Inspection on 18/08/06 for Orchard Court Care Home

This inspection was carried out on 18th 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 Court Care Home 25/08/09

Orchard Court Care Home 26/08/08

Orchard Court Care Home 03/09/07

Orchard Court Care Home 18/01/06

Orchard Court Care Home 29/09/05

Orchard Court Care Home 17/03/05

Orchard Court Care Home 18/05/04

Orchard Court Care Home 19/01/04

Orchard Court Care Home 14/07/03

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Orchard Court Care Home 7 Wrawby Road Brigg North Lincolnshire DN20 8DL Lead Inspector Mrs Kate Emmerson Key Unannounced Inspection 18th August 2006 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 Court Care Home DS0000002869.V309906.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 Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard Court Care Home Address 7 Wrawby Road Brigg North Lincolnshire DN20 8DL 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) 01652 653845 Orchard Court Residential Home Ltd Undergoing Registration Process Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th January 2006 Brief Description of the Service: Orchard Court is close to the centre of Brigg, and all the local amenities It provides residential care for up to 24 service users (older people). The home is pleasant, well decorated and comfortably furnished and is domestic in character. Service user bedrooms are provided over two floors, and there is chair lift access to the first floor There is parking to the front of the building, and large gardens to the rear The current scale of charges (as identified on the pre inspection questionnaire completed June 2006) £312 - £365 per week. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one and a half days during August and September 2006. To find out how the home was run and if the people who lived there were pleased with the care they received, the inspector spent time in the home watching how the care was given. Nineteen service users and twenty staff were surveyed of which ten service users surveys were returned completed and eight staff questionnaires were returned. Five visitor questionnaires were returned and two Health and Social Care professionals returned their questionnaires. The inspector spoke to the senior member of staff on duty the first visit and Operations Director Pam Morris via the telephone. On the second visit the inspector spoke with Julie Sheppardson, manager, Mr Clark, Director - Jasmine Health Care and three of the staff working in the home at the time of the inspection. The inspector spoke to people who lived in the home in small groups or in private. Records kept in the home was also seen, this was to make sure that the checks to ensure staff are safe to work in the home were completed before they started and that they had been trained to their job safely. Records were looked at to make sure that the home and the equipment used in it were safe and were checked often. Since the previous manager left Mrs Morris had been giving management support to the home, the new manager Julie Sheppardson had started work in the home on the 1 May 2006. Some areas had continued to improve, such as activities, but other areas such as staff training and quality monitoring in the home had been maintained in the absence of a permanent manager. The new manager had begun to address some of the deficiencies, for example she had assessed training needs and some training had been completed. As the home had been managed at arms length for some time, some of the required records were not available in the home at the time of the inspection but were provided after the inspection. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 7 The daily records in the care plans had improved and these now gave more detail about the service users health and the care provided. Accredited medication training had been provided for staff administering medication. All service users requiring the aid of a hoist to move around in the home had been individually assessed to ensure that the equipment was the correct size. All the checks to make sure that people were safe to work in the home were completed before they started work. Where the home gave assistance with finances the records were now clearly maintained. The management had completed risk assessments for the home to reduce the risks of accidents and fire. What they could do better: The home must provide information about the terms and conditions relating to admission to the home to each service user. Information given in the service users guide must be accurate. Service users care needs must be assessed before admission to the home to ensure that the home is able to meet the service users needs. If the admission is an emergency an assessment must be completed on admission to ensure that staff can meet care needs. The assessment must take into account all health needs and associate risks. Care plans must reflect all service users health needs and set out the care that is required to meet these needs. Care plans must be checked regularly to ensure that no changes are required and to ensure that individuals care needs are being met. Medication records must be accurately maintained and service users must be given medication at the times prescribed by the GP. Service users said that the medication isn’t always given on a consistent basis. More care should be taken to ensure that service users feel comfortable and safe when using agency care staff. Records of all complaints must be held at the home and minor complaints/concerns taken by staff must also be recorded. The staff must be trained to recognise symptoms of abuse and how to report suspicions appropriately. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 8 Staff and management must be more proactive in addressing environmental hazards as they arise. Service users said that the staff were very busy and although their care needs were met they sometimes had to wait for care to be completed. The manager should review the staffing levels provided at busy times of the day. Staff records regarding recruitment and disciplinary action must be held in the home. The staff must receive regular training to ensure that they are able to work safely. The service users must have access to money held for safe keeping at all times. The quality of the care and services provided in the home must be regularly assessed. The staff must be able to hear the call bells in all areas of the home so they can provide care in a timely manner. Evidence that equipment such as hoists and gas boilers have been safety checked must be kept in the home. 