Inspection on 24/01/06 for Cherry Orchard

This inspection was carried out on 24th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cherry Orchard 18/12/07

Cherry Orchard 29/01/07

Cherry Orchard 29/07/05

Cherry Orchard 12/01/05

Cherry Orchard 02/08/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cherry Orchard Cherry Avenue Clevedon North Somerset BS21 6HT Lead Inspector Nicola Hill Announced Inspection 24th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cherry Orchard Address Cherry Avenue Clevedon North Somerset BS21 6HT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01275 875418 01275 349173 Shaw Healthcare (North Somerset) Ltd Ms Sara Jane House Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 36 persons aged 65 years and over requiring personal care only. 29th July 2005 Date of last inspection Brief Description of the Service: Cherry Orchard is a care home offering residential, respite and day care to older people in the Clevedon area. It is well sited in the community for local amenities and is also well known by local residents. Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection of Cherry Orchard was undertaken with the manager from the home, Sara House. The inspector and the manager discussed the information provided on the pre-inspection questionnaire, and then spent time looking at varied documentation held at the home to support the health, wellbeing and safety of the residents. The inspector also spent time talking to staff members at the home, and touring the home with the manager in order to be introduced to some of the residents. The majority of the afternoon was spent talking with residents should about their life experiences at the home, and the service provided for them. The inspector also had the opportunity to speak briefly with a couple of visitors to home, both of whom were very complimentary about the support received for the care of their elderly relative, and particularly the reception given to visitors on their arrival at the home. Cherry Orchard continues to provide residential and respite care services on behalf of the local authority that have a block contact with them. The home also offers privately funded beds. What the service does well: What has improved since the last inspection? Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 6 The home is undergoing continual redecoration with purchase of new vanity units and new furniture in the bedrooms. The home has been successful in recruiting new staff to the vacant posts, and therefore has provided a continuation of care to the residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home provides sufficient information to allow for informed choices to be made. EVIDENCE: The service user guide and statement of purpose have not been reviewed since last inspection. All the service users have a written contract with their statement of terms and conditions within the home; this is evidenced on the residents’ files. No service user moves into Cherry Orchard without having a pre-admission assessment and the manager being able to meet identified need successfully. The block purchase beds also need a pre-admission assessment. It is the responsibility of the manager to ensure that no person is admitted to the home for which the identified needs cannot be met; and in making this decision the manager has an overview of the needs of the population of the home. This has Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 9 been an issue with the council who fund the beds. However the manager should be commended for applying the admission criteria to all referrals and making a decision based on her experience and knowledge of the client group. Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The care planning on behalf of residents was insufficient to give a picture of the whole person and the level of support needed. EVIDENCE: The inspector reviewed the care files held on the residents at the home, and had discussed in the detail the needs assessments, and the repetition of information held within these files. It is important that the documentation is user-friendly as it was noted that one of the assessments for service users had been completed incorrectly and had indicated problems where there were none. All the care files reviewed contained care management assessment, contracts, evidence of monthly reviews, pre-admission assessments, and risk assessments for the self-administration of medication, and some have appropriate additional assessments, for example, for manual handling. The files also contain information about the personal preferences and social care needs of the residents. However the formats provided for care files are very complex and several have not been completed fully. Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 11 The daily records were informative and the inspector could track the identification of need, the action taken and the evaluation of the care given through the daily record. However, this could not be linked to the care plans. The manager and inspector discussed care planning, as this has been an ongoing issue at Cherry Orchard. The expectation from the Commission is that there will be significant improvement in the standards of care planning and the level of information identified through care planning when a simpler format will have been introduced. This should be by the end of March 2006 and will be closely monitored. The medication at the home is a unit dosage system provided by Boots. The inspector was able to correlate the medication kept in the unit dosage system with the medication administration sheet. The controlled drugs kept at the home were all appropriately recorded; in respect of oramorph, the home are recording the administration but not recording the volume, therefore the administration record does not allow for an audit of the amount left in stock. The inspector advised either that the record of administration, which is in addition to that of the MAR sheet) be scrapped, or the running total of the amount of oramorph is included on the record. The medication not in the blister packs, for example, paracetamol, which has been prescribed to be taken when required, was found to be incorrect for several clients. The inspector and the manager checked through and tried to correlate the records and the amount of medication actually on the premises. What appeared to be happening is that medication, usually low-dose painkillers, has been given but not recorded on the medication record sheet. The manager is now aware of this and will be reviewing the system for recording with the staff responsible for the administration of medication. The manager and the inspector also discussed the number of medications prescribed for some of the residents at the home. There were several examples of polypharmacy at the home, and the manager stated that the local GP practices had no regular system of reviewing medication. The new admissions to the home had undergone a review of medication when they signed on with the local GPs, however, usually a medication review is prompted my illness, and it may not include all the medication prescribed. The manager was advised to contact the specialist nurse for older people who operates in Clevedon, and to seek advice about regularly reviewing the residents’ medication at Cherry Orchard. With respect to the privacy and the dignity of the residents, the inspector spoke with residents and directly asked about this aspect of daily care. The residents were able to state that they had choice over who supported them with personal care, and felt the staff treated them with respect. The staff team were praised for their sensitivity in dealing with difficult situations, particularly one visitor was aware that her relative was difficult to manage, and felt that the home coped extremely well under difficult circumstances. Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 Residents enjoy the lifestyle offered at Cherry Orchard. EVIDENCE: The lifestyle at the home was assessed from the responses given by the residents who spoke with inspector. Residents stated that there were opportunities to join in weekly activities, such as bingo and the weekly exercise class. However, most of the residents were able to have their own social preferences in that they attended their local social groups, had visitors to the home, or went out shopping for personal items like a newspaper. All the residents have the option to do as they would in their own home, or to use the communal facilities, which are equipped with audiovisual equipment. The residents also took the opportunity to make friends with other residents and form their own social groups. One of the team leaders takes main responsibility for organising activities and she also support residents to continue with activities they followed at home when they are admitted. For example, there is the visiting library, and there are all voluntary groups who visit such as the Red Cross. The noticeboard in the hallway is used by residents, and the activities are advertised for them to attend should they wish to. The resident are consulted on a regular basis through the forum of a meeting, at which they are invited to make suggestions about improvements Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 13 to the services offered at Cherry Orchard. Attendance at activities is recorded on the daily record, and the manager stated that it was important to ensure that all the residents were offered the same opportunity to attend activities; the residents confirmed this. Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 The organisation has an accessible and responsive complaints procedure. EVIDENCE: There have been no complaints made to the home or to the Commission since the last inspection. The staff team at Cherry Orchard receives regular updates in the procedures to follow should there be a complaint or adult protection incident. Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22,23,24,26 The residents are supported by the homes’ ethos to have comfortable and individually furnished bedrooms. EVIDENCE: The environment generally is clean and pleasant, although it does not provide for individual sanitary facilities for the residents. There are several communal areas from residents to use, and very pleasant grounds. The home it has been allocated sufficient money so that the main corridors can be redecorated, and so that new furniture can be purchased. The home have a rolling programme of refurbishment of bedrooms, this usually happens when a resident leaves the home, or when residents make a particular request to have particular furniture and furnishings. The residents are supported to bring in personal items in order to have a private space furnished to their individual taste. Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The good practice shown in the recruitment and training of staff support the continued well-being of the residents. EVIDENCE: The manager provided a sample rota to the inspector and this indicated that there are sufficient staff on duty at all times to meet the level of need at the home. The staff also have a dedicated training board which indicated that a course on positive dementia was available to staff; several staff were identified as being in need of an update for the statutory training. Attending training is part of the staff’s contract, staff in general are keen to develop their skills and this is discussed with them during individual supervision. The inspector looked at the staff records for all new members employees and found that the recruitment procedure followed was robust and that no member staff started without being properly interviewed, having references taken up, and clearance through a CRB check. The supervision records are kept in the individual staff files, and the inspector could see evidence that regular supervision had taken place. Supervision was also discussed with members of staff, and they confirmed that it was a useful forum for them to identify any problems with their current work pattern, and to discuss any training issues. Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 17 The comments from the staff team about the home were very positive, in particular the staff felt that the whole team worked together and that there was a very good atmosphere of the home. This promoted a feeling of flexibility within the staff team and to a certain extent of freedom in the work pattern followed. One member of staff said that there was no bad aspects to working at Cherry Orchard, and that in particular joining the team she received a substantial pay rise. Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34 The home has a clear auditing process, which allows for service improvement. EVIDENCE: There has been no change in the manager of the home since last inspection, and at the moment Sara House is working towards achieving a certificate in management studies (CMS). The inspector and the manager reviewed the results of the quality audit which was carried out by the organisation. The auditor spent time in the home looking at the evidence required to meet the standard set by Shaw for their residential care homes. Some of the quality criteria included in the audit was not always applicable to this client group, and the inspector could also read that within the audit some of the results were contradictory. Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 19 However, the area most identified as poorly performing is the care planning. Although within the audit of care plans some of the quality criteria are not applicable, the comments made by the auditor reinforced the impression the inspector had obtained from the care files concerning the quality of the care planning at the home. In order to improve this, the home have an action business plan, and this specifically identifies care planning as an issue that must be improved. The home have set a target of receiving a new acre plan format by the middle of February 2006, and the implementation to staff by the end of February 2006. There should be a subsequent improvement in the care planning by the end of March 2006; the improvement in care planning will be a requirement from this inspection, and inspector will be reviewing how the home have worked towards meeting this requirement at the end of March. The residents and staff have regular meetings; the next meeting for the staff is in February 2006. Staff meetings also take place with the team leaders who specifically discussed the managerial aspects of the home. The home are active in fund raising and have an amenity fund, the inspector was able to see from the record that there was an appropriate expenditure. There is a cash and bank account for the fund, and the cash is reconciled to the account book; the banked money is only accessible through a Halifax passbook for which two members to staff have to be signatories. For the resident there is a composite bank account which allows residents relatives who wish to send money by cheque to have them banked and cashed. The manager was advised to have a record in addition to bank statements so that the cheque numbers can be recorded and monitored on a regular basis. The cash held at the home was checked for five residents, all of which was found to be in order. There are no outstanding health and safety issues at this home. Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 X X X X Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 14,15 Requirement Care planning must be introduced in a format that is usable by the home to fully identify residents’ needs in order to support their health and well being. Timescale for action 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA34 Good Practice Recommendations All financial documentation is recorded (cheques) and audited on a regular basis. Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cherry Orchard DS0000008139.V268257.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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