Inspection on 20/10/05 for Orchard Court Nursing Home

This inspection was carried out on 20th October 2005.

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

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

Other inspections for this house

Orchard Court Nursing Home 18/06/08

Orchard Court Nursing Home 15/02/07

Orchard Court Nursing Home 10/05/06

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 TA1 3RY Lead Inspector Kathy McCluskey Announced 20 October 2005 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 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 D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Orchard Court Nursing Home Address Harp Chase, Shoreditch Road, Taunton, Somerset, TA1 3RY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01823 351155 01823 352277 Tamaris Healthcare (England) Ltd (wholly owned subsidiary of Four Seasons Health Care) Care Home with nursing 44 Category(ies) of Dementia (44) registration, with number Dementia - over 65 (44) of places Mental Disorder (44) Mental Disorder - over 65 (44) Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 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 April 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 Gardens are well maintained and provide interesting features, which include a sensory garden area. The home is registered with the Commission for Social Care Inspection to provide nursing care for up to 44 older people 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. Since the last inspection, the registered manager has resigned from her post. Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted over one day (from 0930hrs – 2020hrs) by CSCI Regulation Inspectors Kathy McCluskey and Jane Poole. The home does not currently have a registered manager. The CSCI had not been informed at the time, of the absence and subsequent resignation of the registered manager Yvonne Evans. Whilst the company had attempted to provide management cover, the structure in place clearly lacks continuity for both service users and staff. Gill Whiter, registered manager of a Four Seasons home in Swindon and Caroline Baker, Care Services Director were available throughout the inspection. The majority of the inspection was spent with service users and talking to staff on duty. A selection of records were examined relating to service users, staff and health and safety. Four completed CSCI relative/visitor comment cards and one service user comment card were received and comments are incorporated into this report. The inspectors were given unrestricted access to all areas of the home. All communal areas and a selection of bedrooms were seen. Following this inspection, the company have agreed with a voluntary ban on admissions. What the service does well: At this inspection the inspectors were unable to identify any areas of good practise. Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: All staff spoken to stated to the inspectors that they did not have enough time to meet even the basic physical needs of the service users living at the home. This was evidenced on the day of the inspection. It was observed that some service users did not receive breakfast until 11.30 am, some were given food earlier but were unable to eat without assistance and food became cold and inedible before assistance was available. The inspectors viewed fluid charts of service users who were being nursed in bed. Some showed large gaps when fluid had not been made available. There appeared to be no system for recording the food intake of any person. Each person living at the home has a care plan but on examination it was ascertained that care was not being delivered in line with care plans. Care staff spoken to stated that they did not have time to look at care plans. The majority of service users at the home are unable to occupy their time without support. The inspectors saw people sitting alone in their rooms or in the lounge areas for long periods with no stimulation or social interaction. There is currently no manager or deputy and the home is being managed on a daily basis by managers from other parts of the company. There appeared to be no consistency of care and no leadership. Staff stated that the different shifts work in very different ways. Two care staff spoken to raised serious concerns with the inspectors in respect of allegations of physical and verbal abuse. This was immediately passed to the representatives of the company on site. Investigations are on-going and appropriate agencies have been informed. Although the home is registered to provide care to older people who have a dementia or other mental health difficulty there is a limited number of qualified mental health nurses and only one carer spoken to had received any training in caring for people who have a dementia. The inspectors toured the building and noted that there were malodours in many areas. Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 Page 7 14 requirements and 2 recommendations have been made at this inspection and the Commission for Social Care Inspection will closely monitor the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 The home takes appropriate steps to ensure that prospective service users are assessed prior to admission. Prospective service users and/or their representatives cannot be sure that the home will meet their assessed needs. Following this inspection, the company have agreed with a voluntary ban on admissions. EVIDENCE: Not all standards were assessed and some records were not available for inspection. These will be followed up at the next inspection. On examination of three service user care plans, the inspectors were able to see evidence that the home had carried out an assessment prior to the service user moving to the home. Copies of social services assessments were also seen in the care files examined. Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 Page 10 At this time, prospective service users and/or their representatives cannot be sure that the home can meet an individual’s assessed needs. Care practise was examined and the inspectors compared this to the individual’s plan of care. It was noted that care provided was inconsistent and not in line with the individual’s assessed needs. All care staff spoken to stated that they did not ‘have time’ to read service user care plans. It was also concerning that care staff stated that ‘each shift does different things’. Many care staff became upset and stated that they ‘did not have time to meet even basic personal care needs’. Concerns about meeting personal care needs were also reflected in CSCI relative comment cards. The home is registered to provide nursing care for service users who have dementia or other mental health problems and, at this time, staff at the home do not have the skills or experience to meet these specialised needs. Concerns were raised at this inspection regarding the lack of registered mental health nurses. At the time of this inspection, the home only has two registered mental health nurses. Only one care assistant met with, has received training in caring for people with dementia. Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 Page 11 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 standard(s) 7, 8, 9 and 10 The home’s care planning process does not ensure that an individual’s assessed needs are fully reflected. Assessed needs of service users are not being met by staff. The home follows the correct procedures for the management and administration of medication. EVIDENCE: Three service user care plans were examined in detail. Care plans and all other relevant documentation were compared to actual care practises. Care plans were found to contain a good range of information on how to meet an individual’s assessed needs. When this was compared to care practises, it was very concerning to note that care plans were not being followed. Some examples of this included service users not being ‘turned’ at assessed frequencies and fluid input charts not being adhered to. Psychological and social needs were not being met. Although detailed social history assessment forms were available in care plans examined, these had not been completed. Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 Page 12 The inspectors were able to see that care plans had been reviewed on a monthly basis but it was noted that for one service user, ‘no change to care plan’ had been recorded. On further investigation, it was apparent that the care plan was not reflective of the individual’s current needs and abilities. The inspectors spoke to all care staff on duty. All stated that they ‘did not have time to look at care plans’. Staff also indicated that ‘each shift does different things’. Many staff spoken with became upset and stated that they ‘did not have time to meet even basic care needs’. Staff stated that they did not have time to spend talking to service users and the home does not employ an activities coordinator, nor does it have allocated time for staff to carry out basic activities. These concerns were raised with the management at the time of the inspection. The inspectors were shown a copy of an internal audit carried out by the company recently. This also had highlighted similar concerns relating to care practises which, the inspectors were assured, were in the process of being addressed. Four completed CSCI relative/visitor comment cards were received as part of this inspection and one relative made contact with the inspectors. Only two indicated that they were satisfied with the overall care provided to their relative. Comments included; ‘staff shortages appear to cause lack of personal care’, ‘I am greatly concerned about staffing levels and staff seem to struggle to provide basic care’. The inspectors examined the home’s procedures for the management and administration of medication. The home uses the monitored dosage system (MDS) with pre-printed Medication Administration Records (MAR). All MAR charts examined had been appropriately completed. All medicines were seen to be securely stored. Medicines are only administered by the registered nurses on duty. Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, and 15 The home does not ensure that service users benefit from appropriate stimulating activities or social interaction. The home offers a wholesome menu but the arrangements for assisting service users is very poor. EVIDENCE: It was very concerning to note that despite being raised at previous inspections, no action had been taken to ensure that service users benefit from meaningful activities. The home does not employ an activities coordinator and there are now no additional care hours allocated for this. The inspectors were informed that there were no records relating to activities. On examination of care records, it was noted that social assessments had not been completed. The care services director did show the inspectors a ‘life history’ which had been completed for one service user and stated that they were in the process of completing these for all service users. Progress will be followed up. On the day of this inspection the only interaction between staff and service users was when staff were assisting with a ‘task’. Staff’s communication with Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 Page 14 service users was noted to be very limited. This resulted in service users either sitting alone in their bedroom all day or spending the majority of time in one of the lounges. The majority of service users are dependant on staff to meet all activities of daily living. Only a small number can mobilise independently. Service users appeared quite ‘subdued’. All staff spoken with during the inspection informed the inspectors that they did not have any time to spend with service users. CSCI Comment cards received from relatives also expressed concerns about the lack of activities. Another comment received indicated that staff interactions lacked ‘warmth’. It has been required at this inspection that the company must take appropriate action to ensure that the psychological and social needs of service users are met. This will be closely monitored by the CSCI to ensure that service users benefit from appropriate stimulation and that staff’s interactions improve. CSCI comment cards indicated that relatives/visitors were made to feel welcome at the home and were able to see their relative in private. Four of the five relatives indicated that they were kept informed of important matters. All meals are prepared and cooked at the home. The main meal is served at lunch time and the menu made available to the inspectors was