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Inspection on 15/11/07 for Cherry Orchard Nursing Home

Also see our care home review for Cherry Orchard Nursing Home for more information

This inspection was carried out on 15th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There is a very relaxed atmosphere in the home and residents receive very good care from a committed staff team. It is evident that the home is operated for the benefit of the residents and the attitude and practice of the staff promotes opportunities for the residents to remain independent as possible and to be able to express choice and their wishes and needs. The majority of the residents require a high level of support in meeting their needs and every effort is made to work closely with other professionals to ensure their needs are met. It was evident that the home is run in the best interests of the residents. Every effort is made to ensure that their views and of significent others are taken into account on any decisions in relation to the running of the home. Residents, relatives and health professionals were very complimentary of Cherry Orchard, "The care provided is very good", "I have no concerns what so ever", "Violet (manager) and the staff are brilliant", "They are lovely girls" and "I wouldn`t want my mum to live anywhere else"

What has improved since the last inspection?

Cherry Orchard was last inspected in January 2007. There were six Requirements set at this inspection and all of these have been met. Care plans are more detailed and are more informative on people`s dementia needs. All records are now kept up to date and the complaints leaflet is now in a pictorial format. The home has purchased sit-on weighing scales, which allows all residents to be weighed. The home is undergoing a redecoration and refurbishment programme, with the main parts of Thames/Ripple (corridors, lounges, conservatories and dining room) having been redecorated and new curtains and armchairs have also been purchased.

What the care home could do better:

There is still an outstanding issue of the carpets in the corridors, lounges, conservatories and dining room (Thames/Ripple) being replaced and the maingate being repaired. The Director of Operations has advised the inspector that both the carpets will be replaced and the gate will be repaired before Christmas.

CARE HOMES FOR OLDER PEOPLE Cherry Orchard Nursing Home Dagenham Avenue Dagenham Essex RM9 6LG Lead Inspector Julie Legg Unannounced Inspection 15th November 2007 10:00 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 Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 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 Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherry Orchard Nursing Home Address Dagenham Avenue Dagenham Essex RM9 6LG 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) 020 8984 0830 0208 596 9127 manager.cherryorchard@careuk.com manager.burroughs@careuk.com Care UK Community Partnerships Ltd Violet Dikeledi Kotu Care Home 40 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (26), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (12) Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered person may provide the following categories of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding Learning Disability or Dementia - Code DE(E) (maximum number of places: 12) Dementia - Code DE (maximum number of places: 2) 2. Dementia -Code DE(E) (maximum number of places: 28) The maximum number of service users who can be accommodated is: 40 9th January 2007 Date of last inspection Brief Description of the Service: Cherry Orchard is a care home with nursing situated in Dagenham. It is some way from public transport, and can be difficult to find. The home is situated in the part of Dagenham Avenue that is next door to the Goresbrook Sports Centre (opposite Eustow Road). Care UK Community Partnership Ltd, a large, private, provider, which has many similar homes across England, manages the home. It is a single storey, purpose built home, which is divided into two units. Castle Green is a 12-place unit for people over the age of 65 who have functional mental health problems. Thames/Ripple is a 28-place unit for people aged over 65 who have dementia; two of these places are for people under 65. All places at the home are block purchased by Barking and Dagenham Primary Care Trust, with two beds on Thames /Ripple being for respite care. All bedrooms are single and have en-suite toilets and wash hand basins, and all are a good size. Castle Green has a small kitchenette and open plan dining and lounge area, leading onto an enclosed patio and garden. There is also a separate Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 5 conservatory. Thames/ Ripple comprises of two corridors, connected by a large dining room. Each corridor has 14 bedrooms, a lounge, small conservatory, bathroom, toilets and shower. All areas of the home including the garden have full disabled access. The Statement of Purpose and the Service User Guide are issued to every prospective resident and both of these documents are displayed in the entrance hall of the home. A copy of the most recent inspection report is also available. A resident or relative/representative could ask for his or her own copy, which the manager would make available. The weekly fees for the home are £715 for people with dementia and £898 for people with mental health issues. This information was given by Violet Kotu (manager) on 25th November 2007. The fees do not include items such as, personal toiletries, hairdressing, chiropodists and other sundries. Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day. The lead inspector Julie Legg was accompanied by Jackie Date another inspector. The manager was available for the majority of the visit and feedback was given the following day by telephone. Discussions took place with the manager, the senior nurse on duty, care staff, the administrator and the cook. Care staff were asked about the care residents receive and were also observed carrying out their duties. The cook was asked about the meals she provided for the residents. Staff were asked about their recruitment, induction programme and ongoing training. Further information about Cherry Orchard was also gathered from residents, relatives and the Primary Care Trust who commission the beds. The local vicar, who visited during the inspection, was also invited to contribute his views of the quality of the service received by people living at Cherry Orchard. A tour of the home was undertaken and all of the rooms were seen to be clean and mainly free from any offensive odour except there was a slight offensive odour on the carpet outside the nurse’s office. Residents’ files were also examined and case tracked; including risk assessments and care plans, together with the examination of staff files and other records. These records included medication charts, financial transactions staff rotas and staff recruitment procedures. Additional information relevant to the inspection has been gained from the Annual Quality Assurance Assessment, Regulation 26 visits which are monthly reports on the home, which are undertaken by the organisation and Regulation 37 notifications, which are any serious incidents or events that are reported to the Commission. The inspector and the manager had a discussion on the broad spectrum of equality& diversity issues and the manager was able to demonstrate a good understanding of the varied needs around religion, sexuality, culture, disability and gender. The inspector had a discussion with the manager, residents and staff as to how the people living in the home wished to be referred to in this report. They expressed a wish to be referred to as residents. This is reflected accordingly throughout this report. The inspector would like to thank the residents, staff and visitors for their input and assistance during this inspection. Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: There is still an outstanding issue of the carpets in the corridors, lounges, conservatories and dining room (Thames/Ripple) being replaced and the main Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 8 gate being repaired. The Director of Operations has advised the inspector that both the carpets will be replaced and the gate will be repaired before Christmas. 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. The summary of this inspection report can be made available in other formats on request. Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 9 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 Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 & 5 People who use this service receive good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Prospective residents, or their relatives can visit the home and they also have the information needed to enable them to decide if they wish to live at Cherry Orchard. Comprehensive assessments are being undertaken for all of the residents prior to them moving in; this ensures that all of the residents’ needs can be met. EVIDENCE: The Statement of Purpose has been revised and further developed. It now clearly sets out the objectives and philosophy of the service. The Service User Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 11 Guide is informative and written in plain English, a copy of this document has been given to every resident and relative. There are copies available on the resident’s notice board. Individual records are kept for each resident and a random sample of four files were examined. A comprehensive assessment had been undertaken and information had also been gathered from families and health and social care professionals. From this assessment and other information, a care plan was drawn up, which identified the residents’ needs and how these needs should be met. (See standard 7). Relatives (residents were unable) were able to confirm that they had been involved in the assessment process. Residents and relatives are able to visit the home prior to a resident moving in. However because of the frailty of the prospective residents, relatives undertake these visits. All of the relatives that were spoken were very complimentary of the welcome they received and the information they were given. Comments from relatives were “I visited two other homes but this was the one that I felt most comfortable in and there was such a nice atmosphere”, another commented “I had not heard very positive things about Cherry Orchard but I was pleasantly surprised when I visited and was bowled over by the attitude of the manager and staff. I certainly made the right choice”. The majority of the residents have previously been in a local acute psychiatric hospital and the manager now has an arrangement that a senior carer works one/two shifts at the hospital for a comprehensive handover and to meet the resident. This makes sure that there is a familiar face when they come to live at Cherry Orchard. The manager was able to demonstrate the home’s capacity to meet the needs of older people with mental health problems or older people with dementia. The home does not provide intermediate care. Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 &11 People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents’ health, personal and social care needs are set out in comprehensive individual care plans and they provide the staff with detailed information they need to satisfactorily identify and meet residents’ needs. All of the residents have detailed risk assessments; this ensures the health and safety of the residents. There are comprehensive policies and procedures for dealing with the administration of medication, which ensures that medication is administered safely to residents. Residents are treated with respect and the arrangements for their personal care ensures that their right to privacy is upheld. Residents have comprehensive ‘End of Life’ care plans; therefore their wishes in relation to their dying and death are clearly identified. Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 13 EVIDENCE: THAMES/RIPPLE The manager and staff have ensured as far as possible that residents are involved in all decisions about their lives. There is a care planning system in place that is clear and concise. Each resident has their own care plan, which relatives and some residents have been involved in formulating. These comprehensive documents cover areas such as, communication, behaviour, health (physical & mental); personal (bathing, toileting), medication, and social care needs. These individual plans are supplemented by other information in ‘life story’ books and activity planners. The care plans are individualised and person centred. One care plan states ‘X does not like to get up early, she will let staff know when she is ready’, another stated, ‘Y will need reassuring whilst sitting in the dining room’, ‘Z enjoys listening to Beatles music’. With some of the residents verbal communication is limited, the staff have spent some considerable time in learning about the different ways the residents communicate through noises, body language