Inspection on 08/09/05 for Orchard Avenue 10

This inspection was carried out on 8th September 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 04/05/05

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 Unannounced 8 September 2005 @ 10.00 am 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 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 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 B Watkins Mrs Mabel B Watkins PC Care Home only 4 beds Category(ies) of OP Old Age registration, with number of places 10 Orchard Avenue 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 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 1st 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 4 May 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, London N20. 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 office is located in a summer house in the garden. The home is close to shops and amenties and there are good public transport links. 10 Orchard Avenue 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a period of four and a half 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, two members of staff, and all four residents were present during the inspection. The inspection process included a full tour of the premises, reading residents’ files and other documents, discussion with the manager, and talking to residents and staff about their experiences of living and working in the home. What the service does well: What has improved since the last inspection? Contracts of the residents’ terms and conditions of service have been provided, which clearly state the fees charged and what they cover. The conservatory has been refurbished and a new window installed, which improves the appearance of the exterior of the home. A new chair has been purchased to enable residents with mobility problems to get into the bath, and toilet roll holders have been replaced. Fire equipment has been serviced. 10 Orchard Avenue 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 10 Orchard Avenue 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 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 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 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. Standard 6 does not apply. General information about the service is available in the Statement of Purpose. However, without a Service Users Guide, residents do not have specific information about their individual accommodation or other residents’ views about the home. EVIDENCE: The Statement of Purpose is satisfactory and provides information about the service. However, a Service Users Guide has still not been drawn up. A requirement is restated to address this matter. New draft contracts contain relevant information about fees and conditions of residency. The manager stated that she was waiting for relatives to sign the documents on behalf of residents who are unable to do this themselves. The home still does not have a written admissions procedure, which was a requirement at the last inspection, and is restated in this report. 10 Orchard Avenue 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 & 11 The residents have a very good quality of care, provided by dedicated staff, who treat them with dignity and respect. The staff have not received training about medication. This could put residents at risk. EVIDENCE: Two residents’ care plans were sampled. They contained assessments of their physical needs, but their emotional/psychological needs had not been assessed. This requirement is restated from the last inspection. There was evidence that the healthcare needs of service users were being met, for example, hospital appointments, G.P’s, physiotherapy and occupational therapists. There were records to show that the district nurse had treated two residents at the home. The medication records were examined and found to be in order. Since the last inspection, written approval from the G.P for homely remedies, e.g., Paracetemol had been obtained. However, a requirement is restated to ensure that staff receive training in medication. 10 Orchard Avenue 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 10 Two of the residents said that the staff were very caring and treated them with dignity. 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 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 15 Residents enjoy living in the home, which meets their expectations. The dietary needs of service users are well catered for with a balanced and varied menu. EVIDENCE: All four residents are frail and have limited mobility. One resident, who is on the ground floor, is bed bound, and the others are accommodated upstairs. There is no lift available. However two residents are able to use the stairs, and they go into the garden, weather permitting, and go out for short walks. One resident who is visually impaired, said that she was quite happy in the home, and likes listening to the radio, tapes and cd’s. The home does not have a communal sitting or dining room. This limits opportunities for the residents to share in activities. The manager said that this problem will be resolved when one of the bedrooms becomes available. There is a well equipped kitchen. At the time of the inspection, there were three different main courses being prepared. The residents stated that they were given food of their choosing and in sufficient quantity. A member of staff was observed assisting a resident to eat, which was carried out in an unhurried and caring manner. The fridge, freezer and cupboards contained ample quantities of food, and fridge and freezer temperatures were recorded daily. 10 Orchard Avenue 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 12 10 Orchard Avenue 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Residents feel safe in the home and are confident that complaints would be properly addressed. However, there is no system in place for residents’ complaints to be recorded. All staff need to attend training in adult protection issues to enhance awareness about abuse issues. EVIDENCE: A complaints procedure is attached to the residents’ contracts, but there was no book or other system in place for recording any complaints. None of the residents had any concerns about the service, but said that any complaints would be addressed appropriately by the manager. Barnet Local Authority’s adult protection procedure was available in the home, and one member of staff had attended training in adult protection procedures. A requirement is made for all staff to attend this training. 10 Orchard Avenue 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 22, 23 & 26 Residents live in a well maintained and comfortable home, but the opportunities for communal activities and leisure are limited because of the lack of communal space. EVIDENCE: A tour of the premises was carried out, including visits to residents’ bedrooms, toilets and bathrooms. The overall standard of décor and maintenance was good. Since the last inspection, a special chair had been purchased to assist residents in and out of the bath, and the conservatory had been refurbished. A new window had also been installed. There is a large attractive garden, However, this is the only communal space available for the residents. This has occurred because a sitting room had been converted to another bedroom. A condition to the registration has been imposed to ensure that when this room becomes vacant, a sitting/dining room must be made available; until that time, this requirement will continue to be restated. 