular local bus service. The home has ample car parking both at the front and side of the building. Accommodation is on two floors. People are able to access the first floor by means of a passenger lift, a stair lift or by using the stair cases. Handrails are fitted to assist mobility. On the first floor there are 16 single bedrooms, 9 of which have en-suite facilities, and 6 shared rooms, 4 of which have an en-suite. On the ground floor there are 7 single bedrooms, all of which have en suite facilities, and 2 shared rooms. There are 3 assisted bathrooms and 7 separate toilets throughout the home. People using the service have access to two communal lounges and a separate dining area. A new conservatory is in place at the back of the home which provides additional seating space looking over the garden. The garden is accessible and is well maintained. We did not seek information regarding the fees charged as part of this key inspection. The reader should therefore contact the service directly for up to date details. Care Homes for Older People Page 5 of 31 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: one star adequate 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: The last key inspection at Orchard House was undertaken during September 2009. During this visit we found a number of concerns which were reported upon within our previous key report. We issued an immediate requirement in relation to bed rails. We carried out a random visit to the service during November 2009 and access that the home had complied with the immediate concern. This key inspection involved two inspectors and was carried out over the period of one day. As part of this inspection, in addition to the visit to the home, we also took into account other information we had received. Prior to our visit we requested an Annual Quality Assurance Assessment (AQAA) from the registered persons. This is a document within which providers of care services are able to demonstrate to us where they believe they are providing a good service and where they believe they could improve in Care Homes for Older People Page 6 of 31 the future. The AQAA also provides us with certain data which we need to know. The AQAA which was completed by the registered manager and her deputy was returned to us as required. Prior to the inspection we sent to the home some surveys for residents to complete. We received five out of the ten surveys sent back before we visited the service. Three of these were completed with the assistance of the manager while the remaining two were completed by relatives. During our time at the home we looked at communal areas as well as some bedrooms. We read the care plans and other records regarding some of the residents. We also looked at medication records and staffing records. We spoke to a number of people including one of the registered providers, the registered manager, the deputy manager, the lead carer, other carers, a visiting professional, visitors and some people living at the home. We observed care practices throughout our time at the service. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 31 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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. The home provides information to help people decide if they wish to move to Orchard House. People can be confident that their needs will be assessed before they move in, so that staff know the care that needs to be provided. Evidence: At the time of our last key inspection, during September 2009, we wrote within our report that information was, at that time, available for people who were considering moving into Orchard House. This information was within a document entitled Service Users Guide. We stated that the guide clearly set out what people can expect from the service and what it is like to live in the home. We did not discuss this document as part of this visit. However we have no reason to believe it to be any different. At the time of this inspection, the home was accommodating 28 residents. Therefore the home had 11 vacancies. As no admissions have taken place since our last inspection it was not possible for us to assess the practice within the home regarding Care Homes for Older People Page 11 of 31 Evidence: assessments prior to a new resident moving into the home. We have therefore repeated the judgment from our last inspection as it remains to be our most up to date and accurate finding of the service in relation to the National Minimum Standards within this section. Care Homes for Older People Page 12 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have an individual care plan which is reviewed monthly. Residents can not however, be fully confident that their plan will give staff clear guidance about their current care and health care needs and how they should support people to keep them safe. Medication is well managed to ensure that people receive prescribed medicines. Evidence: Each person residing at Orchard House has a care plan. A care plan is a document designed to give staff guidance in order to carry out the care required in a consistent way, meeting identified needs. We previously reported that they are clearly laid out and reviewed on a monthly basis. We saw no indication that people living in the home or their relatives are involved in the reviewing process. The residents charter on display within the entrance hall stated, with other things, that people are able to have input into their care plan. We previously stated that this would make care plans more person centred. The Alzheimers Society define person centred care as taking into account each individuals unique qualities, abilities, interests, preferences and needs. Within the care plans we saw some good instructions for staff such. We read about Care Homes for Older People Page 13 of 31 Evidence: one person where staff were told to as approach in a gentle manner with open posture and with a comforting hand on her arm. and may require a supportive