Inspection on 18/06/08 for Orchard Court Nursing Home

This inspection was carried out on 18th June 2008.

CSCI found this care home to be providing an Adequate service.

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 15/02/07

Orchard Court Nursing Home 10/05/06

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Orchard Court Nursing Home Harp Chase Shoreditch Road Taunton Somerset TA1 3RY Lead Inspector Kathy McCluskey Unannounced Inspection 09:15 18 & 20th June 2008 th 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.V366735.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.V366735.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) Mr David John Barenskie Care Home 44 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (44), Mental disorder, excluding learning of places disability or dementia (10), Mental Disorder, excluding learning disability or dementia - over 65 years of age (44) Orchard Court Nursing Home DS0000003276.V366735.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th February 2007 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 older people who suffer with dementia or other mental health problems. The home is owned by Four Seasons Healthcare Ltd. The responsible individual is Pauline Lawrence. The registered manager is David Barenskie. We were informed that fees are currently between £398 & £654 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.V366735.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience Adequate quality outcomes. 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 for each outcome group under four general headings. These are; - excellent, good, adequate and poor. This unannounced key inspection was conducted over two days (7.25hrs). The first day was conducted by CSCI regulation manager Jackie Dolan and CSCI regulation inspector Kathy McCluskey. Kathy McCluskey completed the inspection on the second day. The registered manager David Barenskie was available on the second day of the inspection as was one of the company’s regional managers. We were given unrestricted access to all parts of the home and records required for this inspection were made available to us. We met with the majority of people living at the home and were able to talk to some staff. We used information supplied in the home’s completed Annual Quality Assurance Assessment (AQAA) and comments have been included in this report as appropriate. We would like to thank the management team, people living at the home and staff for their time and cooperation with the inspection process. The following is a summary of the report and should be read in conjunction with the whole of the report. What the service does well: Orchard Court Nursing Home DS0000003276.V366735.R01.S.doc Version 5.2 Page 6 The home ensures that people are appropriately assessed before a placement is offered. Care planning documentation is good and provides detailed information about the individual. Care plans also contain information regarding peoples’ preferences. The home needs to ensure that care is delivered in line with the agreed care plan. We were able to see evidence that people’s relatives/representatives were given the opportunity to be involved in the care planning and review process and there was evidence that the home communicates effectively with relatives. The home ensure that people have access to a wide range of healthcare professionals, including mental health professionals. The home’s procedures relating to the management and administration of peoples medication were found to be good. The home follows robust procedures for staff recruitment though we have made some good practise recommendations. Regular quality assurance/auditing procedures are in place which seek the views of stakeholders. Results from the most recent surveys were positive. The home has a registered manager who has stated his commitment to improving standards at the home. The registered manager promotes a very ‘hands on’ management approach. What has improved since the last inspection? What they could do better: Orchard Court Nursing Home DS0000003276.V366735.R01.S.doc Version 5.2 Page 7 The home need to ensure that care is delivered in line with the agreed plan of care and that staff follow an individuals moving and handling assessment. We have raised requirements relating to these issues. We have recommended that the home give serious consideration to removing personal information about the individual, which is currently displayed outside peoples’ bedroom doors. As the majority of the people living at the home would be unable to consent to this personal information about them being displayed, this raises issues as to their privacy and dignity. It is acknowledged that this information may be of benefit to people and staff but it would be more appropriate if it was located within a persons bedroom. During both days of this inspection, we spent time observing interactions with the people living at the home. On the first day of this inspection we noted that there was little staff interaction with people sitting in the lounge areas. We noted that one person needed repositioning. People who were in their rooms appeared to have little stimulation. When staff did interact with people, they were very kind. We did not observe any activities taking place during the inspection and we have recommended that the home provides us with details of how the home’s activity programme will be delivered in the absence of the activity coordinator. The home is purpose built though furnishings and décor are now looking ‘tired’. These issues have already been acknowledged by the company and funding has been agreed for major refurbishment. This inspection was prompted by concerns raised directly with the Commission regarding the standards of cleanliness and strong malodours in the home. On the first day of the inspection standards of cleanliness were poor and a malodour was apparent. Standards had improved on the second day of the inspection. A requirement has been raised. 