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Inspection on 20/09/05 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 20th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

The home is purpose built to provide care to two distinct groups of older people, whose needs are very different. The people living in Castle Green benefit from this by living in a smaller, self-contained home, and as many of them like a bit of peace and quiet, they appreciate this. When external entertainers are booked to come into the home they can join in, if they wish to do so. The people living in Thames Ripple have a slightly more chaotic lifestyle, but staff work hard to make sure that all their needs are met. Everybody has their own bedroom, with an ensuite toilet and wash basin, this ensures privacy when staff are providing personal and nursing care. Staff are knowledgeable about the needs of service users, and the record keeping is very good. This means that if service users, placing authorities, relatives, or the Commission want to check the quality of care it`s quite easy to do so.

What has improved since the last inspection?

A great deal of thought has gone into how to improve Thames Ripple unit, so that it meets the specialist needs of the people who live there. As this unit is a specialist dementia unit this is very important, as things like the way the home is decorated, and the communal space is used can make a big difference to how the people who live there function. Changes have included the two lounges being used during the daytime, which means that staff are now working with service users in two smaller groups, rather than previously in one large group in the dinning room. A lot of thought has also gone into what food is served and how, particularly for those people who tend not to sit at the dining table for long. There has been a lot of staff training, including a special three-day course on dementia care, and more is planned. Some bedrooms and communal areas have been redecorated, and they look a lot more homely. The manager and two carers have planted a sensory garden, and service users have been enjoying this during the summer months.

What the care home could do better:

The redecoration needs to be completed so that all parts of the home are to the standard of the areas that have already been done. The manager and staff team need to continue to improve the communal and personal space (bedrooms) in Thames Ripple, so that it becomes the best possible environment for people with dementia. A range of activities, both within the home and in the local community needs to be developed. As well as continuing to be trained in specialist mental health care of older people, and in dementia care staff need to have regular supervision i.e. a oneto-one meeting with their manager, where they can discuss how they provide care to each service user, and their own career development.

CARE HOMES FOR OLDER PEOPLE Cherry Orchard Nursing Home Dagenham Avenue Dagenham Essex RM9 6LG Lead Inspector Ms Edi O`Farrell Unannounced Inspection 20 September 2005 10:40 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.V251194.R01.S.doc Version 5.0 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.V251194.R01.S.doc Version 5.0 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 Care UK Community Partnerships Limited Ms Catherine McAweaney Care Home 40 Category(ies) of Dementia - over 65 years of age (28), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (12) Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd March 2005 Brief Description of the Service: Cherry Orchard is a care home with nursing situated in Dagenham. It is someway from public transport, and can be difficult to find, as the postal address does not exactly match its location. Care UK Community Partnership Ltd, a large, private, provider, which has many similar homes across England, runs it. 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. 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 ensuite toilets and wash hand basins, and all are a good size. Castle Green has a small kitchenette and open plan dinning and lounge area, leading onto an enclosed patio and garden. There is also a separate conservatory, which is currently closed following a fire earlier this year. Thames Ripple is comprised of two corridors, connected by a large dinning room. Each corridor has 14 bedrooms, and a lounge, bathroom, toilets and shower. One of the lounges leads into a, newly created, sensory garden. Personal and nursing care is provided on a 24-hour basis, and the nurse in charge of Castle Green is qualified as a psychiatric nurse. The home is visited every two weeks by psychiatrists, who regularly review all service users. The local Community Mental Health Team also continues to work with some of the service users following admission. Where specialist health needs are identified community specialists, such as the tissue viability nurse are involved in the provision of care. All areas of the home have full disabled access. Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This, unannounced, inspection took place on a weekday from 10.40 to 16.30, and was the first inspection for 2004/5. Units were toured, care records were examined and discussed with staff, and staff were observed carrying out their duties. Wherever possible service users were asked for their views. In Castle Green some were unwilling, and the level of disability of many in Thames Ripple means that obtaining views would need to include time to get to know how each person communicates. The Commission is currently looking at ways to improve service user in-put to inspections. Those service users who did give views were very positive. Health and safety, training, and staff recruitments records were checked, along with those of a recent relative’s meeting. The findings of the inspection were discussed with the manager. Service users, the manager, and staff are thanked for their hospitality, and input to the inspection. Where core Standards were not assessed at this inspection they will be fully covered at the next visit, which will also be unannounced. What the service does well: What has improved since the last inspection? A great deal of thought has gone into how to improve Thames Ripple unit, so that it meets the specialist needs of the people who live there. As this unit is a specialist dementia unit this is very important, as things like the way the home is decorated, and the communal space is used can make a big difference to how the people who live there function. Changes have included the two lounges being used during the daytime, which means that staff are now working with service users in two smaller groups, rather than previously in one large group in the dinning room. A lot of thought has also gone into what food Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 6 is served and how, particularly for those people who tend not to sit at the dining table for long. There has been a lot of staff training, including a special three-day course on dementia care, and more is planned. Some bedrooms and communal areas have been redecorated, and they look a lot more homely. The manager and two carers have planted a sensory garden, and service users have been enjoying this during the summer months. 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 Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, & 5. Standard 6 does not apply to this home Prospective service users, and/or their representatives have the information they need to make a decision about moving into the home. Their needs are assessed prior to admission, and care plans developed either on the day, or day following admission. Identifying and meeting needs is given a high priority. Prospective service users are invited to visit prior to admission, but in practice it is often relatives or placing professionals who do so. EVIDENCE: The care plans of three people admitted since the last inspection were examined, and discussed with staff. Each of the service users was spoken to, with one being able to give a view about some aspects of the service. The Statement of Purpose and the welcome pack were examined, and some minor amendments were discussed with the manager. The home uses a standardised pre-admission assessment format. This uses information supplied by the multi-disciplinary team, including written assessments, copies of which are held in the care plan files. This is Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 9 supplemented by information from the service user, where possible, their relatives, and staff from current placements, such as another home or hospital. This information is then used either during admission, or the following day to complete a ‘Pattern of activities of living’, which covers personal safety and comfort, communication, eating and drinking, elimination, personal hygiene, controlling body temperature, mobilising, work and play, and expressing sexuality. These form the basis of the care plans, so that staff know what needs the service users have, and how to meet them right from the start. A Requirement was set at the previous inspection regarding the need to keep the use of beds in Thames Ripple under constant review. In particular, that in assessing any prospective service users, the size and layout of the unit, and needs of other service users must be taken account of. This is important, as the effects of dementia can be physical, resulting in frailty, and psychological, resulting in challenging behaviour. This can create risks for service users. The Commission is satisfied that the manager and the company have taken this seriously. The manager reported that the Primary Care Trust is currently undertaking a full review of the service, and that the health and safety of both service users and staff will be taken account of within this. The Commission look forward to discussing the outcome of this review at the next inspection. Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, & 11 Service users’ health, personal and social care needs are set out very clearly in individual care plans, which are followed by staff meaning that needs are met on a day-to-day basis. The home’s nurses meet health needs, with specialist in-put where needed. How needs are met is well recorded. EVIDENCE: Six care plans were examined, and compared to the service being provided; these included those of the three most recent admissions. Some aspects of care were discussed with staff. Assessments, such as nutritional, risk of falls, tissue viability and moving and handling are carried out either during admission, or on the following day. These, together with the pre-admission information, are used to draw up comprehensive care plans. The daily log reports on the care that has been given, and includes records of moods. It is therefore possible to get a very good picture of the lifestyle of each of the service users. There is also a form for ‘lifestyle and interests’ that gives a good history of the person’s previous life, which is important in dementia services, where personalities may have changed. The home would have scored a 4, commendable, for their care plans, but the sections on death have not been completed. This was discussed with Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 11 the manager who reported that relatives found it very difficult to talk about this subject. The Commission accepts that this is a very sensitive issue, but preferences and wishes need to be established for each service user prior to the event of death. This is Requirement 1. The specific needs of one service user, where the home is unable to meet all needs, was discussed in depth with the manager. As this report is a public document this will be followed up separately so as to maintain confidentiality. Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Service users’ expectations and preferences are identified in their care plans, but their social and recreational needs are not always being met. Recent changes have improved the lifestyle of some service users, and the home needs to continue to build on this. Where possible service users are helped to exercise choice and control over their lives. Recent staff training in the care of people with dementia needs to be built on so as to extend choice and control. Service users receive a wholesome, appealing and balanced diet, and recent changes have improved the surroundings in Thames Ripple. The kitchen is cleaned and equipped to a very high standard, and run in a very professional manner. EVIDENCE: Both units were toured, and the lifestyle of service users was judged by reading care plans and daily records, where possible asking service users for their views, discussion with staff and the manager, and observation. Social and recreational activities are a challenge on both units for separate reasons. In Castle Green some service users are very clear that they do not want to do any activities, preferring to read, watch TV, listen to the radio, or do nothing. Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 13 In Thames Ripple many of the service users have very short attention spans, and are constantly wandering. Others can be very noisy and/or display challenging behaviour, which is very disruptive. An activity co-ordinator is soon to take up post and the manager reported that links with the local community are going to be a priority. Some service users have visitors, who take them out for meals or to the local pub, but many never leave the building, or have visitors. Staff on Thames Ripple have recently done the three day Dementia training provided by the Alzheimer’s Society, with the majority passing the exam. This course includes ideas for appropriate activities for people in varying stages of dementia. The manager reported that increasing activities both within the home and outside was a priority over the coming months, building on both this training and having an activity co-ordinator. Where an outside entertainer has been booked, service users have enjoyed the sessions, and in one lounge in Thames Ripple they were enjoying an old fashion sing along during the afternoon of the visit. One service user on this unit helps with clearing the tables and other chores, and there was evidence that this helps to calm her when she is distressed and confused. This is the type of approach that the home needs to build on. Also on Thames Ripple the manager and two carers have created an enclosed sensory garden, which service users have been enjoying during the warm weather. There was evidence to suggest that this has had a positive effect on the moods and behaviour of some service users. This is again the type of approach that needs to be built on so that the home can become an excellent provider of dementia care. The Registered Manager must ensure that there is a programme of activity to meet the needs of the service users. This must include opportunities for service users to use local community facilities. This is Requirement 2. The menus for a four-week period were examined and discussed with the head chef in the kitchen following lunch. Some service users on Castle Green were asked for their views, and the lunch on Thames Ripple was observed being served. Care records were examined on both units for food preferences and special dietary or cultural needs. In the case of cultural needs one service user is Jewish, and where they had requested a particular meal the non-Kosher nature of it had been explained and recorded by staff. The catering staff are to be commended on their efforts to provide a balanced and nutritional menu, and in their approach to food hygiene. The kitchen and equipment are cleaned to a very high standard, and much of the latter have recently been replaced. Dairy and meat products are stored separately, and all containers are marked with the date of opening, as is any food stored in the Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 14 fridge. The temperature of cooked meat, fish, eggs, and poultry are recorded when cooked, standing and prior to serving. Fridge and freezer temperatures are recorded on a daily basis. Catering staff have been working closely with nursing and care staff to identify how some of the service users on Thames Ripple can be tempted to eat more. This is the group of people who tend to wander, so often do not finish meals, and are therefore in danger of malnutrition. Finger food is now made available at all meals, and sandwiches are provided for nighttimes. A copy of ‘Food for Thought’, an Alzheimer’s Society publication, which gives further ideas, has just been purchased. Also in this unit attempts have been made to improve the environment by putting cloths on the tables, and there is some evidence that this is gradually being accepted by the service users i.e. they are not pulling them off quite as often as they were. The midday meal was a choice of gammon or mince, and it was attractively served, including where pureed. The level of help required at meal times was included in care plans, and where assistance was required observation showed that it was in an unhurried manor. Recent staff meeting records showed that the manager had reminded staff that they must always sit down when assisting someone to eat. Wherever possible service users are encouraged to feed themselves, and specialist cutlery and crockery is provided to assist with this. Service users in Castle Green said that they preferred some meals to others, but that overall they thought the food was very good. The dinning tables in that unit were attractively set. A score of 4, commendable, has been given for Standard 15 in recognition of the work that both catering and care staff (including the manager and nurses) are jointly doing. This particularly relates to Thames Ripple unit, as there is continually emerging evidence of the importance of nutrition and hydration in the treatment and care of people with dementia. The Commission look forward to seeing further examples of team work between these two groups of staff that benefit service users. Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18, both in part The home appear to take complaints seriously, and takes all possible steps to protect service users from abuse. EVIDENCE: The complaint and abuse procedures and records were examined, and discussed with the manager. The record of a recent relatives’ meeting and staff meeting records were also examined. Staff were observed carrying out their duties and the daily logs and care plans were examined with reference to any potential adult protection issues. The care of one service user, who poses a risk to others, was discussed in-depth with the manager. Training records were examined. There have been no complaints since the last inspection so it was not possible to fully assess how the home handles them. Issues raised by relatives had been addressed at a recent meeting, and the manager has given a commitment to continuing these. She has also recently written to all relatives to seek their views. Adult protection training has been provided by the local adult protection coordinator. Both Standards will be more fully assessed at the next inspection, which will also be unannounced. Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 The decoration of parts of Thames Ripple has improved since the last inspection, as has the use of the available space. This gives a more pleasant environment for service users to live in, and staff to work in. The home is giving more attention to how the environment can be used positively in the care of people with dementia. Worked required on bathrooms and showers has been completed. EVIDENCE: Both units were toured, including some of the bedrooms. The major concern at the last inspection was how the communal space in Thames Ripple was being used. During that visit most of the service users were in the dinning room for most of the day. This created a noisy and chaotic environment, where staff were having to perpetually intervene between service users, in order to avoid harm or distress. It was neither a pleasant environment for service user to live in nor for staff to work in. At this inspection Thames Ripple was visited immediately on arrival at the home at 10.40. There were no Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 17 service users in the dinning room, as both lounges are now being used. This is a vast improvement for both service users and staff. Work to toilets bathrooms and showers required by the last inspection have been carried out, and the programme of redecoration of bedrooms is well underway. This is Requirement 3, which has been brought forward from the previous inspection, as the deadline has not yet been reached. Relatives, and where possible service users, have been involved in choosing colour schemes, and best practice in the use of the environment in the care of people with dementia has underpinned the redecoration. For example, using signposting colours that research has suggested aids these service users in recognising places. This is excellent, and if this attention to the detail of the environment in Thames Ripple continues the home could expect to get a score of 4, commendable, at the next inspection. Castle Green provides a homely and pleasant environment. Many of the bedrooms were either visited or viewed from the corridors. Whilst some had some personal possessions on display, many were quite empty, which detracts from the attempts that the home has made to personalise each room. Research shows that people, particularly those with dementia, moving into care homes, often settle better, where they are surrounded by their own belongings, including small items of furniture. This was discussed with the manager, who reported that she had recently written to relatives requesting that such items be brought in. Some had expressed concern that ornaments might get damaged, whereas in other cases because service users have been admitted from hospital their personal possessions have previously been disposed of. The Registered Manager must ensure that every effort is made to personalise each service user’s bedroom, so that it reflects their lifestyle, needs and preferences. This is Requirement 4. The manager and two carers have planted a sensory garden, which is accessed through one of the lounges in the Thames Ripple unit. This has been well used during the summer months, and has been incorporated into some of the care plans, as part of a ‘sun downer’ routine. There is some evidence that this has produced positive changes in behaviour. The home can be difficult to find, as the postal address does not totally match where it is situated. This created some problems earlier in the year when there was a fire, and the fire brigade could not immediately find the home. Since then new signposts have been put up, and the manager has written to the emergency services stressing the location of the home. Immediately following the inspection a very short visit was made to another home on the same road, which is often confused with Cherry Orchard. Staff there reported Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 18 that they have contacted the local authority to ask for signs to be put up on the local high street, and on the route to their home, and then further ones to Cherry Orchard. They reported that the local authority had agreed to this. The fire referred to above happened in June: It was immediately reported to the Commission, and an inspector visited four days later. At that visit she found that manager and staff had carried out a full evacuation in seven minutes. In addition they kept all service users calm and safe whilst the incident was going on, and staff that were off duty, who were aware of the fire, came in and assisted whilst the home was made safe. The manager and staff are to be congratulated on their handling of this incident. Since the fire the home has become no-smoking, the fire officer has carried out two inspections, which are satisfactory. Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, & 30 all in part & 29 in full Service users’ needs are met by the numbers of staff, who are currently receiving training to meet the needs of the service users. Service users are protected by the home’s recruitment policies and practice. EVIDENCE: Staff were observed carrying out their duties, records were examined, and some service users were asked for their views. Recruitment files had all required checks, and new members of staff do not start work until a full CRB and appropriate references have been received. The Primary Care Trust commissions all the beds at this home as continuing care i.e. as an alternative to hospital. They are currently reviewing the overall service, in conjunction with the provider, manager and the Community Mental Health Team, who work with some of the service users. There is currently a dispute over how the needs of one service user should be met, and this was discussed in depth with the manager, as there is a potential risk to other service users. The Commission is satisfied that the home is currently doing all they can to both meet this service user’s needs and protect other service users, and to obtain more specialist in-put, such as psychology. The manager has been asked to keep the Commission informed about this situation. Under the previous manager this home has a history of taking all people who are referred, which has in the past meant that staff were not trained/equipped to meet needs. Since the new manager took up post in March 2005 a Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 20 comprehensive training programme has been put in place. This has included a three-day specialist dementia course, TOPPS induction, all staff either having or being enrolled on NVQ2, and some on NVQ3, and service user involvement. These Standards will be judged in more depth at the next inspection by discussion with staff. Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36, 37 & 38 The health, safety, and welfare of service users and staff are promoted and protected. Staff are still not receiving appropriate supervision. EVIDENCE: Records were checked and discussed with the manager. A sample of Health and Safety records was checked, including gas, electric, fire drill and testing, and kitchen and moving equipment. All were in order, and up-to-date. A requirement was brought forward from the previous inspection that care staff must receive supervision at least six times yearly. This has not yet been achieved, though the manager reported that sessions are to start next week. She explained that the delay had been in having to go back to basics in introducing the system to staff, due to their experience with the previous Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 22 manager. This is Requirement 5 brought forward from previous inspections. In recognition of the problems that the current manager inherited the Commission has set a new timescale for this to be achieved. At the next visit there must be evidence that some sessions have been carried out for each member of care staff, and that these, together with those booked, will result in this set of Standards being met. The manager provided evidence of the nurses attending clinical courses, to update their knowledge. In response to a Requirement set at the previous inspection a staff survey has recently been sent out. Some of the responses have been returned and these were looked at. As this is currently work in progress the full results will be examined at the next inspection. The manager has now been in post for six months, and has made significant improvements, several of which are still ‘work in progress’. The standards not assessed at this inspection will be fully assessed at the next visit, which will also be unannounced. Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 23 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 2 3 3 2 2 3 3 STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 2 3 3 Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? YES 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 OP11 Regulation 12 Requirement The Registered Manager must ensure that the wishes of service users in the event of dying and death are recorded in the care plans. The Registered Manager must ensure that there is a programme of activity to meet the needs of the service users. This must include opportunities for service users to use local community facilities. The programme of redecoration of bedrooms must be continued, including, where necessary, the replacement of floor covering. Brought forward from the previous inspection as the timescale set has not yet been reached. The Registered Manager must ensure that every effort is made to personalise each service user’s bedroom, so that it reflects their lifestyle, needs and preferences. All care staff must receive regular supervision at least six DS0000015587.V251194.R01.S.doc Timescale for action 30/11/05 2 OP13OP12 16 (2) (m) & (n) 31/12/05 3 OP19OP20 23 (2) (d) 31/12/05 4 OP23OP24 23 (2) 31/12/05 5 OP36 18 (2) 31/12/05 Cherry Orchard Nursing Home Version 5.0 Page 25 times a year. Previous timescale of 17/9/04 not met. 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.V251194.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cherry Orchard Nursing Home DS0000015587.V251194.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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