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Inspection on 09/01/07 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 9th January 2007.

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

What has improved since the last inspection?

What the care home could do better:

Carpets throughout the home are being cleaned on a regular basis but are showing signs of wear and tear. Stains are now impossible to remove in some areas and the offensive odour outside the nurse`s office appears to be comingfrom the carpet. The organisation must give urgent consideration to implementing a programme of carpet replacement in the immediate future. Some of the armchair`s covers are worn and the small settee and some of the reclining armchairs are to low for frail older people and could be a health and safety issue for staff. These need to be replaced with more appropriate seating. Some of the residents are extremely frail and bed bound, this makes it very difficult for staff to monitor their weight. It would be beneficial for the residents and staff to be able to weigh the residents on wheelchair weighing scales. Where a resident has a "challenging" behaviour the manager must ensure that the care plan shows the required strategies necessary for staff to implement, which will assist in minimising such behaviours. Record logs are carried out at least twice a day as well as significent events, however these recordings should be influencing the care plans and any change should be recorded on to the care plan and details of how this change is to be met. Life histories for each resident should be developed, but these can only be done with the involvement of the resident, their relatives, friends and staff who know them well. It is extremely important for people living with dementia to have family photographs and other mementoes with them as they play an important part in their reminiscence activities. The more that staff know about each resident the better able they are to relate to him/her as an equal in the journey through dementia. The acting manager and senior staff would benefit from training on the Mental Capacity Act 2005 and the newly appointed senior care staff would benefit from attending a supervisor`s training course.

CARE HOMES FOR OLDER PEOPLE Cherry Orchard Nursing Home Dagenham Avenue Dagenham Essex RM9 6LG Lead Inspector Julie Legg Key Unannounced Inspection 9th January 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.V326134.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.V326134.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 www.careuk.com Care UK Community Partnerships Limited *** Post Vacant *** 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.V326134.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two (2) places can be used to accommodate service users, with dementia, aged 61 and over but under 65 years. 25th September 2006 Date of last inspection 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. 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 conservatory. Thames/ Ripple comprises of two corridors, connected by a large dining room. Each corridor has 14 bedrooms, and a lounge, bathroom, toilets and shower. One of the lounges leads into a 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 and the palliative care team are involved in the provision of care. All areas of the home 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. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 5 A resident or relative/representative could ask for his or her own copy, which the manager would make available. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took pace over a day. Julie Legg the lead inspector was accompanied by another inspector Sandra Parnell-Hopkinson. The evidence for this inspection has been gained by a tour of the home, discussions with the acting manager, the senior nurse in charge and other members of staff. A number of staff and residents’ records were examined and staff were directly and indirectly observed providing care. Health professionals who visit the home were contacted, as were relatives, whose opinions on the care given were sought. Since the last inspection in September 2006 there has been a very marked improvement in the quality of the care being delivered to those residents with dementia. Staff attitudes and interaction with the residents, meal times, signage and décor and care plans have all improved. This has been due to the hard work and commitment of both the management and the staff at Cherry Orchard nursing home. The inspectors were able to talk to some residents, staff, visiting clergy and a health professional during the inspection. The visiting clergyman said how much the home had improved over the past few months and that he will now be visiting the home on a weekly basis, at different times, so that he can meet with and talk to relatives as well as residents and staff. The health professional was attending a meeting with the acting manager to discuss the Department of Health’s national strategy around preferred place of care and end of life matters and how the staff had recently dealt with the death of a resident. The family of this resident had written a letter of thanks and gratitude to the manager. In discussions with the acting manager and some staff it was evident that they are very aware of equality and diversity issues and were clear that these were addressed at the home. Currently with one exception, residents are white British and generally of the Christian faith. However, one resident is from an ethnic minority and the care plan reflects both cultural and religious needs. The manager will be discussing with the family the need to make contact with a local mosque if visits are required. Staff training includes equality and diversity training. All of the comments received from residents, relatives and health professionals were extremely complimentary and all recognised the improvements that have been made at Cherry Orchard during the past six months. Comment from one health professional said, “We were all working together for the good of the resident, that is what good care is all about”. Residents’ comments were “they are all kind”; “the girls look after me”. Relatives’ comments were “I am very Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 7 happy with the care my wife receives”, “the staff are very caring”, “we have noticed a big improvement in the home”. What the service does well: What has improved since the last inspection? The acting manager and her staff have worked extremely hard in improving the care plans, which are now more comprehensive, and all staff were observed to