hand whilst she stands. When we spoke to carers on duty at the time of our inspection. They seemed to have a good awareness of peoples individual care needs. Care plans are reviewed monthly and a revised version is printed out. The plan highlights which sections, if any, have received an amendment. The monthly revisions are not however taking into account the outcomes of previous reviews. For example we saw a care plan which stated ** has had one of her tablets changed to medicine this month. This is to ensure she remains calm and level throughout the day and doesnt become as distressed as she may without it. This would indicate that the change had happened during the previous month. However, this was not the case as earlier care plans contained the same statement. Another statement regarding a wound continually reported Hip still not healed but looking much better. A care plan stated that a resident was not having a bath due to having dressings in place. However other records showed that the person concerned was having a bath. Records regarding bathing showed that people are generally having a bath once a week however the records showed that the gap between these was, at times, greater. We also saw statements such as will be registered with then the name of a dentist and a firm of opticians. Again these were out of date statements as we were told these registrations had taken place. Risk assessments were in place covering some areas. However, these were not always up to date. For example a risk indicator for one resident was blank on the care plan updates since October 2009. We did however see information within care records and elsewhere informing staff on the sling to be used when using the hoist. We saw a risk assessment stating that the individual had no skin problems, however the daily records showed a recent red hip and a small blister on the calf. Reading daily records highlighted some concerns. We saw references to staff noticing skin tears and bruising on people. At times the record stated that the incident was reported to the team leader but no other record was seen. We were told that such events are reported to the community nurse but records held by the home did not show this. We saw no indication of any investigation to establish why the skin tears or bruising had happened. This is important to discover, for example, whether staff require training in moving and handling or if there is a problem environmentally within the home. We saw some instructions given by the community nurse such as ensuring somebodys palms are washed, dried and creamed. However, this instruction did not Care Homes for Older People Page 14 of 31 Evidence: appear in the care plan. We also saw within the daily records an entry regarding an incident which resulted in a injury. Following an altercation between two residents, one person fell and fractured an arm. We asked the home to inform the local authority under safeguarding procedures about this matter. The records showed some other incidents regarding challenging behaviour and earlier confrontations with other residents. We were unable to find any risk assessment regarding challenging behavior. The risk assessment needed to take into account that the person concerned resides within a shared bedroom although we were assured that this situation had not presented any problems. Following our last key inspection, the home was required to carry out risk assessments on the use of bed rails. Within one persons care plan was a sheet showing that a weekly check of this equipment is taking place. The risk assessment itself was not reviewed. It was of concern to read in the daily notes an account that suggested one resident had managed to remove the upper part of the side rail. No injury was recorded following this incident. We mentioned this account to the manager and deputy manager. It was apparent that neither of them knew anything about this incident. We have previously had concerns about how people with mobility care needs are moved. The home now has hoisting equipment available for staff to use. During this inspection, we saw staff using equipment appropriately. Residents were reassured and spoken to in a calm way while staff were using the hoist. We saw, within care plans, reference to pressure relieving equipment. We saw equipment to be in use such as cushions and mattresses. As part of our visit we assessed the storage, administration and management of medication within the home. A medication trolley is held securely, we found it to be locked and chained to a wall. We saw records regarding the safe handover of the key. We viewed a number of MAR (Medication Administration Record) sheets. They appeared to be completed satisfactorily in the majority of cases. We saw some occasions whereby staff had signed that medication was administered. However staff had then signed over the top of the original signature to record medication refused. We audited some medication by checking the number of signatures against the number prescribed. These were found to be correct with the exception of one laxative Care Homes for Older People Page 15 of 31 Evidence: powder. At the time of the previous inspection we found that some boxed items did not have the date of opening recorded upon them. During this inspection we found the majority of items to have this information recorded. We found two boxes without a date on them, both of which had been opened the evening beforehand. Records are maintained regarding the temperature of a fridge used to store items needing such a facility as well as the temperature of the room when stocks are held. At times the room can be too warm. However the vast majority of medication is held within the trolley which is stored elsewhere. The temperature of that area also needs to be monitored. We checked the stock of medication classed as controlled and found the record to be correct. We saw a report following a medication audit undertaken on behalf of the local Primary Care