Inspection on 07/08/06 for Orchard Blythe

This inspection was carried out on 7th August 2006.

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 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 Sandra Wade Key Unannounced Inspection 7th August 2006 07:40 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.V303848.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.V303848.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.V303848.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th February 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 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 (£10.00) hairdressing – variable charges, newspapers (residents charged monthly) toiletries and some outings. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first key inspection to Orchard Blythe for this inspection year. The inspection process consisted of a review of policies and procedures, discussions with the Assistant Manager, staff and residents. This inspection took place between 7.40am and 4.35pm. Two service users were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting with them, talking to them and their families (if possible) about their experiences, looking at resident’s care files and focusing on outcomes. Records examined during this inspection in addition to care records included, staff recruitment records, staff files, training records, social activity records, staff duty rotas and medication records. Before the inspection, a random selection of service users were sent questionnaires to seek their independent views about the home. Comments received are included within this report. A pre-inspection questionnaire was received from the home on 26 June 2006, some of the information contained within this document has also been used in assessing actions taken by the home to meet the care standards. What the service does well: Staff were observed to be cheerful and friendly towards the residents and promptly addressed any requests made of them by residents. All residents stated in questionnaire responses that they felt staff listened to them and acted on what they said. The home regularly hold meetings with residents to obtain their views on the home and services provided so that any concerns or suggestions can be acted upon. Bedrooms were homely and contained residents personal possessions. One resident said that the home was a “lovely place” and said that they had everything they needed in their room. Many of the staff have worked in this home for some time as the home is fortunate to retain their staff. This allows for continuity of care amongst the residents. Residents were positive in their comments about the staff, one said that “all staff are very good” and they could not fault them. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 6 Five of the six comment cards completed by residents stated that they felt they received the care and support they needed, one responded that this happened “usually”. One resident commented, “the care received is very good, carers are kind and considerate”. The home has a varied activities programme which is managed by an Activity Organiser. A schedule of activities is devised on a monthly basis and a copy of this is put on display in the home so residents know what activities are being provided. Residents were seen to enjoy singing during the inspection and two of the residents spoken to said they regularly enjoyed the bingo. What has improved since the last inspection? What they could do better: A further review of care plans is required to ensure these are being kept up-todate with residents needs. Records also need to show that the care needs prescribed are being carried out so that it is clear residents care needs are being met. Risk assessments need to be reviewed to clearly indicate an appropriate plan of prevention and include clear criteria for the risk assessment of falls. Some issues relating to medication management need to be addressed, this in particular applies to record keeping to ensure the home can demonstrate safe practices are being carried out. Infection control management in the home needs to be reviewed to ensure the home is kept clean consistently and sluicing is carried out in a way that promotes good infection control practices to prevent any risks of infection or ill health to residents. Two of the assisted baths in the home were not operational reducing bathing facilities for the residents. The home need to ensure prompt dates for repair are obtained if this should happen. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 7 Training records require updating with the dates of training carried out so that it is clear all staff have completed training within the required timescales and are competent to care for the residents. 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.V303848.R01.S.doc Version 5.2 Page 8 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.V303848.R01.S.doc Version 5.2 Page 9 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): 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are assessed prior to their admission so that staff in the home know they can meet the needs of the resident. EVIDENCE: Care plans viewed contained assessment records stating the care and service needs of the residents. Care plans had been devised based on these needs and conversations with staff confirmed they knew the care needs of residents. One resident said that they had visited the home prior to their admission and they liked the home and thought it was “lovely” so chose to stay. None of the residents were in need of intermediate care. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Improvements are ongoing to ensure that resident’s health personal and social care needs are suitably recorded to support and protect residents and ensure that all care needs are met. Residents feel they are treated with respect and their right to privacy is upheld. EVIDENCE: Care plans are detailed and give clear instructions to staff on what is required of them to meet the needs of the residents. Residents looked well cared for and were positive in their comments regarding their care. Five of the six comment cards received from residents stated they “always” receive the care and support they need. One resident said that this happens “usually”. A care plan for one resident showed that they had diabetes and a small appetite. A detailed risk assessment had been completed showing actions that were to be taken to reduce the risk of fluctuating blood sugar levels and there was also clear guidelines to staff on what symptoms to look for if the resident’s blood sugar was too low or too high. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 11 Records did not state the range of acceptable blood sugar readings for this resident and at what point the doctor should be called. Staff advised that the district nurses monitor the blood sugar levels when required. It was evident that during June the resident had been admitted to hospital with high blood sugar levels. Staff advised that sometimes residents have their own sugary snacks which they don’t tell staff about which can impact on their blood sugar levels. A care plan had been devised for Eating and Drinking. Staff instructions were to weigh the resident two weekly to monitor their weight and records showed that this was being done. Weight records showed that the residents weight was being maintained although it was below their healthy weight range. The care plan stated that due to this residents small appetite, food and drink intake charts are to be completed daily and reviewed daily. It was clear these were either not fully completed or not being completed on a daily basis so it was difficult to know that the resident was receiving a healthy intake of food all of the time. The mobility care plan indicated that the resident was prone to falls and used a walking stick. A manual handling sheet on the care plan indicated that there was no manual handling required by staff. This suggests that the resident does not require any assistance but if the resident is prone to falling, staff may need to provide some assistance to prevent this. The resident was sitting in the lounge watching television and was observed to look frail. The resident chose not to speak to the inspector about their care in the home. It was evident that specialist support is being sought when required, care plans showed access to the Chiropodist, district nurse, and doctor. A second care plan was viewed. The resident was observed to be smiling and happy to chat with other residents and staff. The resident said that they thought the home was a “lovely place” and that staff treated her like a “queen”. One care plan stated there was a problem with the resident’s vision. It was observed that the resident was wearing special glasses to support this problem. Records confirmed that the resident had fallen on three occasions. The care plan dated June 06 stated, “refer to risk assessment”. The risk assessment on the file stated that the resident should be accompanied at all times and assisted whenever possible. The criteria used for assessing the risk of falls were not clearly identified. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 12 The resident was observed to walk into the reception area independently. A manual handling assessment summary sheet within the care plan file stated “no manual handling tasks required”. This was dated May 2006 and contradicted other records on file relating to mobility. It was found that a ‘Manual Handling Assessment’ was available in a separate file which was dated June 2006 and this stated that verbal assistance only was required. It was not clear why this is not being kept on the main file where staff can more easily refer to this. The resident said that if they needed to see a doctor they would “just ask” and it would be arranged. Daily records were being completed by staff but for both care plans viewed the entries were not sufficiently detailed to confirm that the care needs identified were being met. A review of medication was undertaken. Medication trolleys are used to administer medication and excess medications are stored in an appropriate locked cupboard. Staff confirmed that the district nurses come in to the home to draw up the insulin for those residents who are diabetic. Storage of the insulin was found to be appropriate and in keeping with the instructions on the medication. Since the last inspection the home have obtained a new medication fridge and temperatures of the fridge had been recorded. Temperatures had not been recorded to show the minimum and maximum temperatures. This should be done to ensure temperatures do not exceed 8°C or go below 2°C which are considered to be safe storage levels. Paracetamol for one resident had been crossed off the Medication Administration Records (MAR) with no explanation why. Staff said that this had been discontinued. Records should be signed and dated and confirm any instructions given by GPs. Paracetamol prescribed for one resident contained instructions for one or two to be given. It was not clear from records whether one or two had been given. It was also not evident that a protocol was in place indicating how medications should be managed when prescribed in this way. A label on one medication confirmed that one tablet was to be given every day. The MAR stated that one tablet was to be given three times a day which conflicted with the label. Staff said that the doctor had changed the dosage but this was not clear on the MAR which could lead to medication errors being made. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 13 One resident was taking homely remedies. Staff advised that this had been agreed with the doctor but there was no signed documentation in place to confirm this agreement. It was also not evident that the home has a homely remedies policy. This is important so that all staff follow an agreed procedure which includes checking homely remedies with the doctor to confirm there are no interactions with the medications they are taking. It was observed during the inspection that staff were respectful to residents and maintained their dignity. A resident said that staff always knocked the door before they came in. Residents can meet privately with visitors or relatives in their rooms or can sit in the various communal seating areas around the home. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents can participate in various social activities and events to satisfy their social interests and needs and can also exercise their choice in how care and services are delivered to them so they can maintain some independence in the home. EVIDENCE: There is a programme of activities, which is devised and implemented by an Activity Organiser employed by the home. The activity organiser works for 21 hours per week and activities to be provided are confirmed in an Activity Schedule which is put on display in the home. It was noted that this is not in large print which could make it difficult for some residents to read. The Activity Schedule for July showed events such as a coffee morning, bingo, karaoke, shopping in Coleshill, barbeque, reminiscence, and garden club. The Activity Organiser said that a meal had been arranged at “Grimstock” with entertainment for August and she tried to organise at least one outside trip per month. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 15 One resident said that they used to be very active but due to a stroke was now unable to be so active which was a cause of frustration to them. Despite this the resident confirmed that they had participated in bingo and attended a club on a regular basis. The resident said they liked to read a daily newspaper and staff were observed to give a newspaper to the resident when it arrived. This resident said that there were no regular outings and no monthly meetings where they could talk about issues relating to the home. When speaking to staff about this resident, they confirmed this resident attended various clubs and also received regular family visits but they chose not to participate in some of the activities provided. One resident said that they enjoyed the bingo and won prizes sometimes. Five of the six comment cards received from residents stated there are “always” activities they can take part in. One resident responded that there are “usually” activities they can take part in. The Activity Organiser said that regular meetings were held with residents and these were known as “Quality Circle” Meetings. Notes of a meeting held in July showed that a number of residents attended and matters discussed included staff changes, complaints, meals, activities and outings, the accommodation, safety and residents views of the home. Care plans reviewed showed that the religious and cultural needs of residents are established and considered when planning their care. Care plans seen said that the residents like to participate in the hymn sessions held in the home. Participation of activities is recorded by the Activity Organiser and this information is transferred to the main care plan files on a monthly basis. During the day visitors were observed to take residents out or bring residents in for day care. Staff were observed to be friendly and approachable to visitors and made them feel welcome. Care plans are written to reflect resident choices in how their care is to be delivered including such information as preferred times to get up and go to bed and times and frequencies they like to have a bath. During the morning it was observed in each lounge that staff asked residents what they would like for breakfast. Staff gave choices such as brown or white bread and asked if they wanted marmalade. When a resident asked for a banana, the member of staff went to fetch one for the resident. One resident said that the food was “lovely” and there were enough choices. The notes of the ‘Quality Circle’ meeting in July listed comments from residents including two about the food. One comment was “the food is excellent”, and the other “the food is not inspiring at tea time, I fancy a boiled egg sometimes”. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 16 Staff said that the menus are shown to the residents each night for them to choose what they want the next day. Lists of food preferences are kept on each unit. The menus seen showed that the same supper menu is offered each day. Staff said that there are variations to this offered. Copies of menus are available on tables so that residents can see what meals will be served. Meals observed at lunchtime looked appetising and residents said they had enjoyed their lunch when asked. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 17 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): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. A clear and easily accessible complaints procedure as well as a procedure on the protection of adults are in place which indicates an open and positive approach to problem solving. EVIDENCE: A complaints policy and procedure is in place and records of complaints received are maintained. Since the last inspection, the home had received one complaint in regard to staff attitude. Records showed that the manager had addressed this complaint and forwarded a response to the complainant within the timescales indicated in the homes procedures. Residents spoken to were not all aware of the complaints procedure but it was clear that they felt at ease to raise any concerns with staff if necessary. Two referrals have been made to the adult protection team since January 2006. One of these concerned the behaviour of a resident and another was an allegation from a resident that they had been harmed. Both incidents were fully investigated. A risk assessment was put in place in regards to the resident’s behaviour and staff reported that no further concerns had been observed or reported. In regard to the second incident, it was found that the resident was suffering from a medical problem which had caused some confusion and after some deliberation it was found the reported incident could not be proved. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 18 The assistant manager said that some staff had covered training linked to abuse during their induction training when commencing employment with the home. From records available it was difficult to be clear that all staff had completed this training to be sure that they know how to identify abuse and actions they should take. Staff said that any allegation of abuse reported to them would be referred on to the manager to inform the relevant authorities. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 19 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, 21, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents live in a comfortable and generally well maintained environment but not all baths were fully functional for residents to use and some attention to hygiene practices are required to ensure residents are being cared for in a clean and safe environment. EVIDENCE: The property is a single story building and therefore all accommodation is provided at ground level. There is level access to the building and automatic doors to assist entry for wheelchair users. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 20 Since the last inspection the reception area of the home has been refurbished. There is now a bar area, library and recreation area. The library contained various large print books to assist those residents with poor sight. Some residents chose to sit and read their morning papers in the reception area of the home. The home is divided into three units. Some of the individual bedrooms visited were pleasantly decorated and others required some attention. Bedrooms were found to be homely and furnished with residents’ possessions and the ensuite facilities are of a good size to meet resident’s needs. In one bedroom the wallpaper border was hanging off the wall by the bed and the shelves were dusty. One bedroom had a stained carpet and dirty washhand basin and there were various tears to the wallpaper from where hooks had previously been placed. The shelves were dusty. Another room was clean and tidy and had a television, wardrobe and several personal items to make it homely. The seat on the chair was stained. The assistant manager advised that plans were in place for bedrooms to be decorated but dates for this to take place were not clear. The dining areas are linked to the lounge areas and were observed during breakfast to have tablecloths, teacups, milk jugs and pots of tea. Staff said that the stained non-slip mats on the tables had been replaced since the last inspection. During the previous inspection it was advised the kitchenettes in these areas are to be refurbished but this had not been completed at the time of this inspection. A member of staff said that some repairs had been done to kitchen cabinets as an interim measure. The plum lounge had a large TV and comfortable seating area. The carpet was stained and the assistant manager said that a new carpet cleaner had been purchased to clean all carpets in the home more effectively. Communal bathrooms and toilets are easily accessible and are situated close to the lounge and dining areas. Equipment and aids are provided to assist residents and include toilet seat raisers, assisted baths and hoist. Two of the assisted bathrooms viewed had notes on the bath chairs to say they were out of order which meant the number of baths available to residents was reduced. A member of staff said that arrangements had been made for them to be repaired and in the meantime there was one bath with a chair that could be used and three showers. It was not evident that a date for the repairs to be carried out had been confirmed. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 21 Bathrooms in general gave the appearance of being cluttered. One bathroom contained two commodes, yellow bag bin, laundry basket, two toilet seat raisers and a chair with dirty laundry on it. The non-slip bath mat had mould marks on the bottom. The laundry room had two washing machines, a drier and a large double sink to complete the laundry for all residents in the home. The laundry was found to be clean and tidy and clean clothes were labelled and sorted into units so that staff could return them to the right locations. The hairdressing room was in use during the inspection and was found to be locked when not in use so that any chemical products are always kept secure. Staff were observed to wear tabards when serving food and disposable gloves were readily available throughout the home to promote good hygiene practices. Staff confirmed that commode pots would be cleaned in the sluice rooms. A sluice room viewed was cluttered and access to the sluice sink was blocked by vacuum cleaners. Hand-washing facilities were not available in this room. Staff confirmed that all sluice rooms were the same. Staff must have easy access to the sluice sink and the floor area must be easily cleanable. Handwashing facilities must be available and accessible to staff to ensure good infection control practices can be maintained to prevent the spread of infection to residents. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 22 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, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There were sufficient numbers of staff on duty on the day of inspection and residents feel that staff meet their needs. Staff training is ongoing to ensure staff are competent to meet the needs of residents. EVIDENCE: At the time of this inspection the manager was on annual leave, the inspection was therefore carried out with the assistance of Care Officers, the assistant manager and care staff on duty. Sufficient staff were available on the day of inspection but it was evident from the inspection process that staffing can vary from day to day dependent on tasks to be completed and the health of the residents. The inspector was informed that the home aim to have two carers on duty during the day in the Blue area, one carer in the Plum area and one carer in the Green area with one additional carer working between the Plum and Green areas. At night time the home provide two waking care staff for 35 residents in the three units. Care staff on nights confirmed that it could be busy particularly if they have residents with high dependency needs that have come into the home for a period of respite care. Staff also reported that if staff are off sick or on annual leave this can also impact on staffing levels. The assistant manager said that staffing is reviewed when needed. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 23 During the inspection one resident was heard to say to others that they had heard a resident banging during the night and “getting quite mad”. This resident was heard to say that this person started off banging quietly and it got louder due there being no response from staff. It was established during the tour of the home that the resident who overheard this banging was in the room next door. Carers confirmed that they usually worked together during the night. It is clear that if during the night a resident bangs for attention as opposed to using the call bell they may not be heard. Comment cards sent out to residents and returned to the Commission asked the question “Are staff available when you need them?” Six questionnaires were sent out and six were returned. Of these, four residents responded “usually” and two said “always”. In addition to the carers, senior staff are on duty each day, this can include care officers, the manager or deputy manager. At the time of this inspection there were two vacancies for care officers. One care officer confirmed that duties included medication, staff supervision, on call systems, management of first aid boxes and ordering of incontinence pads. The assistant manager said that if the home were short of carer support, sometimes the care officers would provide care. Staff spoken to said that they would like to spend more time with residents but despite this, everything did get done. One carer said that as well as providing care they sometimes do cleaning, breakfasts, and tidy rooms. One Care Officer on duty was rostered to work from 7am to 1pm but advised they had started at 6am so the medications could be sorted before the medication round was done. This Care Officer was still in the home till late afternoon to ensure everything that needed to be done was completed. Staff confirmed that they enjoy working in the home despite the busy periods and it was evident that this home retain their staff which is a good indication that staff value their role in the home. One resident said that staff treated her like a ‘queen’, another resident said “they are all very good” and “I can’t fault them”. The notes of the July resident meeting contained comments from residents about staff. One person said, “I like all the carers and everything”. Another said, “They’re good to me, they wash me, bath me and wash my clothes”. The assistant manager confirmed that at the time of inspection thirteen care staff had attained a National Vocational Qualification (NVQ) II in Care. A list of these staff was provided to the inspector to confirm this but Care Officers were not listed on this to be clear whether they had attained this qualification. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 24 The assistant manager advised a further two staff were in the process of completing NVQ training to enable them to provide more effective care to the residents. The Care Standard relating to NVQ training stipulates that 50 of care staff (excluding the manager) are to achieve this qualification. A list of all staff seen showed that there are 37 people who can provide care, this includes care officers, relief and bank staff. The home will therefore need to continue with further staff training to ensure this standard is met. The home has a ‘TOPSS’ induction programme in place which was viewed and found to contain comprehensive training units. The assistant manager advised that both new staff and existing staff had been asked to complete this training to allow all staff to provide effective and good care to the residents. Statutory training is ongoing within the home. A training schedule seen showed many staff had attended training and other sessions were booked or in progress. The training schedule did not contain dates to be able to confirm that all staff had attended training within the required timescales to maintain their competency. The assistant manager agreed to devise a training schedule detailing this information. The schedule confirmed that some training linked to resident care had been arranged such as continence, pressure area care and dementia care. Staff files were requested for review. The assistant manager advised that the cabinets in which the files were held were locked and not accessible due to the manager’s absence. The manager must ensure that the operation of the home can be supported as far as possible in her absence including access to files. Two files which were available were viewed. All appropriate documentation was available to confirm that when staff were employed they were deemed safe to work with residents. It was found that there were gaps in employment records for both members of staff and no explanation had been given for these gaps. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 25 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, 33, 35, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Systems are in place to ensure the home is run in the best interests of the residents and to ensure the health and safety of the residents is protected. EVIDENCE: The manager has worked at this home for approximately four years and has attained the Registered Managers Award qualification so is suitably qualified to manage the home. The inspection process confirmed that quality monitoring is undertaken in the home on a regular basis. The home send out surveys to the residents who stay in the home on a ‘short stay’ basis to obtain their views on the home and responses are monitored to ensure the home maintain good care and services. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 26 ‘Age Concern’ had conducted a recent survey amongst the permanent residents to obtain their views on the care and services provided. Details of this survey were available in the home. The assistant manager explained that the home were in the process of addressing responses to improve the services and care provided in the home further. In addition to these surveys, ‘Quality Circle’ meetings are held in the home regularly where a variety of issues are discussed such as staff changes, staff attitudes, complaints and suggestions, meals, activities, safety, accommodation etc notes of the meetings are kept and show which residents have attended as well as agreements made in regards to issues raised. Monthly reports detailing the outcome of visits made by the responsible individual provide information on the quality of services provided in the home and copies of these are provided to the Commission. In regard to the management of resident ‘pocket monies’. The home have a ‘corporate special account’ which is a bank account set up in the name of the home. The inspector was advised that this is not an account, which accrues interest. Monies and cheques are paid into this account and computerised records are kept of all resident receipts of money and transactions. Copies of receipts for any purchases made are kept and appropriate arrangements are in place to store any money kept in the home. A balance sheet is completed on a monthly basis to check that money received and paid out has been managed accurately. It was not evident that the pocket money accounts are being externally audited on a regular basis to confirm the resident’s monies are being managed appropriately. On the whole record management in the home is good, areas, which require further improvement, have been highlighted in the relevant sections of this report. A review of health and safety was undertaken. The home confirmed in a preinspection questionnaire forwarded to the Commission that health and safety checks had been completed for emergency lighting (20.4.06), Emergency Call Bell systems (26.4.06), Baths (7.6.06), wheelchairs (5.4.06). The home has stated that fire alarm tests are carried out weekly. The last fire drill is recorded as September 2005 and it was advised that as a good practice measure the frequency of these is reviewed. Records were seen in the home to confirm that the electrical wiring had been checked in October 2004. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 27 Wheelchairs had been checked in April 2006. The Landlords Gas Safety Certificate was not available in the home to confirm gas checks undertaken. Attempts by the assistant manager to locate a copy of this from the relevant department were not successful. Hot water tested in the home on the day of inspection was within safe levels to prevent any risks of scalding to the residents. Cleaning schedules were seen in the kitchen and the home had achieved the Diamond Award in 2005 for good food hygiene which is valid until September 2007. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 28 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 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 X 2 X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 29 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 15,17,14 Sch3 Requirement The registered manager must ensure that the care planned reflects the actual needs of the residents and when changes occur these are clearly indicated and new plans developed. (Above outstanding from February 2006 inspection) Records must demonstrate that the care prescribed is actually being given (eg within daily records). Where risks are demonstrated, an appropriate plan of prevention must be devised which includes clear criteria for the risk assessment of falls and nutrition. (Outstanding from February 2006 inspection) All handwritten entries on the MARs must be dated and signed to confirm any instructions given by GPs. MARs must accurately reflect all medication prescribed. Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 30 Timescale for action 30/09/06 2. OP8 14, 17, Sch3 30/09/06 3. OP9 13, 17 30/09/06 The home must ensure that protocols for the administration of medications are clearly available. This includes how the home are to manage tablets that are prescribed for one or two to be given so that it is clear how many have been given. A Homely Remedies policy is to be developed by the home to ensure these are managed safely. The manager is to advise a date for the two assisted baths to be repaired. The manager is to review infection control and hygiene practices in the home to address the following. The provision of hand-washing facilities for staff in areas where sluicing is undertaken. Ensuring sluice areas are accessible and easily cleanable. Ensuring all areas of the home are clean consistently including carpets. Ensuring dirty laundry is stored appropriately. The manager must ensure that there are clear records of care staff training completed and planned in regards to the NVQ II in Care qualification to demonstrate the home employ sufficient numbers of suitably qualified staff. 4. 5. OP21 OP26 23 13,16 30/09/06 31/10/06 6. OP28 18 30/09/06 Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 31 7. OP30 18(1)(c) The Registered Manager is to forward an up-to-date training schedule showing dates of all training completed by staff to confirm this has been completed within the required timescales. The home must be able to demonstrate staff training in the identification and prevention of abuse. Staff records must be accessible at all times. Health and Safety records must be available in the home to confirm checks made. The manager to forward a copy of the Landlords Gas Safety Certificate. 30/09/06 8. OP37 17, Sch4, 23 30/09/06 Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 32 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. OP7 Refer to Standard Good Practice Recommendations It is advised that the range of acceptable blood sugar levels for those residents with diabetes are established with the appropriate professionals and recorded on their files so that staff can monitor these and take any appropriate actions. The minimum and maximum temperatures of the medication fridge should be recorded to confirm medications are being stored safely. 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. It is advised that the home seek an external person to audit the homes accounts on at least an annual basis to confirm this process is being managed appropriately. It is advised that 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. 2. 3. 4. 5. OP9 OP19 OP27 OP29 6. 7. OP35 OP37 Orchard Blythe DS0000041996.V303848.R01.S.doc Version 5.2 Page 33 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. 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