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.V366735.R01.S.doc Version 5.2 Page 8 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.V366735.R01.S.doc Version 5.2 Page 9 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): 3. 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 people are appropriately assessed before a placement is offered. EVIDENCE: The home’s Statement of Purpose and Service User Guide were not examined at this inspection. These documents provide people with information about the home and services offered. We examined three care plans at this inspection and were able to see evidence that people are appropriately assessed by the home before a placement is offered. The home also obtains assessments from other healthcare professionals where available. Orchard Court Nursing Home DS0000003276.V366735.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 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home’s care planning and assessment process is good though care is not always delivered in line with assessed needs. The home follows the correct procedures for the management and administration of medication. Staff communicate with people in a kind and respectful manner though further improvements could be made to ensure the privacy and dignity of people are fully respected. EVIDENCE: Three care plans were examined at this inspection and these were found to contain detailed and up to date information on each person’s assessed needs. Orchard Court Nursing Home DS0000003276.V366735.R01.S.doc Version 5.2 Page 11 We were able to see that the preferences of the individual had been identified as appropriate. Care plans also contained up to date assessments, which included, reducing the risk of falls & pressure sores, moving and handling needs, nutrition and dependency. We were able to see evidence that the people’s relatives and the individual as appropriate had been involved in the care planning/review process. The home also maintains records for all contact with a person’s relative/representative. Records indicated that the home ensures that people have access to appropriate healthcare professionals. People are weighed monthly by the home and records clearly identify any concerns. Care plans contained information relating to peoples’ social history. During both days of this inspection, we spent time observing interactions with the people living at the home. On the first day of this inspection we noted that there was little staff interaction with people sitting in the lounge areas. We noted that one person needed repositioning. In many bedrooms we noted that dentures were still in pots. People who were in their rooms appeared to have little stimulation. The majority of people were up and dressed but we noticed that sinks, towels and flannels were dry. This was discussed with the registered manager on the second day of the inspection and he stated that these items were replaced after the person had been assisted to wash in the morning. On the first day of the inspection, two people in their rooms did not have access to a nurse call system. When we checked the care plans, this contained information regarding this. It has been recommended that where a care plan identifies a need for frequent checks, a record of all checks including the time, is maintained. We observed on two occasions, that one person in their bedroom did not have easy access to a drink. This person’s care plan indicated that they should have access to fluids. We observed staff assisting people to transfer to/from wheelchair/chair. It was concerning that staff were not following correct procedures and appropriate equipment was not used for people with an assessed need. We discussed this with the registered manager who expressed his concern. We were informed that a meeting would be held for staff at the beginning of the following week. The regional manager confirmed that all staff had received appropriate and up to date training in moving and handling. We spoke to three staff and all confirmed that they had received appropriate training. The home must have systems in place to ensure that staff follow the correct procedures for moving and handling in line with each individuals’ assessed need. Orchard Court Nursing Home DS0000003276.V366735.R01.S.doc Version 5.2 Page 12 We examined the home’s procedures for the management and administration of people’s medication. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). MAR charts were examined and were found to be well completed. Medicines were seen to be securely stored with no excess stocks. We were informed that nobody living at the home was currently prescribed a controlled drug. No stocks were being held. Medicines are only administered by the registered nurse on duty. During a tour of the home we noted that information about people’s history and life had been placed on the outside of their bedroom door. Whilst this information may be helpful to the individual and to staff, the home should give serious consideration to removing this and placing somewhere in the persons bedroom as not all people living at the home are able to consent to their personal information being displayed to other people living there or visitors to the home. This has an impact on people’s privacy and dignity. During interventions, staff were heard communicating with people in a kind and respectful manner. Orchard Court Nursing Home DS0000003276.V366735.