treat residents with kindness, respect and there was also positive interactions between residents and staff. Because of the frailty of some of the residents, the acting manager has rearranged the accommodation and the use of the lounge areas. This has resulted in a drastic reduction in the number of falls sustained by residents, for example one month the falls had reduced to 4 as opposed to a previous month of 15. The acting manager is in consultation with the clinical psychologist around suitable signage and décor for those units accommodating people living with Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 8 dementia. Improvements have already been implemented such as, appropriate colour schemes, touch and feel materials on the walls, memory boxes on the outside of bedrooms to aid recognition of rooms by residents. The handyman has been working extremely hard on the redecoration programme. Ripple unit has been redecorated and work will shortly commence on redecorating Thames. The gate across the enclosed rear garden has been replaced and the handyman has planted some evergreen shrubs in the flowerbeds, which has improved the outlook for residents. It was possible to observe lunch being served and again this was much more congenial for the residents. Mealtimes have been slightly staggered so that those residents requiring a pureed diet are served first. This has given staff more time to ensure that the other residents can be given appropriate assistance with eating and drinking. The atmosphere at lunch was much calmer and residents were observed being encouraged to make choices between the meals offered and to eat and drink in a very interactive and positive manner. The acting manager and the chef have agreed an action plan for the development of pictorial menus. Staff have undertaken further training in dementia care and adult protection. The general cleanliness of the home has improved and there were no offensive odours on the units occupied by the residents. However, the area outside of the nurses’ office did have a slight odour and this was probably due to the carpet, this is being cleaned on a regular basis but is now quite old. Pillows and bedrail bumpers have been replaced, as have some of the armchairs. New curtains and duvet covers have also been purchased. It was very evident from observation and discussions with staff and the residents that the home is now operating for the benefit of the residents. Every effort is made to retain the independence of those living with dementia and for them to continue to exercise choice and control over their lives. The routines of daily living are flexible and varied to the individual needs and capacities of residents, together with their religious and social preferences. The acting manager and staff are to be commended on their hard work and commitment in achieving such improvements in a comparatively short space of time. The residents of Cherry Orchard are now benefiting from a quality service. What they could do better: Carpets throughout the home are being cleaned on a regular basis but are showing signs of wear and tear. Stains are now impossible to remove in some areas and the offensive odour outside the nurse’s office appears to be coming Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 9 from the carpet. The organisation must give urgent consideration to implementing a programme of carpet replacement in the immediate future. Some of the armchair’s covers are worn and the small settee and some of the reclining armchairs are to low for frail older people and could be a health and safety issue for staff. These need to be replaced with more appropriate seating. Some of the residents are extremely frail and bed bound, this makes it very difficult for staff to monitor their weight. It would be beneficial for the residents and staff to be able to weigh the residents on wheelchair weighing scales. Where a resident has a “challenging” behaviour the manager must ensure that the care plan shows the required strategies necessary for staff to implement, which will assist in minimising such behaviours. Record logs are carried out at least twice a day as well as significent events, however these recordings should be influencing the care plans and any change should be recorded on to the care plan and details of how this change is to be met. Life histories for each resident should be developed, but these can only be done with the involvement of the resident, their relatives, friends and staff who know them well. It is extremely important for people living with dementia to have family photographs and other mementoes with them as they play an important part in their reminiscence activities. The more that staff know about each resident the better able they are to relate to him/her as an equal in the journey through dementia. The acting manager and senior staff would benefit from training on the Mental Capacity Act 2005 and the newly appointed senior care staff would benefit from attending a supervisor’s training course. 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.V326134.R01.S.doc Version 5.2 Page 10 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.V326134.R01.S.doc Version 5.2 Page 11 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): 1,2,3,5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users, or their relatives, have the information needed to enable them to decide if they want to live at Cherry Orchard. An assessment is undertaken which is comprehensive; this ensures that all of the residents’ needs can be met. The statement of purpose and service user guide is made available to all residents and their relatives and prospective residents are invited to visit the home prior to admission, but in practice it is often the relatives who do so. Most of the residents now have a written contract/statement of terms and conditions so that they are aware of such things as notice periods, details of funding, and what fees cover and what services are additional to the fees. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 12 EVIDENCE: The Care Home regulations 2001 have been amended with effect from 1st September 2006 for new residents and for existing residents with effect from 1st October 2006 so that more comprehensive information is to be included in the service user’s guide. Details of information to be included are contained with the amended regulations which can be obtained from the Commission’s website www.csci.org.uk When case tracking residents’ files it was evident that some now contain a copy of the statement of terms and conditions. The administrator is in the process of ensuring that all residents have an updated copy of the statement of the terms and conditions. This was a previous Requirement that is now met. Barking & Dagenham Primary Care Trust funds all of the residents, and services are commissioned at Cherry Orchard under a ‘block contract’. THAMES/RIPPLE It was evident from case tracking two new residents that a pre-admission assessment is undertaken for all prospective residents and that care plans are drawn up using this assessment. More detailed and comprehensive assessments are now undertaken around a person’s existing abilities with regard to ordinary activities of daily life and life histories. This was a previous Requirement that is now met. This information is then incorporated into the care plans to enable the staff to provide the right level of care, in all aspects, to assist the residents to continue to live as full a life as is possible, and for as long as possible. The service is endeavouring to provide information in a format that can be more easily understood by people living with dementia. The inspectors were satisfied that an assessment of need is undertaken prior to residents moving into the home and that the registered person is able to demonstrate the home’s capacity to meet their needs, and were also satisfied that staff individually and collectively have the skills and experience to deliver the service and care to people living with dementia which the home offers to provide. This was a previous requirement that is now met. Relatives that were spoken to told the inspector that they was able to visit the home prior to their relative’s admission and that they was able to discuss their relatives’ care needs with the acting manager/senior nurse. One relative stated Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 13 “I was very upset but Violet (acting manager) was so supportive”, another relative stated “The manager and staff made me and my wife very welcome”. CASTLE GREEN A pre-admission assessment is undertaken for all prospective residents and care plans and risk assessments are drawn up using this assessment. The inspectors were satisfied that the registered person was able to demonstrate the home’s capacity to meet the needs of older people with mental health problems, and were satisfied that staff individually and collectively have the skills and experience to deliver the service which the home offers to provide. The home does not provide intermediate care. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 14 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 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Most of the health and personal care needs for residents on both units are set out in individual care plans, however all health needs including “challenging” behaviour and strategies to deal with this are required to minimise such behaviours, which will ensure the safety of residents and staff. Both manual and computer systems are up to date most of the time but any significent changes that are recorded need to be incorporated into the residents care plan to ensure that residents’ needs are being met. All residents have detailed risk assessments; this ensures the health and safety of the residents. The home’s policies and procedures for dealing with medicines ensure that residents are protected and their health needs are met. Residents are treated with respect and their right to privacy is always upheld. Residents have end of life care plans, therefore their wishes in relation to death and dying are clearly identified. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 15 EVIDENCE: Ripple/Thames The files of 4 residents were inspected. All had a comprehensive assessment from which a comprehensive care plan has been produced, which has been recorded on the Saturn system. Care Plans are now regularly reviewed on a monthly basis, or more frequently if necessary, and have been updated to reflect changing needs and current objectives for health and personal care. However, where a resident has a “challenging” behaviour the manager must ensure that the care plan shows the required strategies necessary for staff to implement to minimise such behaviours. This is Requirement 1. It was evident that, as far as is possible, residents and/or their relatives are involved in the drawing up and reviewing of their care plan. Record logs are carried out at least twice a day as well as significent events, however these recordings should be influencing the care plans and any change should be recorded on to the care plan and details of how this change is to be met. This is Requirement 2. Residents are now being encouraged to remain as independent as is possible, and where they are able residents are being assisted rather than doing it for them in undertaking personal and oral hygiene on a daily basis. This can be very time consuming for the care workers and those residents living with dementia, which is why it is essential that there is always sufficient staff time allocated to this. This is a fact that is appreciated by the acting manager and her senior team. Staff must continue to be aware of the importance of listening to what the resident is saying, and getting to know the meaning of words and phrases used by an individual resident. Also it is important that residents are not hurried. Staff did ensure that residents who required aids such as hearing aids, glasses and dentures were provided. As with the production of menus in pictorial format, so the acting manager may wish to give consideration to producing daily living tasks in a pictorial format, as this may assist in the continued independence of the person living with dementia. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 16 There was evidence that continence programmes were included in the care plan, and staff were more 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. Advice is sought from the tissue viability nurse whenever necessary. The acting manager has a close working relationship with the health professionals at Mascalls Park and staff can access professional advice as necessary. All residents are registered with a GP, and also have the services of an optician, dentist and chiropodist. All aids such as spectacles, hearing aids and dentures are marked with the name or initials of the owner. Nutritional screening is undertaken on admission but on a more frequent basis if the health needs of the resident indicate this. Appropriate action is taken if necessary with the involvement of the GP, nutritionist or dietician. All residents are weighed monthly, though this has some practical problems for those residents that are bed bound to access the scales. (see standard 22) Any