Inspection on 11/05/06 for Orchard House

This inspection was carried out on 11th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Orchard House 22/07/08

Orchard House 18/07/07

Orchard House 20/10/05

Orchard House 12/04/05

Orchard House 04/11/04

Orchard House 19/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Orchard House 107 Money Bank Wisbech Cambridgeshire PE13 2JF Lead Inspector Janie Buchanan Key Unannounced Inspection 11th May 2006 08:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Orchard House Address 107 Money Bank Wisbech Cambridgeshire PE13 2JF 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) 01945 466784 01945 588856 Ranc Care Homes Limited Mrs Sharon Wilson Care Home 67 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (37), Mental disorder, excluding learning of places disability or dementia (5), Old age, not falling within any other category (30), Physical disability (10) Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age range of residents with mental disorder (MD) and dementia (DE) and physical disability (PD) is 58 years to 64 years only 20th October 2005 Date of last inspection Brief Description of the Service: Orchard House is owned by Ranc Care Homes Limited. The company also owns three homes in Kent and one in Essex. It is a purpose built home providing residential and nursing care and is registered for 67 places. On the ground floor the home has twenty-six single bedrooms with en-suite facilities and two double rooms. The first floor is designated for residents with a diagnosis of dementia. Nursing staff are always on duty and are supported by a team of care staff and other domestic and catering staff. Four day-care staff provide social activities for the residents. The weekly charge varies from £330 to £707, depending upon a resident’s needs. Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on the 11 May and was unannounced. The inspector arrived during a busy morning and observed whilst staff helped residents get up and get their breakfast. She interviewed the manager, five members of staff and two visiting relatives. She spoke with five residents. A brief tour of the home was undertaken and a range of documents was viewed. The inspector also received a number of completed comment cards from residents and relatives requesting feedback about the quality of the care. Three requirements and two recommendations have been made as a result of this inspection. One requirement made from the previous inspection was unmet. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 6 contacting your local CSCI office. Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 The outcome in this group of standards is good. Information about the home is available to help prospective residents choose if it is where they want to live. However, each resident should be issued with a contract at the point of moving into the home so that they are fully aware of the terms and conditions of their stay there. EVIDENCE: The home has a Statement of Purpose and Resident Guide that give good information about the home and the services it offers. All residents are assessed fully by one of the management team before moving in, and appropriate pre-admission information for three recently admitted residents were viewed by the inspector. Families and prospective residents are able to visit the home to assess its suitability, and a copy of the most recent CSCI inspection report is available in the entrance hallway of the home. Self-funding residents are issued with a contract. However, it was of concern to note that local authority funded residents had not been issued with individual contracts. These should be issued to all residents and clearly set out the terms and conditions of their stay at the home. A requirement was made at the last Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 9 inspection about this. A further requirement for this to be done by 1 August has been made. Failure to comply with the requirements may result in legal action being taken against the home. Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The outcome in this group of standards is good. Care plans set out clearly the action to be taken by staff to ensure that all aspects of residents’ health and personal care needs were met. Residents’ health is promoted. EVIDENCE: New care plans have been introduced for all residents since the last inspection. These were detailed and included information about residents’ needs in relation to their communication, mobility, nutrition, social well being, sleep and mental health. The plans had been reviewed monthly and risk assessments for a number of activities had been completed for residents. Residents have their temperature, blood pressure, blood sugars, pulse and respiration checked monthly and more often if required and this information is recorded. Nutritional assessments are undertaken and residents’ weights are monitored closely. Food and fluid charts are implemented when necessary. The home has suitable policies in place regarding the recording, storage, handling and administration of medications. The inspector viewed staff giving residents their morning medications. This was done in accordance with the requirements. Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 The outcome in this group of standards is good. Social activities are well managed and provide stimulation and interest for people living in the home. Residents receive a varied and nutritious diet. EVIDENCE: The home employs four staff dedicated to providing activities for residents. As a result there is a busy and well-advertised activities programme in place. In addition to daily activities such as games, quizzes, newspaper readings and craft, there are regular church services, visiting entertainers and a residents’ cooking club. A table full of residents’ craftwork was on display in the entrance hallway of the home. Residents are able to receive their visitors in private and visitors interviewed on the day of inspection stated that they were made to feel very welcome by staff at the home. Residents’ nutritional needs are monitored closely. Nutritional screening is undertaken on admission, and residents are weighed monthly and more frequently if required. Staff were able to tell the inspector those residents that were nutritionally at risk, and what additional measures had been put in place as a result. The cook was fully aware of residents’ individual food likes and dislikes and which residents required specialised diets. Breakfast on the day of Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 12 inspection consisted of cereal, toast, scrambled egg, juice and tea: lunch was savoury mince or spaghetti bolognaise, with mixed vegetables, followed by lemon sponge and custard. Additional staff were made available during lunchtime to assist residents feed themselves. Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 The outcome in this group of standards is good. Complaints are taken seriously and the home’s procedures ensure that residents are protected. EVIDENCE: The home has its own complaints procedure that is advertised in its Statement of Purpose and Service User Guide and is on display in the main entrance to the home. The manager works hard to find solutions to concerns raised by residents. For example, one resident recently complained about the noise from other residents. This resident was offered another room within the home. Another resident complained about the food and the manager organised a tasting for her so she could try different foods to see if she liked them. Both visitors to the home interviewed by the inspector confirmed that they were aware of the complaints procedure and felt confident about using it. The Commission for Social Care Inspection has not received any complaints about the home since the last inspection. The home has a satisfactory adult protection procedure in place- ‘Elderly Abuse Policy’ (22/06/04) and this has been updated since the last inspection to include local guidelines. One of the management team has attended a threeday key practitioner course in adult protection and showed the inspector the contents of the training program she was about to cascade to staff. The home has dealt with two adult protection issues recently, and handled these responsibly and professionally. Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,22, 26 The outcome in this group of standards is good. Residents live in a comfortable and well maintained environment, with the necessary equipment to help them maintain their independence. EVIDENCE: The premises were observed to be clean, bright and well maintained, with good quality furnishing and fittings in place. Residents’ rooms were comfortable and personalised. The home has a range of aids and equipment such as grab rails, hoists and raised toilet seats available that promote residents’ safety and mobility. The inspector arrived in the morning when many residents were in the process of getting up. Although staff were very busy, they appeared relaxed, and the atmosphere was calm and pleasant. The manager continues to improve the environment of the dementia care unit: interesting reminiscence posters decorate long corridor walls and residents’ names are in large colourful letters on their bedroom doors. The manager is currently Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 15 collecting old furniture and memorabilia to create a ‘1940’s’ room for residents on the dementia care unit. The inspector welcomes this development. Residents have access to a sizable garden, allowing them exposure to fresh air and sun. The manager should consider enclosing this area so that residents from the dementia care unit can benefit from it without having their safety jeopardised. Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The outcome in this group of standards is good. The number of staff on duty meets residents’ needs and staff training is good. However, the home’s recruitment procedures need to be more rigorous to fully protect residents. EVIDENCE: Staffing levels are satisfactory. There are two nurses and 10 carers on each morning to support 67 residents and two nurses and seven carers in the afternoon. Additional staff are on duty at peak times during the day. During the night two nurses and four carers are available. Scrutiny of the duty rota showed these levels to be maintained. There are also dedicated activities staff and a number of volunteers. No members of staff are currently on long term sick, and the use agency staff has reduced. Residents stated that they did not wait too long for help, and were confidant staff would respond quickly if needed. Visitors interviewed by the inspector praised the staff for their efficiency and caring attitude. Training for staff is afforded high priority and records showed that they receive a variety of training specific to the needs of older people. 50 of staff hold an NVQ level 2 in care. The personnel files for two recently employed members of staff were checked. It was of concern to note that there was no evidence that one member of staff had had a CRB check and there was only one reference available for the other member of staff. A requirement has been made about this. Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 17 Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,36, 38 The outcome in this group of standards is good. The management of the home is good, creating an open, positive and inclusive atmosphere. The health and safety of residents’ is promoted. However formal supervision of staff is poor. EVIDENCE: The manager holds a number of qualifications in care and has worked hard to bring about a number of changes in care practices. The inspector received many positive comments both from staff and relatives about her including: ‘since the new manager took over things have improved dramatically’ and ‘Sharon has turned this place around’. A clinical nurse manger has recently been employed and the home now has a strong senior management team in place. Feedback about the service is actively sought via a ‘Residents and Relatives Satisfaction Survey’ which asks for comments about the quality of the Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 19 environment of the home, the staff and food. The inspector suggested that this survey also be extended to seek the views of the varying health care professionals who regularly visit the home. Secure facilities are provided for safe-keeping of residents’ money and a sample of residents’ cash sheets and fee payments were checked. These were found to be in good order. Formal supervision for staff is poor. Records checked by the inspector showed that one member of staff had only received three supervisions in the last three years; another member of staff had received none. The importance of individual supervision with staff (that covers aspects of their working practices, career development needs, philosophy and policies of the home) was discussed with the manager. A requirement has been made about this. A number of records in relation to health and safety (fire, portable appliance testing, water temperature records, gas, emergency lighting and hoist servicing) were viewed by the inspector and found to be in good order. Staff confirmed they had undertaken training in fire safety, moving and handling, health and safety, and food hygiene. Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 20 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 1 3 x 3 x 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 4 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x 3 x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 x 1 x 3 Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 21 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 OP2 Regulation 5(1b&c) Requirement All residents must be issued with a contract that states the terms and conditions in respect of accommodation and services provided at the home. Timescale of 01/12/05 unmet. A CRB check and two written references must be obtained before an employee commences work. Staff must receive regular supervision. Timescale for action 01/08/06 2. OP29 7,9,19 11/05/06 3. OP36 18 (2) 01/08/06 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. 4. Refer to Standard OP20 OP33 Good Practice Recommendations The home’s garden area should be made safe for those residents in the dementia care unit. The views of stakeholders in the community (GPs, nurses, chiropodists) should be sought as part of the homes quality assurance and monitoring systems. This is DS0000024295.V291828.R01.S.doc Version 5.1 Page 22 Orchard House outstanding from the previous inspection. Orchard House DS0000024295.V291828.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE 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 House DS0000024295.V291828.R01.S.doc Version 5.1 Page 24 - 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. 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