Inspection on 18/06/07 for Orchard Blythe

This inspection was carried out on 18th June 2007.

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 Blythe 07/08/06

Orchard Blythe 16/02/06

Orchard Blythe 27/09/05

Orchard Blythe 06/01/05

Orchard Blythe 01/07/04

Orchard Blythe 29/01/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Orchard Blythe Orchard Blythe HEP Wingfield Road Coleshill Birmingham West Midlands B46 3LL Lead Inspector Lesley Beadsworth Key Unannounced Inspection 18th June 2007 10:45 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 Orchard Blythe DS0000041996.V339097.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. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard Blythe Address Orchard Blythe HEP Wingfield Road Coleshill Birmingham West Midlands B46 3LL 01675 467027 01675 467027 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) Warwickshire County Council Mrs Michelle Bernadette Wilson Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th August 2006 Brief Description of the Service: Orchard Blythe is a Local Authority home for older people. It provides 25 permanent care beds, 5 beds for people on short stays, and 5 beds for assessment purposes. The home is situated very close to the town centre of Coleshill, next to a primary school. There are a few local shops within fifty yards, and Coleshill High Street is within easy walking distance for a mobile service user. There are parking spaces to the front of the home. Orchard Blythe’s accommodation is all on one level and is easily assessable for wheelchair users. It is divided into three units, two wings are for permanent service uses, and one wing used for short stay purposes. There is a very large reception area, which is used by service users to socialise and to participate in therapeutic activities. There are three staff offices, a hairdressing room, a kitchen (with its own staff room and WC) and a laundry. In addition, there is a day care lounge for ten people. All bedrooms have en-suite lavatories and wash hand basins. There are four communal bathrooms with assisted bathing facilities and WCs, and one separate WC. There is a staff room with a WC and a shower. The home is staffed over 24 hours. The usual management team consists of a registered manager, assistant manager care officers. A part time clerical officer provides administrative support to the management team. There are care assistants, providing care during the day and night. In addition to care staff are domestic staff, cooks and assistant cooks. The home does not provide nursing care. Service users who require nursing attention receive this from the community nursing service, as they would in their own homes. The fees for this home range from £84.60 for day care to £380.24 for permanent stay residents. Extra charges are made for private chiropody hairdressing, newspapers, toiletries and outings. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection included a visit to Orchard Blythe. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Although the AQAA was forwarded on time due to technical difficulties it was not received by us until the visit took place. Some of the information contained within this has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to them their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 10.45am and 08.05pm. What the service does well: The first impressions on arrival at the home were good with a small but well tended and attractive front garden and ample car parking space. On entering the home a recently refurbished reception area offered facilities for activities, either in groups or one to one, as described in the relevant section of this report. The home offers the people living at the home comfortable surroundings, which are clean, mainly free of offensive odour, safe and well maintained. All care files examined had a full assessment detailing the needs of the individual residents. A high level of training had been undertaken by staff with more than 58 of the care staff having achieved National Vocational Qualification Level 2 in Care showing that staff have the appropriate qualification for their role. The majority of staff had recently attended an Equality and Diversity workshop giving them the awareness to understand and meet the relevant needs. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 6 All residents have an attached worker who along with a senior member of staff is responsible for gathering information related to the person’s needs in order to devise a care plan to meet those needs. Evidence of the attached workers was seen in the care files. The manager advised that relatives and/or the representative of residents might also be involved in this gathering of information if this is appropriate. All care plans seen covered all the areas of need for the individual resident. Residents and member of staff had signed the plans showing that the resident had been involved in the plan. The care files provided evidence to support that residents on going health needs are met by visits from a dentist, optician and chiropodist. Pressure relieving equipment, such as cushions and mattresses were in use for those residents with a risk of developing pressure sores. Staff interacted well with residents and care was delivered in a respectful manner. Staff spoken with talked respectfully about residents and were aware of the need to maintain dignity and privacy. An activity room stores a good variety of activity materials and there was evidence of crafts that have been undertaken by people living at the home. The programme was varied and offered activities inside and outside the home that were related to residents’ wishes. A ‘Quality Meeting’ is held six weekly and a large part of the minutes made available concentrated on activities and evidenced that activities included entertainment from outside contractors and volunteers. Volunteers from the resident group were requested for involvement in ‘Coleshill in Bloom’ as had previously taken place and offering opportunities to maintain links with the community. Residents spoken with said that their visitors were made welcome and that they were able to visit at any reasonable time. Two visitors were spoken with who also said that the people at the home made them welcome. Records showed that some choices are offered to residents such as times for going to bed and getting up, and choice of meals and activities. That choices in daily life at the home were considered was further evidenced in the minutes of the Residents’ Quality meeting. The cook visited residents after the lunchtime meal to enquire if they had enjoyed their meal and their responses were recorded. Residents spoken with said that they enjoyed the food and comments in the Quality Meeting minutes included: “All in attendance said they were happy with the food arrangements.” Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 7 “All residents said they still enjoy their cooked breakfast twice a week.” Discussion also took place in the meeting about healthy food options and advice given to residents with regard to this. A complaints policy and procedure is in place and records of complaints received and any necessary action taken are maintained. There have been no complaints to us since the last inspection. Training records and discussion with staff showed that the majority of staff at the home have undertaken training related to vulnerable adults to give them the knowledge and skills to identify and protect residents from abuse. Those spoken with said that they were aware of the Whistle Blowing policy and would not hesitate to report any suspicion of abuse to senior staff. Steps were taken to manage infection control by appropriate procedure and practices such as use of protective clothing, suitable hand washing facilities and suitable laundry arrangements. There were sufficient care staff available to meet the needs of the residents but the hours where there are no catering or domestic staff in the home staff may have an impact on this. The home had a ‘Quality Management System’ that is used to monitor and audit that the standards of the service are maintained and that action is taken if there is non-compliance. The home also has Quality Meetings with residents on a six weekly basis where feedback about the service is encouraged and is discussed in more detail in the Daily Life and Social Activities section of this report. Annual surveys were also carried out for feedback from residents about the service and a person independent to the home carries these out with residents in order to enable the responses to be open and objective. Records related to fire prevention, electrical checks, hoists and gas appliances maintenance were checked and were in good order thereby safeguarding the people living and working at the home. What has improved since the last inspection? The following requirements from the last inspection have been met • Daily care records viewed showed what care had been given. • There were clear systems in place for administration of medication and this included how staff were to manage tablets that were prescribed for one or two tablets to be given and a relevant letter had been obtained from the GP. The home also clearly records the number of tablets given on the Medication Administration Record Sheets. • Sluices were required to be accessible and easily cleanable due to the amount of clutter and domestic equipment in them. The use of these rooms Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 8 have now been changed and are being used by domestic staff for their cleaning materials. • Clear plans of prevention have been devised in risk assessments including for falls and nutrition. • Two assisted baths have been repaired and were in use. • Carpets in communal areas are cleaned on rotation once a week by supernumerary staff working late evenings when residents have gone to bed. • More than 58 of the staff have achieved National Vocational Qualification Level 2 in Care. • Staff have undertaken Adult Abuse training in order to be able to identify abuse and to protect residents. • Staff records are accessible for inspection purposes at any time as the person in charge has access to the locked facility. • The home had recently undergone a Health and Safety inspection, which was satisfactory and all checks were available for inspection. In addition to these improvements the reception area of the home has been refurbished and is now an attractive area that offers space for different uses for residents. What they could do better: Care plans were reviewed but not signed by the member of staff or resident and there was no other evidence that residents had been involved in the reviews. This would suggest that they did not have choice in how their care was delivered following the original care plan. One care plan had not been reviewed since changes had occurred in the resident’s circumstances, which included the resident being confined to bed. The risk assessments and care plans related to this resident did not clearly demonstrate that full time bed rest was necessary or that the use of an electric ‘scooter’ was prohibitive or too great a risk to allow its use, despite the resident and staff saying that it could not be used for fear of the resident’s posture causing a fall from the scooter. It was not clear either from records or discussion if any alternative harness or support had been considered to reduce the risk of using the scooter. The nutritional assessment format referred to the need for increasing weight checks if there were concerns about weight loss but one file looked at related Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 9 to a resident who was overweight. Whilst staff were aware that the concern for this resident was an increase in weight this should be made clear in the nutritional risk assessment. Files contained risk assessments related to the individual residents but some of these were generic rather than individualised. An example of this was that all residents who used denture cleansing tablets had a risk assessment that stated these should be stored on top of the wardrobe. This was not appropriate for all of them, particularly those who were independent in their oral care. A requirement from previous inspections for all handwritten entries on the Medication Administration Record Sheets to be dated and signed to confirm GP’s instructions had not been met, with handwritten instructions continuing to be without this. If instructions are from a different source than a GP, for example hospital discharge, this should also be recorded on the Medication Administration Record Sheets. A home remedy policy was also required and this had not yet been implemented. A lack of this policy, which needs to be approved by the GP and pharmacist, means that staff are unable to safely provide medication for shortterm minor ailments such as heartburn or a headache without individual instruction from the GP. Some gaps were seen in the Medication Administration Record Sheets and although these were small in number it is important that there is a signature to show that the medication has been given, or if not given, the reason why. The medication audits were difficult to carry out due to stock being held, with some tablets being in stock since