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 Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 9 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 Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 10 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, 2 and 3 The Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. The home provided clear information and this was freely available in the home. Service users were usually provided with this information before they were admitted to the home. Some of the information provided was not accurate and mislead potential service users. All service users had a care needs assessment but this needs to be consistently applied in terms of detail and timeliness of completion to ensure that all care needs are recorded. EVIDENCE: The statement of purpose and the service users guide had been reviewed and updated since the last inspection and the service users guide now included the last inspection report and service user views. The information was clear and well written although not accurate in terms of staff training. The documents were displayed in the foyer and the manager stated that these were sent to prospective service users, she stated that the documents were also available in large print. Of the ten service users surveyed, six stated that they had Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 11 received sufficient information to make an informed choice about the home. Two service users had been an emergency admission to the home and felt they had not received sufficient information. Two others stated that they had not received sufficient information about the home. The home provided contracts/terms and conditions of stay to the home but of the four cases checked, the two service users who had been admitted to the home since June had not been provided with copies of these. The manager stated that the contracts/terms and conditions were being updated and she would ensure every one received a copy. Where service users were funded by social services there were copies of assessment and care plan information on file. The home also had a comprehensive format for recording the assessment of service users needs. The four people who were case - tracked had all had assessments completed prior to or on admission. Of the four cases checked, two of the service users had been admitted to the home in the 3 months preceding the inspection, one had had a comprehensive assessment of their needs completed and a detailed care plan of how their needs would be met had been developed from this although this had not been completed until 2 weeks after admission. The other service user had had a partially completed assessment and the care plan did not reflect all the needs identified at that point and particularly with regard to a specific condition due to which she had been admitted. This was identified to the staff and by the second day of the inspection there had been a little more information recorded on the assessment and care plan, however this did not fully identify all the needs to be met. The care needs were discussed with the key worker who was able to explain the specific care requirements related to the specific condition for which the service user had been admitted. The service user stated that the staff looked after her well and knew her care needs with regards to her specific condition. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 12 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 and 10 The Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service. Care plans were developed to detail the personal and social needs identified at assessment and the care required to meet these. However care plans had not been adequately developed for some health needs, this may put service users health and welfare at risk. Poor record keeping and stock management may put service users at risk of not receiving medication as prescribed. Service users generally felt they were treated with respect and that their privacy was respected. EVIDENCE: A selection of four care plans was examined. Care plans had been developed and focused on maintaining independence and privacy and dignity. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 13 There had been some improvement in care planning and all those seen had had care plans developed. However there continued to be a lack of monitoring of the service users health needs and lack of consistency in application of care planning and risk assessment in this area. Of the four examined there was one very well developed care plan which covered all the service users health needs but the service user had not been weighed regularly. In another case where the service user was bed dependent and had been identified at high risk of development of pressure sores there was no specific care plan to prevent pressure sores. Although turn charts had been completed to evidence that care had been provided, the care given was inconsistent and it was recorded that pressure relief had been given any where between 3 and 10 times in a 24 hour period. Fluid and diet charts were mainly completed only at meal times and showed little evidence that drinks were offered at other times of the day and there was some evidence that these had not been completed on a daily basis. One of service users had not been weighed on a regular basis to enable staff to identify any problems in this area. One of the service users who had been admitted with a specific health problem which impacted on all aspects of their daily life and required specific positioning in bed had not had a care plan developed to meet these needs. The service user did state that their care needs were met and the key worker was able to discuss confidently the care requirements of this service user. Daily diary records had improved since the last inspection. Monthly evaluations had not been completed in all cases. The manager had noted that reviews had not been completed and had put processes in place for this to be arranged. There was evidence