Trust. The homes medication policy was amended following that visit to cover the action to be taken in the event of the medication fridge breaking down. During the inspection we saw staff being kind, courteous and caring towards people. We did not witness any indication that peoples privacy and dignity are compromised. We saw staff spending time with residents and eating with residents while encouraging people to eat their meal. We were informed that the home has moved away from having routines and become more focused on meeting individual care needs. Care Homes for Older People Page 16 of 31 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 able to engage in daily living tasks within the service. People receive a nutritious and varied diet. Meal times are relaxed with staff eating alongside residents. Evidence: Within the AQAA the manager wrote that Residents are encouraged to become involved in meaningful occupation as opposed to just an activity, the benefits are noticeable with decreased challenging behaviors. We have received information from different sources about recent changes within Orchard House. The home has taken on board a range of ideas regarding up to date thinking regarding dementia care as well as recognizing dignity and respect. We saw information on display about dignity including a number of posters with slogans such as what a difference listening makes and Care is about the whole person. The lead carer, who was on duty at the time of our inspection, is one of five Dignity Champions working within the home. She was able to tell us about recent changes within the home. Other champions are the manager, the deputy manager and two carers. We were told that going to Orchard House is now more like visiting people in their own home rather than going to work. We were told by the lead carer that residents are, since adopting the dementia strategy, eating and sleeping better. Care Homes for Older People Page 17 of 31 Evidence: During our visit we saw a small group of residents peeling some vegetables while others were assisting in laying the tables for lunch. We were told that people are at times involved in baking, using a carpet sweeper and folding washing. Within a daily record we saw reference to a resident enjoying sing a longs and a member of staff reading a book with her. We were also told within the AQAA that Staff are encouraged to dine with the residents and make meal times a more sociable and enjoyable event. This is proving successful as some residents are mirroring staff at meal times. We saw a notice on the front door alerting visitors that staff spend time with residents over lunch time. During the inspection we saw staff sat at the dining tables having a meal as well as assisting or encouraging residents to eat. The mid day meal on the day of our visit was steak and mushroom pie, cabbage, carrots, mashed potato and onion gravy or tuna pasta bake and garlic bread. This was followed by gooseberry sponge. From our observation people seemed to enjoy their meal. One visitor told us that the food is good. Within an update sent to us from the deputy manager before our inspection, we were told about Food snacking bowls around the home for residents to eat as and when they wish whilst going about their day. We saw some snack bowls containing sausage rolls, carrot sticks and cucumber. However we did not seen anybody using them on this occasion. Care Homes for Older People Page 18 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that concerns will be listened to and responded to. Staff are aware of their responsibility to protect people from the risk of harm or abuse. Evidence: A complaints procedure was on display in the dining room. The procedure informs people of their right to contact us at any stage if they have any concerns or complaints about the service offered. On the AQAA the service informed us that they have not received any complaints over the last 12 months. During our visit it was confirmed that the home has no recorded complaints. One relative told us that he would speak to the staff if he had any concerns about the service. During this inspection, staff were able to describe to us the actions they would take if they became aware of actual or potential abuse taking place within the home. The staff training matrix displayed within the office did not show any recent training undertaken by staff in relation to safeguarding. However we are aware that staff have received training in the Deprivation of Liberty Safeguards and on dignity in care. We read some information within care notes following an altercation between two residents. We asked the registered manager to refer this matter to the local authority Care Homes for Older People Page 19 of 31 Evidence: under their safeguarding procedures. Since the last key inspection when the service was rated zero star there has been a multi agency approach involving the service provider to look at how improvements could be made and maintained. The service fully cooperated during this process and provided information regarding the improvements it was making to ensure people are safe. Care Homes for Older People Page 20 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The managers and staff have worked hard over recent months to improve the environment provided for people using the service. The home is clean and tidy. Evidence: Since our last inspection we have received information from the service about improvements regarding the environment. This inspection gave us the opportunity to see these improvements. Orchard House is a country house which has been adapted and extended to provide residential accommodation for older people with a dementia type illness. The home has two lounges which are connected and a large dining room. Since our last inspection a conservatory has been completed. This area is a large bright room with comfortable sofas where people can sit with their visitors. The seating arrangements within the lounges are now more