Inspection on 12/04/05 for Orchard House

This inspection was carried out on 12th April 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 House 22/07/08

Orchard House 18/07/07

Orchard House 11/05/06

Orchard House 20/10/05

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 HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Orchard House 107 Money Bank Wisbech Cambridgeshire PE13 2JF Lead Inspector Janie Buchanan Unannounced 12 April 2005 @ 09:00 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 and Care Homes for Adults 18 – 65*. 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Orchard House, Wisbech Address 107 Money Bank, Wisbech, Cambridgeshire, PE13 2JF 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) 01945 466784 01945 588856 Ranc Care Homes Ltd Sharon Wilson Care home with nursing 67 Category(ies) of Dementia (5), Dementia-over 65 years of age registration, with number (37), Mental Disorder, excluding leraning of places disability or dementia (5), Old Age, not falling within any other category (30), Physical Disability (10) Orchard House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: The age range of residents with mental disorder (MD) and dementia (DE) and physical disability (PD) is 58-64 years only. Date of last inspection 4 November 2004 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. Two care staff provide social activities for the residents.The home is located on the outskirts of Wisbech and is sited near local facilities with good road links to a number of cities. Orchard House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the home’s first inspection for the year 2005/6. The focus of this unannounced inspection was the 37 bed dementia unit. The inspector spent 7.5 hours at the home and talked with six residents, four visiting relatives, six care assistants and the manager. She spent the morning observing care practices on the dementia unit. The inspection also included a brief tour of the entire home and scrutiny of a range of documents. One additional visit has been made since the last unannounced inspection and information following this visit can be obtained from the CSCI office on request. What the service does well: What has improved since the last inspection? What they could do better: Information available about the home is good but should be produced in large print or audiotape to make it easier for people with poor sight to access. Full Orchard House Version 1.10 Page 6 day visits to the home should be actively encouraged before residents move in so that they have an opportunity to sample daily life, and also so that staff can fully assess their needs over a period of time. Individual plans of care are available for each residents but little progress has been made on the requirement that detailed information is recorded so that all aspects of health, personal and social care needs are identified and planned for. There should be more information in residents’ care plans so that their life histories are thoroughly recorded and staff know exactly what to do for each resident. Although staff have received training in dementia care they still do not evidence that they have sufficient knowledge and expertise to fully meet the needs of those residents with difficult and challenging behaviour as a result of their dementia. The home’s reliance on agency staff has significantly reduced since the last inspection. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Orchard House Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) Orchard House Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. 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. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 Information about the home and the services it offers is available to help residents make an informed choice about whether or not the home is suitable for them. However, more must be done to ensure that prospective residents receive this information prior to their admission EVIDENCE: The home has a Statement of Purpose and Service User Guide that contain all the information recommended by these standards. These documents are reviewed and updated regularly. A copy of the most recent CSCI inspection report is also available in the entrance hall of the home. However, residents and visitors reported that they received no written information about the home prior to their admission. The importance of ensuring that prospective residents have good quality information about the home’s services, so that they can make an informed decision about where they are to live was discussed with the manager. The inspector suggested that all prospective residents are given a Orchard House Version 1.10 Page 9 copy of these documents when they, or their families, initially look round the home. These documents should be developed into suitable formats for residents such as large print or audiotape. Visits by prospective residents are encouraged at Orchard House, although many residents told the inspector they were discharged to the home straight from hospital, without visiting first. The inspector suggested that the manager invites all residents to spend a full day at the home as part their assessment process, prior to their admission. This would ensure that residents’ needs could be fully assessed and also give residents a chance to experience life at the home. Orchard House Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7,9,11 Limited progress has been made on improving standards of care for those residents on the dementia care unit. These shortfalls have the potential to place both residents, and staff at risk. Care plans are poor and give little information about residents’ personal histories and life experiences. This information is crucial if staff are to understand and meet the needs of those residents with dementia. EVIDENCE: Orchard House Version 1.10 Page 11 The inspector spent the morning in the home’s dementia care unit observing care practices and talking to residents and staff. The quality of interactions between the staff and residents was generally very poor: residents’ repeated cries for help were ignored, staff conducted conversations in the presence of residents as if they were not there, and the inspector observed one member of staff standing in the lounge doorway for a considerable length of time, just watching residents, rather than actively and positively interacting with them. Staff knew very little about residents’ personal histories and their knowledge of person centred care was poor. None of the three staff interviewed by the inspector had read residents’ care plans: one member of staff reported that she hadn’t had the time, another that he was an agency staff member and therefore didn’t have access to the plans and the third did not have adequate literacy skills to understand the plans. Even if these staff had read the plans, there was little information in them to offer guidance: all that was written for one resident who had a history of being aggressive was ‘use deviating tactics’. No further guidance was given about what deviating tactics to use, and how to implement them. Consequently this had led to inconsistent behaviour management techniques being implemented by staff. The inspector also witnessed two members of staff using the ‘drag lift’ to help residents stand up from their chairs. This move has been banned for a number of years as it can cause serious damage to both staff and residents. The inspector checked the home’s medication storage and administration records. These were generally satisfactory, although some handwritten additions to the records had not been signed. Orchard House Version 1.10 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 Social activities are well managed and provide stimulation and interest for people living in the home. Residents are helped to maintain good links with family and the local community. EVIDENCE: The home employs two activities co-ordinators and there is a busy and wellpublicised activities schedule in place. On the day of inspection itself, residents were participating in a craftwork session. There are also frequent visits by external entertainers and seasonal occasions, such as Halloween and Easter, are celebrated in the home. The home is trying to