Inspection on 10/05/06 for Orchard Court Nursing Home

This inspection was carried out on 10th May 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 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 Nursing Home 18/06/08

Orchard Court Nursing Home 15/02/07

Orchard Court Nursing Home 20/10/05

Orchard Court Nursing Home 19/04/05

Orchard Court Nursing Home 28/09/04

Orchard Court Nursing Home 21/05/04

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

CARE HOMES FOR OLDER PEOPLE Orchard Court Nursing Home Harp Chase Shoreditch Road Taunton Somerset TA1 3RY Lead Inspector Kathy McCluskey Unannounced Inspection 10th May 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 Nursing Home DS0000003276.V292560.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 Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Orchard Court Nursing Home Address Harp Chase Shoreditch Road Taunton Somerset TA1 3RY 01823 351155 01823 352277 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) None Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) Care Home 44 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Mental disorder, excluding learning of places disability or dementia (0), Mental Disorder, excluding learning disability or dementia - over 65 years of age (0) Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Registered for a total of 44 places in categories DE; MD; DE(E) and MD(E). Not more than 10 persons, not less that 50 years, who require care by reason of a progressive mental illness/disorder. Up to 3 places for personal care. Date of last inspection 20th October 2005 Brief Description of the Service: Orchard Court is a purpose built home located in a quiet residential area not far from Taunton town centre. Orchard Court is arranged over one floor and all areas, including the garden areas, are accessible to wheelchair users. The home is registered with the Commission for Social Care Inspection to provide nursing care for up to 44 people over aged 65yrs of age who suffer with dementia or other mental health problems. The home also provides personal care for up to three persons, which is included in the total number of 44. The home is part of Tamaris Healthcare (England) Ltd. The home is currently without a registered manager Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was conducted over one day (8.5hrs) by CSCI Regulation Inspectors Kathy McCluskey and Barbara Ludlow. As part of this inspection, CSCI Pharmacist Inspector Brian Brown carried out an inspection on the homes procedures for the management and administration of medication, on 28th April 2006. The home’s last inspection took place on 20th October 2005. Serious concerns were raised at this inspection which were monitored through six additional inspections and a Vulnerable Adults investigation. As a result further requirements and recommendations were made. A Statutory Notice was also issued relating to nutrition and hydration. At the time of this Key Inspection, 29 service users were residing at the home with one service user in hospital. The home does not have a registered manager and the CSCI are awaiting a manager application from the acting manager, David Berenskie. Mr Berenskie and Four Seasons regional manager, Daisy Matthews were available throughout the inspection. The inspectors were able to meet with the majority of service users, staff and one relative during this inspection. A tour of the premises was conducted and a range of records were examined. The inspectors would like to thank the service users, staff and management for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well: Orchard Court provides an appropriate environment for older people with dementia. Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: It has been recommended that the home reviews its’ contract to provide service users and/or their representatives with more detailed information as to Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 7 the breakdown of fees to be paid and to inform them of how any free nursing care element is awarded/included. It is disappointing that the registered provider has not taken any action to ensure that service users have the opportunity to access appropriate activities. No activities co-ordinator has been employed and no additional time has been allocated for care staff. It should be acknowledged that care staff are spending quality time with service users and staff informed the inspectors that they would put music on and sing-a-long with service users. The manager has also taken steps to access students from a local college to visit the home to do some activities. Given the needs and abilities of older people with dementia, the registered provider should ensure that an appropriately skilled and experienced person is employed to carry out this role. A requirement has been raised. Although the standard of the environment has improved, a number of ‘star’ locks were seen to be in place on service users bedroom doors. A requirement has been raised that these are removed or disabled. It has been required that formal supervision sessions are conducted for all staff at least six times a year, with records maintained. The manager confirmed that he has received good support from the responsible individual. The regional manager stated that she had conducted formal monthly visits in accordance with Regulation 26 of the Care Homes Regulations 2001 but the inspectors were unable to see documentation relating to these visits. Records have not been received by the CSCI since January and were also not available at the home. The regional manager advised that this was an