January 2007. Auditing of medication would be easier if all medication received and any carried over from the previous cycle(s) were recorded on the Medication Administration Record Sheets rather than in a separate book. One Medication Administration Record Sheet had instruction for a barrier cream that can be purchased over the counter or prescribed by the GP. However on this occasion had been described as “samples left by the district nurse”. This is not acceptable and the home should ensure that any medication on the Medication Administration Record Sheets, including ointments/creams, are either prescribed or are included in an approved home remedy policy. As evidence of the medication ordered and to confirm the correct medication has been received the home should retain photocopies of all prescriptions. Plastic picnic-type beakers were used for cold drinks at mealtimes. These are not age appropriate. If a resident is considered to need a plastic drinking vessel as opposed to glass the reasons for this need to be evidenced in the individual care plan or risk assessment. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 10 It became apparent when talking to the activity organiser, staff and the manager that the activity organiser was used for care tasks when there was an absence amongst the care staff, that this happened frequently and any planned activity was cancelled. This is an unsatisfactory arrangement as residents are unable to have confidence in any plans and it is disappointing for them when looking forward to an event. The activity organiser has a role to fulfil in offering residents the opportunities for activity, occupation and mental stimulation and should not be a choice to cover care staff shortages. An outing to Twycross Zoo had been cancelled the week before because the Activity organiser was off sick as there were no other arrangements made to enable the trip to go ahead. The home is divided into living units with a living/dining area and adjacent kitchenette and bedroom corridors off these rooms. Décor and floor covering in these areas was looking tired, with some areas of torn wallpaper and ‘grubby’ carpets, and some of the furniture was past its best although the areas viewed were clean. Storage space would seem to be a problem as wheelchairs and an electric scooter were stored on the corridors, causing a hindrance to passers by and looking unsightly. The unit kitchenettes viewed were dated and shabby. Some of the peeling laminate and the worn internal spaces were a source of infection. Residents’ crockery and serving dishes are washed in the single sink in the kitchenettes and tea towels used for drying them. Apart from this being time consuming for care staff, taking them away from time spent with residents, this practice has a high risk of cross infection. As residents have access to the hot water it is not sufficiently hot enough to sterilise and tea towels are known to be a major source of contamination. Advice should be sought from Environmental Health about the dishwashing arrangements and dishwashers could be a consideration in the refurbishing of the kitchenettes or the use of the dishwasher in the main kitchen. The inside of one bedroom was viewed because of an offensive odour outside the room. The odour came from the bedroom and detracted from the comfort of the occupant and other people living at the home. A further bedroom also had a faint offensive odour, unused picture hooks, and unsightly marks where hooks had once been on the walls. The care staff are required to assist with the preparation and serving of the evening meal as the cooks do not work after 2.30pm. Discussion with the manager, staff and some residents indicated that there are times when there were not enough staff available to meet the needs of residents. Staff files inspected failed to have some required information. These included adequate references, records of training or in one case a Criminal Records Bureau disclosure. This information is necessary to protect residents from the employment of inappropriate people. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 11 The home is without a permanent manager but the new manager was due to take up her appointment in July. The post of assistant manager has not been covered since she has been acting manager, despite the authority trying to recruit to the post. The senior team had therefore had a challenging few months. Staff supervision was carried out but not at the two monthly intervals that is required. 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. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 12 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 Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 13 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, 3, 4 Quality in this outcome area is good. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. Staff have an awareness of equality and diversity and effort is made to meet specialist, cultural and religious needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager advised that the Statement of Purpose and Service User Guide are in need of revising and that this will take place when a new manager is appointed. Copies of the Service User Guide were seen in the bedrooms of the people living at the home. The care files of three residents were looked at for case tracking purposes. The manager advised that a visit to a prospective resident is made within three days of a referral being made to the home. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 14 All three files contained a full assessment detailing the needs of the individual person to enable the home to decide if they could meet the needs of the prospective resident. As a Local Authority home this is carried out in line with the Local Authority criteria and procedure. The manager advised that prospective residents are encouraged to visit the home but that relatives often make this visit on their behalf. Where a resident had been referred to the home by social services an assessment and care plan devised by the care manager were also included in the care file. Assessments covered the appropriate areas of need and were in sufficient detail to enable information to be transferred to a care plan. The history of falls related to the individual resident was recorded on all three files with a risk assessment to minimise the incidence of falls. A new falls assessment tool was being used, identifying the level of risk and the action to be taken. Training records show that staff have attended training in the specialist needs of dementia and continence in order to give them the knowledge required to meet these needs but there is no record of any training being undertaken in other specialist needs such as sensory impairment or physical disabilities associated with this age group. The majority of the staff have recently attended Equality and Diversity workshops giving them an appropriate awareness of meeting relevant needs. Residents are enabled to attend church services in the home or if they are able, to the services outside the home. The home does not currently provide Intermediate Care although it does cater for respite care service users in one of the units of the premises. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is adequate. Care plans are in place and provide appropriate detail although there are shortfalls in involving residents in review of care and in updating information. Residents have access to health care professionals and are cared for in a respectful manner. Some shortfalls in medication procedure create a potential for risk to residents’ well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As part of the case tracking process three care plans were looked at. Two were chosen because of the care they required and the third because of being the most recent person to move into the home. All residents have an attached worker who along with a senior member of staff is responsible for gathering information related to the person’s needs in order to devise a care plan to meet those needs. Evidence of the attached workers was seen in the care files. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 16 The manager advised that relatives and/or the representative of residents might also be involved in this gathering of information if this is appropriate. All care plans seen covered all the areas of need for the individual resident. The residents and member of staff had signed the plans showing that the resident had been involved in the plan. Care plans were reviewed but not signed by the member of staff or resident and there was no other evidence that residents had been involved in the reviews, suggesting that they did not have choice in how their care was delivered following the original care plan and the risk of lack of a person centred approach. One care plan had not been reviewed since changes had occurred in the resident’s circumstances, which included the resident being confined to bed. The risk assessments and care plans related to this resident did not clearly demonstrate that full time bed rest was necessary or that the use of an electric ‘scooter’ was prohibitive due to too great a risk to the resident, despite the resident and staff saying that it could not be used for fear of the resident’s posture causing a fall from the scooter. It was not clear either from records or discussion if any alternative harness or support had been considered to reduce the risk of using the scooter. The manager discussed that alternative means of conveyance were being considered but the resident may not have the independence that the scooter had allowed. In one care file there was evidence that a resident had experienced deterioration in mobility and had sustained falls. Although the resident had been seen by the GP for other ailments there was no record that these symptoms had been discussed or investigated. All files looked at contained risk assessments related to nutrition in order to ensure that nutritional needs are met, and to pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area) to identify those at risk and thereby manage appropriately. The nutritional assessment format referred to increasing weight checks if there were concerns about weight loss but one file looked at related to a resident who was overweight. Whilst staff were aware that the concern for this resident was an increase in weight this should be made clear in the nutritional risk assessment. Files contained risk assessments related to the individual residents but some of this were generic rather than individualised. An example of this was that all residents who used denture cleansing tablets had a risk assessment that stated these should be stored on top of the wardrobe. This was not appropriate for all of them, particularly those who were independent in their oral care. Pressure relieving equipment, such as cushions and mattresses were seen to be in use for those residents with a risk of developing pressure sores. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 17 The care files provided evidence to support that residents on going health needs are met by visits from a dentist, optician and chiropodist. According to the AQAA completed by the acting manager the home encourages residents to continue to administer their own medication if a risk assessment suggests that this is appropriate. This was further evidenced in a care file, and discussion with a resident that was part of the case tracking process. Medication administration is carried out by senior staff who have undertaken the relevant training. The medication is dispensed in a multi dose system of bubble packs and stored in a medicine trolley that is taken to each of the units. A safe procedure was observed on the day of the visit. Outstanding requirements from previous inspections were checked. Of these the requirement for all handwritten entries on the Medication Administration Record Sheets to be dated and signed to confirm GP’s instructions had not been met, with handwritten instructions continuing to be without this. If instructions are from a different source than a GP, for example hospital discharge, this should also be recorded on the Medication Administration Record Sheets. A home remedy policy was also required and this had not yet been implemented. A lack of this policy, which has been approved by the GP and pharmacist, means that staff are unable to provide medication for shortterm minor ailments such as heartburn or a headache without individual instruction from the GP. The home was required to ensure that there were clear systems in place for administration of medication and this included how staff were to manage tablets that were prescribed for one or two tablets to be given. This has been addressed by the home and a relevant letter had been obtained from the GP. The home also clearly records the number of tablets given on the Medication Administration Record Sheets. The medication of the residents that were case tracked was looked at and a random audit was carried out on medication. Some gaps were seen in the Medication Administration Record Sheets and although these were small in number it is important that there is a signature to show that the medication has been given. The reason for any medication not being given must also be recorded by means of a code with an appropriate key. The audits were difficult to carry out due to excess stock being held, with some tablets being in stock since January 2007. Also the record of medication received is recorded into a designated book and only those held in the trolley recorded on the Medication Administration Record Sheets. Auditing of medication would be easier if all medication received and any carried over from the previous cycle(s) were recorded on the Medication Administration Record Sheets. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 18 One Medication Administration Record Sheets looked at contained an instruction for a barrier cream that can be purchased over the counter or prescribed by the GP. However on this occasion it had been described as “samples left by the district nurse”. This is not acceptable and the home should ensure that any medication on the Medication Administration Record Sheets, including ointments/creams, are either prescribed or are included in a home remedy policy. As evidence of the medication ordered and to confirm the correct medication has been received the home should retain photocopies of all prescriptions. Staff were seen to interact well with residents and care was delivered in a respectful manner. Staff spoken with talked respectfully about residents and were aware of the need to maintain dignity and privacy. Plastic picnic-type beakers were used for cold drinks at mealtimes. These are not age appropriate. If a resident is considered to need a plastic drinking vessel as opposed to glass the reasons for this need to be evidenced in the individual care plan or risk assessment. The subject of respect and dignity was not referred to in the completed AQAA, although there was reference for the plans to further develop person centred planning. Orchard Blythe DS0000041996.V339097.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): 12,13,14,15 Quality in this outcome area is adequate. Residents were mainly occupied and stimulated although there were shortfalls in the continuity of this. Visitors were made welcome. Residents had choices in their daily lives. Residents enjoyed the meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home offered day care in a separate unit of the home and some of the activity offered to residents is generated from here. The home had a designated activity organiser who devises a weekly programme of activities and was responsible for its implementation. However it was apparent from discussion with staff, the acting manager and residents that if there is a shortage of care staff the activity organiser role is abandoned so that assistance can be given in care. It was also apparent that this occurs often. Furthermore during the sickness absence of the activity organiser the previous week a planned outing and other activity on the programme was cancelled, as there were no other staff available. This is an unsatisfactory arrangement as residents are unable to have confidence in any plans and it is disappointing for them when looking forward to an event. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 20 The activity organiser has a role to fulfil in offering residents the opportunities for activity, occupation and mental stimulation and should not be a choice to cover care staff shortages. Every alternative should be considered to ensure that programmed outings, activities and events take place in the absence of the activity organiser. An activity room stored a good variety of activity materials and there was evidence of crafts that have been undertaken by people living at the home. The programme was varied and when followed offered activities inside and outside the home that were related to residents’ wishes. A ‘Quality Meeting’ is held six weekly and a large part of the minutes made available concentrated on activities and evidenced that activities included entertainment from outside contractors and volunteers. Volunteers from the resident group were requested for involvement in ‘Coleshill in Bloom’ as had taken place the previous year and offering opportunities to maintain links with the community. Photographs were displayed in the home of the residents planting for hanging baskets at that time. The minutes also recorded asking residents if they were willing to contribute £1.00 a month towards the activities, as “all residential homes in the Warwickshire area already have this policy in place” because fund raising was not creating sufficient funds. Those present had agreed. Residents spoken with said that there was usually enough to do during the day although were disappointed when the planned arrangements were cancelled. One resident who was currently having to spend all day in bed, had previously attended many of the activities and the activity organiser said that they were looking at ways to maintain this involvement. The resident said that lack of occupation was difficult and had previously enjoyed most of the activities in the home. The recently refurbished reception area offered space for activities to take place either in groups or one to one. One service user with visual impairment was playing the electric organ, using headphones to avoid disturbing other residents, and was obviously enjoying this pastime. A computer and tables for craft work were also available for use by residents in this area. A bar area had been made but staff advised that this was now not used for this purpose as the home no longer had a license. It was noticed that contemporary pop music usually enjoyed by younger people was being played in the reception area for part of the day but more age related music was played at other times of the day. the reception area also held a good number of books for residents’ to choose from, many of them in large print for those with poor near vision. Large screen televisions were provided to ensure that it could be viewed more easily. One unit had a budgie that a resident had brought with her. Residents spoken with said that their visitors were made welcome and that they were able to visit at any reasonable time. Two visitors were spoken with who also said that the people at the home made them welcome. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 21 Records and discussion with staff and residents showed that some choices are offered to residents such as times for going to bed and getting up, and choice of meals and activities. That choices in daily life at the home were considered was further evidenced in the minutes of the Residents’ Quality meeting. The home is divided into four living areas and therefore dining areas are small and quite homely. Each living/dining area has an adjoining kitchenette. A meal was taken in one unit. This was as residents were finishing their meal and the meal provided was barely lukewarm. The meal consisted of fish fingers, potatoes, and vegetables and whilst adequate it was not very interesting. Residents spoken with though said that they enjoyed the food and comments in the Quality Meeting minutes included, “All in attendance said they were happy with the food arrangements.” “All residents said they still enjoy their cooked breakfast twice a week.” Discussion also took place in the meeting about healthy food options and advice given to residents with regard to this. The unit kitchenettes viewed were dated and shabby. Staff advised that there were plans to renew these in the near future, although the AQAA stated that there were plans for only one of them to be refurbished in the next 12 months. In the meantime some of the peeling laminate and the worn internal spaces remain a source of infection. Furthermore residents’ crockery and serving dishes are washed in the single sink in the kitchenette and tea towels used for drying them. Apart from this being time consuming for care staff, taking them away from time spent with residents, this practice has a high risk of cross infection. Because residents have access to the hot water it is not sufficiently hot enough to sterilise dishes and tea towels are known to be a major source of contamination. Those in use on the day of the visit were also old and worn. Advice should be sought from Environmental Health about the dishwashing arrangements and dishwashers could be a consideration in the refurbishing of the kitchenettes or the use of the dishwasher in the main kitchen. The cook visited residents after the meal to enquire if they had enjoyed their meal and their responses were recorded. Other records seen in the main kitchen included lists of meals taken, likes/dislikes and dietary needs, a cleaning schedule and a health and safety checklist. Certificates were also on display for three staff who had achieved the Foundation Certificate in Nutrition alongside a catering award from Environmental Health. The kitchen was very clean and appeared well organised. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 22 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): 16,18 Quality in this outcome area is good. The home has appropriate policies, procedures and training to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints policy and procedure is in place and records of complaints received are maintained. There have been no complaints to us since the last inspection. Residents spoken to were all aware that they could raise any concerns with staff if necessary. An opportunity to do so forms part of the agenda for the Quality Meetings. Training records and discussion with staff showed that the majority of them have undertaken training related to vulnerable adults to give them the knowledge and skills to identify and protect residents from abuse. Staff said that any allegation of abuse reported to them would be referred on to the manager to inform the relevant authorities and that they were aware of the Whistle blowing policy. As with all other policies and procedures this was available in the staff room for them to access. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 23 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, 22, 26 Quality in this outcome area is good. The home offers the people living there comfortable surroundings, which are clean, mainly free of offensive odour, safe and well maintained but with some shortfalls in décor and minor odour problems. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The first impressions on arrival at the home were good with a small but well tended and attractive front garden and ample car parking space. On entering the home a recently refurbished reception area offered facilities for activities, either in groups or one to one, as described in the relevant section of this report. There is also a pleasant sitting area used by residents. Two residents using this area in the evening said they frequently met there at that time of day and enjoyed the peace and quiet, rarely bothering with the television that was in that area. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 24 There was a hairdressing room for the residents use, and three offices off the reception area for the manager, administrative assistant and senior care staff. Notice boards and photos advised residents of forthcoming events and displayed past events enjoyed by residents. Not all notices/letters were in a large print to ensure that they could be easily read. A letter from the local authority advised that smoking would not be allowed in the home following the new legislation regarding smoking in public. There was currently no one living at the home that smoked. People living in care homes are exempt from this legislation but it was not clear from the letter or to the manager if this Local Authority ruling would apply to residents at this home. A tour of the home was carried out and the rooms of those residents case tracked were viewed. The home is divided into living units with a living/dining area and adjacent kitchenette and bedroom corridors off these rooms. Décor and floor covering in these areas were looking tired, with some areas of torn wallpaper and ‘grubby’ carpets, and some of the furniture was past its best although the areas viewed were clean. Each unit also had an enclosed courtyard garden for the residents’ use and these were pleasant and well maintained areas with adequate garden furniture. Storage space would seem to be a problem as wheelchairs and an electric scooter were stored on the corridors, causing a hindrance to passers by and looking unsightly. All bedrooms were single and had ensuite facilities. Bedrooms viewed were personalised and the family of one resident had redecorated a bedroom to meet the individual’s taste. All residents spoken with said that they were happy with their room. A resident spending all the time in bed had a nursing bed with a pressure-relieving mattress to assist in the prevention of pressure sores. One bedroom was looked at because of an offensive odour outside the room. The odour came from the bedroom and detracted from the comfort of the occupant and other people living at the home. A further bedroom also had a faint offensive odour, unused picture hooks, and unsightly marks where hooks had once been on the walls, all of which also detracted from the comfort of the occupant of this room. Two baths in need of repair at the previous inspection were in use again at this visit. The laundry area was also viewed and appropriate laundering facilities were in place. The area was clean and well organised. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 25 Staff used protective clothing, such as disposable aprons and gloves, and staff asked about these said that they were in plentiful supply in order to maintain infection control. All hand washing areas had disposable towels and soap dispenser in order to prevent cross infection. The dishwashing and drying arrangements for the home caused concern related to infection control and are discussed in further detail in the ‘Daily Life and Social Activities’ section of this report. At the previous inspection a requirement was made to make sluices accessible and easily cleanable due to the amount of clutter and domestic equipment in them. The use of these rooms have now been changed and are being used by domestic staff for their cleaning materials. A previous requirement to ensure that carpets were kept clean was met by staff cleaning a communal carpet a week in rotation in the late evening when residents were in bed. This was by staff supernumerary to the waking night staff. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 26 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): 27,28,29,30 Quality in this outcome area is adequate. There are sufficient care staff available to meet the needs of the residents but the hours where there are no ancillary staff may have an impact on this. There are shortfalls in recruitment that could put residents at risk. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a rota that shows the designation of the member of staff and the hours worked by them. The usual number of care staff rotered to work each day are five in the morning/afternoon and four in the late afternoon/evening. In addition there is a senior member of staff, and ancillary staff consisting of a cook in the mornings and early afternoon and domestic staff, including a part time laundress. There are also two waking night care assistants between the hours of 10pm and 7.45am. The care staff are required to assist with the preparation and serving of the evening meal as the cooks do not work after 2.30pm. Discussion with the manager, staff and some residents indicated that there are times when there were not enough staff available to meet the needs of residents. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 27 Three staff files were inspected after being chosen at random, but included the file of a recently appointed member of staff in order to assess current recruitment practice. Each file failed to have some required information. The first file belonged to a member of staff who had been at the home for several years and had only one reference rather than two that are required currently. As this employee has been at the home for so long there would no longer be anything gained from seeking a further reference. The second file also belonged to a member of staff who had been at the home for several years and whilst all other required information was on file there was no evidence of a Criminal Records Bureau disclosure. Both of the other files held current Criminal Records Bureau disclosures. This information is necessary to protect residents from the employment of inappropriate people. The two long-term members of staff held evidence of relevant training but there was no evidence of any training, including induction, in the file of the new member of staff. However these files were examined in the absence of the manager and as the AQAA states that all new staff undertake an induction process these records may have been in use by the member of staff. All new staff need to undertake induction training that meets the required standard in order to be able to carry out their job in a manner that meets residents’ needs. Training records and discussion with staff demonstrate that there is a high level of training undertaken by staff. Some mandatory training had been undertaken, although not all staff had undertaken recent moving and handling and there was no record of any staff having undertaken Health and Safety training in 2006/7. As previously mentioned in the first section of this report staff have undertaken training in dementia and continence but there was no evidence available of training in any other specialist needs. The AQAA advised that 54.8 of the care staff had undertaken National Vocational Qualification level 2 in Care; 19.4 were undertaking the training and a further 25.8 were still to do so. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 28 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, 38 Quality in this outcome area is adequate. A person who has previous management experience manages the home, although the post of registered manager was vacant. There are systems in place for the monitoring and auditing of the service and practices to ensure that they operate in the best interests of residents. Staff supervision is not carried out at the required intervals. Health and safety practice protects people living and working at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An acting manager who had worked at the home for eighteen years, and had been the assistant manager for several years, was managing the home. The previous registered manager had resigned since the previous key inspection and the Local Authority had had difficulty recruiting a suitable Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 29 person. However the new manager was due to take up her appointment in July. The acting manager was due to retire shortly after the inspection visit. Staff spoke highly of her management and the support she gave them and were sorry that she was leaving the home. She was present for the large majority of the inspection visit, was aware of the home’s strengths and weaknesses, and able to talk knowledgably about the residents’ needs. The post of assistant manager has not been covered since she has been acting manager, despite the authority trying to recruit to the post. Other senior staff (four care officers) have only been appointed in the last year. The manager confirmed that the last months had been a challenging period for the senior team. The AQAA and manager explained that the home had a ‘Quality Management System’ that is used to monitor and audit that the standards of the service are maintained and that action is taken if there is non-compliance. The home also has Quality Meetings with residents on a six weekly basis where feedback about the service is encouraged and is discussed in more detail in the Daily Life and Social Activities section of this report. Annual surveys are also carried