Inspection on 04/05/05 for Orchard Avenue 10

This inspection was carried out on 4th May 2005.

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.

Other inspections for this house

Orchard Avenue 10 05/06/08

Orchard Avenue 10 16/04/07

Orchard Avenue 10 22/11/06

Orchard Avenue 10 05/04/06

Orchard Avenue 10 08/09/05

Orchard Avenue 10 29/11/04

Orchard Avenue 10 15/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE 10 ORCHARD AVENUE Whetstone London N20 0JA Lead Inspector Tom McKervey Announced 4 May 2005 @ 09.30am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 10 ORCHARD AVENUE Version 1.10 Page 3 SERVICE INFORMATION Name of service 10 Orchard Avenue Address 10 Orchard Avenue, Whetstone, London N20 0JA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8445 2014 020 8445 2014 Mrs Mabel Watkins Mrs Mabel Watkins PC Care Home only 4 Category(ies) of OP Old Age registration, with number of places 10 ORCHARD AVENUE Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users with mobility difficulties who are unable to use the stairs may not be accommodated on the first floor of the home. 2. It is recommended that the number of places for which the home is registered should revert to the original number (3) when a vacancy occurs. Date of last inspection 1st February 2005 Brief Description of the Service: Orchard Avenue is a private care home, which was initially registered to provide personal care for a maximum of three older people. However, a variation to the homes registration was made to permit a fourth person to be accommodated until a vacancy occurs.The provider/manager lives on site at the home and occupies a first floor bedroom. The homes stated aims are to provide a safe, secure, homely environment for service users, where they will be free from physical, sexual and emotional abuse. The home consists of a detached two-storey property, located in a private road in a quiet residential area in Whetstone, Barnet. There were originally three bedrooms, all on the first floor. However, a fourth service user was admitted, providing a total of four bedrooms. Following the advice of the fire service, two service users with mobility problems, were relocated to the ground floor. There is a toilet on the ground floor, and a bathroom with toilet on the first floor. Also on the ground floor, there is a kitchen, leading to a conservatory, where laundry equipment is located. There is also another small toilet room off the conservatory. A small garden fronts the property and there is a large garden at the rear. The home is close to shops and amenties and there are good public transport links. 10 ORCHARD AVENUE Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over seven hours. The purpose of the inspection was to determine what progress had been made since the last time the service was inspected, and to identify any shortfalls. The manager and three members of staff were present throughout the inspection. All four service users were in the home, and were spoken to during the inspection, as well as two relatives who were visiting the home. The inspector also spoke to two staff independently. The inspection process included a full tour of the premises, reading service users’ files and other documents, discussion with the manager, and talking with service users and staff, about their experiences of living and working in the home. What the service does well: What has improved since the last inspection? At the last inspection, twenty requirements had been made, eight of which had been fully met, including; The Statement of Purpose has been amended and now meets the standard. Fridge and freezer temperatures are being recorded. The home has a copy of the local authority’s adult protection procedure. An assessment of a specific service user, has been carried out by an occupational therapist. The local authority’s adult protection procedure has been obtained. Portable electric appliances have been tested. The manager’s hours of work have been adjusted and she now has appropriate rest periods. Staffing levels have been improved, and some staff training has been provided. Cleaning materials are now stored safely. 10 ORCHARD AVENUE Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 10 ORCHARD AVENUE Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection 10 ORCHARD AVENUE Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 & 5. Some progress has been made in providing service users and their representatives with sufficient information about the service to enable them to decide about the suitability of the home to meet their needs. EVIDENCE: The Statement of Purpose has been amended, and is satisfactory. A Service Users Guide needs to be provided, which includes the fees charged and a summary of the Statement of Purpose. New draft contracts contain relevant information about fees and conditions of residency. However, they had not been signed nor issued to service users or their representatives. The case notes of three service users were examined. They contained comprehensive assessments by care managers, where appropriate, and by the home manager. The home does not have a written admissions procedure, which was a requirement at the last inspection. Relatives who were spoken to, stated that they had been able to visit the home several times before deciding to accept the placement on behalf of the service user. 10 ORCHARD AVENUE Version 1.10 Page 9 10 ORCHARD AVENUE Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 & 11. Service users receive a very good quality of care by dedicated staff, who treat them with dignity and respect. The staff have not received training about medication, and the system for the administration of medicines is unsafe. This could put service users at risk. EVIDENCE: Care plans contained good assessments of service users’ physical needs, but only in the case of one service user, were emotional/psychological needs assessed. There was evidence that the healthcare needs of service users were being met, for example, hospital appointments, G.P’s, physiotherapy and occupational therapists. The district nurse was attending to two service users at the time of the inspection. At the last inspection, a requirement was made for an occupational therapist assessment of the needs of a specific service user, to determine whether her placement at the home was appropriate for her needs. The inspector saw