CARE HOMES FOR OLDER PEOPLE
Cherry Orchard Windsor Road Andover Hampshire SP10 3HX
Lead Inspector Annie Billings Unannounced 4th April 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 Version 1.10 Page 3 SERVICE INFORMATION
Name of service Cherry Orchard Address Windsor Road, Andover, SP10 3HX 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) 01264 324831 Hampshire County Council CRH 43 Category(ies) of DE(E), OP registration, with number of places Cherry Orchard Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 21st September 2004 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. The home also accommodates a day centre for older persons, under the same management. Cherry Orchard Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over seven hours as part of the normal regulation and inspection programme, and to follow up on progress made in meeting previous requirements. The home is currently without a registered manager, although an appointment is due to be made in the next month. A partial tour of the premises took place, and care records were inspected. The inspector also had the opportunity to observe lunch being served, and to participate in arts and crafts activity taking place. Ten service users, one relative and four members of staff were spoken to. What the service does well: What has improved since the last inspection?
All areas of the home have now been decorated and worn furniture has now been replaced with new chairs and commodes in place. Window frames have been made good and redecorated, and fly screens are now fitted to all areas of food storage. One member of staff is currently indexing and re-organising residents’ care files, to allow for easier access to information. Cherry Orchard Version 1.10 Page 6 Security of the premises has been improved by fitting a keypad access system to the main entrance, although this can only be in operation outside of day centre hours. Inclusion and consultation with service users has been improved, to ensure that the home is being run for the benefit of service users. Recent questionnaires have been undertaken to ensure that menus and activities are planned to meet service user preference. A newsletter is also being developed to improve awareness of any changes within the home, including a formal welcome to new residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cherry Orchard Version 1.10 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 Version 1.10 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) 2, 3, 5, and 6 Contracts are issued to all residents, although some have not been fully completed. The system of assessment is not always fully completed to ensure the care needs of residents will be met. Prospective service users and families are able to visit to assess the suitability of the home. EVIDENCE: Service users are issued with contracts that state the terms and conditions of admission, although the three sampled did not state the room to be occupied and only one of three had been signed by the manager. Basic assessments have been undertaken for each new resident, although these are not all fully completed, and do not provide sufficient detail for staff to meet all aspects of health, personal and social care. The lack of detailed assessments does not evidence the promotion of independence, as staff are not informed of the resident’s abilities. Risks identified have not been addressed by individual risk assessments to determine what measures should be put in place to minimise potential risks. Cherry Orchard Version 1.10 Page 9 Discussion with service users and the acting manager confirmed that prospective residents and their relatives are encouraged to visit the home before making a decision to move in. The acting manager confirmed that intermediate care is not offered by this service. Cherry Orchard Version 1.10 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, and 10 The care planning system does not provide staff with sufficient, detailed information, to ensure that all personal, health and social care needs are met. Residents are treated with respect and their right to privacy is promoted. EVIDENCE: Basic care plans are available, but a lack of detail suggests that staff do not receive adequate information to ensure that residents’ health, personal and social care needs are met, and does not support service user’s views that all their care needs are met. Information within care plans state: assist with personal care or needs assistance but gives no direction to staff by detailing the assistance required. The lack of daily care records and inconsistencies of other recording systems does not demonstrate that care is delivered consistently or that the care plan is being followed. One care plan suggests the resident is able to transfer independently. Other information within the file indicates this is not the case, and needs assistance, although specific guidance on manual handling is not available. The acting manager is aware of the need to develop these systems, as there is a potential that health and personal care needs are not being met. It was identified that one service user was being treated for leg ulcers. This was not
Cherry Orchard Version 1.10 Page 11 mentioned within the care plan. Two service users spoken with could not remember if they were involved in the development of their care plans. Evidence was not available within files to confirm that all care plans are reviewed with service users on a monthly basis, to ensure they are current. Appointments with other health professionals are recorded, but are kept in a separate file. Observation of interaction between staff and residents, and discussion with service users confirmed that they are treated with respect and privacy and dignity is upheld. Cherry Orchard Version 1.10 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, 14 and 15 Social activities, social contacts and meals are well managed, and reflect variation and interest for service users. EVIDENCE: Service users were observed undertaking a variety of activities during the day. These included an arts and crafts group, bingo and watching TV. One resident commented that, although blind, appreciated being encouraged to participate in the crafts workshop with the support of staff. The results of a recent questionnaire are currently being collated, to ensure the activities on offer remain appropriate to residents’ preferences. Visitors were observed being welcomed into the home, and several residents advised of trips out with relatives recently. Lunch was observed to be unhurried, with appropriate assistance being offered where appropriate. One lunch served was an alternative to the two choices offered on the displayed menu. All food was hot, colourful and attractively presented. Twelve service users spoken with confirmed their satisfaction with the food. One commented: “Food is excellent”. A resident’s survey has recently been undertaken to ensure that menus are planned around resident’s likes and dislikes. A variety of “theme” days are being planned to offer typical food from various countries represented, to create more variety.