and facial expressions. Care plans are evaluated. During the past three months all of the residents have had a review of their placement by the Primary Care Trust. A score of 4 has been given in recognition of the work that has been undertaken in ensuring that care plans are so meaningful for each resident. Residents are being encouraged to stay as independent as is possible and where they are able residents are being assisted rather than doing it for them i.e. brushing teeth, washing hands, combing hair, washing up and dusting. This can be time consuming for the care staff and those residents living with dementia and this is reflected in the staffing levels. There was evidence that continence programmes were included in the care plans and staff were aware of the importance of ensuring that such programmes are implemented consistently. Wound care management is good and where necessary comprehensive care plans are in place and there is a very low incident rate of pressure wounds despite the high dependency of the residents. Nutritional screening is undertaken on admission but on a more frequent basis if the health needs of the resident indicate this. Residents are also weighed on a monthly basis or more frequently if required. Professional advice is sought from the GP or Dietician. Blood sugar monitoring was being maintained accurately. Fluid/food intake charts are detailed and record the food that has been eaten and the size of the portion i.e. two tablespoons, a small bowl, size and number of sandwiches. The details of these recordings Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 14 ensure that an accurate record is being maintained in nutrition. Other health records related to the management of diabetes and the management of in dwelling catheter. Records show that residents are seen by other health professionals such as GP who visits weekly, Psychiatric Consultants and a Clinical Psychologist who visit regularly, Optician, Dentist, Chiropodist, Dietician and the Tissue Viability Nurse. Risk assessments are routinely undertaken for all of the residents around nutrition, moving & handling, continence, falls, pressure sore prevention, seizures, bed rails, accessing the community and safe environment. Residents (where possible) and relatives have been consulted in formulating the risk assessments. There was evidence that risk assessments had been forwarded to the resident’s care plans and these assessments are being reviewed on a regular basis or when a change in need is identified. Only nursing staff can administer medication and there are clear policies and procedures for them to follow. All medication is delivered in blister packs except for one resident who is fed by Nasal Gastric tube and this resident’s medication is administered in liquid form. Controlled drugs are also in blister packs and two nurses sign the controlled drugs register when these are administered. The controlled drugs for one resident were counted and the number of tablets agreed with the register. The Pharmacist delivers training and also carries out periodic audits. Every resident has a profile with a recent photograph and any allergies are clearly noted. Medication Administration Charts (MAR) records were appropriately completed. Medication is kept safe; the locked medication trolley is chained to the wall of the medication room, and there are two metal cupboards also attached to the wall - one cabinet is for stock medication and the other cupboard is for controlled drugs. The door to the room is kept locked and the nurse in charge has the keys with them at all times. Relatives and a few residents were asked about the care in the home. Residents’ comments were “They are good girls”, “The staff are friendly and I am happy living here”. Relative’s comments were “They are absolutely brilliant, I couldn’t fault the care”, “Violet (manager) and the staff are really wonderful, I am very happy with care my relative receives”, “Marvellous, they are all marvellous”. Staff talked about and were observed to treat residents in a respectful and sensitive manner. They were seen to be very gentle when undertaking moving and handling and offered explanation and reassurance throughout the activity. During lunch one of the residents became distressed regarding a member of her family, a carer dealt with the situation in a sensitive and calm manner; taking time to explain to the resident about her relative. When the resident had calmed down the carer asked her if she would like to assist her with the Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 15 washing up. The carer and resident were then seen enjoying each other’s company; laughing whilst washing up together. All of the residents have ‘end of life’ care plans. The manager is currently working with one resident’s family as their dying and burial requirements are very specific. The manager of the home has been working closely with the coordinator for the North East London Cancer Network and has implemented the Liverpool (LCP) Care Pathway for residents who were dying. This transfers the hospice model of care into other care settings and has been effectively used in care homes. The manager has also registered for the Gold Standard Framework Initiative; where previous deaths in the home are looked at ‘what went well’, ‘what did not go so well’ and ‘what could have done better’. The manager is attending four workshops on the ‘end of Life’ initiative. One of the nurses has attended a foundation course in ‘End of Life’ and some care staff have attended ‘Introduction to palliative care’ training at a local hospice. Since the home has registered for the Gold Standard Framework three residents have passed away, where their preferred end of life wishes (to remain at Cherry Orchard) were able to be carried out. During the inspection the vicar visited the home and stated, “The care is wonderful”. Bereaved relatives had written “Thank you for the loving care you showed W, she died peacefully with us all there, “Our heartfelt thanks to Violet and all the staff for the wonderful care they gave V at the end”. On the day of the inspection the manager and members of staff attended a resident’s funeral. The manager took the resident’s memory box with her, as family wished for it to be placed with the deceased resident. A score of 4 has been awarded in recognition of the work that has been undertaken in ensuring that residents’ last wishes are recorded in meaningful ‘end of life’ care plans and the sensitive way staff have supported residents and relatives at the time of the resident’s death. CASTLE GREEN All of the residents’ care plans, health records and risk assessments were of the same high standard as on Ripple/Thames unit. Residents are able to access the same health professionals either in the community or they visit the home. There is also good liaison with health professionals around the mental health needs of the residents on this unit and a consultant psychiatrist visits regularly. Residents appeared relaxed and there was good interaction between the staff and the residents. Residents were engaged in a number of activities; reading the newspaper, watching television, listening to music in their bedroom and others were chatting. A relative stated, “We are very happy with the care, the staff are very caring”. Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People who use 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 activities programme is varied and is tailored to meet the needs, choices and expectations of the residents. Visiting times are flexible and people are made to feel welcome when visiting the home. This ensures that residents are able to maintain contact with their families and friends as they wish. The attitude and practice of the staff working in the home, promotes opportunities for residents to remain independent, exercise choice and express their wishes and needs. Meal times are flexible and there is a choice of meals, which are well presented and nutritionally balanced. This allows residents to have choice around when and what to eat. EVIDENCE: Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 17 The home employs two activities co-coordinators; one co-coordinator works 10 hours a week on Castle Green Unit and the other co-ordinator works 24 hours on Thames/Ripple Unit. THAMES/RIPPLE There is a variety of small and large group activities and the activity coordinators take into account the needs, preferences and capabilities of all the residents. Activities are arranged to suit individual interests and these include sing-a-longs, board games, bingo, drawing, quizzes, and exercise through music, knitting and cake making. Some of the activities are left out, which means that people living with dementia can ‘dip in and out’ as they wish. The ‘Life History’ books that are being completed with every resident will further enhance the choice of activities. These books cover areas such as, background information, personal calendar with important dates, pictures and photographs, hobbies and interests, beliefs, special memories and stories and other favourites (colour, music, clothes, films, books, flowers etc). Staff are also encouraged to spend time sitting and talking to residents and this was very evident on the day of the inspection. Regular visits by professional entertainers and Pat a Dog evening also take place where residents get to stroke and interact with the dogs. During the past couple of months residents have been to Lakeside (shopping centre), Maldon, Queens Theatre and a pub lunch and more trips are arranged for December. Events within the home have included; a summer fete, a barbeque (residents, relatives and staff) and various other festivals such as, Easter, St George’s Day and Halloween have been celebrated by decorating the home and serving appropriate food. There are now regular visits by the local clergy and if any resident wished to attend a religious service outside of the home then this would be arranged. Other special dates like birthdays and anniversaries are also celebrated with cards, cakes and flowers. One resident stated, “When it’s your birthday, they make a cake and make you feel special”. Portable CD players have been bought for residents who are bed bound, so that they can listen to music. One resident’s relative was involved in choosing the music and this has had a beneficial effect on her mental well-being and she now sings to her favourite songs. The home is introducing the ABC (Activity Based Care) and this was one of the ideas that was piloted as part of this project. On the day of the inspection staff were attending an awareness session on ABC. Memory boxes are now in place by residents’ bedroom doors. These boxes contain photographs and other objects of interest; one resident has a miniature dartboard, another resident has flowers and another resident has a bar of chocolate, these boxes aid memory orientation and reminiscence. Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 18 The signing in book shows that there is a steady stream of visitors to the home on most days and on the day of the inspection there were at least six residents who received visitors (some who visit daily). Relatives are encouraged to attend events within the home and indeed the summer barbeque was very well attended. Visiting times are very flexible and visitors confirmed that they could visit at any time. Residents have the choice as to where they see their relatives and friends, either in the lounge, conservatory, the garden or their own bedroom. Relatives stated that they were all made to feel welcome and were offered tea or coffee. Relatives stated, “It doesn’t matter what time I visit I am always made to feel welcome”, “I feel very comfortable when I visit and the staff are all very pleasant”, “the staff are very welcoming”. There are a few of the residents who go out with their families either to their homes or out for meals. In a customer satisfaction survey one comment was ‘more activities could be provided’. Residents’ care plans indicate their preferred name and their wishes regarding their death. Residents are encouraged to bring into the home some of their own possessions and this was evident when visiting residents’ bedrooms. Items such as radios, televisions, photographs, pictures and ornaments. Residents are involved (as far as possible) with menu planning, choosing their own clothes, and buying their own toiletries, activities and the décor of the home. The manager and staff are also aware of the need to minimise any reduction in the freedom of residents to walk about the home and realistic risk assessments are in place that balances safety with the individual’s right to be as free and in charge of their actions as far as possible. CASTLE GREEN Most of the activities that take place on this unit are individually or in small groups. Only two of the ten residents access the community; this is their choice. These two residents enjoyed some of the outings with Thames/Ripple (going to the pub, shopping at Lakeside) as well as individual outings to the shops and other places of interest. The majority of the residents