out for feedback from residents about the service and a person independent to the home carries these out with residents in order to enable the responses to be open and objective. The manager and the AQAA advised that residents are encouraged to manage their own financial affairs or where this is not possible relatives or other representative or advocate act on their behalf. However the home holds monies for the majority of the residents. This complex system involves double recording and has a risk of errors occurring for individuals. Sums of money are paid in by the residents’ representatives and paid into one generic interest free bank account. A petty cash sum of money from this account is then held by the staff of the home and money for such things as hairdressing, chiropody or other incidentals for individual residents is taken from this cash, recorded in a book and receipts held for each transaction. The Administrative assistant then updates the formal individual and computerised records between once a week and once a month from this book and the receipts, balancing the total spent by all residents with the total money held in the bank. Whilst the total balance can be seen as correct it is difficult to check that individual records are correct, for example an unintended error made by attributing a transaction to the wrong resident would not affect the overall balance. As at the previous inspection it is strongly recommended that this system is independently reviewed and audited in order to ascertain that this is a safe system of managing the residents’ money. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 30 Staff spoken to and records looked at showed that there was some staff supervision received by staff but this is not as frequent as required. Staff supervision gives management and staff the opportunity to discuss work practices, staff development and the philosophy of the home and to address these as required. It is also an opportunity for staff to contribute to the way in which the service is delivered. The home had recently undergone a Health and Safety inspection, which was satisfactory. Records related to fire prevention, electrical checks, hoists and gas appliances maintenance were checked and were in good order thereby safeguarding the people living and working at the home. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 2 X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 3 Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 32 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 Requirement The people living at the home must have care plans that indicate when changes occur to ensure that residents’ needs are met. (the previous timescale of 30/09/06 was not met) Timescale for action 15/08/07 2. OP7 15 The people living at the home 15/08/07 must be consulted, wherever this is practicable, when their care is reviewed. This will ensure people centred care that meets the needs of the resident. All handwritten entries on the 15/08/07 Medication Administration Record Sheets must be dated and signed to confirm any instructions given by GPs. This will ensure that the correct medication is given to the people living at the home. A Homely Remedies policy must be developed to ensure that residents have safe access to treatment for minor ailments. (the previous timescale of 30/09/06 was not met) 3. OP9 13 Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 33 4. OP9 13(2) When medication is given to people living at the home it must be correctly recorded. This will ensure that people will receive the correct levels of medication. Copies of prescriptions must be maintained at the home. This will ensure that the medication prescribed by the GP is received by the home. 15/08/07 5. OP19 23(2) All parts of the home must be kept in a good state of repair and décor. This will ensure that the residents live in a comfortable environment. Storage areas must be provided for aids and equipment. This will ensure that these articles do not cause a hazard to people in the home. Advice must be sought from the Environmental Health Department regarding the current dishwashing and drying practices on units. This will ensure the safety of the residents. There needs to sufficient staff with appropriate skills in the home throughout the day in order to meet all the needs of the people living at the home. A robust recruitment procedure must be in place and all the necessary staff information maintained. This will protect residents from the appointment of inappropriate employees. Staff employed at the home must undertake training relevant to the specialist needs of the residents. this will ensure that these specialist needs are met. DS0000041996.V339097.R01.S.doc 30/08/07 6. OP22 23(2) 30/09/07 7. OP26 16(2)(j) 15/08/07 8. OP27 18 15/08/07 9. OP29 19 15/08/07 10. OP30 18(1) 30/09/07 Orchard Blythe Version 5.2 Page 34 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. 2. 3. 4. 5. 6. Refer to Standard OP9 OP9 OP10 OP19 OP27 OP29 Good Practice Recommendations Only medications prescribed for the resident should be written on the Medication Administration Record Sheets or form part of an approved home remedies policy. The minimum and maximum temperatures of the medication fridge should be recorded to confirm medications are being stored safely. Age related drinking vessels should be used by residents unless a care plan or risk assessment suggests otherwise. The manager is requested to forward a maintenance plan for the home, which shows areas to be decorated, and timescales to address these. It is advised that the duty rotas stipulate the designations of staff so that it is clear in what capacity each person works in the home. In regard to the recruitment process. It is advised that the manager ensure any gaps in employment are fully explored and explanations are recorded on staff files as appropriate. The home should have manager that is registered with the Commission for Social Care Inspection. The way in which the home manages the money of people living at the home should be reviewed and audited by a person independent to the home. Care staff should receive formal supervision at east 6 times a year. 7. 8. 9. OP31 OP35 OP36 Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 35 10. OP37 Any notices that are put on display in the home such as activity schedules, notes of meetings are provided in large clear print to ensure all residents can read them easily. Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Orchard Blythe DS0000041996.V339097.R01.S.doc Version 5.2 Page 37 - 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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