Inspection on 03/09/07 for Orchard Court Care Home

This inspection was carried out on 3rd September 2007.

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 18/08/06

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 Stephen Robertshaw Key Unannounced Inspection 3rd September 2007 08:45 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.V350169.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.V350169.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 Position Vacant Care Home 24 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (24) of places Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd May 2007 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 for services provided through the home are between £329 and £380 per week. A copy of the last inspection report is made available to the service users and is included in the homes statement of purpose. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on and includes information gathered during a site visit to the home on the 03rd September 2007. The visit was unannounced and the inspector was at the home for approximately six hours. An Annual Quality Assurance Assessment had been returned to the Commission by the management of the home. Surveys were sent out to four of the service users that were case tracked. All of these surveys were returned to the Commission. Twelve surveys were sent out to the care staff and none of these were received back by the Commission before the report was completed. On the day of the site visit the care staff confirmed to the Commission that they had received the surveys. During the site visit the inspector spoke to the senior member of staff on duty and the services Operations Director. The inspector also spoke with nine of the service users. This included talking to people individual and in small groups. Other information received by the Commission since the last inspection has been used to inform some of the evidence provided in this report. What the service does well: The health care needs of the people living in the home are well met and staff are provided with the right training to make sure that they understand the needs of the service users and makes sure that they can do their jobs well. The staff and the service users appear to have very good relationships with each other and the atmosphere between them is relaxed and friendly. This helps the service users to feel very settled and this means that they can rely on the staff for any support that they may need. Service users are provided with meals that they choose and like, however they are encouraged to follow a healthy diet including lots of fresh fruit and vegetables to try and maintain their health. The home was generally clean, tidy and comfortable. The people that live in the home say that they are ‘well looked after’ and they are happy to be living there. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the service users had a care needs assessment completed before they were admitted to the home, however the assessments were very basic and this would provide staff with difficulty in preparing care plans from them. EVIDENCE: The statement of purpose and the service users guide had been updated and since the last inspection and included the last inspection report. The information was clear and included the details of staff training. These documents were not on general display but were in a cupboard in the main office area. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 9 The inspector cast tracked five of the twenty-one service users living at the home. The home had provided contracts/terms and conditions of stay to the home and a copy of these were included in the service users individual care file information. Where service users were funded by social services care management teams there were copies of their assessment and care plan information on the individual peoples files. Pre-admission assessments had also been completed by the home to ensure that the service users needs could be met within the homes registration. These records were very brief and basic and it would be difficult to develop a care plan from the information included in the preadmission assessment of need. Therefore all of the service users needs may not be completely identified or be met through the services provided at the home. The care needs of individual service users were discussed with the staff on duty and they were able to explain the specific care requirements related to the condition of individual service users and how they should be met. The service users spoken to by the Commission stated that the staff looked after them well, one service user stated that ‘the home is good, the staff know how to look after you properly’ and another said ‘It’s alright here, it’s not like your own home, but it’s close’. The manager of the home must make sure that all of the pre-admission assessments that are completed are fully dated and are signed to identify who completed them and when. Four service users returned their surveys to the Commission. Two of these clearly stated that they had been given the opportunity to visit the home before they made a decision to move there. Discussions with service users and staff also confirmed that the individuals are invited to visit the home to see if it will be suitable to them, and to give them the opportunity to meet the other service users and staff. The home has the capacity to meet the needs of all of the current service users, however a lot of the care provided is through the understanding of individual service users by the staff and not through the information provided through the completed assessments. Intermediate care is not provided at the home. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the health and personal care needs of the service users are met through the services provide through the home and its partners, however the documentation to support this evidence was not always up to date and had not been accurately recorded. EVIDENCE: The Commission case tracked the services and care provided to five of the service users living at the home. Care plans were in position for all of these people however they had not been fully developed to maintain and develop their independence, privacy, dignity and safety. The care plans identified the needs that had been highlighted in the individual’s assessments of need and these had been evaluated on a regular basis to make sure that they were still appropriate to the individual needs of the service users. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 11 The care plans were very basis and generic. They were printed lists and needs that were evident were highlighted. This care plans must be improved to include how the individual needs of the service users must be met. An example of this is that it is not good enough to simply identify that a person has mobility needs. The care plans should identify how the individual service users mobility needs affect them and how they would prefer for them to be met. The inspector spoke with nine of the service users living at the home and they were all very positive in relation to the care that they received at Orchard Court and they all confirmed that when use their call bells the staff are usually very quick to respond. One service user said ‘the staff are very good, they are always around and give us choices of what to do’. The staff interviewed by the Commission had an understanding of the service users needs and how they should be met, however they accepted that these were not fully detailed in individual care plans, but they understood them due to their personal awareness of the service users. Care plans were supported with daily records detailing individual’s care. These records were very brief and did not include and expressions of service users personal moods or demeanours. The care plans where appropriate were supported with risk assessments. Once again these assessments and care plans were generic and were very basic they did not include any individuality for the people that were included in them. An example of this was risk assessments for people with dementia care needs. These simply listed all of the possible personal traits for an individual who has dementia. They did not include how ant of these traits affected the individual service users and how any risks could be minimised for them. 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 and provided evidence that appropriate care had been provided. Since the last inspection service users had been weighed on a regular basis to enable staff to identify any possible problems with their health. Evidence was provided that the service users or their representatives had seen and agreed to their care plans. Since the last inspection the Commission carried out a specialist pharmacy inspection at the home due to the consistent medication problems previously identified in the home and earlier inspection reports. Only senior care staff administer medication to the service users. The staff administering medication had stated that they had received accredited medication training and the homes training records supported this evidence. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 12 Direct observations made by the Commission on the day of the inspection identified that prescribed medication was taken from the individual service users supplies and was given to them in plastic pots. The pots were left on the dining tables with all of the service users and the staff did not observe them being taken, however the staff signed the MAR sheets to state that they had. These practices must cease as they are placing the service uses health and safety at risk. This includes service users not taking medication that has been signed out for them, or confused service users taking the medication that is prescribed for other people. Staff spoken to stated that this was common practice in the home. 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. Where water low assessments and pressure are care plans had been completed they had not been reviewed on a regular basis when high dependency needs were identified and the plans were generic in nature This could cause difficulty in recognising and managing any risks in relation to individuals skin conditions and ultimately may cause a problem with their personal healthcare. The senior care staff responsible for the home at the time of the site visit stated that the home only has access to one district nurse now and this has improved the relationship between the home and the district nursing service, and this has also meant that a more consistent service is provided to the people living in the home. The district nursing notes identified all of the contact they had with the individual service users. The homes records for contact with outside professionals were not up to date and did not identify when the district nurse had seen individual people. The information gained in relation to the service users on their care plans includes their last wishes in the event of their deaths. Where this information was not included notes were included to state why this information was not available. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the service users have choice in their daily lives and this helps to enable them to enjoy a better quality of life, however the frequency and variety of activities available to the service users are limited. EVIDENCE: The social, personal and religious needs of the service users social needs were identified as part of the assessment process. If service user wished to follow their religion whist at the home then this was also identified. There were no people in the home that had any identified different cultural or religious needs. During the site visits there were no activities observed taking place in the home. Service users spoken too by the Commission generally stated that the activities in the home were frequent enough and that there were a variety of activities available. One service user stated that they used to regularly play dominoes with other service users, however recently one of them died and they have not played dominoes since. Another person stated that their eyesight was poor (don’t do a lot as I cant see) and therefore they did not take Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 14 part in many of the activities at the home, they also added that ‘the staff help with a game of some sorts, but sometimes forget I can’t see’. Other people expressed to the Commission that they are provided with the opportunity to go out to the local shops and pubs and further visits to the coast and shopping centres were also available. Service users were able to exercise choice in all areas of their life from when they got up from bed and retired to bed again and to the meals provided. This was observed in practice and interviews with care staff and discussions with service users also supported that this is the policy that is maintained in the home. The inspector ate lunch with three of the service users in the main dining area of the home. The atmosphere was very relaxed and the service users spoken to confirmed that they enjoyed their meals at the home, the quality of the food and that choices were always made available to them. One service user told the inspector that they only liked a ‘light breakfast every day’ and another said ‘I have a cooked breakfast every day, but I have asked for smaller ones now as I don’t eat as much’. The dining room was spacious and comfortable and although the carpet had been replaced since the last inspection there were still stains present on the floor. The care staff were observed to assist service users with meals individually and where required in a way that supported their dignity and respect. Staff stated to the inspector the service users always had a choice of meal and that there was variety in the menus. The home had a 4-week rotating menu that included two choices at lunchtime and teatime. Observation of the kitchen found it to be clean and well organised. The only problem was that the fly killer needed to be cleaned out. Currently the home is short staffed in relation to the Kitchen and care staff are often employed in the kitchen cooking or preparing meals. The cook explained to the inspector that a new member of staff has been employed to work in the kitchen and that this should mean that the kitchen is fully staffed and operational. This problem was highlighted in the last inspection report. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the complaints procedure is accessible to service users and visitors and staff are training to protect the service users from any possible abuse. EVIDENCE: The service has a clear complaints policy and procedure and copies of this were seen to be available around the home. Service users spoken to by the inspector stated that they understood how to make a complaint of they wished to. Care plans included a signed agreement by the service users to state that they understood the complaints procedure, however these documents had also been signed by either the service users who had been identified as suffering from dementia related care of their key workers to state that they also understood the complaints procedure and this was very questionable. It was highlighted in the homes Annual Quality Assurance Assessment that the home had received four complaints. The services complaints records also supported this evidence. The home had policies and procedures to safeguard the service users and to protect them from abusive situations. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 16 Staff training records supported the evidence that they have receive training in relation to the protection of vulnerable adults. This training varied from involvement with the local authority, distance learning courses and in-house training. Care staff spoken to by the inspector confirmed that they had received adult protection training and their responses also showed that they were aware of how to report any allegations of abuse at the home. Staff personnel files that were observed by the inspector supported the evidence that appropriate safety checks through the Criminal Records Bureau (CRB) were completed by the service prior to the staff being employed to work in the service or have contact with the service users. This helps to support the health and safety of the service users at the home. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the service provides a homely atmosphere, however there are area of the home that are badly in need of redecoration. EVIDENCE: The Commission made a tour of the premises and found the home to be generally clean and tidy and free from any offensive odours. Since the last inspection new carpets had been fitted to the corridors and dining area. The service users spoken to by the Commission stated that the home was usually clean and tidy. One service user commented ‘my room is generally kept clean and tidy by the staff, I do as much as I can by myself and the staff help me with the rest’. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 18 Service users stated that the care staff were generally good at answering bells one stated ‘the staff come to answer the bell quick’, however as identified through discussions and interviews with the care staff the call bells only ring at the central control box and they cannot be heard in other areas of the home. This is an outstanding issue with the service. This was discussed with the senior management of the home and they were requested to look at options to ensure that staff could hear call bells wherever they were used and wherever the staff were positioned in the home. There was evidence that where hoists were required for moving and handling the management had individual occupational therapy or district nurse assessments completed. There was also evidence provided that the hoists are regularly maintained and serviced to make sure that they are fit to use with the service users. There were some areas of the home that could have caused difficulties with cross-infection and hamper the control of infection in the home. Two bathroom areas included open shelves with towels and bed linen placed on them. They were open to access by anyone and everyone. On the second floor of the home there were several cupboards that were open with their keys left in them. In these cupboards were more bed linen and the homes hot water boiler. Again this could difficulties within the health and safety regulations of the home, possibility of cross infection of diseases and possibility of scalds due to contact with the boiler or its pipe work. In the large bathroom the cold tap top was missing from the sink unit. This means that if the water temperature is too hot for the service users then they cannot regulate it by adding cold water to the sink. The lilac toilet room is desperately in need of redecoration. There was a large area where the wallpaper was missing and the wall was bare behind it. The lemon toilet room was very damp and evidence of the damp were in the plaster work and skirting boards. The management of the home stated that this room was planned to be changed in the upcoming developments of the home. The fire escape was covered in moss and this could provide slip injuries if it had to be used. This must be thoroughly cleaned to ensure the health and safety of the service users if they have to access this route. The handyman has to access the cellar of the home to carry out some of their duties. The entrance is down very steep stairs and there are no handrails. The walls of the stairwell must be provided with handrails to ensure safe entry and exit to the cellar area. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 19 As previously identified the kitchen area was very clean with the exception of the wall mounted insect killer. This was full of dead moths and needed to be cleaned out so that no infection could be spread through the kitchen. The outside of the home was very unkempt. The senior management stated that there were two reasons that accounted for this firstly the handyman was off sick and would attend to this on his return to work and secondly the rear of the home was going to be redeveloped in the near future including building work and therefore this area was not currently available to the service users. The home has a small laundry and the washing machine was programmable to disinfection and sluicing standards. The washing machines also had automatic feeds for the detergents and this means that the staff do not have to make any contact with any caustic substances. Four service users invited the inspector in to their personal rooms. These had all been decorated and furnished to their own tastes and preferences. This included service users bringing in their own furniture if they wished and their ornaments and pictures. One service user commented ‘it’s not like being in your own home , but it’s OK here’, another service user stated ‘I like my room, it is always clean and tidy’. All of the rooms are provided with central heating that is controlled through thermostatic valves. This makes sure that the service users can regulate the temperature of their own rooms. The radiators had been provided with protective covers to make sure that the service users were not injured through any direct contact with them. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the staff are appropriately employed to work at the home, however their training is not all up to date and they do not receive the supervision that they require to monitor the quality of their work. EVIDENCE: The staffing levels in the home are maintained just below the minimum guidelines and although there had previously been a lot of use of agency staff in the home this has now be maintained to a minimum with the same agency staff returning to the home to provide consistency to the service users. The inspector believes that the staffing levels calculated by the home had not included the hours required for the difficulties in relation to the general layout of the environment and that one or more service users require special assistance. In the calculations made by the inspector the hours required are 461.28 and the average hours provided between the weeks 18th and 25th August 2007 was 450.5 Most of the service users spoken to by the inspector stated that the staff are ‘nice’ and ‘friendly, however some also responded that ‘the staff are short at present, but they are very nice and help me as much as they can’. Another Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 21 service user stated that ‘there are not always enough staff to see to you quickly’. Staff training has improved and training records showed that all of the staff have almost completed all of the mandatory training that is required of them and some specialist training had been provided in relation to dementia care, infection control and the protection of vulnerable adults. Staff are not provided with the necessary formal supervision to make sure that they understand the training that they have received and that they understand how to appropriately support the service users with their individual care needs. Staff stated that there had been problems with sickness levels over the past few months and it appeared to them that it was usually ‘the same people’ that were always off work sick. They commented that this had affected the staffing levels in the home. There are no male carers working in the home to provide choice to the service users as to who should offer personal care to them. The area director stated to the Commission that this was as the service users had stated that they only wanted female carers in the home, however there was no direct evidence to support this view. Care staff also supported this view. Service users spoken to by the inspector were split on their feelings towards this issue. This could possibly be an area that should be approached through the homes quality assurance programme. The care staff were still preparing meals at teatime as this post had not been filled as promised by the area manager at the time of the last inspection. 