the report of the outcome of this assessment, which confirmed that this service user’s needs were being met. Two service users take medication. Their medication records were examined. In the case of one service user, the amount of medicine being given was less than the stated dose on the prescription. The manager stated that this had 10 ORCHARD AVENUE Version 1.10 Page 11 been agreed verbally by the G.P., but there was no written evidence about this arrangement. The manager is required to write to the G.P to have the prescription amended. Although there was a supply of Paracetemol, which the manager described as a homely remedy, there was no written authorisation from the G.P for this to be given when necessary. Two of the service users who were spoken to, stated that the staff were very caring and treated them with dignity. The staff were observed interacting with service users in a respectful and patient manner. The case files contained references that the relatives of service users were responsible for funeral arrangements. 10 ORCHARD AVENUE Version 1.10 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 The dietary needs of service users are well catered for with a balanced and varied menu, which meets their individual tastes and preferences. Service users have limited activity and leisure opportunities within the home because of the poor layout and structure of the building. EVIDENCE: The home does not have a communal sitting or dining room. This limits opportunities for service users to share in activities. All four service users are frail and have limited mobility. Three service users are accommodated upstairs and there is no lift available. However two service users are able to use the stairs, and when the weather is favourable, there was evidence that they go into the garden and out for short walks. One service user stated that she liked listening to tapes and cd’s, which was confirmed by her relatives. During the inspection, two relatives visited the home and were spoken to. They stated that they were always warmly welcomed by the staff. There were records of frequent visiting in the visitors’ book. There is a well equipped kitchen. However, there were no colour-coded food preparation boards available. 10 ORCHARD AVENUE Version 1.10 Page 13 The menus indicated that the food provided was varied and wholesome. Service users stated that they were given food of their choosing and in sufficient quantity. One service user stated, “I am well looked after and I am asked every day what I would like to eat” There was a record of food actually eaten by the service users. A member of staff was observed assisting a service user to eat in an unhurried, appropriate manner. The fridge, freezer and cupboards contained ample quantities of food, and fridge and freezer temperatures were recorded daily. 10 ORCHARD AVENUE Version 1.10 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, & 18 Service users and relatives feel safe in the home and are confident that complaints would be properly addressed. Staff have a good understanding of adult protection issues. EVIDENCE: A complaints procedure is available and the contact details of the Commission for Social Care Inspection are provided. No complaints were recorded in the complaints book, but service users and relatives spoken to, stated that they knew how to complain if necessary. Barnet Local Authority procedure was available in the home. There was a record of one staff attending training in adult protection procedures. The manager stated that arrangements were in hand for all staff to attend this training. The staff who were spoken to were knowledgeable about abuse issues and the principles of “Whistle-blowing”. 10 ORCHARD AVENUE Version 1.10 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 & 26 Service users benefit from a homely, relaxed atmosphere and the home is well maintained. However, it is not acceptable for service users to be restricted to having bed-baths only, and not to have the choice of a general bath or shower. EVIDENCE: A tour of the premises was carried out, including visits to service users’ bedrooms, toilets and bathrooms. The overall standard of décor and maintenance was good. In the upstairs bathroom/toilet, there was no toilet roll holder. There were no aids/adaptations to assist service users in and out of the bath. The manager stated that no service users use the bath, but are given bedbaths instead. A requirement is made to provide appropriate equipment to assist service users to have baths or showers. There is a large attractive garden, However, this is the only communal space available for the service users. This has occurred because a sitting room had been converted to another bedroom. A condition to the registration has been 10 ORCHARD AVENUE Version 1.10 Page 16 imposed to ensure that when this room becomes vacant, a sitting/dining room must be reinstated. Service users’ bedrooms were spacious, clean, well furnished and attractive. There was evidence of service users’ private possessions in their rooms. Service users expressed satisfaction with their accommodation. A locked cupboard has been provided to store cleaning materials. At the time of the inspection, the home was very clean and attractive and there were no offensive odours. 10 ORCHARD AVENUE Version 1.10 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 Although there are positive relationships between service users and staff, service users’ safety and welfare could be put at risk because of poor recruitment practices and procedures. EVIDENCE: The staff group has been together for a number of years and are experienced at caring for older people. The staff rota showed that there is normally two staff on duty during the day and one on waking night duty. The manager lives in the home and she stated that she is available for advice and assistance, if required during the night. One member of staff has attained NVQ level 2. There is no recruitment procedure in place. This requirement is restated form the last inspection. None of the staff records meet the required standard. In some cases there was no record of application forms, no photographs of staff or other proof of identity. The manager stated that applications for CRB/POVA clearances had been returned requesting further information. These were being re-processed during the inspection. An immediate requirement was made for the regulations to be complied with. A programme has been planned, but not yet initiated, for all staff to undertake training in mandatory subjects and adult protection. This requirement is restated from the last inspection. Two staff were spoken to independently. Both were knowledgeable about the service users and their needs. 