CARE HOMES FOR OLDER PEOPLE
Cherry Orchard Windsor Road Andover Hampshire SP10 3HX Lead Inspector
Annie Billings Unannounced 25.08.05 11:15 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 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 H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Cherry Orchard Address Windsor Road Andover Hampshire SP10 3HX 01264 324831 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hampshire County Coucil CRH 43 Category(ies) of OP Old age registration, with number of places Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 04.04.05 Brief Description of the Service: Cherry Orchard is a local authority managed care home, providing care for up to 43 older persons, all accommodated within single rooms. Cherry Orchard was purpose-built in the mid-1970s, and is organised into five small selfcontained units, each with their own kitchenette, dining room and sitting room. Accommodation is arranged on two floors with a passenger lift providing easy access to the first floor. Six communal bathrooms are available to service users, two of which benefit from assisted baths. Other aids and adaptions have been fitted throughout the home, to assist residents to maintain their independence. Accommodation is arranged around a central paved courtyard, providing additional seating areas around raised flower beds. The home is located in a quiet residential area on the outskirts of Andover, and provides easy access to the town centre, local shops and other facilities. Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 4.5 hours and was the second of two annual inspections for the year 2005/2006. Many of the standards were assessed at the last inspection, and residents and relatives comments received confirm that these standards are being maintained. The home is currently without a registered manager, although an appointment has been made, and the manager is currently undergoing the registration process. A partial tour of the premises took place, and care and other records were inspected. The inspector also had the opportunity to talk to eleven service users, one relative and six members of staff. Written feedback was received on comment cards from two service users, sixteen relatives and one health care professional. Additional information was supplied within a pre-inspection questionnaire. What the service does well: What has improved since the last inspection?
The recent closure of the day centre, incorporated into the home, has meant that the keypad system can now be utilised at night to improve security. Consideration for the future use of these facilities are being considered, in Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 Page 6 consultation with residents. This additional communal area may take the form of an activities room or additional lounge / dining area. Communication and consultation with residents continues to improve, with the implementation of a newsletter, which is circulated to all residents to inform, raise awareness of any changes within the home and to act as a formal welcome to new residents. A recent recruitment campaign has been successful with new appointments being made, and an increase in staffing levels. This responds to five comment cards indicating that relatives consider staffing levels should be raised. Only one care assistant vacancy remains to be filled, and interviews for a night coordinator are expected to fill the only remaining vacancy. New staff uniforms have been introduced, and looked very smart and professional. Since the last inspection two new beds and five new trolleys have been purchased. Cherry Orchard is also to trial a newly developed assessment and care planning system, which, if successful, will be introduced across all local authority homes in the county. A new care planning training course for staff is to be introduced next February to coincide with this new system. What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 Page 9 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 standard(s) 2, 3 Contracts are issued to all residents, although some do not indicate the room to be occupied. The admission process ensures that needs are assessed prior to moving into the home, but action necessary to minimise risk needs to be more detailed. EVIDENCE: Service users are issued with contracts that state the terms and conditions of admission, although two of three sampled did not state the room to be occupied. The manager gave assurances this would be completed. Since the last inspection some progress has been made in developing the assessment process. Three files sampled had fully completed pre-admission assessments and where a risk has been identified individual risk assessments had been undertaken. In a number of cases the control measures to minimise the risk was not explicit, for example, “safe working practice”. One resident was identified at risk of falls, and a moving and handling assessment had been undertaken. Information within the file suggests the resident has a tendency to lean over when walking, and needs to be encouraged to walk upright, to avoid the risk of falling. This was not mentioned in the control measures or
Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 Page 10 the care plan, but states “safe working practice”. The manager is aware of the need to continue to develop this process, although it is understood that a new assessment process is to be introduced in the near future. This will be assessed at the next inspection. Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 Page 11 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 standard(s) 7, 9 Despite some progress being made in developing the care planning process, inconsistencies of other recording systems do not demonstrate that care is delivered consistently or that the care plan is being followed to ensure that all personal, health and social care needs are met. Systems are in place to ensure that medication is well managed. EVIDENCE: Since the last inspection some progress has been made in providing more detail in care plans, to ensure that residents personal care needs are met, although care records inspected indicate that further work is necessary. Some instances were identified where care is not being delivered consistently, because of a lack of detail. For example one care plan directs staff to “prompt to empty catheter bag”, although does not detail who is responsible for changing the bag. Care records detail “leg bag near to bursting”, suggesting that the care plan is not being followed. Another entry in care records identifies the resident as having “swollen legs – please observe”. There was no indication this was being done, as no further entries were made. These issues were discussed with the manager, who advised that a new system has been developed, which is to be trialled in the home over the next few months. A care planning training course has also been developed for staff, which is to be
Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 Page 12 introduced in February 2006. The manager gave assurances that the process will continue to be developed, and it was agreed that this standard be reassessed at the next inspection. The requirement has therefore not been repeated. Comments received from residents and relatives indicate their overall satisfaction with the care provided. Comments included, “(my relative) has received great kindness, consideration and utmost care from all members of staff. I am most impressed with the running of the home”, and “the care has been excellent and thanks to all the staff for their dedication”, and one visiting relative commented, “the care is exceptional, I can’t fault it. Staff have infinite patience with residents, and are very kind and caring”. All of nineteen comment cards received indicate an overall satisfaction with the care provided. One comment received from a district nurse states, “staff are always polite, welcoming and informative, and respond rapidly if problems arise with residents”. Systems are in place to ensure that medication is well managed, although a new monitored dosage system is to be introduced in the next few weeks, once staff are all familiar with the blister pack system. The pharmacist audited the homes stocks and records on the 25th July, and no issues were identified. Medication administration records were examined and a couple of omissions identified. Investigations subsequently identified these as refused medication, and the manager has given assurances that this will be recorded in the future. Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were assessed. EVIDENCE: Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 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 standard(s) 18 Policies and procedures are in place to protect residents from abuse. EVIDENCE: All staff members spoken with had an excellent understanding of abuse issues and the reporting procedures in the event of an allegation of abuse. And two were able to confirm they had received training. Discussions with management confirmed that further training courses were to be booked, to ensure that all staff receive formal training. No personal allowances for residents are held by the home, and all financial matters are dealt with the support of families or advocates. Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 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 standard(s) 19, 21 The home décor is much improved following completion of the redecoration programme, although further refurbishment and replacement is necessary to ensure the home remains comfortable for residents. EVIDENCE: A partial tour of the premises was undertaken, including a number of bedrooms and bathrooms and all communal areas. The central heating boiler and system was being changed from oil to gas. This was seen to be well managed, with very little disruption to residents’ routines, and many residents spoken to were unaware this was happening. The recent closure of the day centre incorporated into the home, has meant that the keypad system can now be utilised at night to improve security. Proposals for the future use of these facilities are being considered, in consultation with residents. These additional communal areas may take the form of an activities room or additional lounge / dining area, but will require refurbishment before any plans are implemented.
Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 Page 16 Several areas of carpeting and curtains are looking tired and worn, and do not do justice to the recent improvements in decor throughout the building. The unit manager said that plans are being made to replace these in the near future. There are sufficient bathrooms and WC’s to meet the needs of residents, although bathrooms are in need of refurbishment. The manager said that two were programmed for work to commence in this financial year, therefore no requirements have been made. New door closures are being fitted to communal WC’s in the next ten days, to ensure the privacy of residents. Since the last inspection two new beds have been purchased and the telephone room on the ground floor has been decorated, and now appears more welcoming, although the cupboard door handle remains broken. The manager gave assurances this would be fixed, and a tin of paint removed. A new telephone trolley is also being proposed, to provide better access to those less mobile, and additional laundry trolleys have been provided. The manager was also advised that attention is needed to a broken window latch in room 107 kitchen. Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 Residents are supported and protected by a competent and well-trained workforce. EVIDENCE: From observation and assessment of the duty rota, appropriate numbers of staff were available to support the residents’ needs, although comments received from five relatives suggest there are not always enough staff on duty. Discussion with staff confirmed that staffing levels have improved, that they never feel under pressure, are well supported by management, consider the training programme is extensive and work well together as a staff team. The relaxed atmosphere in the home would confirm this. One relative commented, “ .. likes the relaxed atmosphere, and is never made to feel a nuisance”. Comments received from residents and other relatives included, “Staff are always pleasant and helpful”, “they’re marvellous”, “staff are very kind and caring”, “there is always someone about”, and “they do everything I want done”. One relative who visits daily said, “staff have infinite patience with residents”. A recent recruitment campaign has been successful with new appointments being made, and an increase in staffing levels. Only one care assistant vacancy remains to be filled, and interviews for a night co-ordinator are expected to fill the only other remaining vacancy. Three new staff files examined were well organised and confirmed that all pre-employment checks had been carried out prior to employment, and induction training commenced immediately.
Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 Page 18 New staff uniforms have been introduced, and looked very smart and professional. Training records examined confirm that mandatory training for all staff is up to date, although duty managers advised that booking courses in some subjects was proving difficult due to communication difficulties. Additional training courses are also being undertaken in safe handling of medication, diversity and two staff training as activities organisers. Adult protection training is still to be booked, although the manager has an awareness of this. Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 38 Residents’ finances, health, safety and welfare are protected by the practices and procedures in the home. EVIDENCE: Communication and consultation with residents continues to improve, with the implementation of a newsletter, which is circulated to all residents to inform, raise awareness of any changes within the home and to act as a formal welcome to new residents. No personal allowances for residents are held by the home, and all financial matters are dealt with the support of families or advocates. Maintenance certificates, other records examined and care practices observed confirm that residents health, safety and welfare are protected by the policies and procedures in the home. Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 2 x 2 x x x x x STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x x x 3 x x 3 Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 Page 21 NO Are there any outstanding requirements from the last inspection? 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 Regulation Requirement Timescale for action 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 Good Practice Recommendations Cherry Orchard H54 S37319 Cherry Orchard V241569 250805.doc Version 1.40 Page 22 Commission for Social Care Inspection 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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