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. Their time was also very limited in the kitchen as they also had to maintain their care responsibilities. The homes induction programme includes the national standards for care. All new care staff to the service completed the induction training. Two staff were identified that are currently undertaking their induction at the home and one of their record logs was also observed by the Commission. The manager of the service had developed a training matrix for the home that identified how mandatory training will be kept up to date in the future. Staff personnel files were checked to make sure that all of the appropriate safety checks had been completed before they were employed to have any contact with the service users. Evidence was available that supported that the staff receive two references and a Criminal Records Bureau (CRB) vetting before their employment commences at the home. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 22 The management and staff were committed to National Vocational Training (NVQ). The Annual Quality Assurance Assessment returned to the Commission identified that approximately 33 of the care staff have completed NVQ qualifications in care and a further six staff are working towards the awards. This information was also supported through the evidence provided in the staff training logs and the homes training matrix. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 and38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the management of the home is approachable and understands the needs of the service users and the staff group, however they have not yet registered with the Commission to be recognised as the registered manager of the service. EVIDENCE: The manager of the service had 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. The manager was not available on the day Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 24 of the site visit. The person responsible on the day was a senior carer and they were later joined by the services area manager. The manager of the home has not yet made an application to the Commission to be recognised as a fit person and to be recognised as the registered manager of the service. This must be undertaken as a priority due to the time that she has already been in post. The Care and Operations Director (area manager) continues to provide management support to the home. They visit the home on a weekly basis. The home had a system of monitoring the quality of care in the home, however the most recent surveys that had been sent out had not been evaluated, action planned or published. There was some evidence to suggest that the quality assurance and monitoring system was used in the home since the last inspection. There were no records available to support that regular service user and staff meetings are held at the home. It is important that these meetings are reestablished to allow the people involved to be able to air their views on the running and development of the service. This would also support the home quality assurance and monitoring system. However staff and service users spoken to by the Commission felt that they would be listened to by the management if they had anything to say. One service user stated ‘you can talk to whoever you want all of the time, the manager and the staff are always able to see you’. The interviews with care staff and observation of their personnel files showed that they do not receive the recommended minimum of six formal supervision periods per year pro-rata). This area must be improved to make sure that the staff understand their roles in the home and to help to identify any training needs that they may have to meet the needs of the service user. The proprietors complete their Regulation 26 visits regularly and provide reports to the Commission. Records required by regulation were all in position in the home. However some of these were only basic recordings as described earlier in relation to care plans. The records were all stored in accordance with the Data Protection Act 1998. The management were able to produce a business and financial plan that supported the financial viability of the service. This was also supported by a maintenance and refurbishment plan for the home. The Commission was also provided with evidence that all of the equipment that required servicing and maintenance had these carried out on a regular basis. This included the Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 25 moving and handling equipment. The home also had up top date certificates for the fire, electrical and gas appliances. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 26 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 3 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 2 3 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 3 3 2 2 3 Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard 1. OP3 OP37 Regulation 14.1,2 Requirement Timescale for action 30/10/07 2. OP3 14.1 3. OP7 15 4. OP8 15 The quality of the homes preadmission assessments must be improved to enable a clear and detailed plan of care to be developed from them and all of the individual care needs must be identified. Whoever completed the pre-admission assessments must also sign and date the documents. The risk assessments completed 30/11/07 for individual service users must be specific to their needs and not be identified in a generic format. The registered person must 30/11/07 ensure that the care plans detail how the individual service users needs must be met through the services provided at the home and the generic forms must be discontinued. The registered person must 30/11/07 ensure that care plans are developed to reflect the care required to meet all health needs. (Previous timescale 01/11/06, 01/01/06, 01/04/06 and 02/05/07 DS0000002869.V350169.R01.S.doc Version 5.2 Orchard Court Care Home Page 28 5. OP9 13.2 6. OP10 13.4c 7. OP16 15.2b 8. OP19 23(2)(n) 9. OP26 13.3 10. OP27 18.1a 11. OP27 18.1a were not met) The registered person must ensure that all prescribed medication in the home is appropriately administered to the service users and they are observed taking the medication before it is recorded. Medication must not be left with individual service users to uphold the health and safety of all of the service users. The registered person must make sure that when service user are at risk of pressure areas on their skin, then their water low assessments are up to date and are regularly evaluated to identify any changes in the persons health and personal care needs. The registered person must make sure that all consent forms, including the complaints procedure is only signed by the service users if they understand them or by their representative. The registered person must ensure that call bells can be heard in all parts of the home by the staff. (Previous timescales 01/11/06 and 02/05/07 were not met)) The registered person must make sure that infection control policies and procedures are adhered to in the home to ensure the health and safety of the service users. This includes no open storage of linen towels and bed linens. The registered person must make sure that there is adequate staff to work in the kitchen area to allow the care staff to continue with their own responsibilities. The registered person must DS0000002869.V350169.R01.S.doc 07/09/07 30/09/07 30/10/07 30/10/07 14/09/07 30/09/07 07/09/07 Page 29 Orchard Court Care Home Version 5.2 12. OP28 18.1a 13. OP31 9 14. OP33 25 15. OP36 18.2 make sure that the residential forum is used to calculate the care hours required by the home at any time. This would mean that appropriate numbers of staff are available to support the service users with their personal and health care needs. The registered person must make sure that a minimum of 50 of the care staff have achieved a minimum of NVQ 2 in care (or equivalent). The registered person must make sure that the appointed manager of the home applies to the Commission to be accepted as the registered manager of the service. The registered person must ensure that the quality assurance procedures are maintained (Previous timescales 01/12/06 and 02/05/07 were not met) The registered person must make sure that all of the care staff receive the recommended minimum of six formal recorded supervision periods per year (pro-rata) to ensure that they understand their roles and to identify any training needs that they may have. 28/02/08 30/09/07 30/01/08 28/02/08 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 most current statement of purpose and service user guides should be made available to all of the service users DS0000002869.V350169.R01.S.doc Version 5.2 Page 30 Orchard Court Care Home 2. OP8 3. OP8 OP37 4. OP12 5. 6. 7. 8. 9. 10. OP19 OP19 OP19 OP21 OP19 OP21 OP19 OP19 11. 12. 13. OP19 OP27 OP33 and visitors to the home. The registered person should make sure that there is consistency in the daily recording of the activities that individual service users are involved in. This should detail such things as mood etc to give an overall picture of how the service users respond to their care in the home. The registered manager should make sure that the service users care files are up to date especially in relation to the professional contact paperwork. This helps to identify other agencies and the support that they offer to the home to care for individual service users. The registered person should continue to develop the range and frequency of the activities that are made available to the service users and these should be stimulating and be recognised as activities chosen by the service users themselves and they are appropriate to their individual needs. The registered person should make sure that the dining room carpet is kept clean to support the homely environment of the home. The registered person should make sure that the water boiler area of the home is not accessible to service users to protect them from contact with hot surfaces. The registered person should make sure that all of the homes bath and sink tap tops are fitted to allow individual regulation of water temperatures. The registered person should make sure that all of the bathrooms and toilets in the home are decorated to a homely standard. The registered person should make sure that the stairs to the cellar are fitted with handrails to support the health and safety of individuals that use these stairs. The registered person should make sure that the insect killer in the kitchen is regularly cleaned out to ensure the hygiene in the kitchen area and to uphold the health and safety of the service users. The registered person should make sure that the outside areas of the home are well maintained and provide a good and accessible environment for the service users. The registered person should make sure that the care staff continue with all of their mandatory training and make sure that all refresher training is completed as required. The registered person should make sure that service user, and staff meetings are regularly held at the home. This will allow the management to gain other peoples views on how the services are being delivered. Orchard Court Care Home DS0000002869.V350169.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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