prefer to engage in activities within the unit; four residents have daily newspapers, some enjoy watching quiz programmes (Countdown, Deal or No Deal) on the television. Others enjoy painting and reading and some of the residents enjoy cooking and to encourage their independence the manager has purchased a blender and a bread-making machine. Residents are also encouraged to participate in light domestic chores and making cups of tea. Both units are served by one kitchen. A visit was made to the kitchen and the inspector was able to discuss the storage and preparation of food and menus with the cook. Cupboards, refrigerators and freezers were amply stocked and all food was labelled appropriately. The majority of the vegetables are fresh, fruit is readily available and the cook makes her own cakes, pies and pastries. The cook is very experienced and is very much aware of all the residents’ likes and dislikes and their dietary requirements. Some of the residents have to Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 19 have their meals pureed; all of the meal is blended separately, this ensures that residents receive the individual taste of each part of the meal. Two of the residents are not white British, however they choose to eat traditional English food (other than one particular meal, that the cook prepares for them). Residents are able to choose their meals from pictorial menus but can also choose their meal at the point of serving. There is always a choice of two meals but the cook stated that she would always cook something different if either of the choices were not to their liking. On the day of the inspection there was a choice of chicken & mushroom pie or meatballs with carrots, swede, broccoli and either mashed or new potatoes, desert was carrot cake and cream and there is also a choice of meals at teatime and breakfast. As well as meals, drinks and snacks are readily available during the day. The cook was present in the dining room during lunch, she stated, “I like to be in here and I can gage what residents are eating and to see if there is anything they don’t like”. The majority of the residents choose to eat their meals in the dining room, though some choose to eat in their bedrooms. Mealtimes are flexible and are slightly staggered so that those residents requiring some assistance are served first. This has given staff more time to ensure that the other residents can be given appropriate assistance and encouragement. Both residents and relatives were very complimentary of the food. One resident stated “I love the food”, a relative stated “ I can’t fault the meals at all, they always look nicely prepared and T always enjoys them”. As stated earlier some of the residents require assistance and others require encouragement with eating their meals. Staff were seen to give assistance in a caring and positive manner; talking to the residents and not rushing them. Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16&18 People who use 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 manager and staff make every effort to sort out any complaints or concerns. Residents and relatives can be confident that their complaints will be listened to and acted upon. There are policies and procedures on safeguarding adults and staff have received training to ensure that there is an appropriate response to any allegations of abuse EVIDENCE: The home has a clear complaints procedure, which is available in written and pictorial format. A copy of this procedure has been available to all of the relatives and residents. The manager does have an open door policy and encourages residents and relatives to raise their concerns. Staff now have as part of their mandatory training ‘Customer care’, which deals with how to handle complaints and who to report them to. The manager states in her AQAA, ‘The manager and staff have built strong but professional relationships with relatives to encourage openness, inclusion and transparency within the home’. There have been 2 complaints since the last inspection (January 2007), One of these complaints has been dealt with and the complainant was satisfied Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 21 with the outcome, the other complaint is ongoing and this is regarding the installation of CCTV on the exterior of the building and the repair on the main gate to the home. The Director of Operations is aware of this complaint and advised the inspector that both the gate and CCTV would be resolved before Christmas. There are also regular resident and relatives’ meetings, where people can share their concerns and complaints as well as a suggestion box, which is situated in the reception of the home. Five relatives were asked, “If you were unhappy about anything in the home, who would you talk to?” Three of the relatives stated, “I haven’t had a need to complain but I would speak to Violet (manager)”, another relative stated, “I did make a complaint quite a while ago and Violet dealt with it straight away and to my satisfaction”. Another relative stated, “I have an ongoing complaint, not with Cherry Orchard, I am very happy with the care. My complaint is with the Organisation, they tell me it will be sorted by Christmas but we will wait and see”. The home has policies and procedures for the safekeeping and expenditure of residents’ money and all monies are held securely within the home. The head office of Care UK is corporate appointee for a couple of the residents, however their families deal with most of the residents’ finances. The Organisation has a policy that a £100 a resident is the maximum amount that should be held and this is used to pay for items such as, toiletries, chiropody, hairdressing and any other sundries. The manager and the administrator are the only two people who have access to this money. Appropriate records are kept, receipts are issued and all cash is stored in separate plastic wallets for each resident. Three residents’ finances were checked and the amount of cash in the wallets agreed with the record. The home has comprehensive ‘safeguarding adults’ policies and procedures; these include the local authority (London Borough of Barking & Dagenham) policy and procedure, the Department of Health ‘No Secrets’ document and the Organisations’ policies and procedures. The manager was very clear in what incidents needed to be referred to the Local Authority as part of the local ‘safeguarding adults’ procedure. There have been no reported ‘safeguarding adults’ issues since the last inspection. Staff members were clear on what constituted abuse and their responsibility in reporting any potential or actual abuse. Staff files indicated that all members of staff have attended ‘safeguarding adults’ training and this was a subject that is covered during staff meetings and induction training. The manager and the staff have received training in the Mental Capacity Act 2005, as this has implications for providing service for people living with dementia and mental health issues. Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19.20,21,22,23,24, 25 & 26 People who use 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 is homely and provides the residents with a clean, safe and comfortable environment. Residents’ bedrooms suit their needs and are decorated and furnished in a way that suits their lifestyles. Residents have access to suitable bathrooms and toilets. EVIDENCE: The home is situated in a residential area of Dagenham where community facilities are accessible. The home is purpose built and there is wheelchair access to all areas of the home, with specialist toilet, bathroom and shower facilities, which gives residents a choice regarding their bathing needs and Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 23 wishes. Other specialist equipment is also available such as, hoists, handrails, adjustable beds and reclining chairs. A tour of the home was undertaken including the kitchen and laundry room. The home is decorated and furnished in a homely fashion and all areas of the home are well maintained, clean and free from any offensive odour except in the area outside of the nurse’s office (Thames/Ripple). A visit was made to both the kitchen and the laundry room; all units share these facilities. The cleanliness of the kitchen was very high; cupboards, refrigerators and freezers were all clean and amply stocked with all food being stored and labelled appropriately. Refrigerator and freezer temperatures are also regularly recorded. The laundry area was very clean and well equipped with washing machines and dryers and all hazardous substances were stored appropriately. The home has an Infection Control Policy and would seek advice from external specialists if and when required. Staff have been trained in hand hygiene and sanitising mousse has been installed in every residents’ bedrooms, toilets, sluice rooms and bath and shower rooms. There is a full time maintenance man who is responsible for maintaining the building and equipment, in conjunction with the service contracts. He also carries out checks on water temperatures, nurse call bells and keeps records in good order, together with external testing for Legionella, gas and electrical checks. Thames/Ripple The living area of Thames/Ripple consists of two lounges, two small conservatories and a dining room. This allows residents a choice of rooms in which to sit. Both of the lounges and conservatories have now been redecorated and new armchairs and curtains have been purchased. The dining room has been redecorated and the manager is in discussion with a clinical psychologist regarding appropriate artwork for the dining room walls. The corridor walls have also been redecorated. All of the bedrooms are single and en-suite and all have been personalised with televisions, radios, CD players, photographs, family pictures and ornaments. Some of the bedrooms have been redecorated and refurbished with new duvet covers and curtains and the manager is looking to redecorate and refurbish the remaining bedrooms next year. As the ability of people living with dementia to communicate with words decreases, the use of non-verbal cues and the environment are important in enabling them to cope with daily life and orientation. All of the bedroom doors are painted different colours and also have a doorknocker and a picture of the resident. On the side of the door is a ‘memory box’, which contains photographs and objects of interest; one resident has a miniature dartboard, another resident has flowers and another resident has a bar of chocolate. All Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 24 of the toilet door frames have been painted different colours and pictorial signage is also displayed on the doors. All of these ‘cues’ aid orientation for people living with dementia. The manager applied for and was successful in obtaining £12,500 from the Government’s ‘capital grant’ fund and this money will be spent in improving the quality of life for the residents at Cherry Orchard. The carpets in the corridors, lounges and dining room are to be replaced and the corridors are undergoing further transformation with different scenes (countryside, shops etc,) one park bench is already in place, which will allow residents to sit and look or touch and feel. The site where Cherry Orchard now stands use to be a school and hopefully a replica picture of the school will also be painted onto the wall. As stated earlier in the report there was a slight offensive odour on the carpet outside the nurse’s office, this was reported in the last inspection report (9th January 2007, the carpets are quite old and no amount of cleaning is able to remove the odour and stains) Residents and relatives are currently being asked their views on the type of flooring they would like. The front of the building is well maintained except the main gate, which needs to be repaired to ensure the safety of the residents. The Director of Operations has advised the inspector that carpets in the corridors, dining room and lounges (Thames/Ripple) are to be replaced and the gate will be repaired before Christmas. For this reason, the previous requirement has not been repeated in this report. Some of the relatives have requested CCTV cameras to be placed on the exterior of the building. The Director of Operations again advised the inspector that the CCTV cameras would be in place before Christmas. The rear garden has disabled access, is laid to paving and flower beds. There are a number of sitting areas for the residents and new garden furniture has been purchased. There are raised flowerbeds, which allows residents to assist with the planting and in the Spring the sensory flowerbed is going to be extended. CASTLE GREEN This unit is clean, nicely furnished and with no offensive odours. The lounge/dining room had small vases of flowers on the dining room tables; plants, magazines and pictures were also present, which made this room feel homely. All of the bedrooms are en-suite and have been personalised with residents’ possessions, such as, televisions, radios, photographs and in some bedrooms there was evidence of the resident’s own art work. Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 &30 People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home’s staffing levels are satisfactory and there are sufficient staff on duty, all of whom have the appropriate skills and training to meet the needs of the residents. The home has a clear and robust recruitment policy and procedure and appropriate checks are undertaken, which ensures the protection of the residents. EVIDENCE: Staff rotas were examined and the rota correlated with the number of staff on duty. On Thames /Ripple there are currently 27 residents and the staffing levels are: two nurses and 6 carers on each day shift. The activities coordinator also spends 24 hours a week across Thames/Ripple. On Castle Green there are currently 12 residents and the staffing levels are: one nurse and two carers on each day shift and across the units there are 2 nurses and 3 carers at night. Permanent and bank staff cover the majority of the shifts, very little agency care staff is used (average 5 hours a month over the past year) and no agency nurses have been used over the past year. This is clearly to the benefit residents as it provides continuity of care, which is extremely important to Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 26 people who are living with dementia or mental health issues. In discussion with the manager and staff at all levels, it was apparent that staff morale is high and they are enthusiastic and positive about wanting to continue to improve the quality of life for the residents. Staff retention is very good and many of the staff have worked at the home since it opened (1999). The home has a key worker and named nurse and staff on the units know the residents and their families very well. The staff have recently won an award from Care UK ’Dedication to Care’. Care UK has a robust recruitment and selection procedure in accordance with the requirements of legislation, equal opportunities and anti-discriminatory practice, which ensures the protection of the residents. Four staff files were examined and all showed that all of the recruitment procedures had been adhered to. All files had a completed application form, two written references, satisfactory Criminal Records Bureau checks, copy of birth certificate and passport were also on files and nurses’ pin number had been checked. Two people are involved with the interviewing process and there were notes that had been written during the interview. The manager carries out audits on personnel files to monitor compliance with Care UK’s recruitment policies. The Organisation employs a workforce from diverse cultures and backgrounds, some of which are different from the people living in the home. However, staff have undertaken training in ‘equality and diversity’. This ensures that the spiritual, dietary, cultural, sexual and any other diverse needs of the residents are appropriately met. Staff are able to demonstrate a thorough understanding of the particular needs of individual residents and can therefore deliver meaningful person centred care. All newly appointed staff undertake an induction programme, which is in line with Skills for Care. Topics covered during the induction are, moving & handling, first aid, understanding the principles of care, recognising and responding to abuse, equality & diversity, communicating effectively and maintaining safety at work. From talking to staff, inspecting training records and observation, it was evident that staff have the opportunities to undertake a variety of training courses and that such training is put into practice within the home to the benefit of the residents. Staff have undertaken training specific to the caring for people living with dementia and mental health issues. This has included communication, Mental Capacity Act, dementia awareness/mapping, palliative care, and mental health in later life, ‘end of life’. Other training that has taken place includes, catheterisation, nutrition, incontinence, and food safety, wound care, protection of vulnerable adults, infection control and fire awareness. The effectiveness of this training was evident in the attitude and practices of the staff when interacting and caring for the residents. Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 27 An overall record of staff training is kept in the office but there is also laptop system (L-Box) that is accessible for all staff and compliance figures are very high, with the majority of the staff having achieved 100 pass rates in all mandatory training. The NVQ 2 has been achieved by 92 of the care staff and senior care staff have undergone supervision and appraisal training. One of the nurses has her Registered Manager’s Award and 2 nurses have achieved their NVQ 4 in management. A score of 4 has been given in recognition of residents being supported by a very competent and qualified staff team. Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, 36 and 38 People who use this service receive excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is managed by a qualified and experienced manager who also has very sound management practices. This means that residents’ health and welfare are promoted and protected. Residents can be confident that their views underpin the self-monitoring, review and development of the service. EVIDENCE: The manager is a registered nurse and has the relevant clinical and management qualifications. Since the last inspection she has become the registered manager. She is committed to providing and improving good quality Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 29 care at Cherry Orchard. To achieve this she works closely with residents, relatives, health and social care professionals. She has many years experience in providing nursing care services and continues her own personal and professional development by attending further training. She has attended training in the Mental Capacity Act, Legionella control, fire warden training, ‘end of life’. The manager has obtained her Level 5 in Diploma in Management with the Chartered Management Institute and is currently studying for her level 7. The manager has recently received an award from Care UK ‘NVQ trainer of 2007’, this was in recognition of the highest number of trained NVQ staff in the organisation. She has a sound knowledge of both strategic and financial planning and how the development plan for the home fits into these. She has responsibility for the financial budget of the home and is aware of her budgetary limitations. As stated earlier the manager applied