CARE HOMES FOR OLDER PEOPLE
Orchard Court Nursing Home Harp Chase Shoreditch Road Taunton Somerset TA1 3RY Lead Inspector
Kathy McCluskey Unannounced Inspection 15th February 2007 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.V321450.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 Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 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) Vacant 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.V321450.R01.S.doc Version 5.2 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 19th October 2006 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 owned by Four Seasons Healthcare Ltd. The responsible individual is Pauline Lawrence. The home is currently without a registered manager and the commission is awaiting an application from the acting manager David Berenskie. The home accepts service users funded by social services with a ‘top up’ fee of £50 per week. For those not funded by social services, the fees are currently £585 per week. Where service users are awarded a ‘free nursing care’ element (RNCC), this is taken by the home and not refunded to the service user. Additional charges are met by service users for; hairdressing, aromatherapy, chiropody and personal toiletries. Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the Commission’s ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. The home’s last Key inspection was carried out on 10th May 2006. A further random inspection was conducted on 19th October 2006. This unannounced Key Inspection was conducted over 1 day (6hrs) by CSCI inspectors Kathy McCluskey and Barbara Ludlow. At the time of this inspection 34 service users were living at the home and the inspectors were able to meet with the majority of these people. The manager designate David Berenskie, was available throughout this inspection. Five staff were spoken with in depth and the inspectors were able to meet with 4 relatives at the home. As part of this key inspection the commission sent comment cards to a number of service users, relatives, healthcare professionals and G.P’s. At the time of this report 8 comment cards had been received from relatives, 2 from healthcare professionals and 6 from G.P’s. All comments and responses were positive and have been incorporated throughout the report. 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. This was a very positive inspection where no additional requirements have been made. Several improvements were noted. 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 comfortable environment for older people with dementia. The standard of cleanliness at this inspection was noted to be high. Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 6 The atmosphere at Orchard Court was noted to be calm and relaxed. Where able, service users were seen to be moving freely around the home. Relatives also commented on the atmosphere at the home; ‘The home has a calm atmosphere and all the staff interact in a calm and reassuring way with residents’, ‘a warm and welcoming atmosphere’, ‘The home has a calm and peaceful atmosphere and the staff are always very welcoming’ The home ensures that service users are appropriately assessed prior to moving to the home. The manager has taken steps to ensure that staff have the necessary skills to meet the needs of service users. In commission comment cards, G.P’s and healthcare professionals indicated that they felt satisfied that staff had the necessary skills to meet the needs of service users. No concerns were raised. Service users are offered choices and are treated with respect. This was also confirmed by relatives. Service users are offered a wholesome and varied menu. All meals are freshly prepared and cooked on the premises by the chef. Service users enjoy their meals in a comfortable and relaxed environment and staff ensure that mealtimes are a pleasant experience for service users. The home’s care planning systems have greatly improved. Those seen had been completed to a very high standard. Care needs were clearly identified and instructions for staff were detailed and took into account the preferences/wishes of service users. Care staff confirmed that they are encouraged and supported to access service user’s care plans. Staff spoken with demonstrated a good understanding of the needs and preferences of service users. Comment cards received from healthcare professionals and G.P’s indicated that they were satisfied with the standards of care at Orchard Court and that the home communicated effectively with them. Comments received from relatives were very positive; ‘Staff give great consideration to the different needs of each resident’, ‘I am extremely impressed by the standard of care at Orchard Court’ My relative is ‘cared for in warm and thoughtful manner’, ‘An excellent care home’, ‘I wouldn’t want my relative to go anywhere else’, The home ‘respects patients and their families, provide appropriate care and nursing and consult with families’, ‘I am 100 satisfied with the care at Orchard Court’. Staff morale is high and this has a positive outcome for service users. This was observed by the inspectors, confirmed by staff and commented on by relatives. Staff were observed interacting with service users in a kind and respectful manner. Service users appeared relaxed and responded positively to staff. Service users who were able to express a view commented on the kindness of staff. The home takes appropriate steps to ensure that the healthcare needs of service users are met. The home liaises closely with G.P’s and other healthcare professionals. This was confirmed by all 6 G.P comment cards.
Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 7 The home’s procedures for the management and administration of service user’s medication were found to be excellent. The inspectors were able to see that the manager ensures that medicines are reviewed regularly. Appropriate steps are taken by the home to reduce the risk of harm or abuse to service users. Robust recruitment procedures are followed by the manager and the manager has ensured that staff awareness in abuse has been raised through regular meetings and training sessions. The home employs a very pro-active manager who has taken appropriate steps to raise standards of care at Orchard Court. The commission is currently awaiting an application for Mr Berenskie to be registered manager. Throughout this inspection, very positive comments were received from relatives and staff, ‘ There has been a transformation in Orchard Court since David and the current staff have been employed’, ‘Very well managed and David is very approachable’, ‘Very much hands-on and very aware of the needs of the residents’ ‘Very supportive and has arranged lots of training for staff’, ‘David is always out on the floor and you can ask him anything’ ‘An excellent manager’, ‘David or the nurses always keep us well informed’. The home has effective quality assurance programmes in place. Orchard Court takes appropriate steps to ensure the health and safety of service users, staff and visitors. What has improved since the last inspection?