that two of the service users or their representatives had seen and agreed to their care plan. The records regarding handling medication in the home had not been adequately maintained to ensure an audit trail whilst the medication was in the home. There were gaps in medication administration records and incorrect calculations when adding new stock to running totals in the controlled drug administration records. There was evidence that not all controlled drugs were signed for as administered, that the process of administering controlled drugs were not witnessed every time and controlled drugs were not counted to ensure that the balance recorded was correct before administration. There was no evidence that where there had been discrepancies noted that these had been reported to the manager and there was no evidence that the management regularly audited the medications and checked balances of controlled drugs. There was evidence that controlled drugs to relieve pain had not been given at the prescribed times as the home had run out of stock, even though this had been ordered in good time, no one had followed this up. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 14 One of the service users stated that ‘the medications aren’t always given on a consistent basis’. At the second visit the medication records had improved and there were no gaps in the records but there were still some issues in regards to staff maintaining an accurate running total in the controlled drugs book. There was a new medication policy and procedure in place but in light of the above issues this needs to be further developed and more specific instructions must be included for all aspects relating to handling of medication. The management was also requested to carry out a full audit of the controlled drugs and inform the relevant authorities if there is any suspicion of misappropriation of drugs. A format for weekly audit of medication and associated records was developed as recommended by the inspector was forwarded to the Commission following the inspection. Only the senior staff administered medication. The staff administering medication had commenced accredited training, five had completed the training and three were in the process of completing. The service users rooms were all personalised to their own tastes and they were able to bring in some of their own possessions. Service users stated that the staff were ‘nice’ and respected their privacy by ‘knocking on the door before entering’. Some said that staff were good at answering call bells and others said they sometimes had to wait as the staff were very busy. One of the service users didn’t like the use of agency staff as they didn’t know who was going to walk in to offer care and particularly wasn’t happy with male carers offering personal care. The manager stated that this had been addressed and male carers when used had been instructed to offer personal care only to male service users. The service users had use of a telephone in private in the ground floor office. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 15 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, The Quality in this outcome area is good. This judgement has been made using available evidence including a site visit to this service The home takes residents feedback seriously and makes changes where possible. Management listen to residents and make considerable effort to provide a flexible service, which enables them to enjoy a better quality of life. Meals have improved over recent weeks and service users were satisfied with the choice offered. EVIDENCE: Service users social needs and religious needs were now identified as part of the assessment process and a varied daily activity programme had been developed. An activities coordinator had been employed to provide activities 12 hours per week. The service users were involved in a lively dominoes game during the inspection assisted by the activities coordinator. Some were also completing cross-stitch pictures. Service users stated that the activities had improved a lot since the last inspection and stated that they now had the opportunity to go out shopping. Seven of the ten service users surveyed stated that there was usually or always activities arranged that they could take part in 3 others stated that there were sometimes activities they could take part in. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 16 Service users spoken with were very appreciative of the care and attention of the activities coordinator and her dedication to the role. Service users had the opportunity to take part in monthly religious services in the home and two service users attended the local church. Service users were able to exercise choice in all areas of their life from when they got up to the meals provided. Service users spoken to on the day of the inspection stated that they enjoyed their meals and stated that the quality of the food had improved over recent weeks following discussion with the management. One service user said the meat was tough and difficult to chew at times, others didn’t agree. They stated that they always had a choice and there was variety in the menus. The home had a 4-week rotating menu that included two choices at lunchtime and teatime. On checking the records of food provided there was some evidence that the menus had not been followed over recent months. The cook stated that this was due to there being only one cook but the situation was soon to be resolved as another cook was due to start that weekend. The cook stated that there hadn’t been much time for home baking due to the above situation but the service users said that the ‘baking had improved’ and there were ‘good cakes and sweets’. The service users confirmed that while there were always sandwiches offered at tea times there was also an alternative offered, salads on hot days and a hot snack such as jacket potatoes at other times. Fresh fruit was provided in a fruit bowl in the dining room or was available on request. On arrival at the home on the first day of the inspection some of the service users were still having breakfast, all had different choices provided and one service user had had a bowl of porridge, which he stated was very good. The staff confirmed that service users could have breakfast when they wished and that food, like porridge, was kept hot in a hot plate. The kitchen was exceptionally clean and tidy. The dining room spacious and comfortable although the carpet was very stained. The staff were observed to assist service users with meals individually and discreetly. Orchard Court Care Home DS0000002869.V309906.