CARE HOMES FOR OLDER PEOPLE
Cherry Orchard Cherry Avenue Clevedon North Somerset BS21 6HT Lead Inspector
Nicola Hill Unannounced 29 July 2005 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 D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Cherry Orchard Address Cherry Avenue Clevedon North Somerset BS21 6HT 01275 875418 01275 349173 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) Shaw Healthcare (North Somerset) Ltd. Ms Sara Jane House Care Home 36 Category(ies) of 1. Old age people both male and female. registration, with number of places Cherry Orchard D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. May accommodate up to 36 persons aged 65 and over requiring personal care only. Date of last inspection 12 January 2005 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 D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector undertook the unannounced inspection of Cherry Orchard with the manager Sara House. Talking with the residents at Cherry Orchard and consultation with staff provided evidence for this report. The inspector also reviewed care files for residents and administrative records relating to the implementation of health and safety at Cherry Orchard. At the time of the inspection there were four vacancies at the home. The inspector spoke with several residents, all of who were very complimentary about the lifestyle offered to them. The residents also discussed the activities they were able to follow in the home and access in the community. What the service does well: What has improved since the last inspection?
All the requirements from the last inspection have been met. The main lounge area has had new furniture and soft furnishings.
Cherry Orchard D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 Page 6 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 D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Cherry Orchard D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 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 standard(s) 1,2,3,5 There is clear information available about the service for potential service users and verifiable admission proceedures for potential service users. EVIDENCE: The statement of purpose has not been reviewed since the last visit to the home. There have been four recent admissions to the home. Pre-admission assessments were available for all the new residents to the home. The home has admitted a married couple, with very different levels of dependency. The main caring role was carried out by the wife, who apart from being tired has no care needs. Her husband is very dependent for personal care and requires oxygen therapy. In order to support her husband, this lady has come into Cherry Orchard, but has lost her role as carer and is finding that there is very little for her to do. The four-week assessment period was discussed and she was made aware that at any time she might change her mind about living at Cherry Orchard. Cherry Orchard D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 Page 9 The inspector and manager discussed the four most recent placements and their appropriateness in relation to the level of need. The manager was able to demonstrate how the four-week assessment period was used to carry out an in-depth assessment of the individual. She had arranged for a review of one new resident who has already been identified as wrongly placed; and is aware of the difficulties of the couple. Cherry Orchard D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 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 standard(s) 7,8 The staff have a very good understanding of the residents’ support needs, this is evident from the positive relationships that have been formed between the staff and residents. EVIDENCE: All of the residents at Cherry Orchard have a care file and progress is being made to transfer all residents to the new care plan formats. The case tracking through the case files indicated that the health, personal and social care needs was fully identified and the home use various assessment tools, such as Waterlow. Not all residents will need all the specific assessments to be completed. Often these are used to cover a specific period of ill health for the residents and the inspector advised the manager that once this period is over and the resident has recovered, the assessment should be removed from the care file and archived. The care files contained evidence of health needs being reviewed and visits to hospitals, GPs, etc recorded with outcomes. The daily records at the home have improved since the last visit and are completed in a non-judgmental, factual manner. They supply a good source of information and insight into the daily lives of the resident. The home also has a monthly review of all residents care.
Cherry Orchard D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 Page 11 The community nurses support the home with residents who have health care needs requiring nursing intervention. Cherry Orchard D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 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 standard(s) 12,13 The activities for residents currently are the responsibility of the home support workers; they are variable and supplemented by external entertainers. EVIDENCE: As part of the care planning process the recreational and social preferences for the residents at the home are identified. The inspector spoke with several residents who confirmed that various activities were available. During the visit the inspector was able to observe residents going out to centres or with relatives, some were watching television and others were listening to music. Some residents prefer to stay in their own rooms and use them as a bed sitting room. One newly admitted resident felt that there were insufficient social activities at the home; the manager has identified this as an area for development. Cherry Orchard D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 Page 13 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) 16,18 Complaints and concerns relating to the protection of vulnerable adults are acted upon appropriately. EVIDENCE: The organisation has a rigorous complaints procedure; no formal complaints have been received since the last inspection. The management team deals with minor issues that arise informally. All staff at home have undertaken training to enable them to recognise abusive practice and the action taken to report any concerns. There have been no adult protection issues at the home. Cherry Orchard D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 Page 14 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) 19,26 The home was clean and free from any offensive odours. EVIDENCE: A brief tour of the building did not indicate any areas where there were any health and safety risks to either the residents or staff team. The main lounge has new furniture and soft furnishings, which enhance the cosy, homely atmosphere. The handyman has redecorated several of the bedrooms that were in need of improvement. There are ancillary staff at home that maintain its cleanliness. Cherry Orchard D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 Page 15 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 Residents benefit from a settled and familiar staff team who are experienced in meeting the resident’s identified needs. EVIDENCE: The rota indicated that staffing levels at the home are met. Training for staff is available and there is an expectation that staff will attend statutory training updates as required. All staff have attended training days over the recent months and the home has more than 50 of staff with NVQ 2 in care. The manager has a training plan for the year and staff can identify during the supervision specific training to improve their job role. (i.e. dementia care). There are currently 134 home support worker hours vacant at the home. Some of these hours are filled on a casual basis by staff doing overtime or bank staff in order to provide a familiar team to the residents. Use of agency staff is minimal. All of the residents have an allocated key worker. Cherry Orchard D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 Page 16 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) 32,38 The manager has successfully provided leadership for the staff at the home and has also provided a safe environment for the residents, staff and visitors. EVIDENCE: The manager has achieved NVQ 4 in care. She will be starting the Certificate in Management Studies in September 2005. The staff team as a whole works well together and is able to raise issues in the staff meetings. One member of staff stated to the inspector that she enjoyed her work and the support of the staff team. This made coming to work a pleasure. The Regulation 26 records indicate that the responsible person has visited the home and there was documentary evidence to support this.
Cherry Orchard D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 Page 17 The inspector reviewed the maintenance records for the passenger lift; fire alarm system; hoists and portable electrical appliances, all of which were upto-date. An environmental health officer visited the home in December 2004. The home underwent an external quality assurance audit in May 2005; the manager has not yet received the report. Cherry Orchard D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 Page 18 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 3 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x x x 3 Cherry Orchard D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 Page 19 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 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 D53_D02 S08139 Cherry Orchard V231259 290705 Stage4.doc Version 1.30 Page 20 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier, Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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