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Inspection on 24/01/06 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 24th January 2006.

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

The home is well managed, with a committed staff team, who have defined roles, and work effectively together. There is a welcoming atmosphere, and an increasing pleasant, and well-maintained, environment. Staff are knowledgably about, and work hard to meet, the needs of service users. Friends and relatives are encouraged to be involved in their loved ones` care, and the overall workings of the home. Nursing and care staff receive training specific to the needs of the people who live there.

What has improved since the last inspection?

The home, in particular the dementia unit, has continued to improve. There is a more homely and calm atmosphere than a year ago. Most parts of the building have now been redecorated, and service users` bedrooms have more of their personal possessions. All lounges now have new TVs, DVDs, and music centres, as well as many service users having this type of equipment in their own rooms. Some new chairs have been bought, which look less institutional, yet are comfortable for the service users. A group of care staff have gained a qualification in care, and others have just started this training. Some staff have also done a specialist course on dementia, and got excellent results in the test. They are to be congratulated.

What the care home could do better:

The major thing that this visit has identified is some problems with the medication practices. Records did not always match up with the amount of tablets that were in the medication trolley. The manager is going to look into this, and send a report to the Commission. There needs to be an increase in the number and types of social and leisure activities, both within the home, and in the community.

CARE HOMES FOR OLDER PEOPLE Cherry Orchard Nursing Home Dagenham Avenue Dagenham Essex RM9 6LG Lead Inspector Ms Edi O`Farrell Unannounced Inspection 10:55 24 January 2006 th 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.V278905.R01.S.doc Version 5.1 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.V278905.R01.S.doc Version 5.1 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.burroughs@careuk.com 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.V278905.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th September 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 it is set back from the 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. 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. 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.V278905.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This, unannounced, inspection took place on a weekday from mid morning to mid afternoon. It was the second statutory inspection visit in the inspection programme for 2005/6. Over the course of the two visits all core standards have now been assessed. Eight Requirements were set at the previous inspection and the registered person has complied with all of the required action. During a tour of the building, several service users, and one relative, were spoken to. Medication administration systems were checked on both units, and discussed with two nurses and the manager. Staff were observed, both directly and indirectly, and the activity programme was discussed with the coordinator. Staff supervision and meeting records were checked, along with the record of a recent relative’s meeting. What the service does well: What has improved since the last inspection? The home, in particular the dementia unit, has continued to improve. There is a more homely and calm atmosphere than a year ago. Most parts of the building have now been redecorated, and service users’ bedrooms have more of their personal possessions. All lounges now have new TVs, DVDs, and music centres, as well as many service users having this type of equipment in their own rooms. Some new chairs have been bought, which look less institutional, yet are comfortable for the service users. A group of care staff have gained a qualification in care, and others have just started this training. Some staff have also done a specialist course on dementia, and got excellent results in the test. They are to be congratulated. Cherry Orchard Nursing Home DS0000015587.V278905.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Cherry Orchard Nursing Home DS0000015587.V278905.R01.S.doc Version 5.1 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.V278905.R01.S.doc Version 5.1 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): None at this inspection These Standards were not tested on this visit. However evidence from the last inspection was that 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 of, 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 professionals who do so. Standard 6 does not apply to this home. EVIDENCE: The above Standards were not specifically tested on this visit, as there were no outstanding requirements. At the time of the last inspection, all of the Standards were assessed as met. These Standards will be re-tested at a future inspection. Cherry Orchard Nursing Home DS0000015587.V278905.R01.S.doc Version 5.1 Page 9 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): 9, 10 & 11 Service users are not fully protected by the home’s procedures for dealing with medication. Service users feel they are treated with respect, and their right to privacy is upheld. Service users’ wishes in relation to dying and death have now been documented, increasing the likelihood of they, and their families, being treated with care and sensitivity. EVIDENCE: Discrepancies were found on both units between stock received, held, and recorded as administered. One example was a bottle of Diazepam where seven tablets were unaccounted for. This must be investigated and a report forwarded to the Commission as a Regulation 37 notification with 28 days. This is Requirement 1, which was fully discussed with the manager during the inspection. A further problem was that the information on the bottle label did not fully match the prescription. Whilst both stated ‘when necessary’, the bottle stated this should be at night, whilst the script did not. The nurse was clear that Cherry Orchard Nursing Home DS0000015587.V278905.R01.S.doc Version 5.1 Page 10 when the dose is given it is only given at night. This discrepancy should have been noticed when the medication was being checked in. At that stage the dispensing pharmacist should have been contacted and agreement reached as to appropriate action, for example, that the nurse would correct the prescription. This should then have been recorded. This is Requirement 2. The fact that the discrepancy had not been noticed must mean that correct medication administration procedure is not always being followed. This is a basic procedure of checking the bottle label, with the prescription. This is Requirement 3. The above is one example only, but several other discrepancies were also found, the details of which were given to the manager during the visit. Due to their level of disability many of the service users are unable to give their views, but those who did felt that staff treat them well. This view was backed up by observation of staff and service user interaction, with staff demonstrating a high level of knowledge of service users’ needs and preferences. Life stories are currently being compiled with the input of service users wherever possible. The information they provide is pooled with that from relatives, and from the case files. Several of the sheets were looked at, and they demonstrate a wide variety of background and experiences. This type of approach is very important in helping staff to see each service user as a unique individual, rather than a ‘dementia case’. In response to a Requirement set at the