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, 14 & 15 Quality in this outcome area is Adequate This judgement has been made using available evidence including a visit to this service. The home has a programme of activities for people but it is not clear how this will be delivered in the absence of the activities co-ordinator. People who are able, can move freely around the home but the home needs to ensure that those who are more dependent also have the opportunities for social stimulation. Meals are freshly cooked at the home and people’s preferences are recorded. EVIDENCE: We were informed that the home employs an activities person 0900hrs1400hrs Monday to Friday but that this person had recently commenced maternity leave. We were provided with a programme of forthcoming events planned. This included outside entertainers, visits to a garden centre, picnic at Taunton’s Vivary Park and an annual Bar-b-que at the home. We have recommended that the home provides us with details of how activities will be delivered in the absence of the activities co-ordinator. Orchard Court Nursing Home DS0000003276.V366735.R01.S.doc Version 5.2 Page 14 No activities were observed taking place during this inspection. On examination of care plans we were able to see evidence that, up until recently records of activities had been recorded for each individual. We noted that the home’s ‘snoozlem’ room was not available to people. We were informed that this was in the process of being refurbished. We did not see any relatives during this inspection. During this inspection we were able to observe, those people who were able, moving freely around the home. People who were in their bedrooms and lounge areas were observed to receive limited interaction from staff. On the second day of this inspection, we were able to see lunch being served. This appeared wholesome and plentiful. Meals are prepared and cooked at the home by the chef. We were informed that the chef was due to attend training on nutritional needs for people with dementia. We were informed by the regional manager that they were currently in the process of purchasing moulds to enhance the presentation of soft diets. People who were able to express a view told us that the food was ‘good’ and that there was ‘plenty to eat’. We did not identify any concerns regarding weight loss when we examined care plans. Care plans contained people’s preferences regarding food and drink. We did not examine menus at this inspection. Orchard Court Nursing Home DS0000003276.V366735.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 & 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 satisfactory systems in place to enable people to raise concerns. Procedures are in place which reduce the risk of harm or abuse to people living there. EVIDENCE: The home displays a satisfactory complaints procedure. The registered manager informed us that the home had not received any complaints since the last inspection. This was also confirmed in the home’s completed Annual Quality Assurance Assessment (AQAA). The Commission have recently received one concern about the home which related to the standard of cleanliness and malodours. This inspection was used to look into these concerns. We were able to see evidence that staff at the home had received training in the protection of vulnerable adults. The latest update was recorded as having taken place on 28/05/08. The home follows satisfactory procedures for the recruitment of staff. Orchard Court Nursing Home DS0000003276.V366735.R01.S.doc Version 5.2 Page 16 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 & 26 Quality in this outcome area is Adequate This judgement has been made using available evidence including a visit to this service. The home is in need of refurbishment and the company have agreed funding for this. The standard of cleanliness requires some improvements. 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. The home has three lounges, conservatory, and a large dining room. The sensory room is not currently in use. During this inspection we looked at a number of bedrooms and all communal areas. Some areas of the home and furnishings are now beginning to look Orchard Court Nursing Home DS0000003276.V366735.R01.S.doc Version 5.2 Page 17 tired. We were able to see that this has already been acknowledged by the company and we were informed that funding is currently in place for ‘major refurbishment’. We were able to see that action plans had been drawn up and that the home were currently working towards the ‘Excellence in Dementia Care Award’ This is a company award which has been validated by the Bradford Dementia Group. We identified some issues where furniture and sink taps required repair and where some seat cushions required replacement. We were given assurances by the registered manager that these would be addressed. A number of bedrooms did not have the provision of a bedside light. The registered manager advised us that these had been ordered. Progress will be followed up. The home employs a full time maintenance person. On the second day of this inspection, materials arrived for the garden area as this is in the process of being redesigned/landscaped. We noticed that one assisted bath was currently out of use. We were informed by the registered manager that this had been the case for the last two weeks and the home was awaiting delivery of a new Arjo