increase/decrease in weight is now monitored, together with the actual daily diet of each resident. This was a previous Requirement that is now met. Residents are never sent to hospital or to attend appointments outside of the home without being accompanied. Wherever possible family and friends are encouraged to support these appointments, but where this is not possible then a member of staff will accompany the resident. In discussions with the acting manager she demonstrated an awareness that some behaviours in residents living with dementia, such as refusing food, quiet rocking, or really challenging behaviour, could be due to an individual experiencing pain, or other discomforts. Therefore, she was very well aware of the need to exclude this when trying to understand what residents were trying to express through their behaviour. There were clear medication policies and procedures for staff to follow, and only the nurses are responsible for giving medication. A review of the medication records showed that the policies and procedures were being followed and the inspector was satisfied that residents were safeguarded with regard to their medication. The actual application of cream is now being recorded onto the medication administration records. This was a previous Requirement that is now met. The acting manager was undertaking weekly audits of medication and records but because of the improvements made by the nurses she has been able to reduce her medication audits to monthly. Nurses and care staff monitor the condition of residents on medication and if there are any concerns, they will call in the G.P. Currently there are no service users who are able to selfmedicate on either Ripple or Thames unit. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 17 Staff were observed to knock on a bedroom door before entering, and obviously had a good knowledge and understanding of the needs of residents with regards to what they preferred to be called. Staff were seen to treat residents with respect, understanding and kindness. One member of staff was seen talking to a resident, who was distressed in a calm and kindly manner trying to ascertain why she was upset. A relative stated “they have so much patience with Mum, they never loose their cool”, another relative stated, “my mum has settled really well and she is more alert that when she was in the other home”. This was a previous Requirement that is now met. One resident use to be seated in his bedroom on a lounge chair, which was placed on a dustsheet, this was because of his eating habits. This dustsheet has been removed and replaced with an appropriate rug and his furniture has been changed around so that he can now see people walking past his bedroom. The resident seemed far happier and spoke to the inspectors. During discussions with some staff it was very evident that they enjoyed working with people living with dementia, although some said that this could also be very stressful. The needs of all residents have been reviewed and this has resulted in some residents being moved between Ripple and Thames. This has been very beneficial to all residents as now the frailer residents are together, and the more mobile are together. This has had the effect of reducing the number of falls from 15 in one month to 4 in the last month. A relative stated “Mum seems more content since she moved onto the other unit”. From viewing the care plans and talking to the acting manager and some staff, the inspector was satisfied that residents who may be dying, are treated with care and dignity, and the necessary religious rites observed where appropriate. The acting manager and her staff are now developing preferred place of care plans in line with the Department of Health guidance. This was a previous Requirement that is now met. Recently a resident’s family made the decision to not send a dying resident to hospital, and the care of this resident was handled in a very thoughtful, kind and caring way. The appropriate health professionals, such as the palliative care nurse, the GP, the tissue viability nurse and a local hospice were involved. Two of the health professionals stated that they were happy with the actions taken by the manager and staff to allow the resident to die in a caring way. The family were extremely grateful for the care given to both the resident and themselves, and the manager had received a letter of thanks from the family. Staff found this situation both rewarding but also quite draining, and they may benefit from some additional training in this area. The acting manager was also very aware of the need to increase staffing levels at such times, to ensure that the needs of all residents could still be met without putting additional pressure on the staff. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 18 CASTLE GREEN Residents’ assessments were found to be comprehensive. Where necessary risk assessments were in place and the health care needs were being met with weight and dietary monitoring in place. There is good liaison with health professionals around the mental health needs of the residents on this unit, and a consultant visits on a regular basis. Residents are seen by a GP when necessary, and either sees a visiting dentist, optician or chiropodist in the home, or are taken to the necessary surgery or clinic. Residents were dressed appropriately, one resident was in a smart trouser suit and another was in jogging bottoms and a tee shirt. Residents appeared very relaxed with good interaction between themselves and the care workers. Some residents were reading newspapers, some watching the television and others were chatting. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An activity co-ordinator has been recruited and she is taking the lead in the delivery of activities. These activities are now more tailored to meet the individual needs of residents. There is a choice of meals, which are well presented and mealtimes are more flexible to maintain independence and exercise choice around food and eating. More choice could be achieved if menus were in pictorial format. The dining room now provides a congenial setting for residents to sit and eat their meal. Residents are helped to exercise choice and control over their lives, which enables them to retain as much independence as is possible. 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 family and friends as they wish. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 20 EVIDENCE: THAMES/ RIPPLE There is a general programme of activities available for all residents, and these include sing-along, board games, bingo, drawing, quizzes and visiting entertainers. A new activities co-ordinator has been employed and she will be continuing the very positive work begun by her predecessor (who had only been in post for a short while). It is also essential that all staff appreciate that activities are the remit of all as just sitting and talking to someone with dementia is an important and worthwhile activity. Residents living with dementia have a very short concentration span and this does make the organising of activities very difficult. All residents have had an activity profile completed and this is providing guidance on the appropriate level of activity for each individual. This was a previous Requirement that is now met. It is recommended that life histories for each resident should be developed, but these can only be done with the involvement of the resident, their relatives, friends and staff who know them well. It is extremely important for people living with dementia to have family photographs and other mementoes with them as they play an important part in their reminiscence activities. The more that staff know about each resident the better able they are to relate to him/her as an equal in the journey through dementia. This is Recommendation 1. Staff do give great consideration and time to the retention of an individual’s daily living skills, and the task of assisting a resident living with dementia in washing and dressing can be very time consuming. Some residents may like to dust, help clear the tables, and fold napkins and should be encouraged to do this. Others may wish to help in the garden, when the weather improves, with planting plants or bulbs into tubs or raised flowerbeds, staff should actively pursue these activities during the warmer weather. The acting manager now ensures that staff are given the time to sit and talk to residents on a small group or individual basis, and the further development of the life histories will help in this area. The inspector was able to observe that residents felt able to speak to staff, and that staff did not ignore them. Activity resources are available, and it is recommended that these be left out during the day so that residents can “dip in and dip out” as they wish, as the organising of a designated time can prove to be very difficult for those residents with dementia. This is Recommendation 2. There are now regular visits by local clergy and if any resident wishes to attend a religious service outside of the home then this would be arranged. Other annual festivals are celebrated and these include the birthdays of residents. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 21 Some residents were able to say that they had enjoyed the Christmas celebrations, and that staff were very kind. Mealtimes are now more flexible and have been slightly staggered so that those residents requiring a pureed diet are served first. This has given staff more time to ensure that the other residents can be given appropriate assistance with eating and drinking. One relative stated, “they have changed the meal times and the staff now appear to have more time to sit and encourage my dad to eat”. Four meals per day are served and these are: • • • • Breakfast 7.0 a.m. and 09.30 a.m. Lunch – between 12.45 and 1.45p.m. Tea – between 4.45 p.m. and 5.45 p.m. Supper – from about 8p.m. Drinks and snacks are freely available between these times, and during the night. A member of staff stated, “residents can always have a snack, either a sandwich, a piece of fruit or a cake”. Lunch was observed being served, the meals were nicely presented and residents were not being hurried. A choice was being offered to residents, and they were able to make a decision at the time of the meal. Sufficient staff were on hand to give assistance where required, and any assistance was being given in a positive and caring manner. This was a previous Requirement that is now met. Menus were viewed and these give a choice for residents, but there are also other choices available if neither of the main dishes are liked. Menus are going to be produced in pictorial format to aid choice. On the day of the inspection the cook was off duty, but staff assisting in the kitchen were well aware of the recorded dietary and cultural needs of each resident. The acting manager and care staff were also very aware of the importance of providing “finger” foods where residents are experiencing difficulty in using cutlery. The dining room tables now have tablecloths and the manager is exploring other avenues with the clinical psychologist to enhance the atmosphere of the dining room. It was apparent from observation and talking to some residents and staff, that residents can choose when to get up and go to bed. Contact with family and friends, and the local community, are encouraged and periodic residents/relatives meetings are held. All of the relatives that were contacted said that they are always made to feel welcome. One relative stated, “I visit at all different times and I am always offered a drink”. It was obvious during the inspection that the acting manager and her staff are very aware that Cherry Orchard is the home of the residents and they are trying to make this as appealing as is possible. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 22 The acting manager and staff were also very 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 possible. The acting manager also ensures that the rights of all residents are recognised and addressed and balances the needs of all with the needs of individuals. Appropriate signage and décor is now being put into place to aid the orientation of residents living with dementia. Also pictures around the home are now more in keeping with the memories of residents, which are pictures of the local areas as they used to be. CASTLE GREEN Meals on this unit were taken in congenial surroundings with the tables being nicely laid and each had a vase of flowers. Service users can make choices and are encouraged to do so. The employment of an activities co-ordinator has meant that residents will have a programme of general activities. However, residents on this unit are more able and staff do ensure that they are engaged in some daily activities, such as visiting a local shop, reading, music and games therefore the activities co-ordinator is initially concentrating on the activities on Thames/Ripple units. As previously stated the provision of activities should not just be left to an activities co-ordinator. This person may take the lead and organise “whole” home events such as external entertainers or day trips, but care workers must recognise the very important part that they play in the day-to-day life and activities of residents. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 23 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s complaints policy and procedure provides residents and their relatives with the appropriate information to ensure that formal complaints are dealt with promptly. However, not all of the residents would be able to use the formal written process and a complaints form in a format accessible for people living with dementia would be beneficial. Staff have received training in Adult Protection/Abuse Awareness. However the manager must ensure that the policies and procedures are adhered to at all times and that any risks identified are dealt with through risk management and not restraint. EVIDENCE: The inspector was able to speak with relatives who felt confident that they knew who to complain to and that they would be listened to. Residents living on Castle Green where asked, “If you wanted to make a complaint, who would you speak to?” Some residents said they would tell the manager and others said they would tell their family. However, there was no Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 24 evidence available that the complaints form is in a format accessible for people living with dementia i.e. pictorial format. This is a Requirement that has not been met and has been set with a new timescale. This is Requirement 3. Complaints are recorded together with the actions taken as was evidenced from viewing the complaints log, and in discussions with the manager she viewed complaints in a positive way. There have been no complaints recorded since the last inspection. One relative said, “I don’t have any complaints but if I did I would speak to Violet (acting manager)”. Another relative did raise a concern with the inspector but said she would be speaking to Violet on her next visit. Staff that spoken to during the inspection were aware of the action to be taken if there were concerns about the welfare and safety of residents, and they had received training in adult protection. The rights of all residents must be protected at all times. The use of restraints must be through a risk management process and when restraints are used this must be recorded and the reasons why. During the previous inspection it was observed that a child safety gate was in place across the bedroom doorway of one resident. The relative had requested that this be put in place, as he was concerned as to the safety of his relative when he was not visiting. The child safety gate has been removed, the acting manager has rearranged accommodation and the use of the lounge areas, so that residents who are frail are in one part of the unit and staffing levels have also been rearranged to ensure the safety of all the residents. The relative is satisfied with these arrangements. This was a previous Requirement that is now met. As stated in the past inspection report the introduction of the Mental Capacity Act 2005 in April 2007 will have implications for providing services for people living with dementia and mental health issues, all managers will need to familiarise themselves with its contents. It is a recommendation that the acting manager undertakes some training in this area, as people living with dementia and mental health issues will be directly affected. This is Recommendation 3. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 25 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is welcoming, comfortable, clean and hygienic, but does not provide all of the residents with a safe, well-maintained environment. There are sufficient and suitable toilets and bathrooms for the number of residents. Not all of the residents have the appropriate specialist equipment they require this could compromise theirs and staff’s safety. Residents’ bedrooms meet their needs and are furnished with their own personal possessions. EVIDENCE: Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 26 GENERAL A visit was made to both the kitchen and laundry, which were both maintained to a good standard. The kitchen area was inspected and this was found to be clean with foods being stored and labelled appropriately. The laundry area was also visited and again this was found to be clean with the laundress being aware of the need to take precautions were necessary i.e. using protective clothing and the storing of hazardous substances. THAMES/ RIPPLE A tour of the premises was undertaken and the home was found to be well lit, clean, pleasant and hygienic with no offensive odours except in the area outside of the nurse’s office. Specialist equipment such as hoists, handrails, adjustable beds and adjustable reclining chairs were evident, however the reclining chairs are very low and the organisation needs to be mindful of residents but in particular staff injuring their backs. As stated earlier in the report all residents are weighed monthly but this is a difficult task for residents who are bed bound. The organisation should look at purchasing wheelchair- weighing scales. The home must have the specialist equipment it requires to meet the health needs of the residents. This is Requirement 4. All of the bedrooms are single with en suite, and have been fitted with an emergency alarm, which is within easy reach of each resident’s bed. Most of the bedrooms have now been personalised with televisions, radios, photographs and ornaments. Some of the bedrooms have been redecorated and refurbished with new duvet covers and curtains. The bedroom that had no curtains has been fitted with new ones and new pillows and bedrail bumpers have also been obtained. This was a previous Requirement that has now been met. There is a mixture of suitable baths and showers, which gives a resident choice. At the previous inspection there was an offensive odour coming from one of the shower drains, this has now been rectified. This was a previous Requirement that has now been met. The toilet doorframes are being painted in a different colour with appropriate signage to aid orientation for people living with dementia. All of the toilets were equipped with toilet paper, towels and soap, and hot water was plentiful. The acting manager and staff are proactive around infection control and staff have undertaken training in this important area. The acting manager is continuing to find appropriate pictures and photographs for display in the corridors and sitting areas to provide points of interest for Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 27 residents. Also on Thames unit touch and feel materials have been fixed to the walls of the corridor. Work has also commenced in fixing memory boxes to the outside of the individual bedrooms, and these contain