Inspection on 16/04/07 for Orchard Cottage

This inspection was carried out on 16th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Cottage 03/03/06

Orchard Cottage 19/09/05

Orchard Cottage 18/01/05

Orchard Cottage 27/07/04

Orchard Cottage 16/02/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Orchard Cottage 78 Old Road East Gravesend Kent DA12 1PE Lead Inspector Sally Hall Key Unannounced Inspection 16th April 2007 09:30 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 Cottage DS0000040147.V336111.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 Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard Cottage Address 78 Old Road East Gravesend Kent DA12 1PE 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) 01474 321127 info@orchardcarehome.co.uk Mrs Tersaim Kaur Khaira Richy Khaira Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd March 2006 Brief Description of the Service: Orchard Cottage is a detached property situated in a residential area of Gravesend. It is privately owned and is currently registered to provide residential care for ten older people. The accommodation consists of six single rooms, one of which has an en-suite facility, and two double rooms. There is a chair lift to the first floor. Each room has telephone and TV points and a call system. There is an emergency lighting system in place throughout the building. The entire building is decorated to a high standard; the furniture and fittings are also of a high standard and are very homely. The home has attractive gardens. Fees range from £385 to £600 per week. Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key Inspection at Orchard Cottage took place on 16th April 2007 between 10.30 and 15.45 hrs the link inspector was Sally Hall On the day of the inspection the Inspector agreed and explained the inspection process with the Manager in the first instances and later the owner. Time was spent reading all of the care plans, some written policies and procedures and records kept within the home. Staff were spoken with and a large part of the home was seen. The focus of the inspection was to assess Orchard Cottage in accordance with the National Minimum Standards for Older People. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. The home was ask to complete a pre–inspection questionnaire, and surveys were sent out to health professionals that are involved with the service users at the home, evidence from these documents is also included in this report. What the service does well: Maintains a friendly and homely atmosphere, one service users for example said “it is like living in a family and I love it”. A visitor on the day said “I call in at all odd times when I am passing it is never a problem I am always made to feel welcome”. The home staff conduct them selves in such a way to preserve the service users dignity and privacy, one service users said “I like the way they always make sure the door to my room is closed properly while I get dressed and things, I may be old but I am a very private person.” The environment is well maintained and adds to the homely feel with lots of pictures and ornaments around the home in the communal areas. All service users are encouraged to personalise there bedrooms. The meals are all home cooked and made form fresh ingredients. The service users invited the inspector to join them for dinner, this just another sign of how ‘at home’ they feel. All the service users enjoy each others company and spend time together but they also come and go as they wish too. The service users are very much in control of their own lives within the home, with staff enabling them to do what they choose to do. Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 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 Cottage DS0000040147.V336111.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Service users’ needs are fully assessed prior to admission and they can be sure if offered a place that the home can meet their needs. EVIDENCE: Prospective service users are always asked to spend a day at the home during which time an assessment is carried. It is also an opportunity for the prospecive service user to meet other residents within the home. This is a small and very friendly home and the current service users said that it was important that all service users feel comfortable with each other. Just one new service user has been admitted since the last inspection. Evidence was seen of the assessment process. For example, it contained information about mobility, personal care needs and social needs. The home has also added to this the areas ‘home environment’ and ‘life style opportunities’ in order to give a fuller picture of the person they are admitting to the home. The new service Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 9 user spoken to explained how she had spent the day at the home, and having been to several other homes knew this was the place for her. The service users said “It is like living in a family and I love it”. Orchard Cottage DS0000040147.V336111.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can feel confident that their personal, social and health care needs are met. Service users benefit from living within a home where they are treated with respect and their rights to privacy are upheld. Service users can be sure they will receive the medication they are prescribed. EVIDENCE: As this is a small home all the service users files were examined. The files all contained assessments and care plans apart from the new service user’s file. The assessments and care plans had been reviewed and rewritten within the last four months. Reviews are held monthly and these were seen for all service users. They show the outcomes clearly and indicate changes required in their care provision to meet their changing needs. It was however strongly Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 11 recommended by the inspector that all assessments and documentation in the care plan file be dated to show when they were undertaken. The care plans are simple and easy to follow and cover the areas of need with the action staff need to take to meet those needs. Service