administrative oversight and action was taken to rectify. A requirement has been raised that these are forwarded to the CSCI on a monthly basis until further notice. The registered providers procedures for the recruitment of overseas staff is not robust and does not protect service users from the risk of abuse. A requirement has been raised and it is the intention of the CSCI to liaise further with the company regarding this. The homes procedures for the management and administration of medication have improved though further improvements are required. Improvements are required to ensure the health and safety of service users, staff and visitors. Please contact the provider for advice of actions taken in response to this Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4. Standard 6 is not applicable as the home is not registered to provide intermediate care. Service users are provided with a contract though this would benefit from more detailed information. The homes ability to meet the assessed needs of service users has improved. EVIDENCE: The home has produced a Statement of Purpose which is available to service users, prospective service users and their representatives. This was not examined at this inspection. The inspectors were able to examine a selection of contracts at this inspection. The contract identified fees to be paid but did not identify any free nursing care element awarded (RNCC) or how this affected the total fees. It is understood that the RNCC is paid directly to the company and not refunded to the service user. A recommendation has been raised. Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 11 The inspectors examined care records relating to six service users, one of which included the most recent admission to the home. The inspectors were able to see evidence that service users needs had been appropriately assessed prior to moving to the home. Copies of assessments from other professionals had also been obtained where appropriate. At the last inspection concerns were raised regarding the home’s ability to meet the assessed needs of service users. The inspectors noted that there have now been significant improvements in this area. Care records had improved and care practice appeared consistent. Care staff spoken with during the inspection were more positive and felt better informed. The acting manager, who is a registered mental health nurse, has been proactive in sourcing appropriate training for staff in caring for older people with dementia. The inspectors were informed that an additional registered mental health nurse was due to commence employment next month. Progress will continue to be monitored. Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 The home’s procedures for ensuring service users assessed needs are met is much improved. Service users are treated with respect and their dignity maintained. The management of medication in the home although much improved still has areas that have the potential to place service users at risk of harm. EVIDENCE: The inspectors examined five service user care plans. The inspectors were informed that the home is in the process of implementing revised paperwork to ensure that care plans are more personalised. This is felt to be positive and progress will be followed up. Care records seen contained pre-admission assessments and, where appropriate, assessments from other professionals. Social historys appeared more detailed and, in many cases, had been completed by the service user’s family. Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 13 The inspectors were able to see evidence that staff, whilst still working with the Four Seasons generic care plans, were trying to ensure that a more personal and individual approach to care was recorded. All care plans seen were up to date and had been reviewed monthly. The acting manager has been proactive in ensuring that service users have access to appropriate health care professionals. Evidence was seen in care plans that input was being received for one service user from a community psychiatric nurse. Other professionals which have provided input/advice include a tissue viability nurse and physiotherapist. During a tour of the premises, the inspectors were able to see a good supply of pressure relieving equipment in use. The inspectors were informed that one service user was currently suffering with a pressure sore and was receiving input from a tissue viability nurse. This was reflected in the individual’s plan of care and appropriate pressure relieving equipment was seen to be in place. Where required, appropriate care plans were in place for dietary and hydration needs. Records relating to the service users intake were also seen. Records for one service user with identified nutritional and hydration needs, did not identify any diet offered after 1700hrs. This was discussed with the acting manager at the time of the inspection who agreed to follow up. The inspectors were able to meet with the majority of care staff on duty during the inspection. Staff morale appeared much improved and staff stated that they felt well informed as to the needs of service users, that they were encouraged to look at service user care plans and that they had more time to meet the needs of individual’s. Staff stated that ‘all teams now worked together’ and that they felt service users received ‘good care’. Staff stated that the acting manager had arranged training for them in dementia care and was in the process of organising some training in managing aggression. This is a very positive improvement, which has a positive outcome for service users. Staff interactions with service users were observed throughout the day. Interactions were kind, respectful and unhurried. Service users appeared well attired and comfortable in their surroundings. The inspectors were able to see that service users were treated with respect. Service users who were able to express a view informed the inspectors that they liked living at the home and felt well cared for. CSCI Pharmacist Inspector Brian Brown visited the home on the 28th April 2006 to examine the homes procedures for the management and administration of service users medicines. The findings were as follows: Variable doses are recorded for the administration of analgesics prescribed this way but the actual dose administered is not always recorded for the administration of aperients. Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 14 All medication is stored at the appropriate temperatures although there did appear to be a discrepancy in the displayed temperatures on the fridge thermometer. Some out of date sterile products were found. For a service user with diabetes the home have a corporate care plan for the management of diabetes although the blood sugar levels indicated do not follow current best practice guidelines. The manager agreed to review this at the inspection. Some medication prescribed to be administered “when required” does not have clear guidance to ensure the consistency in administration of this medicine. The home had care plans relating to those drugs prescribed for behaviour management but not for the provision of analgesia. Not all of the medication storage cupboards are fixed to the wall to comply with current regulations. Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The registered provider has not taken action to ensure that service users benefit from a range of appropriate activities. Service users are supported to exercise choice over their lives. Service users benefit from a wholesome and varied menu and the home’s arrangements for assisting service users has greatly improved. EVIDENCE: The company have not taken any action to employ an activities co-ordinator and no additional care staff time is allocated for activities. It is again concerning that the company have not taken any action to ensure that service users have the opportunity to benefit from meaningful activities. Whilst it is positive that staff informed the inspectors that they had time to sit and chat to service users and ‘play music’ and the acting manager is in the process of arranging for some college students to do various activities for service users, the registered provider must give serious consideration to employing a suitable activities co-ordinator who has the skills and knowledge Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 16 to ensure that service users with dementia have access to a range a suitable activities and trips outside of the home. Feedback from staff regarding previous input from college students was positive. CRB clearance will be required for any volunteer input where they have regular unsupervised contact with service users. The inspectors noted the relaxed atmosphere in the home and that staff were spending time interacting with service users. During this inspection, service users appeared content and the atmosphere felt more inclusive. Very few service users were in their bedrooms and the staff were observed moving around the home to spend time with service users. Staff were heard asking service users where they would like to go or sit. It was apparent that service users were given the opportunity to choose where to spend their day. The inspectors were able to meet with one relative during the inspection. Comments regarding the home, staff and care that their loved one received was positive. The relative confirmed that they were always made to feel welcome. All meals at the home are freshly prepared by the chef and are served in the dining room. The inspectors were able to see lunch being served during this inspection. The majority of service users enjoyed their lunch in the dining room, though some were assisted in one of the lounges. Service users were provided with a drink on arrival at the dining room. Tables were attractively laid with table-cloths and linen napkins. A choice of menu was displayed and staff were heard asking service users what they would like. Service users had access to appropriate cutlery. Lunch time was noted to be unhurried and relaxed. Staff assisted service users as required, in a dignified manner. This was also observed in the lounge area. Service users who were able to express a view were positive about the meals offered. Staff informed the inspectors that they now had more time to spend with service users and felt able to meet individuals’ needs. Records relating to nutrition and hydration needs were found to be appropriately completed. Copies of a two week menu were made available to the inspectors. Meals appeared wholesome and varied. Choices were identified for every meal. Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The home has an appropriate complaints procedure in place. The registered provider is not taking appropriate steps to protect service users from the risk of abuse (this refers to staff recruitment) EVIDENCE: The home has produced a complaints procedure. This was seen to be displayed in the foyer area of the home and included the CSCI contact details. The inspectors were informed that the home had not received any complaints since the last inspection. At the last inspections serious concerns were raised with CSCI Regulation Inspectors, which resulted in a investigation under the Vulnerable Adults Procedures. The investigation concluded on 22/11/05. Issues investigated, which were substantiated included; moving and handling procedures, verbal and physical abuse, respect & dignity, management of the home, staffing levels, staff training and standards of care. Requirements were made and a Statutory Notice was issued. Since the last inspection, the CSCI carried out six additional inspections to monitor compliance. The registered provider took appropriate action to address the concerns and to ensure the safety of service users. Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 18 The CSCI investigated a complaint raised directly with the commission relating to the care of a service user. The investigation concluded on 14/02/06 and outcome was that the complaint was not substantiated. Staff spoken with during the inspection informed the inspectors that they would not hesitate in raising concerns if they had any. Staff stated that they found the acting manager very approachable and felt confident that their concerns would be acted upon. The registered providers procedures for the recruitment of overseas staff require improvement as they do not protect service users from the risk of abuse. Refer to Standard 29. This was also raised at the last inspection and it is the intention of the CSCI to have further discussions with the company representatives. Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 19 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, 20, 21, 22, 23, 24, 25 and 26 Service users live in a comfortable purpose built environment which has benefited from redecoration. The standard of cleanliness has greatly improved and service users now benefit from an environment which is clean and free from malodours. EVIDENCE: The home is purpose built on one level. There are 40 single bedrooms of which 22 have en-suite toilet facilities. The 2 double bedrooms do not have an en-suite facility. All communal areas and a selection of bedrooms were seen at this inspection. It was evident that service users were encouraged to personalise their rooms. Some bedrooms contained items of furniture belonging to the service user. Specialist beds and pressure relieving equipment were seen to be in place where there was an assessed need. Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 20 The home has three lounges, conservatory, and a large dining room. The sensory room is no longer in use and the inspectors were informed that there were plans to use this room for a reminiscence area. Progress will be followed up at the next inspection. Given the dependency levels of service users, the majority require staff assistance to mobilise and therefore their choice of where to spend their day is dependant on staff. It was positive to note at this inspection that staff were heard asking service users where they would like to sit. Staff were also observed walking with service users around the home. Staff were observed utilising mobile hoists and assisting service users in wheelchairs. Several adjustable beds were seen to be in use and the home appears to have an adequate supply of pressure relieving equipment. Nurse call bells were seen in all bedrooms examined. Lockable space was available for service users in all bedrooms seen. The inspectors noted that ‘star locks’ were in situ on some bedroom doors. The need to ensure that these locks are removed or disabled was discussed with the acting manager and regional manager at the time of the inspection. A timescale for action has been specified at the end of this report. At the last inspection it was noted that service users did not have free access to the dining room or garden as doors were locked. At this inspection the inspectors did not find the dining room locked and staff confirmed that several service users had recently enjoyed time in the garden. Since the last inspection, several areas of the home have benefited from redecoration. This is a positive improvement. At the last inspection, concerns were raised regarding the cleanliness of the home and malodours. The standard of cleanliness noted by the inspectors at this inspection was noted to be high and there were no malodours. The inspectors made a point of discussing these positive improvements with the two domestic staff on duty. Appropriate hand washing facilities are sited throughout the home. Two pedal bins were found to require replacement. The acting manager took appropriate action to address at the time of the inspection. Since the last inspection, ten staff attended training on the management of MRSA. One staff member spoken with stated that they were currently completing an infection control course. The laundry area was not examined at this inspection. Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 21 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 numbers and skill mix of staff have improved since the last inspection. This has a positive outcome for service users. The company’s procedures for staff recruitment, potentially put service users at risk of abuse. EVIDENCE: At the last inspection, several concerns were raised regarding the numbers, skills and experience of staff on duty. At this inspection some improvements were noted. Staffing levels were adequate and staff informed the inspector that they did not experience any difficulties in meeting the needs of service users. Staff indicated that ‘things were much better’ and that they ‘didn’t feel rushed anymore’. Staff stated that they now felt that service users ‘got good care’. The acting manager indicated that he felt confident that this would continue even when the home is full. The