conducive to promoting interaction between people. Within the AQAA the registered manager told us that Tactile touch boards are in various areas around the home, rummage boxes are present in lounge areas that residents appear to find beneficial. We saw these boards and boxes during our inspection. We previously commented upon the fact that the service had a door with a key pad Care Homes for Older People Page 21 of 31 Evidence: fitted. This key pad was recently removed. This change, which needs to be suitably risk managed, is to enable people easy access to all parts of the home and is in line with the new dementia strategy in place within Orchard House. The home has a passenger lift to afford easy access to all areas of the home. A stairlift is fitted to one of the staircases. The seat of this piece of equipment was not folded away, therefore reducing the space available to go up and down the stairs. The service has recently had the corridors painted. These areas are all a similar colour and therefore may not be a visual aid to people with a dementia illness to know their whereabouts. Signage within the home has improved including identifying areas such as the dining room, toilets and bathrooms and naming corridors. We viewed a small number of bedrooms and found them to be clean and tidy, although some had a malodour. One bedroom contains new furniture and bedding. We were told that this is the standard of accommodation the home wants to provide throughout Orchard House. The furniture and carpets in some parts of the home were tired looking or worn. People had brought in items of their own such as photographs and ornaments to give their room a more homely feel. Bedroom doors had a picture on them of something important to the individual residing within that room. Some doors had the label with the persons name written on it removed, we were told that some residents had done this. Chains are fitted to windows to prevent them from opening too wide and therefore reducing the risk of people either accidentally or deliberately falling. The suitability of these chains needs to be kept under review. Some pipework in a corner of the lounge was very hot to the touch. One of the registered providers assured us that he would box the pipes in to prevent accidental scalding. We observed some other potential health and safety issues during our look around the home. The door to a store room housing a hot water tank was open and a flex to a heater in the conservatory presented a trip hazard. Bathrooms were clean and tidy. One bathroom felt cool when we entered it. We were told that it was infrequently used. However the main bathroom on the ground floor was equally cool. Within this bathroom were two thermometers. One read 15 degrees C while the other read 16 degrees C. These rooms did not provide a welcoming feel for people to prepare for a bath. We were told of proposals to provide a greenhouse for people to grow items as well as a proposal to have raised flower beds and a sensory garden. Care Homes for Older People Page 22 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive appropriate care and support from staff. Training is provided to ensure that staff have the skills and knowledge they need to carry out their job however some people have not undertaken all areas that may be seen as required in order to fully meet peoples care needs. Evidence: Within our last key inspection report we wrote that staff were generally kind and caring in their approach to people living at the home. During this inspection we saw a caring staff team to be engaging with residents. We saw good interactions taking place whereby staff were talking, reassuring or encouraging residents as appropriate. As reported elsewhere within this report, the way staff work has changed since our last key inspection. Staff no longer work to rigid routines but work alongside residents actively encouraging and supporting people while also meeting their care needs. Staff were seen to be spending time sat with residents. There were five carers on duty when we were in the home. The rota showed that there are 5 carers throughout the day. The nights are covered by 3 members of staff. The home has 1 lead carer as well two senior carers. The manager and deputy manager work Monday to Friday. In addition are other staff such as catering, maintenance and domestic support. Care Homes for Older People Page 23 of 31 Evidence: At the time of our last inspection we looked at how the home operates recruitment procedures and found a number of areas of concern. During that inspection we found that the home had not obtained a PoVA (Protection of Vulnerable Adult) first check and a CRB (Criminal Records Bureau) disclosure on a new member of staff. We also had concerns about the obtaining of references. These are checks to ensure that people are suitable to be working with vulnerable people. We were told that the service has only appointed one new employee since our last inspection. We noted that an Independent Safeguarding Authority (ISA) first check was in place. The CRB had not, at that time, arrived with the service. A reference held on file regarding the applicants former employment was not from the manager or employer. Following our inspection this matter was discussed with the deputy manager who agreed to following up on our concern. We have previously found the homes training records to be out of date. We have received information since the last inspection regarding the training put into place. A training matrix within the office showed that some staff have not undertaken recent training in moving and handling however we were earlier told of a forthcoming training date which was due to take place shortly after this inspection. The majority of staff have undertaken training regarding the Mental Capacity Act and Deprivation of Liberty safeguards. We are aware that the majority of staff have undertaken dignity in care training provided by the local authority. Looking at the training