10 ORCHARD AVENUE Version 1.10 Page 18 10 ORCHARD AVENUE Version 1.10 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 36, 37 & 38 The manager provides good leadership, and service users benefit from a good quality of care. However, this ethos is being undermined by the lack of adequate policies and procedures and no formal supervision of staff. EVIDENCE: The registered manager has very many years experience of running a care home. However, she has no formal qualifications, which is a requirement under this standard. Two staff stated that they enjoyed working in the home and were very positive about the manager’s ability and her “hands-on” approach to the care of the service users. They stated that she was very approachable. One staff said, “I look forward to coming to work”. Two relatives were also appreciative of the manager and said that she was always very welcoming and kept them informed about service users’ welfare. 10 ORCHARD AVENUE Version 1.10 Page 20 A quality assurance audit has not been carried out to formally seek the views of service users, relatives and stakeholders in the service, about whether the aims and objectives of the home are being met. The manager stated that service users’ financial affairs are managed by themselves or their representatives, and no money is held in the home on their behalf. There is no system in place for formal supervision of staff. As stated elsewhere in this report, under the relevant standards, some policies have not been produced, even though these were noted in the last inspection, including; Lifting and handling Recruitment Infection control Admission procedure. The requirement to produce these policies and procedures was restated at the last inspection, and therefore must be made available within the restated timescale in order to avoid enforcement action by the Commission for Social Care Inspection. There were records of weekly fire alarm tests, and fridge and freezer temperatures. Safety certificates for gas and electrical systems and portable appliances were available. A requirement is made to have the water system tested to exclude any harmful bacteria. 10 ORCHARD AVENUE Version 1.10 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 3 x 2 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 2 2 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 3 1 x 3 1 2 3 10 ORCHARD AVENUE Version 1.10 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4(1)(a) & 5(1) Requirement Timescale for action 30/6/05 2. 2 17(2), Sch 4.8 3. 5 12(1)(a) 4. 7 15(1) & 13(1) The registered manager must provide a Service User Guide that shows the fees charged and contains a summary of the information in the Staten=ment of Purpose. Part of this requirement is restated from the last inspection The previous timescale was 13/2/05. The registered manager must 30/7/05 ensure that service users contracts of the terms and conditions are signed by them or their representatives. This requirement is restated from the last inspection. The previous timescale was 13/2/05. The registered manager must 30/6/05 ensure that there is an admissions procedure in place. This requirement is restated from the last inspection. The previous timescale was 31/1/05. The registered manager must 30/6/05 ensure that service users care plans address both the emotional and physical needs of the service users. Version 1.10 Page 23 10 ORCHARD AVENUE 5. 9 13(2) 6. 9 13(2) 7. 12 & 22 12(2) 8. 18 13(6) This requirement is restated from the last inspection. The previous timescale was 31/1/05. The registered manager must ensure that staff receive training in the administration of medicines. This requirement is restated from the last inspection. The previous timescale was 27/2/05. The registered manager must ensure that the G.P amends prescriptions to show the required dosage of medicines. And gives authorisation for the administration of homely remedies. The registered manager must provide suitable adaptations and equipment to enable service users to have a general bath. The registered manager must ensure that all staff attend training in adult protection. This requirement is restated from the last inspection. The previous timescale was 13/2/05. 30/6/05 31/5/05 31/8/05 31/7/05 9. 20 23(2)(g)( h)(i) 10. 11. 21 29 23(2)(b) 7,9,19, Sch 2 & 4 The registered manager must 31/12/05 ensure that when a bedroom becomes vacant, a communal sitting/dining room is provided. This requirement is restated from the last inspection. The previous timescale was 13/2/05. The registered manager must 30/6/05 ensure that a toilet roll holder is provided en each toilet. The registered manager must 14/5/5 have complete records of all staff who work in the home as outlined in Schedules 2 & 4 of the regulations. This is an immediate requirement, and is restated Version 1.10 Page 24 10 ORCHARD AVENUE 12. 30 18(1)(c) 13. 14. 31 33 9(2)(1) 24(1)(2) from the last inspection. The previous timescale was 13/2/05. The registered manager must ensure that all staff are trained in the mandatory sujects in the foundation programme. The registered manager is required to attain NVQ level 4 in managerment. The registered manager is required to carry out a qualtiy assurance audit of the service. This requirement is restated from the last inspection. The previous timescale was 13/2/05. The registered manager is required to provide policies on staff recruitment, admission to the home, and safe lifting and handling, control of infection. This requirement is restated from the last inspection. The previous timescale was 13/2/05. The registered manager is required to provide at least six formal supervision sessions per year for staff. 31/7/05 31/12/05 31/8/05 15. 36 10(1) 12(1)(a) 30/6/05 16. 37 18(2) 30/6/05 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 Good Practice Recommendations 10 ORCHARD AVENUE Version 1.10 Page 25 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate London N14 6HA 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 10 ORCHARD AVENUE Version 1.10 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!