assisted bath. There appears to be a good supply of hoists and other equipment to assist people with moving and handling needs. As previously mentioned in this report, staff were not using equipment where there was an assessed need. Nurse call bells were seen in all bedrooms examined. Lockable space was available for service users in all bedrooms seen. On the first day of the inspection the standard of cleanliness was of a poor standard and there were strong malodours apparent throughout our visit. Many bedrooms needed vacuuming and some carpets appeared stained. One clinical waste bin in a bathroom needed emptying. We were informed that only one domestic was on duty instead of the usual two. On the second day of the inspection two domestics were on duty and the standard of cleanliness was much improved. Bedrooms appeared fresh and clean. We were also able to see that carpets had been cleaned in some areas. The Commission have recently received concerns about the standard of cleanliness and malodours at the home. It has been required that the home ensure that appropriate systems are in place, to include sufficient numbers of domestic staff, to ensure that the standard of cleanliness at the home is maintained to a satisfactory standard at all times. Appropriate hand washing facilities are sited throughout the home. Orchard Court Nursing Home DS0000003276.V366735.R01.S.doc Version 5.2 Page 18 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 & 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staffing levels appear satisfactory and staff confirmed that they were able to meet people’s assessed needs. The home follows appropriate staff recruitment procedures though these could be further improved. The home ensures that staff receive appropriate and up to date training. EVIDENCE: At the time of this inspection 41 people were receiving nursing care at the home. We were informed that the home is currently staffed as follows; AM – 2 registered nurses and 7 care staff PM – 2 registered nurses and 6 care staff Night – 2 registered nurses and 2 care staff. The home also employs domestic, catering, maintenance and laundry staff. As previously mentioned in this report. The home needs to ensure that sufficient domestic staff are on duty at all times to ensure an acceptable standard of cleanliness is maintained. (refer to standard 26) Orchard Court Nursing Home DS0000003276.V366735.R01.S.doc Version 5.2 Page 19 The registered manager works in addition to the care hours identified. We spoke to three staff and no concerns were raised regarding staffing levels or of their ability to meet the assessed needs of people at the home. Care plans contained assessments for people relating to their level of dependency. The registered manager confirmed that staffing would be increased as needed. Staff were positive about the training they received and they confirmed that they had the skills to meet people’s needs. Care staff confirmed that they were encouraged to refer to people’s care plans. A registered mental health nurse in on duty at all times. The registered manager confirmed that the home had not yet achieved 50 of its care staff trained to a minimum of an NVQ level 2 in care. In their completed AQAA, the home have identified this as an area for improvement in the next 12 months. During this inspection we examined two staff recruitment files relating to staff recently employed by the home. Files contained all required information including evidence of a criminal records check (CRB) and protection of vulnerable adults check (POVA). We noted that the employment history for one staff member was insufficient in that, only details from 2006 had been provided. This was discussed with the registered manager at the time. It has been recommended that the home obtains at least 10 years employment history. It has also been recommended that, where a person commences employment on a POVAfirst, pending a full CRB, a risk assessment is completed which identifies any restrictions on the employee during this time. This should be signed by both the home and the employee. A daily allocation sheet is used to identify which staff member will be responsible for supervising staff who are working pending a full CRB. The home maintains individual training records for each staff member. During this inspection the regional manager completing a 6 monthly audit of the home which also included examining all staff training records. We were informed that all mandatory training was up to date and that further training in dementia care was planned. We were able to see evidence that training in person centred planning and care was already arranged. This will be made available to all staff at the home. Orchard Court Nursing Home DS0000003276.V366735.R01.S.doc Version 5.2 Page 20 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, 33, 35 & 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is managed by an appropriately qualified and experienced registered manager. Appropriate quality assurance procedures are in place. Procedures are in place to ensure the safe management of peoples’ money. Systems are in place to ensure the health & safety of persons at the home but moving and handling procedures require improvements. EVIDENCE: Orchard Court Nursing Home DS0000003276.V366735.R01.S.doc Version 5.2 Page 21 David Barenskie has managed the home since December 2005. Since the last inspection the Commission have approved an application for him to be the registered manager. Mr Barenskie is a registered mental health nurse. Since taking up post Mr Barenskie has been pro-active in improving the standards of