matrix it was evident that gaps in training remain such as in infection control, challenging behavior and safeguarding however improvements have taken place. In addition the matrix shows that training has not recently taken place in relation to risk assessment. Earlier within this report we have highlighted a shortfall and a training need in relation to risk assessing. Within the AQAA we were told that 16 members of staff are undertaking an NVQ (National Vocational Qualification). Currently 5 members of staff have achieved this level of training, therefore the National Minimum Standard is not yet achieved. Care Homes for Older People Page 24 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in the management of the service have taken place. However people are not always safeguarded to the extent that they should be because further improvement is necessary. Evidence: Orchard House is managed by Lavinia Williams and her deputy. They have worked together for many years and have considerable experience of working with older people. The managers are supported by a team of care staff including two supervisors and a lead carer. At the time of our last inspection we identified some concerns regarding the effective management of the home. We expressed concerns regarding the management of health and safety and staff recruitment. We also identified areas of concern regarding the services ability to meet the needs of people with a dementia type illness. The service took notice of our concerns and has since then actively engaged with Care Homes for Older People Page 25 of 31 Evidence: ourselves and the local authority in order to address these areas. Throughout this report it is evident that people have worked hard to try and improve the service offered and therefore enrich the lives of people living at Orchard House. Since our last inspection both the manager and her deputy have enrolled on a diploma in dementia care. We are aware that the manager and her deputy have attended training within the home covering areas such as the Mental Capacity Act and the Deprivation of Liberty safeguards. Prior to this inspection we asked for an Annual Quality Assurance Assessment (AQAA) to be completed and returned to us. The AQAA is a document within which providers are able to provide evidence of how they are meeting their regulatory obligations. The document was filled in and returned to us and contained some useful information which assisted us in our preparation for this inspection. From the AQAA and during our inspection we saw that the management team are begining to develop a better insight into the quality of the service and ways of improving it. Within our recent inspection reports we have recommended that the home should introduce a quality assurance scheme as a priority. Having such a scheme in place provides the service with a means of monitoring the service provided and assess the outcomes for people using the service. It was pleasing to see that the service has commenced work on this area looking at compliance with the current National Minimum Standards. We saw records of some recent medication audits which have taken place. The home has had a staff meeting, however the minutes showed that only the staff on duty attended this meeting. We were told that discussions involving other staff have taken place although these were not recorded. Other than a brief look at the medication procedure we did not look at any other policies and procedures during this inspection. Within the AQAA we were told that a range of procedures were last reviewed during the early part of 2009. We were told that the home does not look after any money on behalf of people living in the home therefore leaving this responsibility with peoples relatives or representatives. We found a yellow metal ring within the file of one resident. We were told that it was there ready to be handed over to a family member. It was however a concern as this personal item could have easily become detached or mis placed. Furthermore the item was not secure as it was accessible to every member of staff. Within the AQAA the service informed us of the dates when servicing had taken place to pieces of equipment such as hoists, the lift and fire equipment. We looked at the homes fire records and found these, including emergency lighting and fire drills, to be Care Homes for Older People Page 26 of 31 Evidence: up to date. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 30 12 (1) You must ensure that 23/11/2009 staff have the skills and knowledge necessary to provide care which meets the needs of the people living at the home. This is so that people can be confident that they will be cared for by staff who are trained and competent to do their jobs. 2 38 13 You must ensure that an 23/11/2009 effective system is in place to ensure that all parts of the home are safe for people who live there, within a risk management framework. This is so that people can be confident that they are not at risk of harm or injury. Care Homes for Older People Page 28 of 31 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 15 Regulation 15 (2). All people living in the care home must have an up to date plan of care so that it accurately relects each individuals health and welfare needs and provides clear guidance for staff to follow. This is so staff have the relevant details available to them in order to meet identified care needs. 23/04/2010 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 The home should review their own medication policies and procedures to ensure that they are in line with current guidance and that staff are adhering to these documents. References should be obtained from a potential employees former manager or employer prior to the applicant commencing duties at the home. Page 29 of 31 2 29 Care Homes for Older People 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 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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