previous inspection the wishes of service users in the event of dying and death have now been established. Whilst this has been a difficult process for relatives and staff it will make sure that these events are treated sensitively and with respect. Cherry Orchard Nursing Home DS0000015587.V278905.R01.S.doc Version 5.1 Page 11 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 Service users’ expectations and preferences are identified in their care plans, and the life story work is building up a real picture of each person. EVIDENCE: Since the last inspection a new activity co-ordinator has taken up post and the current programme was discussed with her during this visit. A record of both group and individual activities is kept, along with photographs of significant events, such as the Christmas party. Staff reported that most relatives had come to the party, and in the pictures on display it certainly looked like everyone had a very good time. Several service users went shopping up Dagenham Heathway just prior to Christmas. New Televisions, DVDs and music centres have been purchased, so now each lounge has these, as well as many service users having their own in their bedrooms. There are plans to increase both activities within the home, and in the community, and staff will be basing these on the information being collected for the life stories. It was noted in the last report that social and recreational activities are a challenge on both units for different reasons. In Castle Green many service users prefer to read, watch TV, listen to the radio, or do nothing. In Thames Ripple many of the service users have a very short attention span, and constantly wander. There is, however, a wealth of available information Cherry Orchard Nursing Home DS0000015587.V278905.R01.S.doc Version 5.1 Page 12 about creative ways of working with people with dementia and all staff need to continue to be committed to increasing the level of activities. This is Requirement 4. Cherry Orchard Nursing Home DS0000015587.V278905.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The judgement made at the last inspection was that the home takes complaints seriously and takes all possible steps to protect service users from abuse. EVIDENCE: These Standards were assessed in part at the last inspection when records were examined. There have been no complaints or potential abuse situations since the last inspection, so further examination was not possible. Staff have either already received adult protection training or are booked onto forthcoming events. Those spoken to were clear about their responsibilities to report any concerns. Cherry Orchard Nursing Home DS0000015587.V278905.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23 & 24 The environment continues to be improved by the programme of redecoration, and purchase of new equipment, and furniture. The use of the communal space in Thames Ripple is now being used more effectively to meet the needs of the service users. Bedrooms now reflect the personalities and interests of the service users. EVIDENCE: Over the past year there has been a vast improvement to the environment within the home, in particular on Thames Ripple. Bedrooms and communal areas have been redecorated, and new chairs purchased. There are new pictures on the corridor walls, and bedrooms are now more personalised. There is a much more homely feeling to this unit than previously. The two lounges continue to be used, and this has contributed to a quieter and calmer atmosphere. Cherry Orchard Nursing Home DS0000015587.V278905.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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 The numbers and skill mix of staff meet service users’ needs, and service users are in safe hands. Staff are trained and competent to do their jobs, but the refresher training in safe medication practices seems to be needed. EVIDENCE: Training and supervision records were examined, along with the staff rota. Staff were observed interacting with service users, and some were asked about care practices. The home has met the target for at least 50 of carers to achieve NVQ Level 2 by 31 December 2005. A further 13 carers have just started the course, with a target timescale of mid 2006 to achieve the award. Staff on Thames Ripple have also completed the Alzheimer’s Society three day course, Yesterday, Today, Tomorrow, and are all to be congratulated on their test scores. The medication administration discrepancies found indicate that some nurses need refresher training. This is Requirement 5. Cherry Orchard Nursing Home DS0000015587.V278905.R01.S.doc Version 5.1 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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): 31, 33, 35 & 36 Service users live in a home that has improved under the current manager, and is run in their best interests. Service users financial interests are safeguarded. A staff supervision programme is in place. EVIDENCE: Over the past year this home has shown continual improvement, which is evident in both the environment and atmosphere within the home. There has been greater attention to the mix of service users, and the effect that different types of behaviour can have on both other service users, and staff. Staff training has been given a high priority, and carers are being encouraged to gain new skills and knowledge by attending clinical sessions held by local health trusts. Cherry Orchard Nursing Home DS0000015587.V278905.R01.S.doc Version 5.1 Page 17 The manager has kept the Commission informed of events within the home, and demonstrated a commitment to considering the needs of current service users when new referrals are made. The company have sound audit tools, and are currently introducing new forms, which are even more comprehensive. A staff supervision programme has been started, and time is needed to see if this will meet the target of six sessions per year. This is Requirement 6. Cherry Orchard Nursing Home DS0000015587.V278905.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 3 X X STAFFING Standard No Score 27 3 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X X Cherry Orchard Nursing Home DS0000015587.V278905.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) & 37 Requirement Timescale for action 17/02/06 2 OP9 3 OP9 4 OP12 The Registered Manager must investigate the reasons for the discrepancy between the diazepam recorded as given and that remaining in the bottle. The outcome must be reported to CSCI as a Regulation 37 notification within 28 days of this inspection visit. 31/03/06 13 (2) The Registered Manager must ensure that all medication is checked against prescriptions when received from the pharmacist. Any discrepancies must be notified to the pharmacist and agreement reached as to appropriate action to rectify it. Detailed records of this type of contact must be maintained. 13 (2) The Registered Manager must 31/03/06 ensure that all nurses always follow correct procedure when administering medication. 12&16(2)( The Registered Manager must 31/03/06 m)&(n) ensure that the recreational and social needs of service users remains a high priority. In particular efforts continue to be DS0000015587.V278905.R01.S.doc Version 5.1 Cherry Orchard Nursing Home Page 20 5 OP30 18 6. OP36 18 (2) made to increase activities outside of the home. Following an audit of medication administration practice refresher training must be provided for nurses identified as needing it. The Registered Manager must be able to demonstrate that all care staff have received supervision at least six times a year. 30/04/06 31/08/06 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.V278905.R01.S.doc Version 5.1 Page 21 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.V278905.R01.S.doc Version 5.1 Page 22 - 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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