Inspection on 29/09/05 for Orchard Court Care Home

This inspection was carried out on 29th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 18/01/06

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 Unannounced Inspection 29th September 2005 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.V255593.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 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.V255593.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21 March 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.V255593.R01.S.doc Version 5.0 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 September 2005. 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 manager and three of the staff working in the home at the time of the inspection. The inspector spoke to six people who lived in the home and were able to answer some questions about the home and one relative. 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. 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 ‘very good’, ‘kind’ and ‘come when you ring the bell’. A relative said that ‘nothing was too much trouble’ and that they ‘communicated well’. The staff enjoy working at the home and have a good relationship with their manager which means that there is low turnover of staff. The home provided enough staff to care for the residents and they had had the training they needed to provide care safely. The manager had made sure that the home was safe by making sure the staff had had the training they needed and by doing safety checks on equipment regularly. Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 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.V255593.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 and 3 All service users had their needs assessed before moving in to the home. Information regarding the home and the services available was provided for the service users in a statement of purpose, service users guide and a written statement of the terms and conditions. EVIDENCE: A service user who had been admitted to the home since the last inspection stated that the manager had visited them at home to assess them and they had received a booklet with information about the home. They had also been given a contract when they were admitted. Records of detailed assessments of service users needs were held in service users files. The manager completed these prior to service users being admitted to the home even where that admission was in an emergency situation. Care plans had been developed from the information gathered at this stage. The manager wrote to service users following assessment to inform service users that their needs could be met in the home. Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 Page 9 Information about the home and the services provided in the form of a statement of purpose, service users guide and statement of terms and conditions were provided. These documents were well developed and informative. To meet standard 1, the statement of purpose must provide information on the criteria for admission to the home including emergency admissions. The service users guide must include service users views of the home and the most recent inspection report. Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 and 9 Care plans had improved and 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 which may put service users health at risk. Handling of medication and associated records had improved. EVIDENCE: The manager had developed a new and improved format for recording the service users care requirements and these had been implemented for all the service users. Records were clear and well organised. Care plans had been evaluated monthly and were up to date. There was evidence that the service users had seen and agreed to their care plan. There were some deficiencies in the care plans, which must be addressed if health needs are to be met. For example one service user had been assessed as requiring a liquidised diabetic diet but this had not included in a care plan and one service user had a catheter fitted but there was no plan of care Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 Page 11 recorded. Bowel function monitoring charts were completed but in one case it was noted that it had only been completed once in August 2005. Risk assessments were in place but some care instructions to minimise the risk were sometimes not specific enough. For example, where a service user was at risk of pressure sore development the care plan stated turn regularly and for another service user at risk of wandering form the home unaccompanied the instruction was to monitor regularly. Generally recording had improved but there were some deficiencies noted in the daily diary records and recording of significant events. In one case where a service user had been admitted to hospital there was no recording of the circumstances regarding this admission. 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 of these eight staff, two were qualified to NVQ level 3 in which the safe handling of medication was included and one had completed an accredited course in the safe handling of medication. The other staff had completed half-day system training and were on a waiting list with a local college to commence an accredited course. Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 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. 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. The service users commented on the improvement of the activities available in the home and all stated they enjoyed the exercise class. The service users also stated they had enjoyed trips out over the summer to the garden centre and the seaside. Religious needs were met through the provision of a monthly service in the home. Service users were able to exercise choice in all areas of their life from when they got up to meals. One service user particularly enjoyed the fact that they could have bacon buns, in bed, for their breakfast if they wished. A new four week rotating menu had been developed with the service users input and this now offered at least two choices at all meal times. All the Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 Page 13 service users spoken with expressed satisfaction with the meals and choices available. The service users had access to telephone facilities for use in private or could have a telephone in their room. A relative spoken with stated that they were always made to feel welcome and that staff were very good at communicating with them and keeping them informed of their relatives progress. Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The service users were protected form abuse. EVIDENCE: 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 although the home did not have a copy of the Local Authority Protection of Vulnerable Adults multi disciplinary procedure in the home. The manager was advised to obtain a copy of this and attend the managers training. Training in this area was included in induction and was part of the training plan. Eight of the twenty-one staff had received training in the week prior to the inspection and further training sessions were planned. The staff spoken with were knowledgeable and were aware of procedures for reporting suspicions of abuse. The recruitment procedures did not offer adequate protection for the service users. Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 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): 19 21 25 and 26 The home was clean, tidy and well maintained. The hot water temperatures in the home may put the service users at risk of accidental scalds. EVIDENCE: Almost all the requirements form the previous inspection had been met. All the radiators now had covers fitted, repairs to a sash window in room three had been completed and this room temperature had also been controlled satisfactorily. The home had put systems in place to control the risks of Legionella. Door guards had been purchased and fitted to prevent inappropriate wedging open of fire doors. The only requirement, which had not been met, was the control of hot water temperatures to 43°C. Records had been maintained and showed that the hot water temperatures in bathrooms had been as high as 59°C but this had been reduced to between 43 and 48°C by the 26 August 2005. The records also showed that on this date eight of the bedrooms had had no hot water and one had no heating. The manager stated that the home had contracted with an Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 Page 16 external company to address the issues of the variation in temperatures and were due to visit again on the day of inspection. Whilst there was evidence that the management were trying to address the issues there was little in the way of risk assessment and risk management to minimise the risk of accidental scalds. The manager was requested to send a report and action plan with timescales to the Commission with regard to how the issues were to be addressed. There was evidence that then home had a programme of redecoration and refurbishment. A new reception area was being developed and a new laundry had been built in what had been the smoke room further work was required to prevent soiled laundry being transported through the dinning room although systems had improved with the introduction of covered laundry trolleys. The fire officer visited on the day of the inspection he required the home to complete some work to fire doors and final exit doors and also to update the fire risk assessment. Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 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 28 29 and 30 The staffing numbers and skill mix of the staff provided met the service users needs. The staff training had improved and ensured that the staff were trained to do their job safely. Although there was some improvement in processes staff recruitment did not offer adequate protection to the 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. 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 as the staff had their workbooks at home. There was evidence that an initial induction had been completed in the first week of employment. A training programme had been developed and this included all the mandatory training such as moving and handling, first aid, infection control and fire Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 Page 18 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 bee prioritised to ensure that all the staff had attended moving and handling and fire training. Staff had been encouraged to do NVQ training and at the time of the inspection five staff were undertaking NVQ 2 and one NVQ 3. There had been three new care staff commence employment since the last inspection. Of these only one case had had all the information obtained to provide adequate protection for the service users. In the two other cases Criminal Records Bureau (CRB) checks had not been obtained prior to employment, one had been employed on a CRB from the previous employer, which is not appropriate. There was no evidence that identity had been checked for one of the staff members. Some processes had improved and records of interviews were now completed. Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 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): 31 33 38 The manager had made many improvements in all areas of the home since the last inspection but had informed the Commission she was leaving. The Registered Person had plans in place for the continued management of the home until a new manager could be recruited. The arrangements for maintaining health and safety in the home had significantly improved and all but one requirement had been met. The hot water temperatures continued to be a significant risk for service users and there was a lack of risk assessment and risk management in this area. EVIDENCE: On the day of the inspection the manager Eileen McCarthy stated that she would be leaving her employment on the 21 October 2005. The Care and Operations Director Pam Morris stated she would be assisting in the management of the home together with the current Head of Care Norma Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 Page 20 Darker until a new manager was recruited. All the staff and service users spoken with had a good relationship with the manager and stated that the home had improved in all areas since she had been in post. 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 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 and had been addressed. . • Training had been provided to ensure at least one staff member on each shift has appointed persons first aid certificate. • Records showed that staff had received fire training since the last inspection. • There was evidence that the home had systems in place to control the risks of Legionella. • The records of fire alarm system testing showed that the system was tested weekly. • The broken sash window had been repaired. • Fire doors were not wedged open and door guards had been provided. • Staff had completed moving and handling. • Radiator covers or low surface temperature radiators had been provided to all areas accessed by service users. The requirements not met from the last inspection: • The water temperatures were not regulated close to 43°C. There was evidence that work had been done but this had not been successful in addressing the issues. The plumber was due in the home on the day of inspection. Requirements arising form this inspection: • Environmental and fire risk assessments required updating. Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X 3 X X X 2 3 STAFFING Standard No Score 27 4 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 2 Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Not applicable as new proprietors since the last inspection. 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 4 Requirement The registered person must ensure that the Statement of purpose includes information on the criteria for admission to the home including emergency admissions The registered person must ensure that the service users guide includes the most recent inspection report. The registered person must ensure that care plans are developed to reflect the care required to meet all health needs. The registered person must ensure that staff receive accredited training in the safe handling of medication. The registered person must ensure that the water temperatures in the home are maintained to within 2°C of 43°C to minimise the risk of scalds. The registered person must ensure that action to minimise DS0000002869.V255593.R01.S.doc Timescale for action 01/01/06 2 OP1 5 01/01/06 3 OP8 15 01/12/05 4 OP9 13(2) and 18(1) 13(4) 01/01/06 5 OP25 01/11/05 5 OP25 13(4) 29/09/05 Page 23 Orchard Court Care Home Version 5.0 the risks of scalds is implemented until the work is completed. 6 OP29 19 The registered person must 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. 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. The registered person must review and update the environmental and fire risk assessments. 29/09/05 7 OP33 24(2) 01/01/06 8 OP38 13(4) 01/11/05 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 Refer to Standard OP1 OP18 Good Practice Recommendations The registered person should ensure that the service users guide includes service users views. The registered person should ensure that there is a copy of the Local Authority policy and procedure for the Protection of Vulnerable Adults and that the manager accesses training in these procedures with the Local Authority. Orchard Court Care Home DS0000002869.V255593.R01.S.doc Version 5.0 Page 24 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. 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