10 Orchard Avenue 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 15 Residents’ bedrooms, all of which were visited, were spacious, clean, well furnished and attractive. There was evidence of private possessions in their rooms. The residents said they were very satisfied with their rooms. At the time of the inspection, the building was very homely, clean and attractive and there were no offensive odours. 10 Orchard Avenue 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 16 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, 29 & 30 Residents’ safety and welfare is at risk because of poor recruitment practices and procedures, and lack of staff training. EVIDENCE: The staff group has been together for a number of years and are experienced at caring for older people. The staff rota was not up to date and did not accurately reflect the staff who were on duty at the time of the inspection. For example; the manager and one other member of staff appeared to be working every day without a break, including doing night duty. Another staff was on duty but not recorded on the rota. A requirement is made relating to this issue. There is no recruitment procedure in place. This requirement is restated from the last inspection. As found at the last inspection, the staff records still do not 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 still being re-processed at the time of this inspection. Some training had been provided for staff, but only one person had completed all of the mandatory foundation training. Requirements are restated about all these matters. 10 Orchard Avenue 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 17 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) 37 & 38 31, 32, 33, 36, The manager is well regarded by residents and staff. The residents are well cared for generally. However, their safety and welfare 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, and she stated that she was unwilling to undertake the National Vocational Qualification, level 4, or equivalent qualification, which is a requirement under this standard. A frank discussion took place about the difficulties the manager said she was experiencing in meeting and complying with this, and many other standards and regulations. Several options were discussed and it was agreed to allow time for the manager to seek advice and explore the options, after which, a 10 Orchard Avenue 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 18 meeting would take place with the Commission for Social Care Inspection regarding the future of the service. Two staff stated that they enjoyed working in the home and were impressed with the manager’s “hands-on” approach to the care of the residents. They also found her to be very approachable. A quality assurance audit has not been carried out to seek the views of service users, relatives and stakeholders in the service, about whether the aims and objectives of the home are being met. There is no system in place for formal supervision of staff. As stated elsewhere in this report, under the relevant standards, some policies and procedures have not been produced, even though these were required in previous inspections, 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. However, a fire drill had not taken place to test staff and residents’ response to an emergency. Safety certificates for fire equipment, gas and electrical systems and portable appliances were available. A requirement was made at the last inspection to have the water system tested. The manager stated that this was now in hand but a date had not been fixed. This requirement is therefore restated. 10 Orchard Avenue 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 x x x 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 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 1 x 3 x x x 3 STAFFING Standard No Score 27 2 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 2 3 2 x x 1 2 2 10 Orchard Avenue 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 20 Yes 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 The registered manager must provide a Service User Guide that shows the fees charged and contains a summary of the information in the Statement of Purpose. This requirement is restated from the last inspection. The previous timescale was 30/6/05. The registered manager must ensure that service users care plans address both the emotional and physical needs of the service users. This requirement is restated from the last inspection.The previous timescale was 30/6/05. 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 30/6/05. The registered manager must provide a system for recording complaints. The registered manager must ensure that all staff attend training in adult protection.This requirement is restated from the Timescale for action 31/12/05 2. 7 13(1) & (15(1) 31/12/05 3. 9 13(2) 31/12/05 4. 5. 16 18 17(2) Sch 4 13(6) 31/10/05 31/12/05 10 Orchard Avenue 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 21 6. 20 23(2)(g)( h)(i) 7. 27 17(2) Sch 4 7,9,19, Sch 2 & 4 8. 29 9. 30 18(1)(c) 10. 31 9(2)(1) last inspection.The previous timescale was 30/6/05. The registered manager must ensure that when a bedroom becomes vacant, a communal sitting/dining room is provided.This requirement is restated from the last inspection.The timescale for this requirement has not been reached. The registered manager must provide and maintain a written rota that accurately reflects the staff on duty. The registered manager must provide complete records of all staff who work in the home as outlined in Schedules 2 & 4 of the regulations.This is restated from the last inspection.The previous timescale was 14/5/05. The registered manager must ensure that all staff are trained in the mandatory sujects in the foundation programme. This is restated from the last inspection.The previous timescale was 31/7/05. The registered manager is required to attain NVQ level 4 in managerment.This is restated from the last inspection.The previous timescale was 31/7/05. 31/12/05 31/10/05 31/10/05 31/12/05 31/1/06 11. 36 18(2) The registered manager must 30/6/05 ensure that all staff receive at least six formal supervision sessions a year.This is restated from the last inspection.The previous timescale was 31/7/05. The registered manager is required to provide policies on staff recruitment, safe lifting and handling, and control of infection.This requirement is restated from the last 31/12/05m mkk 12. 33 & 37 10 (1) & 12(1) 10 Orchard Avenue 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 22 13. 14. 38 38 23(4)(e) 13(4)(c) inspection.The previous timescale was 30/6/05. The registered person is required to carry out regular fire drills. The registered person is required to have the water system tested for the presence of harmful bacteria. 31/12/05 31/12/05 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 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 23 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate LondonN14 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 20050908 Orchard Avenue X00015 UN Stage 4 S10473 V245011 G59.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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