items and photographs, which are familiar to the occupier. The manager has her own memory box outside her office. A relative stated, “I really like the idea of the materials fixed to the walls, my mum really enjoys touching them as she walks along”. The lounges have had some of their armchairs replaced; however there are still some that need to be replaced as the vinyl is worn and there is also a small settee, which is too low for elderly frail people and this could cause an injury to a resident or a member of staff. All of the furniture should be fit for the purpose. This is Requirement 5. The lounge on Ripple unit has been redecorated and is awaiting new curtains. The conservatory was being repainted during the inspection. Plans are in place for the lounge, bedrooms and corridor on Thames to be redecorated. The dining room is very large, but the use of tablecloths and the re-varnishing of the dining room chairs have improved the ambience of this area and the acting manager and the staff are continuing to explore options for further improvement. The rear garden area is laid to paving and flower beds and has sitting areas for residents and also has disabled access from the two units. New evergreen shrubs have been planted in the raised flowerbeds and a new gate has been put across the enclosed garden, which makes this safer for residents who wish to walk outside. This was a previous Requirement that has now been met. There is an ongoing programme of redecoration and refurbishment, and this must now include the need for the carpets in the home to be replaced as they are stained and as stated previously there is an offensive odour, which appears to be coming from the carpet outside the nurse’s office. No amount of cleaning is able to remove the stains or odour, as the carpets are quite old. In the short term it would be beneficial if the home had a second carpet shampooer to assist with this task. However there also needs to be a programme put in place for the replacement of all the carpets. This is Requirement 6. CASTLE GREEN This unit was nicely furnished with appropriate pictures. Bedrooms had been personalised and there were no unpleasant odours. The lounge and dining areas were nicely decorated and furnished and the atmosphere was very homely and calm. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 28 Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 29 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,and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are currently satisfactory and there were sufficient staff on duty to meet the needs of the residents. Staff have received training to ensure that they are equipped with skills and knowledge necessary to ensure the safety of residents. The home has a clear recruitment policy and procedure and appropriate checks are undertaken, which ensure the protection of residents. EVIDENCE: The home has clear recruitment policies and procedures. Personnel files of recently employed staff were viewed and it was evident that the organisation’s recruitment processes are robust. Evidence was found that two references are taken up and that Criminal Records Bureau disclosures are obtained and that an initial check is made against the Protection of Vulnerable Adults list prior to a member of staff commencing employment. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 30 All new care staff undertake an induction programme that covers areas such as, principals of care, health & safety, adult protection, emergency first aid, communication and role of the organisation. In addition to qualified nurses and care staff, the home employs an activity coordinator, catering, laundry, domestic, maintenance and administrative staff. At the time of the inspection there were sufficient staff on duty to meet the needs of all of the residents and staff rotas that were examined correlated with the number of staff on duty. Thames/Ripple The acting manager has recently employed two senior carers (these are new posts), who will take the lead and supervision of the care staff; neither member of staff have undertaking a supervisor’s role before. It is a recommendation that these staff attend a supervisor’s training course. This is Recommendation 3. As stated earlier in the report, because of the frailty of some of the residents, the acting manager has rearranged the accommodation and the use of the lounges. To accommodate this change she has rearranged the staffing in Thames/Ripple to ensure the needs of the residents are met. There are two nurses on duty a.m. and one nurse on duty p.m. Ripple unit has the more frail residents and are cared for by four care staff, Thames unit has residents who are more physically able but whose behaviour can at times be ‘challenging’ and these residents are cared for by two care staff. However, these rotas are not rigid and staff were seen going from one unit to another. The activities coordinator also spends a considerable amount of her time on Thames unit. It would be advisable for the manager to monitor these new rotas closely to ensure that the residents’ needs are being met at all times. This will be discussed with the acting manager at the next inspection. Three of the nurses will also be undertaking further intensive training and will be taking the lead in their specialist subjects: dementia, palliative care and management. One of the nurses has acquired her Registered Manager’s Award, another nurse has achieved NVQ 4 in management and another nurse is applying for training for the NVQ 4. Care staff are now being supported and enabled to develop the skills, knowledge and abilities required to successfully enable residents to continue to exercise choice in their daily lives and reach their full potential for as long as is possible. Training is available for all staff and recent areas covered are; manual handling, fire safety, first aid, health & safety, dementia awareness, service user involvement, care planning and personal development. More than 50 of the care workers have obtained their NVQ2. Further training has been arranged in dementia mapping and palliative care. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 31 CASTLE GREEN Staff on this unit have also undertaken training in health & safety, adult protection, first aid and training appropriate to mental health issues. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 32 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): 31,33,35,36,37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is run in their best interests by an experienced and qualified manager. Residents’ financial interests are safeguarded by the policy and procedures of the home. Staff are appropriately supervised and the health, safety and welfare of service users and staff are promoted and protected. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 33 EVIDENCE: The acting manager has applied to the Commission to become the registered manager. She has previous experience in providing care services and her previous post was as a deputy manager. She has recently attained the diploma level 5 in Management of Care and is a member of the Chartered Management Institute. The acting manager and the organisation are keen to work in collaboration with external agencies and the Commission. The inspectors had met with the acting manager and the service manager after the last inspection to discuss the Commission’s concern regarding the care being provided at Cherry Orchard. Both stated they were committed to improving the standard of care and provided the Commission with a very detailed improvement plan. It was evident during this inspection that the home is now being very well managed and due to her leadership and the hard work of all the staff, the residents are now being provided with a high quality service. One relative stated, “The manager is well on her way to making a good home”. Another comment was “I am very confident in the new manager”. Some of the staff were asked as to whether they felt the manager had made a difference in the six months she has been in post. Comments received were “she is brilliant and I look forward to coming to work now”, “The manager is great and has made some really good changes”, “it has been hard work but it has been worth it”. In discussions with the staff they said that the management style is open and inclusive and that they receive regular supervision. Supervision is undertaken by 1:1 sessions, direct observation of care practices, annual appraisals and group team meetings, and this was evidenced from viewing the staff files and records. This was a previous Requirement that is now met. Through staff training, supervision and good management, staff are ensuring that residents receive a high standard of care and that the home is run in their best interests. Relatives’ comments were “the carers are very good”, “the girls do my mum proud”. Maintenance records including fire safety, fire alarm testing, insurance, lift maintenance, electrical and gas checks, boiler, central heating systems and water temperatures were viewed and found to be up to date and in good order. PAT testing is also carried out annually. The acting manager ensures that policies and procedures are reviewed on a regular basis and that she keeps up to date with new and changing legislation. Spot checks and quality monitoring systems provide management evidence Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 34 that practice reflects the homes policies and procedures. Unannounced visits are made by the manager during the night and at weekends to ensure that the care being delivered at other times is also consistent with the ethos, policies and procedures of the home. The responsible individual regularly undertakes the regulation 26 monthly monitoring visits which are unannounced and are now more comprehensive covering both the good areas and areas for improvement. This was a previous requirement that is now met. The acting manager is looking to undertake quality assurance questionnaires with staff, health professionals, relatives and residents. Relatives/residents meetings and uses the information gained to make any improvements or changes in the service delivery. Information gained from complaints, concerns and compliments are also used to influence service delivery. The health and safety of both residents and staff is a high priority and the acting manager ensures safe working practices by way of training and the provision of any necessary equipment, together with appropriate risk assessments which are regularly reviewed. Currently the acting manager does not act as an appointed agent for any resident. Residents’ financial affairs are managed by their relatives/ representatives. The home has responsibility for the personal allowance of several residents, which is usually managed by the home’s administrator. Through discussion with the acting manager and records inspected, there was evidence to show that residents’ financial interests are safeguarded in line with the organisations policies/ procedures. Secure facilities are provided for the safekeeping of money and valuables held on behalf of residents. Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 35 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 3 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 3 2 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 3 Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 36 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 OP7 Regulation 15(2) Requirement Care plans must be more detailed and more information on people’s dementia needs in particular behaviour that ‘challenges’. All records within the home must be kept up to date. Previous timescale of 31/12/06 not met. The complaints format must be accessible to people who are living with dementia. Previous timescale of 31/12/06 not met. Residents must have access to specialist equipment to meet their assessed needs. The registered persons must ensure that the furniture in the home, particularly the chairs and settee must be suitable and fit for the purpose. The registered persons must put in place a programme to replace the home’s carpets. Timescale for action 31/01/07 2 OP8 17(3) 30/04/07 3 OP16 22 31/03/07 4 5 OP22 OP25 23 23 31/03/07 31/03/07 6 OP25 23 30/04/07 Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 37 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations It is recommended that life storybooks be developed for each resident. It is extremely important for people living with dementia to have family photographs and other mementoes with them as they play an important part in their reminiscence activities. It is recommended that activity resources are left out during the day so that residents can “dip in and dip out” as they wish, as the organising of a designated time can prove to be very difficult for those residents with dementia. The manager and senior staff would benefit from training on the Mental Capacity Act 2005 The newly appointed senior carers would benefit from attending a supervisor’s training course 2 OP12 3 4 OP18 OP30 Cherry Orchard Nursing Home DS0000015587.V326134.R01.S.doc Version 5.2 Page 38 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.V326134.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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