care at the home. Mr Barenskie is very much a ‘hands-on’ manager who promotes an open and inclusive style of management. Through discussions with Mr Barenskie, it was apparent that he had a very good understanding of the needs and preferences of the people living at the home. People responded to him in a positively. Staff told us that the registered manager was very supportive and that they found him approachable. The home has quality assurance systems in place. Questionnaires are sent to relatives and other stakeholders on an annual basis. Results are analysed by the company and discussed with the home. We were able to see the results of the most recent survey which was conducted in December 2007. Reponses averaged 80 positive responses in all areas. No issues were highlighted as a concern. Regular meetings are held for staff and minutes are maintained. Formal meetings for people living at the home at not felt to be appropriate at this time. As part of its’ quality assurance programme for the home, a company representative carries out regular audits and monthly unannounced visits which are in line with the requirement of the Care Homes Regulations 2001. We were able to see the report relating to the most recent visit which was conducted in June 2008. The home manages money on behalf of people where requested. 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 person. Statements identify items or services purchased by/or on behalf of people. Receipts are obtained. Statements are sent to peoples’ relatives or representatives on a monthly basis. During this inspection a regional manager for the company completed a full audit of these procedures and we were informed that no concerns were raised. We toured the premises and examined records relating to health and safety. FIRE SAFETY – Annual servicing was carried out by an external contractor on 03/06/08. The home carries out weekly checks on the home’s fire alarm systems, equipment and emergency lighting. We were able to see evidence that staff receive regular training in fire safety. ELECTRICAL SAFETY – The home’s portable appliances (PAT) are tested annually. The home has an up to date electrical hardwiring certificate dated 12/06/06 and valid for 5 years. Orchard Court Nursing Home DS0000003276.V366735.R01.S.doc Version 5.2 Page 22 HOT WATER OUTLETS/SURFACES – To reduce the risk of injury, all bath hot water outlets have been fitted with thermostatic controls. The home carries out weekly checks to ensure that temperatures do not exceed safe upper limits specified by the Health & Safety Executive (HSE). To reduce the risk of legionella, outlets not regularly used, are flushed through in accordance with HSE guidance on a weekly basis. EQUIPMENT SERVICING – Six monthly servicing on equipment was carried out by an external contractor in January 2008. Call bells and bed rails in use are checked by the home weekly. The home has been informing the Commission of significant events at the home as required in Regulation 37 of the Care Homes Regulations 2001. As previously mentioned in this report, concerns were raised at this inspection regarding moving and handling procedures. A requirement has been raised. The manager and the regional manager took action to address this at the time of the inspection. Orchard Court Nursing Home DS0000003276.V366735.R01.S.doc Version 5.2 Page 23 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 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 2 3 3 3 x 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Orchard Court Nursing Home DS0000003276.V366735.R01.S.doc Version 5.2 Page 24 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 OP8 Regulation 12(1)(a) & 13(4) Requirement Timescale for action 30/06/08 2. OP8 12(1) 3. OP26 16(2)(j) The registered person must ensure that at all times, staff follow the correct procedures when assisting service users with moving and handling needs. All staff must follow the individual’s moving and handling assessment. The registered person must 30/06/08 ensure that all care is delivered in line with the individual’s plan of care. The registered person must 10/07/08 ensure that appropriate systems are in place and that there are sufficient domestic staff on duty to maintain a satisfactory level of cleanliness in the home at all times. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000003276.V366735.R01.S.doc Version 5.2 Page 25 Orchard Court Nursing Home 1. 2. Standard OP8 OP28 The registered person should ensure that where there is an assessed need, records of any checks carried out on service users are maintained. 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. To ensure service users right to privacy and dignity are upheld, the registered person should give serious consideration to removing personal information from the outside of bedroom doors. The registered person should provide the Commission with details of how the home’s activity programme will be delivered in the absence of the activity co-ordinator. The registered person should update the home’s staff application form to request at least a 10 year employment history. The registered person should complete a risk assessment for any staff member who is employed on a POVAFirst pending a full CRB. This should clearly identify any restrictions imposed on the employee during this period and should be signed by the home and the employee. 3 OP10 4 5 6 OP12 OP29 OP29 Orchard Court Nursing Home DS0000003276.V366735.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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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