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 and 18 The Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service Complaints in the home were taken seriously and service users were informed about the procedures. Records of all complaints must be maintained in the home. All staff must receive training in the protection of vulnerable adults to provide adequate protection from abuse for service users. EVIDENCE: Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 18 A clear complaints procedure was displayed in the home and was included in the service users guide. Of the ten service users surveyed 8 said stated they would know how to make a complaint. One service user stated that the food had improved in the home after they had complained to the management. The Commission had received three complaints about the home since the last inspection. The Commission, the Provider and the Protection of Vulnerable Adults Team investigated separate elements of these. The providers had thoroughly investigated the complaints referred to them and cooperated fully in all external investigations. They had taken appropriate actions in response to the findings of the complaints. The complaints included one complaint of verbal abuse, poor moving and handling techniques, poor medication practise and lack of choice for service users in daily routines. Appropriate staff disciplinary actions and referral of the staff members involved to the appropriate authorities had been completed. However records of this were not held at the home the manager stated they were held at head office. This was due to the area manager dealing with these issues prior to the new manager starting. All records must be held at the home and open for inspection. Just prior to this inspection the Commission received a further complaint and this was investigated as part of the inspection. The complaint related to inadequate staffing levels, food quality, service users being left in wheelchairs too long, service users not receiving breakfast, domestics doing cleaning and cooking on same shift. All these were unfounded. Other elements of the complaint included the carpet dining room being dirty and the hall carpet being a trip hazard, both these elements were founded. The provider advised the inspector at the inspection that new carpets were to be laid in these areas within two weeks following the inspection. It was indicated on the pre inspection questionnaire that the home had received four complaints at the home. The area manager had investigated these and had forwarded reports of actions taken to the home. However there were no records in the home regarding the original complaint or the investigation process. This was due to the area manager dealing with these issues prior to the new manager starting. All records must be held at the home and open for inspection. Full records of all complaints must be maintained in the home and be open for inspection. There was also evidence that staff were dealing with minor complaints /concerns on an informal basis and although these were being dealt with at the time by the staff, there were no records of these or the actions taken. It is recommended that all complaints are recorded so that the quality of the service and care practise can be monitored. Following the inspection the management forwarded to the inspector, a new format for recording complaints in the home, which should improve recording in this area. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 19 The home had policies and procedures to promote the protection of vulnerable adults and at the last inspection they had obtained a copy of the Local Authority Protection of Vulnerable Adults multi disciplinary procedure however this could not be found by the new manager on the day of the inspection. She stated that she would obtain another copy. Training in this area was included in induction. Eight of the twenty-one staff had received training with the Local Authority prior to the inspection and the manager stated she was waiting for further dates for training. She stated she had completed protection of children training but not protection of vulnerable adults (POVA) but would access this as soon as possible. The providers informed the Commission following the inspection that they had purchased a training pack for carers and the manager and that training was to be provided in October to all staff. Evidence was provided that appropriate checks were completed prior to the recruitment of staff. Where staff were employed to start with a POVA 1st check there were records to evidence that they were supervised until the Criminal Records Bureau check (CRB) had been received. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 20 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 and 26 The Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service The home was generally clean, tidy and well maintained. However the staff and management must be more proactive in addressing potential hazards where risks are identified. EVIDENCE: The home was generally clean and tidy although the carpet in the hallway and dining room was dirty. The hall carpet was also well worn and held down with tape. These issues had been identified as part of the homes Quality Assurance plan and by staff in meetings but it had been decided that work would not commence as they were to have a lift fitted in the home in the very near future. However the hall carpet was a trip hazard and following the inspector’s discussion with the providers new carpets were ordered and the providers stated that these would be fitted within two weeks following the inspection. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 21 Of the 10 service users surveyed, 8 stated that the home was always clean and tidy, 1 said it was never clean and tidy and 1 said it was sometimes clean and tidy. One service user spoken with on the day of the inspection stated that she was satisfied that the room was cleaned regularly but stated that the ‘windows had not been cleaned for ages and this could be improved’. The kitchen was exceptionally clean and tidy. Although service users thought that staff were generally good at answering bells, staff pointed out that, due to the call bells only ringing at the central control box, they could not hear call bells if they were upstairs. This was discussed with the providers and they were requested to look at options to ensure that staff could hear call bells wherever they were in the home. One of the service users stated she had been wet on waking due to the rain, on further investigation the roof had been leaking in two of the bedrooms. Inadequate action had been taken by staff to ensure service users and their own safety and comfort. Due to the significant risk of harm to both service users and staff, the leaks were near/onto electrical equipment; the inspector requested that the service users in the two rooms be transferred to an alternative room immediately until the problem was resolved. On the second visit the inspector was informed that the leaks had been resolved. The fire officer had last visited the home 22 May 2006 and some requirements were made, the providers were able to provide an action plan to meet the requirements and evidence that work had been completed to meet the majority of these. One bedroom on the ground floor had been taken out of commission until work in this area could be completed. There was evidence that where hoists were required for moving and handling the management had individual occupational therapy or district nurse assessments completed. Individuals were provided with their own sling. Staff confirmed that these were named and kept in individual’s bedrooms to prevent cross infection. The first floor bathroom had been redecorated and carpeted since the last inspection. Orchard Court Care Home DS0000002869.V309906.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 and 30 The Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service Staffing levels are maintained in the home to minimum guidelines and although there has been a lot of use of agency staff this should be resolved following the recruitment of new staff. Service users feel that their needs are met but the quality of the care is reduced, as staff were too busy. Staff recruitment has improved since the last inspection although all records must be held in the home. Staff had not received all the required training and updates in the last year to ensure that they were safe and competent to do their jobs however this was being addressed by the new manager. EVIDENCE: There was evidence that the home monitored the service users dependency on a monthly basis and at the time of the inspection provided staffing levels, which met the Residential Forum minimum guidelines. At previous inspections there had been evidence that a tool to formally measure dependency was being used but there was no evidence of its use at this inspection. Five of the 10 Service users surveyed stated that they always received the care and support they needed, two said they usually got the care they needed Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 23 and 2 said they sometimes got the care they needed and one said they never got the care they needed. A service user described the staff as ‘always rushed’ and ‘busy’. They said they ‘sometimes have to wait for the call bell to be answered’. Another service user stated that ‘nothing is too much trouble – no matter how busy the staff are’. Another service user said that ‘they are very busy in the morning but are good at answering the bells. However staff sometimes start assisting them with personal care and then disappear half way through and there is a wait for them to come back, sometimes 20 or 30 minutes’. Five of the six visitors commented that they thought there was not sufficient staff on duty and one stated that she sometimes had difficulty gaining access to the home in the evening either because staff were too busy or they filed to hear the doorbell. Staff stated that there had been problems with sickness levels over the past few weeks, which had affected the staffing levels and agency staff had been used frequently to maintain adequate staffing levels. Staff stated that at times there had been two agency staff and only one permanent member of Orchard court staff which had caused some difficulties in care provision. However this situation had been resolved with the employment of new staff and the manager had other staff waiting to start on receipt of all appropriate checks. A service user had stated that at times they never knew who was going to offer them care and the female service users did not like male carers offering personal care. This had been resolved with the management but shows the impact of the use of agency staff in the home. When the use of agency staff is necessary the home should consider how these staff would be introduced to the service users to ensure that they feel safe and comfortable. At the last inspection Mrs Morris, area manager, stated that a kitchen assistant would be commencing work once all the employment checks had been completed satisfactorily to work in the kitchen over the tea time period. However the care staff were still preparing meals at teatime as this post had not been filled. This affected the type of food available at teatime as care staff did not like preparing meals or had no experience in a kitchen. The cook left simple snacks for care staff to prepare. An induction programme had been developed in line with the TOPPS standards. Although there was no evidence in the home that new staff were completing this one of the new members of staff was able to describe how she had completed this document. There was evidence that an initial induction to the home had been completed in the first week of employment. Senior staff mentored new staff and this made them feel supported. Of the two more recently employed members of staff one stated that they had not completed any moving and handling training since starting but the other stated they had received this training. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 24 There was evidence in staff records and from staff that training had been received in fire safety, protection of vulnerable adults, first aid, dementia care and safe handling of medication since the last inspection. The new manager had identified some training needs and training had been booked. However she did not have an overview of the training completed and some staff hadn’t received updates in areas such as moving and handling and food hygiene or training in infection control and health and safety. The manager had not ensured that she had received copies of training certificates from staff on employment to evidence the training that had been already been completed. The manager must develop a training plan for the home that at least shows how mandatory training will be kept up to date in the next year. Staff files were checked to ensure that all appropriate checks had been completed. There was evidence that for the majority of those employed since the last inspection, references, CRB and POVA 1st checks were completed prior to employment. Where staff had been employed on a POVA 1st check there were records of supervision until the CRB had been obtained. In only one case were there was no evidence of CRB or POVA 1st and only one reference. This person had since left the home but the recruitment process must be completed for all staff prior to employment. Although some of the information was not available in the home at the time of the inspection as the area manager had been completing the process prior to the new manager commencing employment. The information was provided to the inspector following the inspection but all the records must be held at the home and ready for inspection. The management and staff were committed to provision of NVQ training. The pre inspection questionnaire indicated that eight staff of the 21 staff had achieved NVQ level 2 or above. There were 2 further staff that had almost completed level 2 and 1 who had completed and was waiting for their certificate. A further staff member had almost completed level 3. Five staff were waiting to start the training. Orchard Court Care Home DS0000002869.V309906.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): 31,32, 33, 35 and 37 The Quality in this outcome area is adequate. This judgement has been made using available evidence including a site visit to this service There is an experienced and qualified manager in charge of the home. The manager has not yet applied to the Commission be registered manager of the home. The staff and service users find the manager approachable and staff morale has improved. Although the quality assurance process had not been implemented in full over the past year the service users felt they could raise the management took issues seriously. Although staff have not had regular supervision over the last year they felt supported and the manager had a supervision plan in place. Where service users received assistance with their finances processes were in place to safeguard their interests although this was at the expense of free access to their money. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 26 There were systems in place to maintain health and safety but some of these had not been adequately maintained over the past year to ensure that staff had received adequate training and equipment was safe to use. In some cases there was a lack of evidence in the home for work completed. EVIDENCE: A new manager Julie Shepherdson had been in place at the home since 1st May 2006. She has eleven years experience in care, 9 years in senior positions. Julie completed her Registered Managers award in 2005 and has completed other training relevant to the role such as foundation in Management and Btec in Care. Julie has yet to apply to the Commission to become Registered Manager of Orchard court. The Care and Operations Director Pam Morris had been providing management support to the home since the previous manager had left. Mrs Morris is a registered manger at another home in the company and has many years experience. She visited the home at least twice a week. Service users were able to receive assistance in handling finances form the manager. Records of financial transactions for this assistance were checked. The records were clearly maintained and of the three service users records checked against cash held, all balanced with the records and receipts held. It was brought to the inspector’s attention that service users did not have access to their money at all times due to key holding policies. The proprietor was informed and asked to address this and ensure that service user had access to their money at all times. Although the home had a system of monitoring the quality of care in the home there had been little work in this area since the November 2005. The new manager had commenced quality audits in finance employment files and management since June 2006. The proprietors had produced a report and action plan based on the information over the previous twelve months and this had been provided to the commission and made available to service users via the service users guide and this was displayed in the hallway. Service users were involved in the running of the home through service user meetings that were generally attended by approximately 10 service users. There were records to evidence three service user meetings meeting in 2006. Through discussion with the service users it was evident that they felt empowered to raise issues where they were not happy, for example the quality of the food and the use of male carers. They felt that the management generally listened to them and their concerns were addressed. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 27 There was evidence that the staff had received one formal supervision session with the new manager and further sessions were planned but had not had any supervision prior to this since the previous manager had left. The staff had had five staff meetings in 2006 and although the staff stated the morale had low earlier in the year they felt that this had improved. They stated that the new manager was ‘nice’ and ‘approachable’. New staff had a mentor and this had made them feel supported. The proprietors complete their Regulation 26 visits regularly and provide reports to the Commission. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 28 There were systems in place to maintain health and safety but some of these had not been adequately maintained over the past year to ensure that staff had received adequate training and equipment was safe to use. In some cases there was a lack of evidence to show that work had been completed, see below – issues arising form this inspection. The new manager had identified and dealt with health and safety deficiencies such as lack of fire training and service user moving and handling assessments since her appointment. There was good management of falls in the home. Detailed accident records were maintained which included actions taken and checks over a 36-hour period. The manager then evaluated these monthly and further action was taken if necessary. For example where this system had highlighted an increase in falls for two service users the service users had been referred to their GP for medication/walking aid review. Further evaluation showed a marked decrease in falls for the two service users. The following issues regarding health and safety in the home were raised during the last inspection and had now been addressed. • • Environmental and fire risk assessments had now been updated Fire alarm testing had been completed weekly. Issues regarding health and safety outstanding from the last inspection. • Although five staff received moving and handling training in April 2006 there was still evidence that some new staff had not had moving and handling training. Health and safety issues arising from this inspection. • • • • Calls bells can only be heard when staff are in the vicinity of the kitchen near the control board. Staff have not received updates in moving and handling training and food hygiene. Pam Morris wrote to the inspector following the inspection stating that training for 10 staff had been arranged for 3 October 2006. Staff have not received training in health and safety and infection control. There was no evidence that electrical systems and portable electrical appliances had been safety checked. Pam Morris wrote to the inspector following the inspection to state that this work had been completed earlier in the year and she would provide evidence of this on receipt from the electrician. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 29 • • There was no evidence that gas boilers had been safety checked. Pam Morris wrote to the inspector following the inspection to state that this would be completed on the 22 September 2006 and would send evidence on completion of this. There was no evidence that the stair lift and hoists had been safety checked/serviced. Pam Morris wrote to the inspector following the inspection and stated that this had been completed in August and she would send evidence of this. All equipment such as hoist and stair lifts should be serviced/safety checked six monthly. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 30 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 2 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 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 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 2 X X 2 Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 31 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 OP2 Regulation 5 Requirement The registered person must ensure that all service users are provided with a copy of the homes contract/terms and conditions on admission to the home. The registered person must ensure that the service users needs are assessed and recorded prior to or on admission. The registered person must ensure that care plans are developed to reflect the care required to meet all health needs. (Previous timescale 01/01/06 and 01/04/06not met) The registered person must ensure that the service users are weighed at least monthly. The registered person must ensure that care plans are evaluated monthly and full reviews are completed 6 monthly. The registered person must ensure that accurate medication administration records are maintained. A full audit of the DS0000002869.V309906.R01.S.doc Timescale for action 01/12/06 2 OP3 14 14/10/06 3. OP8 15 01/11/06 4 5 OP8 OP7 13(4) 15 01/11/06 01/11/06 6 OP9 13(2) 17 14/10/06 Orchard Court Care Home Version 5.2 Page 32 7 OP16 17 8 OP18 13(6) 9 OP19 23(2) 10 OP19 23(2)(n) 11 OP30 18(1) 13(5) 12 OP29 17(2) 13 OP33 25 14 15 OP35 OP38 12 23(2) controlled drugs records must be completed and relevant authorities informed if there is any suspicion of misappropriation of drugs. The registered person must ensure that a full record of all complaints, including action taken and outcome, is kept in the home The registered person must ensure that all staff have received training in the protection of vulnerable adults. (Previous timescale 01/04/06 not met) The registered must provide evidence to the Commission that new carpets have been fitted in the hall and dining area. The registered person must ensure that call bells can be heard in all parts of the home by the staff. The registered person must ensure that a training programme is implemented to ensure that mandatory training needs are met. All staff must complete moving and handling training. (Previous timescale 01/03/06 not met) The registered person must ensure that all records relating that the employment of staff and disciplinary action are kept in the care home. The registered person must ensure that the quality assurance procedures are maintained The registered person must ensure that service users can access their money at all times. The registered person must provide evidence that electrical systems and portable electrical DS0000002869.V309906.R01.S.doc 14/10/06 01/11/06 01/11/06 01/11/06 01/11/06 14/10/06 01/12/06 14/10/06 14/10/06 Orchard Court Care Home Version 5.2 Page 33 appliances, gas boilers and stair lift and hoists have been safety checked RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP1 OP27 OP27 Good Practice Recommendations The registered person should ensure that the information provided in service users guide the home is accurate. The registered person should review staffing levels at the times of day when service users require more assistance. The registered person should develop procedures to enable service users to feel comfortable and safe with agency staff. Orchard Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Court Care Home DS0000002869.V309906.R01.S.doc Version 5.2 Page 35 - 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. 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