Inspection on 18/01/06 for Orchard Court Care Home

This inspection was carried out on 18th January 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 18/08/06

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

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Larchfield Manor

Hawkhills

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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 Unannounced Inspection 18th January 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.V279278.R01.S.doc Version 5.1 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.V279278.R01.S.doc Version 5.1 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.V279278.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th September 2005 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 Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over one day in January 2006. To find out how the home was run and if the people who lived there were pleased with the care they got the inspector spent time on in the home watching how the care was given. The inspector spoke to the Operations Director Pam Morris and for of the staff working in the home at the time of the inspection. The inspector spoke to people who lived in the home and formally interviewed 2 who were able to answer some questions about the home. Paper work kept in the home was also seen, this was to make sure that the checks to make sure staff are safe to work in the home were done before they started and that they had been trained to their job safely. Paperwork was looked at to make sure that the home and the things used in it were safe and were checked often. Since the previous manager left Mrs Morris has been giving management support to the home. Some areas have continued to improve but other areas such as staff training and quality monitoring in the home have not continued in the absence of a permanent manager. What the service does well: The home was clean, tidy and comfortably furnished. The residents said that they enjoyed living in the home and said that they were offered choices in all areas if their life. They said that there were a wide variety of activities available to them and the food was good. They enjoyed having breakfast in bed if they wished. The residents said that the staff were ‘nice’ and ‘come when you ring the bell’. They felt that they were treated with respect by the staff. They said the home continues to improve. The home provided enough staff to care for the residents and most of the staff had had the training they needed to provide care safely. The management have been very good at making sure things get done as required after inspections. Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 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. Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 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 Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Detailed information about the home and the service s it provides was available in the home. The service users guide requires the inclusion of the last inspection report to meet the standards and regulations. EVIDENCE: The statement of purpose had been further developed to include the criteria for admission to the home and this document now met the standard. The service users guide still did not include the last inspection report or service user views. Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 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 or for a service user accessing respite care, this may put service users health and welfare at risk. Handling of medication and associated records had continued to improve but accredited staff training is required in this area. Service users felt they were treated with respect and that their privacy was respected. EVIDENCE: A random selection of care plans was examined. Care plans had been developed and focused on maintaining independence and privacy and dignity. Care plans and risk assessments were in place relating to nutrition, pressure area care and mobility but these lacked specific details about the care that was required to meet needs. For example where risks had been identified regarding pressure sore development there were no clear instruction as to how often pressure relief should be given. Where monitoring charts were used Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 Page 10 these had not been completed regularly or consistently and service users had not been weighed on a regular basis to enable staff to identify any problems in this area. Where a service user had been admitted for respite care a care plan had not been completed even though risks of wandering and confusion had been identified at assessment. Daily diary records were generally good but staff must take care to record significant events. In one case where a GP had been requested to visit a service user there was no records of a visit being made or any further action taken to follow up the request. There was evidence that the service users had seen and agreed to their care plan. The records regarding handling medication in the home had improved and were adequate to ensure an audit trail could be maintained whilst the medication was in the home. Only the senior staff administered medication. The staff had completed halfday system training and at the last inspection the manager had stated that staff were on a waiting list with a local college to commence an accredited course in safe handling of medication. This had not been commenced due to lack of funding. The staff must administering medication must receive accredited training. Service users stated that their privacy was respected and that staff were ‘nice’ to them. One service user stated that they now called him by his preferred name and that staff treated him with respect. They stated that this area had improved over the past few months. The service users had use of a telephone in private in the ground floor office. Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 The service users stated that all areas of daily life and activities had improved and there was evidence that the service users were able to exercise more choice and control over their lives. Service users were provided with a varied nutritious diet. EVIDENCE: Service users social needs and interests 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 10 hours per week. Key worker records showed that service users were involved in a wide variety of activities and some staff were very committed to this role. There was evidence that staff took service users out to lunch or shopping in their own time. The service users stated that hey enjoyed the variety of activities available in the home. The staff confirmed that activities were available every afternoon. Service users were able to exercise choice in all areas of their life from when they got up to the meals provided. Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 Page 12 Service users stated that they enjoyed their meals and the quality of the food was good. They stated that they always had a choice and there was plenty of variety. The home had a 4-week rotating menu that included two choices at lunchtime and teatime. Home baking and fresh fruit was provided. The kitchen was exceptionally clean and tidy. The dining room spacious and comfortable. The staff assisted service users individually and discreetly. Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 Page 13 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 Complaints in then home were taken seriously and service users were informed about the procedures. All staff must receive training in the protection of vulnerable adults to provide adequate protection from abuse for service users. EVIDENCE: The home records all concerns and complaints received. Records of 3 minor concerns were seen and the actions taken in response to these had been recorded. A clear complaints procedure was displayed in the home and was included in the service users guide. Service users spoken with stated they would know how to make a complaint. The homes ethos has significantly changed and promotion of service users rights was at the forefront of the way the service was delivered. The home was now managed to meet the lifestyle choices of the service users and care planning and staff training promoted this. The home had policies and procedures to promote the protection of vulnerable adults and they had obtained a copy of the Local Authority Protection of Vulnerable Adults multi disciplinary procedure since the last inspection. Leaflets explaining the policy and procedure provided by the Local Authority had been placed in the home. Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 Page 14 Training in this area was included in induction. Eight of the twenty-one staff had received training prior to the last inspection but no further training sessions had been provided since then. Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 Page 15 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): 25 The home was clean, tidy and well maintained. The hot water temperatures in the home were within an acceptable range. EVIDENCE: A random selection of bedrooms was inspected. The home was well maintained and clean and tidy. There was evidence that regular checks of the hot water in the home was conducted and that action had been taken to control the water at safe temperatures. The temperature of hot water at outlets checked was within an acceptable range. Two bedrooms, which had been used as a single with a sitting room (No 7), had been changed back to two single bedrooms. (Now No’s 7 and 8) The work wasn’t complete in regards to decoration and a radiator cover was required in what is now room 8. An individual call bell had not been provided for room 7 and room 8 call bell rang as room 7. Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 Page 16 One fire extinguisher in the hall way was not hung safely as the bracket had come loose from the wall. Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 Page 17 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 and 29 The staffing numbers and skill mix of the staff provided met the service users needs. Staff had received a variety of training in the last year but the training programme had not continued since the previous manager had left and this may put service users health and safety at risk. Although there was some improvement in staff recruitment processes there was a lack of the required references which does not offer adequate protection to service users. EVIDENCE: The home assessed and monitored the service users dependency on a monthly basis and provided staffing levels slightly above the Residential Forum minimum guidelines. There were improved processes to deal with absenteeism and provide cover where necessary. Staff stated that the rotas were managed appropriately and that they were now not called in on days off. At an additional inspection on 25 November 2006 all the staff spoken with had concerns that the extra assistance to make the service users tea time meal had been discontinued which meant that one of the three staff on duty spent long periods of the afternoon shift in the kitchen preparing meals rather than on the floor providing care. At this inspection Mrs Morris stated that a kitchen Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 Page 18 assistant would be commencing work once all the employment checks had been completed satisfactorily to work in the kitchen over the tea time period. An induction programme had been developed in line with the TOPPS standards although there was evidence in the home that new staff were completing this. There was evidence that an initial induction had been completed in the first week of employment. New staff stated that they had not completed any moving and handling training. At the last inspection a training programme had been developed and this included all the mandatory training such as moving and handling, first aid, infection control and fire safety. Training in tissue viability, incontinence awareness, key working and care planning had also been provided. Records were maintained to show which staff had attended training. Training was provided through a mix of external providers and in house training supported with videos. Training had been prioritised to ensure that all the staff had attended moving and handling and fire training. Mrs Morris stated that there had been no training since the last inspection. There had been two new care staff commence employment since the last inspection. Both staff files contained only one reference rather than the required two references. The area manager stated that in both cases she had received two references but could not locate them during the inspection. All the other checks had been obtained. Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 Page 19 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): Although the home does not have a registered manager the Registered Person had ensured that plans were in place for the continued management of the home until a new manager could be recruited. EVIDENCE: At the time of the inspection 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. A new manager had been in post since the 2nd January 2006 but at the time of writing the report the home given notice to the Commission the she was leaving. Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 Page 20 Pam Morris will continue to offer management support and Lorraine Driscoll had been employed as head of care. Assistance in handling finances was provided by the home. Records of financial transactions for this assistance were checked. The records were clearly maintained but there was evidence that the staff had taken money to pay the chiropodist without recording this, which meant that the cash held didn’t balance with the records of transactions. The records must be maintained so that they reflect the activity in the account. There had been no further work done in the quality assurance processes since the last inspection. At the last inspection a quality assurance programme was in place, based on seeking the views of service users and relatives through anonymous satisfaction questionnaires. However the service users had not been informed of the outcome of the surveys or the action to be taken where improvement was required, as results of surveys were not published and annual development plan had not been developed. . The previous manager had improved all areas of health and safety and staff had received training in mandatory areas. The following issues were raised during the last inspection had been addressed. . • The water temperatures were now regulated close to 43°C. Requirements not addressed from the last inspection and from additional inspection 25th November: • • Environmental and fire risk assessments required updating. Fire alarm testing had not been completed weekly. Records showed that fire alarm testing had only been completed twice a month since the beginning of October 2005. Requirements arising from this inspection: • New staff had not had moving and handling training. Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 Page 21 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 X X 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 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X X X X 2 X STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 Page 22 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 OP1 Regulation 5 Requirement The registered person must ensure that the service users guide includes the most recent inspection report. (Previous timescale 01/01/06 not met) 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 not met) The registered person must ensure that staff receive accredited training in the safe handling of medication. (Previous timescale 01/01/06 not met) The registered person must ensure that all staff have received training in the protection of vulnerable adults. The registered person must ensure that rooms 7 and 8 are completed and include call bells DS0000002869.V279278.R01.S.doc Timescale for action 01/04/06 2 OP8 15 01/04/06 3 OP9 13(2) and 18(1) 01/04/06 4 OP18 13(6) 01/04/06 5 OP25 23(2) 01/03/06 Orchard Court Care Home Version 5.1 Page 23 6 7 OP25 OP30 23(4) 18(1) 13(5) 8 OP29 19 individually set for each room, a radiator guars for room 7 and decoration of the doorway between the two rooms. The registered person must 01/03/06 ensure that fire extinguishers are secured safely. The registered person must 01/03/06 ensure that the training programme is delivered to ensure that mandatory training needs are met. All staff must complete moving and handling training. The registered person must 18/01/06 ensure that staff are not employed until all the required information and checks as listed under Regulation 19 of the Care Home Regulations 2001has been obtained. (Previous timescale 29/09/05 not met) The registered person must complete a report on the review of the quality of care and make a copy available to the service users and the Commission. (Previous timescale 01/01/06 not met) The registered person must ensure that accurate records of financial transactions are maintained where support is offered to service users in this area. The registered person must ensure that the fire alarm is tested weekly. (Previous timescale of 25/11/06 not met) The registered person must review and update the environmental and fire risk DS0000002869.V279278.R01.S.doc 9 OP33 24(2) 01/04/06 10 OP35 17 18/01/04 11 OP38 23(4) 18/01/06 12 OP38 13(4) 01/04/06 Orchard Court Care Home Version 5.1 Page 24 assessments. (Previous timescale 01/11/05 not met) 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 OP1 Good Practice Recommendations The registered person should ensure that the service users guide includes service users views. Orchard Court Care Home DS0000002869.V279278.R01.S.doc Version 5.1 Page 25 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.V279278.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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