users said that the help they want from staff is discussed with them. No risk assessments, apart from mobility, were seen in the files. This was discussed with the owner/manager and it was strongly recommended that all service users be reviewed regarding risk and a management strategy be put in place to reduce the risk if appropriate. The daily records were seen and these indicated whether the report was ‘am’ or ‘pm’. However, it still does not always indicate the time that events are actually occur. The daily notes themselves are not detailed enough and they need to show what has actually happened and abbreviations should not be used. Service users’ care is not being recorded fully and it is difficult to establish the input they are having. However, the service users appear well cared for and certainly they were able to explain what staff do for them on a daily basis. This was discussed with the owner/manager who agreed more detail is necessary. Evidence was seen in the files of visits from health care professionals, including visits from GPs and chiropodists. Service users’ families normally escort their relatives to hospital appointments etc and the staff make sure that they are ready to leave on time and send any relevant information with them. Evidence was seen in the records of staff documenting when someone is not well and this was followed up. Service users all said that staff treat them with the greatest respect and that their privacy and dignity is preserved at all times. One service users said “I like the way they always make sure the door to my room is closed properly while I get dressed and things, I may be old but I am a very private person.” Medication recording and storage was seen and an audit of some items was undertaken. Medication is signed in when it arrives at the home and the home does have it in a pharmacy dispensed system though it was noted that some medication delivered during the month had not been signed in. However, the recording for giving out medication was correct and an audit showed the amounts to be correct. The storage facilities are adequate and secure. The home has no controlled medication at this time. Currently there are two service users who self medicate all or part of their medication. The owner manager was made aware that a monitoring system needs to be in place to make sure medication continues to be taken as prescribed. Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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 this service. The service users can be confident that they will be offered a programme of activities throughout the week, however trips out have not been regularly available from the home. Service users benefit from being offered a choice of home cooked, nutritious meals. EVIDENCE: The service users explained that, encouraged by staff, they undertook activities most afternoons. Activities included participating in games such as ‘Snakes and Ladders’, ‘I want to be a millionaire’, ‘Tiddly Winks’ and exercise activities were also regularly offered. There are no outings arranged by the home since most service users made their own arrangements with their families, friends and their church. For example, one service users goes out three nights per week to play whist, whilst another goes out with the church on a regular basis. The local church visits the home and holds a service monthly. However one service user who does not have family nearby is not Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 13 able to go out. This was discussed with the owner/manager and trips will now be arranged. All service users said that their families can visit whenever they like and that there are no restrictions. This was confirmed by a relative who visited his mother. He said “I call in at all odd times when I am passing it is never a problem I am always made to feel welcome”. The inspector was invited to have lunch by the service users. The lunch was home cooked with the choices of cold lamb or cottage pie. The inspector was given a little of both and the meal was considered to be of a good standard. The vegetables had been freshly prepared. The service users confirmed that they always have a choice and all said the meals are very nice. The choice offered for pudding was rhubarb and custard or banana custard. Two service users lay the table ready for lunch and one helps in the kitchen after lunch. One service user said she does it because she likes to keep as active as possible. The home provides a choice at all meals and staff record what service users have eaten each day. It was recommended that the way this is done is reviewed to make sure that abbreviations are not used in the daily records. Service users also talked about what they like to do with themselves during the day. This varied from person to person and it was apparent that all the service users are very much in control of their own lives within the home with staff assisting them when they cannot manage by themselves. Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. 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 this service. Service users can be sure that any complaints made will be taken seriously and addressed by the home. The service users are protected by the home’s robust adult protection policy and procedure. EVIDENCE: The service users said that they would talk to the staff or the manager if they were not happy about anything; “Most things are sorted out before someone needs to actually complain officially” one said. The home does have a complaints procedure and this has been reviewed recently. The home also had a policy on Adult Protection, which had also been reviewed. The was a copy of the Local Authority Adult Protection Protocols in the home and the owner manager makes sure this is up to date although the latest update from February is still needs to be added. It was also recommended that when policies and procedures are updated then the old documentation should be removed from the files to avoid confusion. Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 15 Staff training records showed that staff are receiving training in Adult Protection. The owner/manager was reminded that this training has to be refreshed every three years. Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 16 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, 26. Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. Service users live in a safe, well-maintained and clean environment. The standard of décor, furnishing and fittings are high, providing a homely and pleasant living environment for the service users who live there. EVIDENCE: The inspector felt that it was like walking into someone’s home when anybody is shown into the home. All the furniture is of a good domestic nature and the living areas are made up of a lounge, dining area and a conservatory that is also used as a lounge. The conservatory overlooks the garden and again is a very pleasant room. There are pictures and ornaments that all add to the feeling of home and the service users all agree that it is a very comfortable place in which to live. The home was found to be very clean, and there were no unpleasant odours anywhere. As rooms become empty the owner takes the opportunity to redecorate them. All the service users’ bedrooms had been Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 17 personalised and furniture had been moved to suit each individual. Service users all confirmed they were very happy with their rooms. There is just one en-suite bedroom, but all other rooms have facilities nearby. Evidence was seen that staff have had infection control training and use personal protective equipment, i.e. gloves. The home does all the laundry inhouse. However, it does not currently have a sluicing machine but will obtain a suitable machine in the future. The owner/manager confirmed there are few incontinence problems currently but is aware this could change. Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 18 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 good This judgement has been made using available evidence including a visit to this service. The service users can be confident the robust recruitment procedures protects them. The staffing levels are sufficient and reviewed to ensure they meet the service users’ needs. Staff are trained to provide them with the skills and knowledge they need to care for service users. EVIDENCE: Staff files were seen for four members of staff including the newest staff member employed. All files contained documentation required for recruitment. No staff are employed until they have suitable references and CRB check that is satisfactory. Nine members of staff are employed by the home. During the inspection there were three staff on duty, a domestic and two care staff. The care staff are responsible for cooking the lunch. At night there is one staff member undetaking a waking night shift and two staff are always on call should an emergency arise. Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 19 Newly recruited staff have an in-house induction only as they have completed an induction programme to work force training target standard in a previously held position. The staff training records shows that there have been a number of courses undertaken since the last inspection. Whilst this is to be commended it is important that all staff undertake all the required training and refreshers in the set time limits, i.e. Moving and Handling yearly. It was recognised that a number of courses have been booked and will be taking place in the next couple of months. Staff are encouraged and supported to undertake NVQ’s in Care at Level 2. Currently the home has achieved the 50 target of staff with an NVQ. Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 20 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, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is also the owner although he does have a manager of the care provision also working in the home. The manager has completed his R.M.A. although he is not ‘hands on’ within the home and tends to do the administration, maintenance and sees to the day-to-day management issues. The owner is known and liked by all the service users. They said that he is very approachable and nothing is ever too much trouble. Staff also said that he is very supportive. The completed Pre-inspection questionnaire confirmed that all the maintenance certificates have been obtained and continue to be in date. There is a system in place for staff to report any maintenance issues. The fire log is kept up to date with checks happening within the home as recommended. For example, Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 21 the weekly sounding of the fire alarms. A COSHH file available. Staff training in Health and Safety has been completed recently. However, not all staff have had all the required training to date. The quality assurance questionnaires are to be sent out later this year to health professionals and families, these are normally done yearly. The owner/manager holds regular staff meetings and service users also have regular meetings and are consulted about the everyday things around the home. The service users’ personal money is kept for service users if requested and is documented. However, receipts also need to be kept for all purchases including hairdressing. An audit of the money held was correct. The owner said that the staff at the home had no other dealings with the service users’ monies and if they were not able to manage alone then their families supported them. Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 22 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 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations The daily record shows all the care provided by staff and any events that have occurred. That this is written accurately and in a way that cannot be miss understood. That it shows the time of the provision or event. All service users should be revisited to identify whether they are at risk, and if so then a risk assessment, with management strategy should be produced and the risk monitored. 2 OP8 Orchard Cottage DS0000040147.V336111.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Cottage DS0000040147.V336111.R01.S.doc Version 5.2 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!