for and was successful in obtaining £12,500 for the Government’s ‘capital grant’ fund and this money is being spent on improving the quality of life for the residents of Cherry Orchard. In discussion with the manager it is clear that she receives effective and regular support from the organisation and that there are clear lines of accountability. Discussions with the manager showed that she was able to describe a clear vision of the home based on the organisation values. It was evident that she was able to communicate a clear sense of direction and demonstrate a sound understanding and application of good practices, particularly in relation to continuous improvement of the service. Both relatives and the vicar for the home have undergone training in dementia awareness; this will enhance their knowledge and assist them in responding appropriately to the residents who are living with dementia. As stated earlier in the report the home is registered for the Gold Standard Framework Phase 4 programme, which is to improve ‘end of life’ care for the residents. The manager has carried out ‘spot checks’ out of ‘normal hours’ and this is supported by regular supervision of all staff, which is in 1:1 sessions, in groups and through direct observation, annual appraisals and regular staff meetings are also taking place. Other quality monitoring also takes place such as, residents and relatives meetings, feedback from quality assurance surveys, which included the Primary Care Trust who block purchase all of the beds, ’the standard of care especially recently has I think been very good, Violet is very good indeed’. Relative’s comments were ‘ the home is extremely welcoming’, ‘the staff are caring’, ‘I cannot thank the staff enough for their kindness and help’ and ‘more activities could be provided’. From this information the home has a development plan that reflects the aims and outcomes for the residents. In March 2007 Care UK revised their policies and best practice guidelines for all aspects of the care service that is provided and these are supplemented by written local policies, which are specific to Cherry Orchard. Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 30 The manager with the assistance of senior staff carries out monthly care plan, medication, staff records and pressure sore audits to ensure adherence to policies and that high standards of care are maintained. A monthly management report is also produced, which includes accident and incident figures and analysis of trends and evidence shows a very low level continues despite the high care needs of the residents. The manager also produces a similar quarterly report for the Primary Care Trust, who has a block contract with the home. The home has policies and procedures for the safekeeping and expenditure of residents’ money and all monies are held securely within the home. The manager and the administrator are the only two people who have access to this money. Appropriate records are kept, receipts are issued and all cash is stored in separate plastic wallets for each resident. During the course of the inspection the manager was seen leading from the front, by directly engaging with the residents, relatives and staff. Comments from residents, relatives, staff and the local vicar were extremely complimentary. Residents’ commented, “She (Violet) is lovely”, “My favourite girl”. Other comments received were, “Nothing is too much trouble for her”, “Violet is wonderful”, “She is the best thing that has happened to this home”, “Violet is right on the ball, if there is anything wrong she deals with it straight away”. Staff commented, “She is a wonderful manager, very supportive”, “I really enjoy coming to work, I love it here, she (Violet) is the best”, “Violet is the manager but we all work together for the benefit of the residents”. The manager was able to demonstrate knowledge and commitment to equality and diversity issues; sourcing appropriate training, discussions with residents and their families, contacting specialist organisations and surfing the Internet. It was also evident that the manager followed the policies and procedures of the organisation. Record keeping remains of a consistently high standard with records being kept securely locked in accordance with the Data Protection Act. All of the working practices within the home are safe, within a risk management system. The manager proactively monitors the home’s health & safety performance and consults other specialist agencies when necessary. Risk assessments were in place for fire, first aid, infection control and moving & handling. Staff have the benefit of an induction programme that is in line with the Skills for Care Council and subjects such as, infection control, moving & handling, safe use of hoists and safeguarding adults. A wide range of records were looked at and these were found to be detailed, up to date and accurate. Refrigerator and freezer temperatures are taken and recorded daily and food that had been opened was stored, covered and dated. Fire drills are taking place, as required, fire alarm system and equipment is Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 31 checked regularly as required and fire call points are checked weekly. The gas certificate is dated June 2007 and the five-year electrical certificate is dated May 2004, portable electrical appliances have been tested this year. Water temperatures are checked weekly and the water system was checked for Legionella in January 2007. All hoists and electric baths were checked in September 2007. Regulation 26 visits are undertaken by the organisation and copies of these reports are available to the Commission, as are Regulation 37 notifications that advise the Commission of any significent events within the home. A score of 4 has been given in recognition of the manager’s leadership and the benefit that the residents receive living in a home that is well run and in their best interests. Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 32 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 3 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 4 4 X 4 Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 33 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. 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. Refer to Standard Good Practice Recommendations Cherry Orchard Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Nursing Home DS0000015587.V354202.R01.S.doc Version 5.2 Page 35 - 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. 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