It is very positive to note that many improvements have been made since the last inspection. The manager has been proactive in addressing all outstanding requirements raised at previous inspections. The home’s recruitment procedures have improved and now provide better protection for service users. The manager has taken steps to ensure that staff have received appropriate training in dementia care. This is very positive and the inspectors were informed that further training is being planned. Staff spoken with were very positive about the training they had received. The manager has introduced a structured system to ensure that staff receive appropriate supervision at least 6 times a year. Staff were very positive about the support they received. Appropriate systems have been put in place to ensure that service users are not at risk where bedrails are in use.
Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 8 The home are currently advertising for an activities co-ordinator. 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 Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Standard 6 is not applicable as the home is not registered to provide intermediate care. Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The home ensures that prospective service users have the information they need to enable them to make an informed choice about moving to the home. Service users are appropriately assessed prior to moving to the home. The home has taken appropriate steps to ensure that staff have the skills to meet the needs of service users. EVIDENCE: The home has produced a Statement of Purpose which is available to service users, prospective service users and their representatives.
Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 11 The inspectors were able to see that this document had been reviewed last year. Service users are issued with the home’s contract. The inspectors examined three contracts at this inspection and were able to see that, as recommended at the last inspection, contracts had been reviewed to provide clearer information on the breakdown of fees. The inspectors were able to see evidence that prospective service users are fully assessed prior to a placement being offered. Three care plans were examined and all contained appropriate pre-admission assessments. Assessments from other healthcare professionals were in place as appropriate. Service users move to the home on a trial period to ensure that all parties are happy that the home can meet the assessed needs of individuals. The manager has been pro-active in ensuring that staff at the home have the skills and knowledge to enable them to meet the assessed needs of service users. The majority of staff have now received training in dementia care. Staff spoken with were very positive about this. The commission sent comment cards to a number of relatives. At the time of this report 8 had been returned and comments regarding the skills of staff were positive. Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The home’s care planning systems are excellent and promote a person centred approach to care. The home takes appropriate steps to ensure that individual’s healthcare needs are met. Service users are treated with respect and their right to privacy is upheld. The home’s procedures for the management and administration of service users medication are excellent. EVIDENCE: Three service user care plans were examined in detail at this inspection. The standard of care plans seen were excellent. Care plans contained detailed and
Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 13 up to date assessments which included reducing the risk of pressure sores, nutrition and manual handling needs. Care plans identified the individual’s needs and contained very detailed instructions for staff. The psychological/mental health needs of the service users had been fully identified and care plans promoted a person centred approach to care. This was felt to be very positive. Care staff spoken with at the inspection confirmed that they were encouraged and supported to be fully involved in the care planning process. Detailed records were in place relating to service user’s contact with G.P’s and other healthcare professionals. The manager confirmed that the home had excellent links and support from doctors and other healthcare professionals. Service users weights are monitored on a monthly basis. Up to date records were seen in the care plans examined. Where there is an assessed need, the home monitors the diet and fluid intake of service users. Up to date and well maintained records were seen to be in place in those individual’s bedrooms. During this inspection the inspectors were able to speak to four relatives. All were very complimentary about the care their relative received. The standard of care was described as ‘excellent’ and all commented on the kindness of the staff and manager. Relatives stated that they were kept very well informed and that they felt very reassured that their relative was being well cared for. The commission sent comment cards to relatives, healthcare professionals and GP’s as part of this key inspection. At the time of this report 8 had been received from relatives and comments regarding the care their relative received were very positive; ‘The staff go to great lengths to make my relative as comfortable as possible’, ‘people are treated with respect and are given appropriate care’, ‘I am 100 satisfied with the care my relative receives’. Two comment cards were received from healthcare professionals and both confirmed that they were satisfied that the needs of service users were met by the home. Six G.P’s completed the commission’s comment cards and all indicated that the home worked in partnership with them and demonstrated a clear understanding of the care needs of service users. During this inspection the inspectors observed staff interacting with service users in a kind and professional manner. Care staff were also observed assisting service users to drink, eat and transfer in an appropriate manner. Staff morale appeared high and staff informed the inspectors 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 were very positive about the training they had received in Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 14 dementia care. 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. Service users are treated in a manner which respects their privacy and dignity. This was confirmed by relatives and was observed by the inspectors. The inspectors examined the home’s procedures for the management and administration of service users medication. All medicines were found to be appropriately stored and records were very well maintained. Medicines are only administered by the registered nurse on duty. All staff involved in the management and administration of medication have been appropriately trained. Further training was taking place on the day of the inspection. The inspectors were informed by the manager that the home had worked closely with G.P’s and other healthcare professionals to ensure that prescribed medicines are fully and regularly reviewed for each service user. The use of sedating and anti-psychotic medication was found to be very low. Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. The home is advertising for an activities co-ordinator and service users would benefit from this provision. Service users are supported to exercise choice over their lives. Service users benefit from a wholesome and varied menu. Meals are enjoyed in comfortable surroundings and staff offer assistance in a kind and unhurried manner. EVIDENCE: At previous inspections, concerns have been noted regarding the lack of activities available to service users. It was very positive to note that the home is now advertising for an activities co-ordinator. Although structured activities are not yet in place, staff confirmed that they were able to spend more quality time with service users. Since the last inspection the manager has reopened the ‘snoozlem’ room. Two service users were observed enjoying this facility during the inspection.
Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 16 The inspectors found the atmosphere at the home to be happy and relaxed and the most obvious improvement noted was the staff’s communication with service users. This was very positive and was also commented on by all four relatives spoken with. Relatives stated that they were always made to feel very welcome at the home. Service users who were able to express a view informed the inspectors that they could choose how and where to spend their day. They also confirmed that they decided what time they got up in the morning and retired to bed. During the inspection service users were observed moving freely around the home. Service users had access to all communal areas and their bedrooms. 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. 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.V321450.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure in place. The home takes appropriate steps to reduce the risk of harm or abuse to service users. 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. No concerns or complaints have been raised directly with the Commission. 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. This was also confirmed by relatives spoken with and through responses to the commissions comment cards from relatives and healthcare professionals. Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 18 Since the last inspection, training has been provided for staff in the protection of vulnerable adults. The home’s procedures for the recruitment of staff has greatly improved and now provides better protection for service users. Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 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. 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 Good This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable purpose built environment where they can choose where to spend their day. A number of lounge areas are available. Service users are encouraged to personalise their bedrooms. The standard of cleanliness is high and the home takes appropriate steps to reduce the risk of the spread of infection. 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 have an en-suite facility.
Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 20 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. The home has three lounges, conservatory, and a large dining room. Since the last inspection, the manager has reinstated the sensory room. Two service users were observed enjoying this facility during the inspection. 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 home employs domestic staff. At the time of this inspection the standard of cleanliness was noted to be high. No malodours were apparent. Relatives spoken with also commented on the cleanliness of the home. Appropriate hand washing facilities are sited throughout the home and staff have access to a good supply of protective equipment. Staff confirmed that they had received training in infection control. Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. Service users benefit from a stable staff team. Staffing levels are appropriate to meet the needs of current service users. Staff training has greatly improved and service users now benefit from an appropriately trained staff team. Staff morale is high and this has a positive outcome for service users. The home’s procedures for the recruitment of staff has improved and now provides better protection for service users. EVIDENCE: The acting manager stated that the home now has a stable staff team and no agency staff have been used. At the time of this inspection 34 service users were living at the home and the inspectors were advised that the following staffing levels were in place; Morning – 2 registered nurses and 5 care staff
Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 22 Afternoon/eve – 2 registered nurses and 4 care staff Night – 1 registered nurse and 2 care staff. In addition to the care team, the 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 and since the last inspection, the home have employed a full time maintenance person. During this inspection, staff morale was noted to be high. The inspectors spoke with domestic staff, care staff and qualified staff. All were very positive about the support they received. None expressed any concerns about staffing levels at the home. Care staff stated that there were sufficient staff to meet the care needs of service users and that they also had time to spend ‘quality time with service users’. The four relatives spoken with were very complimentary about all staff at the home. Comments received in completed comment cards sent to relatives were very positive about the staff and included; ‘staff treat people with great respect’, ‘staff ensure that people are given the care they need’, ‘The home provides staff that work well together in teams and work happily’, ‘Staff interact in a calm and reassuring way with the residents’, ‘staff are always cheerful’. Everybody spoken with were very positive about the manager. They commented in the improvements he had made at the home and of the support that he offered. The manager has been very proactive in addressing the requirements raised at the last key inspection. Staff have received training in dementia care and this is on-going. Care staff in particular were very positive about this. Comment cards completed by healthcare professionals for the commission were very positive about how the manager has addressed staff training needs. There has been no improvement regarding NVQ training for staff as yet though the manager stated that he is currently taking steps to source appropriate training. Progress will be followed up at the next inspection. Three staff recruitment files were examined at this inspection and improvements were noted. The inspectors were able to see evidence that the requirements and recommendations raised at the last inspection had been addressed. The home’s procedures for the recruitment of staff are now more robust and provide better protection for service users. All files examined contained all information required including criminal records checks (CRB) and protection of vulnerable adults checks (POVA). Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 23 All newly appointed staff undergo a period of induction. Since the last inspection, the home’s staff induction programme has been reviewed. Staff now complete a more in-depth programme which appears to meet with Skills for Care requirements. Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 24 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): 33, 35, 36, 37 and 38 Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. Although this could not be fully assessed, the manager designate ensures that the home is effectively managed. Staff are appropriately supervised. The home has an effective quality assurance programme in place. The home takes appropriate steps to ensure the health and safety of service users, staff and visitors. EVIDENCE: Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 25 Standards 31 and 32 were not assessed as the home does not have a registered manager. David Barenskie commenced employment in December 2005 as manager designate. Mr Barenskie is in the process of completing a CSCI application to be registered manager. Staff spoken with during the inspection were very positive regarding the support and training they received from Mr Barenskie. Staff stated that he was very approachable. Positive comments were also raised by all relatives spoken with. Mr Barenskie is very much a ‘hands-on’ manager who promotes an open and inclusive style of management. Since the last inspection, Mr Barenskie has been very proactive and committed to improving the standards of care at Orchard Court. The inspectors were able to see that the company representative had visited the home on a monthly basis. Written reports were available at the home and no concerns were noted in the records examined. The home has a quality assurance programme which seeks the views of service users and stakeholders. Regular meetings are held for staff and the manager has planned a meeting for relatives in March. Formal meetings for service users are not felt to be appropriate at this time. As part of its quality assurance programme, the home sent surveys to relatives in December ’06. A selection were sampled at this inspection and comments were positive. As part of this key inspection, the commission sent comment cards to a selection of service users, relatives, healthcare professionals and G.P’s. Comments and responses were positive and have been incorporated throughout the report. 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. Statements are sent to service users’ relatives or representatives on a monthly basis. As required at the last inspection, the manager has implemented a staff supervision programme for staff. Records seen were detailed and contained feedback from the staff member. Any training needs had been identified and that manager had taken action to arrange appropriate training for staff as required. This is a positive improvement.
Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 26 The following records were examined relating to the Health and Safety: FIRE SAFETY – Clear records were available to confirm that the home conducts weekly in-house checks on the fire alarm systems, fire fighting equipment, emergency lighting and fire doors. Annual servicing by an external contractor was found to be up to date. Records indicated that all staff had received up to date fire safety training on 07/02/07. This was also confirmed by staff spoken with at the inspection. ELECTRICAL SAFETY – The home’s portable appliances (PAT) are tested annually. This was last carried in October 2006. As required at the last inspection, the home has forwarded a copy of the electrical hard wiring certificate to the Commission. This is dated 12/06/06 and is valid for 5 years. GAS SAFETY – The home has an up to date annual gas safety certificate dated 11/01/07. HOT WATER OUTLETS/SURFACES – To reduce the risk of injury to service users, all bath hot water outlets have been fitted with thermostatic controls. Records were available to indicate that hot water outlets are checked at least monthly to ensure that temperatures remain within safe limits. As required at the last inspection, the home ensures that any showers or outlets not regularly used, are flushed through in accordance with HSE guidance to reduce the risk of legionella. Records indicated that these checks are carried out weekly. EQUIPMENT SERVICING – Up to date servicing records were seen dated 13/11/06. Moving and Handling equipment is due to be serviced again in 6 months. Call bells are checked by the home weekly. Systems were serviced by an external contractor in January 2007. It was positive to note that the manager had taken appropriate action to address the requirement of the last inspection regarding bed rail safety. Detailed safety check records were in place for all bed rails in use. These checks are conducted on a weekly basis. Records indicated that the last check was conducted on 07/02/07. The inspectors checked a selection of bed rails at this inspection and no concerns were noted. ACCIDENTS – The home maintains appropriate records relating to accidents. The manager analyses accidents on a monthly basis to identify any traits or concerns. Detailed records are maintained by the manager, which also identifies any action taken to reduce the risk of reoccurrence. Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 27 Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 28 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 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 3 3 3 3 Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP12 Regulation 16(2)(m) &(n) Requirement 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. (Previous timescale of 31/07/06 partly met) Timescale for action 01/06/07 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 OP28 Good Practice Recommendations To ensure service users benefit from a trained and competent workforce, the registered person should ensure that a minimum ratio of 50 of care staff achieve an NVQ level 2 in care. Orchard Court Nursing Home DS0000003276.V321450.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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
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