develop links with local people and is currently advertising for volunteers to visit residents. There is involvement by local community groups: on the afternoon of the inspection the local MP was due to visit residents. Residents reported that their relatives and friends visit often and are made to feel welcome by staff. Orchard House Version 1.10 Page 13 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Complaints are taken seriously, and dealt with promptly and thoroughly. EVIDENCE: The home has a satisfactory complaints procedure in place that gives clear timescales for responding, and details of how to contact the Commission for Social Care Inspection. The Commission for Social Care Inspection has received a number of complaints over the past year alleging poor care practices at the home. The manager has taken these complaints seriously and conducted prompt and thorough investigations into them. Action taken in their light, has led to significant improvements in care practices at the home. Less serious complaints are also responded to appropriately: one relative told the inspector ‘any concerns I’ve had about my mother’s care have been remedied immediately by staff on the unit’. Orchard House Version 1.10 Page 14 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) 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. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) 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 Residents live in a clean and well-maintained environment with specialist equipment in place to promote their mobility and independence. However, the dementia care unit is too large, both in its size and number of residents, to adequately meet the needs of those living there. 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 avaialble that promote residents’ safety and independence. There have been improvements in the environment of the dementia care unit: corridors have been decorated in Orchard House Version 1.10 Page 15 different styles and colours and now feel less institutionalised, a family room has been created so that visitors can be entertained privately, and staff have worked hard to combat the overwhelming smell of stale urine that was present during the last inspection. The provider acknowledges that the layout of this unit is not ideal for people with dementia as long corridors make it more difficult for staff to supervise residents, and may reduce residents’ orientation. Staff are aware of the difficulties of managing up to 37 service users (some of whom have nursing needs) in this unit whose condition may vary from mild confusion to extremely aggressive. They have worked hard to develop strategies to ensure service users’ needs are met. Orchard House Version 1.10 Page 16 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Staffing levels at the home are adequate to meet residents’ needs and there has been a reduction in the use of agency staff since the last inspection. The home’s recruitment procedures need to be more rigorous to fully protect residents. EVIDENCE: Staffing levels within the home meet minimum requirements in accordance with guidance recommended by the Department of Health. On the day of inspection, 3 agency staff were working on the dementia care unit as many of the regular staff were attending a training course. One of these staff told the inspector that he had no formal training in looking after people with dementia. The home also employs a number of overseas staff: one relative told the inspector that sometimes communication with these staff was difficult, one resident told the inspector that she often struggles to understand them. Eight members of staff have left since the last inspection: this has been as a result of a management initiative to improve the overall quality of care at the home. Staff training in the home is improving and on the day of inspection itself 10 members of staff were attending training in dementia care facilitated by the Orchard House Version 1.10 Page 17 manager. The home is also making good progress in its NVQ level 2 training: 10 staff have completed the award and a further 8 are currently undertaking it. The home’s recruitment and selection procedures have improved since the last inspection but still need to be more rigorous in order to protect residents. One new member of staff told the inspector that she was still awaiting the result of her CRB check. Although the manager stated that this member of staff had been checked against the POVA register, evidence of this could not be found. Two written references are obtained before appointing a member of staff, however these are not always adequate. One reference seen by the inspector only stated the dates the person had worked for her previous employer and gave no information about the person’s suitability to work with vulnerable adults. Orchard House Version 1.10 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. 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 a well run home and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33 There are good procedures in place to consult residents about their personal care, interests and preferences. Staff receive regular supervision and feel supported by the manager. EVIDENCE: The manager holds a number of qualifications in care and has worked hard to bring about a number of changes in care practices. She is clearly committed to raising standards throughout the home. Staff have regular meetings with residents which allow them take place which allow them to air their views. Care staff receive formal supervision and appraisal. Orchard House Version 1.10 Page 19 No major health and safety hazards were observed during the inspection and the inspector was pleased to see that a number of fire safety concerns raised at the last inspection had been addressed. Orchard House Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 2 3 3 3 4 4 5 3 6 N/A HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 2 2 3 3 2 3 x 3 Score Standard No 7 8 9 10 11 Score 1 x 3 x 3 Standard No 27 28 29 30 3 2 2 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x x MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 3 33 x 34 x 35 x 36 3 37 x 38 x Orchard House Version 1.10 Page 21 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. Standard 7.2 Regulation 15 Requirement The registered person shall prepare a written plan as to how the residentss service users needs in respect of their health and welfare are to be met. These plans should include comprehensive information about the residents life history and personal experiences. The registered person shall not employ someone to work at the home until two written references have been . These references must give appropriate information about the persons suitability to work with vulnerable adults. Unnecessary risks to the health and welfare of residents are eliminated. The use of the drag lift by staff at the home must be stopped. Timescale for action 1 June 2005 2. 29 7,9,19 schedule 2 Immediate and ongoing 3. 38.2 13.4 immediate and ongoing 4. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Orchard House Version 1.10 Page 22 No. 1. Refer to Standard 1 Good Practice Recommendations The homes service user guide and statement of purpose should be developed into more suitable fomats for residents such as audiotape. These documents should be proved for prospective residents before they move into the home Prospective residents should be invited to spend a full day at the home so that their needs can be fully assessed and they can experience a taste of life at the home. Hand written additions to the medical adminsistration records should be signed and dated. A box of toys is provided in the family room to encourage younger visitors to the dementia care unit. Familiar objects should be placed on bedrooms doors on unit to help residents orientation. Any specialist terminology use in care plans must be clearly explained and understood by staff. This is outstanding from the previous inspection. 2. 3. 4. 5 9 19 6. 7 Orchard House Version 1.10 Page 23 Commission for Social Care Inspection 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 Version 1.10 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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