Inspection on 27/09/05 for Orchard Blythe

This inspection was carried out on 27th 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 Blythe 18/06/07

Orchard Blythe 07/08/06

Orchard Blythe 16/02/06

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 Yvette Delaney Unannounced Inspection 27th September 2005 15:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 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.V254590.R01.S.doc Version 5.0 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.V254590.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th January 2005 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, 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. 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 management team consists of a registered manager; assistant manager and four 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. Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection, carried out on a Tuesday during the hours of 15.00 pm and 22.00 pm. A tour of the premises was undertaken. Records were examined, which include care plans, risk assessments, staff files and records maintained in the kitchen for recent checks. Conversations were held with six members of staff and formal and informal conversations with a number of residents. The inspection focused on the progress made on the requirements and recommendations made at the last inspection. The home provides facilities and services for up to thirty-five older people requiring long term care. The home manager and deputy manager were present for the first part of the inspection, followed by the support of one of the senior care officers. Staff were receptive and positive throughout the inspection with a good level of knowledge about residents in their care. Residents were happy with the home, relaxed and able to speak openly about their day-to-day life in the home. What the service does well: What has improved since the last inspection? What they could do better: The registered manager must ensure that action is taken to address requirements made following inspections. Staff need to receive training and guidance on the completion of the new care plan documentation, which will support staff in completing the care plans effectively. Examination of care plans made it clear that staff were unsure as to what should be included under each heading, causing confusion, which could lead to omission of care. Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 6 Risk assessments need to be completed, which are based on identified criteria, which verifies the outcome. Medication procedures in the home must be audited to ensure that safe practices are followed at all times. Staffing needs to be improved to ensure that there are sufficient staff on duty at all times who are suitably trained and have a NVQ qualification at level 2 or above. Systems must be in place, which ensure that appropriate checks are made when recruiting staff. When taking up references the manager must ensure that references are requested from suitable referees. 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. Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The home’s Statement of Purpose and Service Users’ Guide are good providing residents and prospective residents with details of the services the home provides enabling an informed decision about admission to the home. EVIDENCE: Both the Statement of Purpose and Service User Guide have been completed and are accessible to residents and visitors to the home. Copies of the Service User Guide are available in the resident’s room. The information is informative and some of the residents have read the document. Residents were happy with the home and one resident said that the home had been recommended saying ‘I’m very fortunate, can’t complain’ another said ‘marvellous’. Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9 Residents’ health, personal and social care needs were not consistently described in care plans, which could result in the oversight of care and possible harm to residents. Some risk assessments did not identify the criteria used to assess the resident against and were not updated regularly which could result in the oversight of care and possible harm to residents. Care staff are not following the policies and procedures for the administration of medicines in the care home, which could result in residents not being protected from harm. EVIDENCE: The Inspector was informed that the care plan documentation is relatively new to the home. Care profiles are based on the activities of daily living, which requires the person carrying out the assessment to identify a residents strengths, needs/problems and causes of problems. The information, which identifies a residents health, personal and social care needs is available but is not clearly identified. Care plans examined do not clearly identify the action to be taken by staff to meet individual residents needs. Care plans forms are not completed consistently to correspond with headings on care plan formats. Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 10 Examination of care plans made it clear that staff were unsure as to what should be included under each heading, causing confusion and could lead to omission of care. Risk assessments are completed and available in care profiles, those examined include moving and handling, nutrition and falls. The criteria used for assessing the risk of falls were not clearly identified. The date on some risk assessments did not demonstrate that they are regularly updated the falls risk assessment seen was dated May 2005 and nutrition screening June 2006. Risk assessments had also been completed related to the individual needs of residents for example smoking. Medication procedures were examined and the following was noted • • • • • • • The fridge used for storing medication is a novelty fridge, it was in need of defrosting and temperatures of 8°C and 9°C were recorded. Tablets available in a dispenser in the drug cupboard were not labelled to indicate who they were prescribed for. The drug cupboard was used to store other items than medication, which includes hearing aid batteries. Oil had been decanted into smaller bottles these were not labelled to indicate what was in the bottle and not dated. The larger bottle of what looks like the same fluid states the expiry date as May 2004. Medicine bottles were being used to decant steradent tablets. Respiradone tablets were decanted into another medicine bottle and relabelled by staff. Numerous omissions were noted where medication had not been signed to confirm that they had been administered. Omissions noted were mainly for ointments, creams and eye drops in all units. These were also not labelled with the date of opening for those that need to be disposed of after 28 days or 1 month of opening. Appropriate risk assessments had been carried out for those residents who were self-administering medication. Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This section was not assessed at this inspection. EVIDENCE: Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This section was not assessed at this inspection. EVIDENCE: Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 The environment is varied throughout the home in relation to safety, maintenance, comfort and cleanliness, which overall promotes a positive experience of quality of life for residents. EVIDENCE: A tour of the home was carried out with one of the senior care officers. The property is a single story building, therefore all accommodation is provided at ground level. At this visit to the home, work was in progress to make changes and refurbish the reception area of the home. Safety measures have been implemented to ensure the safety of residents and visitors to the home, which includes providing a temporary entrance to the home. Security checks are carried out twice a day by late staff and repeated again by night staff. Checks involve ensuring windows and doors are securely locked and staff also cross check each other’s units. Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 14 A separate smoke room is provided for those residents who smoke. The inspector was informed that the room is cleaned daily and bins are emptied. The vents in this room were dirty. A separate staff room is provided for staff, which provides a comfortable area for staff to have a break. The home is divided into three units. Individual bedrooms visited were well decorated, homely and furnished with residents’ possessions. One of the bedrooms has been decorated and refurbished by the relatives to suit the residents taste. Each bedroom has en suite facilities, which are of a good size and meet resident’s needs. There were no bins in the en suite and pads have been stored on the floor. Suitable accessible communal bathrooms and toilets are situated close to the lounge and dining areas. Equipment and aids provided for the use of residents include toilet seat raisers, assisted baths and hoist. There are kitchenettes in each unit these are relatively clean. Cleaning clothes were non-disposable and dirty and the non-slip mats on tables were heavily stained and also looked dirty. Information was not available to confirm that fridge temperatures are checked in the kitchenettes. The main kitchen is tidy and looks well maintained. Records were available to confirm food temperatures, fridge and freezer temperatures, which were within normal range. The cleaning rota available identified daily, weekly, fortnightly and monthly cleaning routines. House keeping cupboards containing products for cleaning were locked. Product details were available and the cupboards were locked as required to ensure the safe storage of chemicals. The hairdressers’ room was not locked and products were not securely stored and locked away. The laundry room was spacious, clean and contained suitable equipment for laundering residents clothing and linen. Domestic lighting is provided in the home and natural lighting and ventilation provided by windows, which are fitted with suitable opening restrictors, adding to a safe environment for residents. Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 29 The numbers of staff during the day of inspection were sufficient to meet the needs of residents accommodated in the home, which should lead to appropriate care provision and support an increase in the quality of life of individual residents. There was no evidence to demonstrate that the deployment and number of staff provided during the night shift are sufficient to meet the care needs of residents. There are not sufficient care staff in the home with a NVQ level 2 qualification, to ensure that the skill mix of staff on duty are appropriate to meet the care needs of residents and that residents are in safe hands at all times. The procedures for the recruitment of staff are not robust to ensure that all safeguards are accessed to offer protection to residents living in the home. Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 16 EVIDENCE: Examination of staff rota and observation of staff on duty identify that there are sufficient staff on duty during the day. Concern is raised about only two care staff on duty at night for 35 residents. Separate ancillary staff are employed to cover catering and housekeeping duties. Night care staff also carry out laundry duties. The manager confirmed that there is currently only one member of staff working towards completing the NVQ level 2 qualification, which does not ensure that at least 50 of care staff are appropriately qualified. The personnel records for four members of staff were inspected the files contained all required pre employment checks to determine fitness. There is a concern that in two of the files references were requested from the friends of employees even though applications give details of past employment, from who appropriate references could have been requested. Staff records provided details of staff having received supervision, which was detailed as being carried out 3 monthly, which would not meet the recommendation of staff receiving supervision at least 6 times per year. Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 36 and 38 The manager and her senior team operate each shift with clear leadership and direction so that changes in resident’s needs are identified and action taken to meet those needs. There are concerns that the health safety and welfare of residents are not consistently promoted. Poor practices related to the administration of medicines do not safeguard residents and could result in risk from harm. Staff are supervised to ensure that they have the support, skills, practises and knowledge to meet residents needs. EVIDENCE: Observations made indicate that the manager is approachable, has good interaction with residents and staff. Residents expressed positive comments about the manager and were happy with the way the home is run. Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 18 Staff spoken to and practices observed, particularly in relation to the environment, care planning and medication as discussed in this report indicates that there are varying levels of knowledge and understanding of health and safety issues in the home. Care staff said that they are receiving supervision, which is carried out by their line manager. Records were examined to confirm that supervision sessions had taken place. The frequency in which supervision of staff would be carried out was noted as three monthly. This would provide supervision four times a year instead of the recommended minimum of six times a year. Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 3 3 3 3 3 X STAFFING Standard No Score 27 2 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X 2 X 2 Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 20 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 Timescale for action Care plans must set out in detail, 31/12/05 the action needed to be carried out by care staff to ensure all aspects of the health; personal and social care needs of the service user are met. Written information must allow for methodical monitoring and provide evidence that all care needs are identified. To support this staff must receive training and clear guidance on how the new care profile information is to be completed. The registered manager must 31/01/05 ensure that a clear criteria is available which details the assessment carried when determining a residents level of risk in relation to falls to ensure that the needs of all resident’s are appropriately assessed. The registered manager must 31/12/05 make arrangements for ensuring that the safe administration of medication is adhered to at all times. The issues highlighted in this report must be addressed. Requirement 2 OP8 12, 13 3 OP9OP38 13(2) Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 21 4 OP26OP38 13(3)(4), 16 The registered manager must ensure that effective measures are in place to control the risk of infection and maintain the health and safety of residents at all times. The following must be addressed: • The vents in the smoke room must be cleaned. • • Suitable bins must be provided in en suite rooms. A suitable place to store pads in residents’ bedrooms must be provided. The dirty cleaning cloths and non-slip mats currently in use in the dining room and kitchenette areas need to be replaced. Fridge temperatures in the kitchenette area must be checked and consistently maintained. 31/12/05 • • • 5 OP27 18(1)(a) 6 OP28 18(1)(a) Hair products kept in the hairdressers’ room must be securely stored and locked away and the hairdressers’ room must be locked when not in use. The registered manager must provide evidence to confirm that there is sufficient care staff on night duty to meet the needs of individual residents. The registered provider is required to devise an action plan detailing the arrangements for ensuring care staff undertake a NVQ Level 2 or equivalent and shall submit a copy of the action plan to the Commission. Outstanding from inspection dated 6 January 2005. DS0000041996.V254590.R01.S.doc 31/12/05 31/12/05 Orchard Blythe Version 5.0 Page 22 7 OP33 26 8 OP36 18(2) The registered provider must ensure that monthly, unannounced visits are conducted, and a written report on the conduct of the care home prepared. A copy of which must be supplied to the registered manager of the care home and to the Commission for Social Care Inspection. Previous timescales of 30.04.04 and 31.03.05 not met. The registered manager must ensure that staff working in the care home are appropriately supervised, which includes reviewing the frequency of supervision sessions. 31/12/05 28/02/06 Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 23 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 OP16 Good Practice Recommendations It is recommended that details of the stages in the complaints process be included in the complaints procedure document. This Standard was not assessed at this inspection. Foundation training to National Training Organisational Standards should be available within the first six months of appointment. This Standard was not assessed at this inspection. 2 OP30 Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Orchard Blythe DS0000041996.V254590.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!