inspectors were advised that, since the acting manager has been in post, the home have not had to use any agency staff. At the time of this inspection 30 service users were living at the home. The home is providing staff as follows: Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 22 two registered nurses are on duty throughout the day along with 5 care staff in the morning and 4 in the afternoon. Nights are covered by one trained nurse and two care staff. Two domestic staff are on duty during the week, with one at the weekends. Laundry staff cover 7 days a week. Chefs and kitchen staff are on duty every day. The home also employs an administrator. During the inspection, interviews were taking place for a maintenance person. Since the last inspection, a manager has been employed who is an appropriately qualified and experienced registered mental health nurse. This has had a positive outcome for service users and staff as training in dementia care has taken place for some staff and further training is planned. Progress will continue to be monitored. The inspectors were informed that a further registered mental health nurse is due to commence employment next month. The inspectors were informed that staff training records were in the process of being updated. As limited information was available, this will be followed up at the next inspection as will NVQ training. Three staff recruitment files were examined at this inspection. Once again, it was very concerning to note that the company’s procedures for the recruitment of overseas staff is not robust and does not protect the service users from the risk of abuse. The home’s manager is not involved in the recruitment of overseas staff. References available had been addressed ‘to whom it may concern’ There was no evidence that the company had applied for references or checked the authenticity of references. References seen had either not been dated or were dated a considerable period of time ago. Examples included; staff member employed 10/01/06. Both references addressed ‘to whom it may concern’. One not dated, the other dated 2nd August 2004, eighteen months prior to employment. Another example; staff member employed 31/10/05. One reference addressed ‘to whom it may concern’ dated 1993. These are unacceptable practises, further requirements have been raised and the CSCI will be contacting the company to discuss further. Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35, 36 and 38 Leadership at the home has improved and this has a positive outcome for service users and staff. The home’s procedures relating to health and safety require improvement. EVIDENCE: Standards 31 and 32 were not assessed as the home does not have a registered manager. David Berenskie commenced employment in December 2005 as manager designate. Mr Berenskie informed the inspectors that he was in the process of completing a CSCI application to be registered manager. Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 24 Staff spoken with during the inspection were very positive regarding the support and training they received from Mr Berenskie. Staff stated that he was very approachable. Positive comments were also raised by a relative. As already mentioned in this report, serious concerns were previously raised regarding the lack of management at the home. Since Mr Berenskie has commenced employment, he has been proactive in addressing many issues. Staff routines appeared more ‘organised’ and person centred and staff morale is much improved. Mr Berenskie indicated that he had received good support from the company representatives though the inspectors noted that copies of the responsible individual’s records relating to their visits to the home were not available since October 2005. No records had been received by the CSCI since January 2006. Under Regulation 26 of the Care Homes Regulations 2001, these visits must take place at least monthly and, given previous concerns, it was agreed that copies of records would be sent to the CSCI each month. This was discussed with the regional manager, Daisy Matthews at the time of the inspection who stated that visits had taken place and that it was an oversight by administrative staff that copies of visits had not been received. Ms Matthews agreed to address and fax copies to the CSCI. These have not been received at the time of this report – 15/05/06 The inspectors did not examine further records relating to the home’s quality assurance procedures at this inspection. This will be followed up at the next inspection. The home displays appropriate and up to date employers liability insurance. Where required, the home manages small amounts of money on behalf of the service user. The inspectors were able to examine the home’s management of service users personal finances. Details are maintained on a computerised system which is managed by the home’s administrator. Monies are held in a pooled account with individual statements relating to each service user. Statements seen clearly identified items or services purchased by/or on behalf of service users. Receipts were available. The administrator informed the inspectors that statements are sent to service users’ relatives or representatives on a monthly basis. The administrator stated that the home has an ‘amenity fund’ which is used to benefit service users. The inspectors were informed that monies in the fund were obtained from donations, fund raising and from ‘unclaimed’ monies belonging to deceased service users. The inspectors were informed that the home does not act as appointee for any service user. Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 25 The acting manager acknowledged the need to implement formal supervision sessions for staff. Whilst the inspectors recognise that the manager has not long been in post, a requirement has been raised that this is implemented for all staff within a given timescale. The following records were examined relating to the Health and Safety: FIRE SAFETY – Records were not available at this inspection to confirm that appropriate checks had been carried out on the homes fire detection systems or emergency lighting. Arrangements were made at the time of the inspection for an appropriate person from a sister home to check systems the next day. Confirmation that appropriate fire alarm checks had been carried out were received by CSCI the day after the inspection. No information was received regarding emergency lighting. ELECTRICAL SAFETY – The home’s portable appliances (PAT) are tested annually. This was last carried out 09/09/05. During this inspection the inspectors found two free standing radiators requiring PAT testing. One radiator required repair and was unstable. Both radiators were removed from the bedroom at the time of the inspection. At the last inspection it was required that a copy of the home’s electrical hard wiring certificate was forwarded to the CSCI. The CSCI has no record of this having been received. A further requirement has been raised. GAS SAFETY – The home’s last annual gas safety check was conducted on 12/10/04. It has been required that an up to date satisfactory certificate is forwarded to the CSCI. HOT WATER OUTLETS/SURFACES – To reduce the risk of injury to service users, all bath hot water outlets have been fitted with thermostatic controls. No records were available for this inspection and a requirement has been raised. The home must also ensure that any showers or outlets not regularly used, are flushed through in accordance with HSE guidance to reduce the risk of legionella. EQUIPMENT SERVICING – Hoists were last serviced in November 2005 and are due to be serviced again this month. The inspectors noted that regular safety checks on bed rails in use were not being maintained. The acting manager was advised to implement and to ensure that the person responsible had a good knowledge regarding the fitting and maintenance of bed rails. Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 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 x 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 3 3 3 3 3 2 3 3 STAFFING Standard No Score 27 3 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 3 3 1 x 1 Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 27 Are there any outstanding requirements from the last inspection? no 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 OP12 Regulation 16(2)(m) & (n) Requirement Timescale for action 31/07/06 2 OP9 13(2) 3 OP24 13(4) 4 OP29 19(4)(c) The registered provider must ensure that suitable arrangements are made to enable service users to engage in appropriate activities to include opportunities outside of the home. Serious consideration should be given to the employing an activities co-ordinator who has the skills and experience of working with people with dementia. The registered person shall make 28/06/06 arrangements for the safe administration of medication in the care home. This refers to the need to have clear guidelines for the administration of these medicines and a record to be made of the decision to administer or not having been made. The registered person must 29/05/06 ensure that ‘star’ locks on bedroom doors are removed or disabled. The registered person shall not 19/05/06 allow a person to work at the home until appropriate DS0000003276.V292560.R01.S.doc Version 5.1 Orchard Court Nursing Home Page 28 5 OP33 26 6 OP36 18(2) 7 OP38 13(4) 8 OP38 13(4) 9 OP38 13(4) 10 OP38 13(4) references have been received and that the authenticity of the references has been checked The registered provider must ensure that monthly visits are conducted in accordance with Regulation 26 and that records are maintained at the home with copies forwarded to the CSCI until further notice. The registered person must ensure that all staff receive formal documented supervision sessions at least 6 times a year. The registered person must take appropriate action to ensure that weekly in-house checks are carried out by a competent person on the home’s fire detection systems and monthly checks on emergency lighting. Records must be maintained. The registered person must ensure that monthly checks are carried out on all hot water outlets to ensure they do not exceed HSE upper limits. Appropriate records must be maintained. Shower heads and any other outlets not regularly used, must be flushed weekly to prevent the risk of legionella. The registered person must ensure that appropriate checks are carried out by a competent person to ensure bed rails remain safe. The registered person must forward copies of certificates relating to Gas servicing and electrical hardwiring. 30/06/06 31/07/06 11/05/06 22/05/06 31/05/06 22/05/06 Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 29 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 OP2 Good Practice Recommendations The registered provider should ensure that service user contracts provide a more detailed breakdown of fees to be charged and also include information regarding any free nursing care element. It is recommended that the home review the fixings of the cupboards in the treatment room. 2 OP9 Orchard Court Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Nursing Home DS0000003276.V292560.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!