varied and appeared wholesome. The inspectors were informed that choices are made available on request. Tea consists of sandwiches, or a choice of light hot snacks. Home made cakes were also offered. A comment was made to the inspectors that ‘it was always sandwiches for tea’. The inspectors noted that the dining room was locked apart from mealtimes, therefore preventing service users from accessing this communal area. On the day of the inspection, the inspectors noted that at 1130am some service users had not yet had breakfast. The inspectors met with one service user who was in her bedroom. The service user had not touched the food. The porridge and cup of tea had gone cold. The service user was complaining of feeling hungry. Fluid balance charts were seen in some bedrooms. On examination of these, it was not clear whether these service users were having adequate or regular fluids. This was of great concern and was brought to the attention of the management at the time. This will be followed up. Staff spoken with stated that given the high number of service users who required assistance with their diet and fluids, they felt that staffing levels at the home were not sufficient to meet the needs of service users. Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home has an appropriate complaints procedure in place. The home is not taking 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 unable to view the homes complaints records at this inspection. This will be followed up. Concerns have recently been raised directly with the CSCI regarding staffing levels at the home. This is in the process of being investigated by the CSCI. Inspectors spoke with all staff on duty on the day of the inspection. Some staff raised serious concerns with the inspectors. These concerns were immediately passed to the home’s management to investigate further. The progress/outcome of this investigation will be monitored by the CSCI. As detailed in standard 29, the home’s recruitment procedures do not ensure that service users are protected from harm or abuse. Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 Service users live in a purpose built environment but are dependant on staff to access all communal areas. Service users do not have ‘free’ access to the garden or dining area. Malodours were apparent on the day of the inspection and some areas would benefit from redecoration. 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. Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 Page 17 Specialist beds and pressure relieving equipment were seen to be in place where there was an assessed need. The home has four lounges, a large dining room and a sensory room. 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. On the day of this inspection, the inspectors saw a number of service users in their bedrooms, all communal lounges were utilised. The dining room could not be accessed by service users as this was noted to be locked other than meal times. Doors to the garden were also noted to be locked. The inspectors were informed that some bedrooms had been decorated since the last inspection. Corridors, bathrooms and some communal areas would benefit from redecoration. The inspectors were informed that there were plans to decorate these areas. Progress will be monitored by the CSCI. Malodours were noted in the reception area of the home, corridors, some bedrooms and bathrooms. The laundry area was found to be clean, well-equipped and well organised. The laundry person met with had a good understanding of COSHH and Health and Safety requirements. Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Currently, staff at the home do not have the specialist skills or experience to meet the needs of service users. Staffing levels are not sufficient to meet the assessed needs of service users. The home is not following robust recruitment procedures. EVIDENCE: At the time of this inspection, the home only has two registered nurses who specialise in service users with mental health needs. Only one member of care staff spoken with had received training in caring for people with dementia. This is of great concern given that the home is registered to provide specialist nursing care, and this must be addressed. Concerns were also raised at the last inspection. Information provided by the home indicated that only one member of staff had achieved an NVQ level 2 in care. Five care staff had been identified to undertake this award, though dates had not been arranged and it was not clear if the staff members had been registered. During observations throughout the day, speaking to staff and on examination of care records, it was apparent to the inspectors that the psychological needs of service users were not being met by staff. Staff had little or no insight into the mental health needs of service users in their care. Basic physical needs were not always being met. Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 Page 19 The numbers of staff on duty were unable to meet the needs of service users. The inspectors observed service users waiting an unacceptable length of time to be assisted with meals. Fluid balance charts had not been followed which resulted in service users not being assisted with adequate levels of fluid. No social interaction took place and communication between staff and service users was limited. Care plans were not being followed. The inspectors spoke with all staff on duty during the day of the inspection. All expressed concerns about staffing levels at the home and that they were unable to meet even the basic personal care needs of an individual. Concerns about staffing levels at the home have been raised directly with the CSCI and in CSCI completed relative/visitor comment cards. It has been required that these issues are addressed,. The CSCI will be monitoring the home closely to ensure compliance. A selection of staff recruitment files were examined at this inspection. Once again, it was concerning that the home was not following robust recruitment procedures. In one staff file, the only references available were addressed ‘to whom it may concern’. One was undated and the other was dated 6 months prior to employment. These references are unacceptable and there was no evidence that the authenticity of the references had been checked. In another staff file, no risk assessment was in place for a member of staff awaiting a Criminal Records Check. The inspectors were assured that the staff member did not work unsupervised. A POVAFirst check had been obtained. Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 34, and 38 The home lacks appropriate leadership which is having a negative outcome for service users, staff and visitors. EVIDENCE: Since the last inspection, the registered manager Yvonne Evans has left employment. The inspectors were informed that the company have provided management support Monday to Friday, to the home in the absence of a registered manager. The CSCI had not been informed at the time, of the absence and subsequent resignation of the registered manager Yvonne Evans. Whilst the company had attempted to provide management cover, the structure in place clearly lacks continuity for both service users and staff. Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 Page 21 On examination of monthly visit reports which had been forwarded to the CSCI in accordance with Regulation 26 of the Care Home Regulations 2001, it was concerning to note that no reference had been made by the company representative, regarding the management situation at the home. Staff appeared to lack direction and leadership, and when asked, were unsure as to who they would raise concerns with. CSCI completed Visitor/relative comment cards indicated that they were not always kept informed of important matters regarding their loved ones. Several stated that they were kept waiting for longs periods on arrival at the home. It is the intention of the CSCI to monitor the home closely until a satisfactory management arrangement is in place. The following records were examined relating to the Health and Safety: FIRE SAFETY – The home conducts weekly checks on the home’s fire detection systems and monthly checks on emergency lighting. Records are maintained. Fire detection systems and fire fighting equipment are serviced by an outside contractor on an annual basis. This was last recorded as 17/08/05. ELECTRICAL SAFETY – The home’s portable appliances (PAT) are tested annually. This was last carried out 09/09/05. It has been required that confirmation of portable appliance testing is forwarded to the CSCI. The electrical hardwiring certificate could not be located for this inspection. 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 – The home maintains records of monthly checks on all hot water outlets. Records seen indicated that bath hot water outlets were within HSE recommended limits. To reduce the risk of injury to service users, all bath hot water outlets have been fitted with thermostatic controls. EQUIPMENT SERVICING – The inspectors were informed that all hoists had recently been serviced although servicing records could not be located at the time of the inspection. It has been required that these are forwarded to the CSCI. Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 x 15 1 COMPLAINTS AND PROTECTION 2 2 3 3 3 3 3 2 STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 1 1 x 3 x x x 2 Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard OP4 OP7 OP7 Regulation 14(1)[d] 15 (2)[b] 18(1) Requirement The home must not admit service users if they are unable to meet their assessed needs. Care plans must be up dated to ensure that they reflect the needs of service users. The responsible individual must ensure that all staff are working in a consistent manner to ensure that service users assessed needs are met The responsible individual must ensure that nutritional assessments are carried out and regularly reviewed. The home must provide social and psychological stimulation for all service users. (PREVIOUS TIMESCALE OF 30/06/05 NOT MET) The responsible individual must ensure that all service users receive an adequate diet at appropriate times. The responsible person must ensure that there are adequate staff to assist service users to eat meals and receive adequate fluids. The responsible individual must provide an action plan giving Timescale for action All future admissions 30/11/05 07/11/05 4. OP8 12(1)[a] 16/11/05 5. OP12 16 (2)[m] 30/11/05 6. OP15 16 (2) [i] From date of report From date of report 7. OP15 16 (2) [i] 8. OP19 23 (2)[b] 30/11/05 Page 24 Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 9. OP26 23 92) [d] 10. OP27 18 (1) [a] 11. OP18 & 29 19(1) 12. OP30 18 (3) 18(1) 13. OP31 18 (1) [b] 8(1) [a][b] 14. OP38 13(4) details, including timescales, of how the evironment will be up graded The responsible individual must ensure that the home is kept clean and free from offensive odours. The responsible individual must ensure that there are suitable numbers of appropriately skilled and qualified staff on duty at all times, including domestic staff, to meet the needs of service users. (PREVIOUS TIMESCALE OF 30/06/05 NOT MET) The responsible individual must evidence the authenticity of staff references. (PREVIOUS TIMESCALE OF 19/04/05 NOT MET) The responsible individual must ensure that suitable numbers of nurses with mental health qualifications on duty at all times. All Care staff must receive training in caring for people who have a dementia. The responsible individual must ensure that an appropriately skilled and experienced manager is in place in order to give continuity of care for service users and leadership to staff. The responsible individual must provide the CSCI with copies of the following: - An up to date Electrical Hardwiring Certificate - Evidence that all portable appliances have been checked by a competent person - Up to date servicing records for all mobile and fixed hoists 07/11/05 30/11/05 For all future employees 30/12/05 30/12/05 14/11/05 Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP19 OP28 Good Practice Recommendations The responsible individual should ensure that service users have access to all communal areas, including outside space, at all times. 50 of care staff should have an NVQ at level 2 or above. Orchard Court Nursing Home D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection 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 D53 - D02 S3276 Orchard Court Nursing Home V244484 201005 Stage 4.doc Version 1.40 Page 27 - 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. 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