Cherry Orchard Version 1.10 Page 13 Cherry Orchard Version 1.10 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) 16 The home has a satisfactory complaints system, with evidence that some service users are aware of the process to follow. EVIDENCE: Several service users indicated they were aware of the process for complaints, and would be happy to raise any issues with the acting manager. One resident was aware they could complain, but stated they had nothing to complain about. Cherry Orchard Version 1.10 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, 20, 22, 23, 24, 25, 26 The environment continues to improve, and provides a comfortable, attractive place for service users to live. Provision of a separate entrance to the day centre would enhance security of the premises, and be less intrusive to the home. EVIDENCE: Since the last inspection the programme of repair and redecoration has been completed, and all areas viewed are now to a reasonable standard. New chairs and commodes are in place and fly screens have been fitted to all areas of food storage. Service users feel the home is comfortable, and all those who expressed a view confirmed their bedrooms were comfortable and meet their needs. All six rooms sampled had been personalised with the resident’s personal possessions. Door closures on communal WC’s are currently being trialled, to optimise privacy and independence to those with mobility difficulties. The ground floor telephone room looked uninviting. The useful information board has been removed and the light bulb needed replacement. This was dealt with promptly, and the manager advised the information board
Cherry Orchard Version 1.10 Page 16 would be replaced. A portable telephone designated for use by residents is being considered. Alternative venues for the day service are being discussed, as an alternative to providing a separate entrance to meet a previous requirement made at earlier inspections. Cherry Orchard Version 1.10 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) 28 Service users are well supported by a stable and effective staff team. EVIDENCE: A large proportion of the workforce have worked at Cherry Orchard for a number of years, and have formed positive relationships with service users. Service users confirmed they are well supported by kind and friendly staff, and are encouraged to maintain their independence as much as possible. One service user said that: “staff are lovely, and will do or get you anything you want.” Cherry Orchard Version 1.10 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 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) 31, 32, 33 The acting manager has a good understanding of the areas in which the service needs to improve, and intends to develop a plan of action to address these areas. Regular consultation with service users and staff ensures their involvement in the way the service is run. EVIDENCE: The home is currently without a registered manager, although it is understood a manager will be appointed this month. The acting manager has worked at Cherry Orchard for many years, and has a good understanding of their role and responsibilities. Service users and staff confirmed the manager is approachable and open. Regular meetings are held with service users, who have been actively involved in menu and activities planning recently, although the results of questionnaires have yet to be collated. Service users not attending the meetings are given copies of the meeting minutes. A newsletter is also being developed, to ensure that all are fully involved with the running of
Cherry Orchard Version 1.10 Page 19 the home. Staff meetings are held on a quarterly basis. Staff members confirmed they feel well supported by the management team. Cherry Orchard Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 3 x 3 3 3 3 3 STAFFING Standard No Score 27 x 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 3 x x x x x Cherry Orchard Version 1.10 Page 21 YES 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 3 Regulation 14 Requirement The pre-admission assessment process must be further developed to ensure that needs of service users are fully assessed and kept under review. In consultation with service users, care plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet service users health and welfare needs, and keep these under review. A separate entrance must be provided to the day centre. (Previous timescale not reached) Timescale for action 30th June 2005 2. 7 15 31st July 2005 3. 4. 19 23[2]a 31st July 2005 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. 2. Refer to Standard 2 7 Good Practice Recommendations Terms and conditions of admission should state the room to be occupied. Daily care records should be completed to demonstrate that care plans are being followed consistently. Cherry Orchard Version 1.10 Page 22 Commission for Social Care Inspection 4th Floor Overline House Blechyden 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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