Inspection on 16/01/07 for Orchard House

This inspection was carried out on 16th January 2007.

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 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 06/11/09

Orchard House 17/09/09

Orchard House 09/06/08

Orchard House 05/02/06

Orchard House 22/06/05

Orchard House 06/10/04

Orchard House 01/06/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Orchard House Kinnersley Severn Stoke Worcestershire WR8 9JR Lead Inspector Yvonne South Unannounced Inspection 16th January 2007 9:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard House Address Kinnersley Severn Stoke Worcestershire WR8 9JR 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) 01905 371445 www.orchardhouse.co.uk Mr Anthony Gordon Williams Mrs Susan Harris Mrs Lavinia Rachel Williams Care Home 39 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (39), of places Physical disability over 65 years of age (39) Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th February 2006 Brief Description of the Service: Orchard House is registered to provide residential care for up to 39 residents who may have a physical disability and/or mental health needs associated with old age. The maximum number of people who can be accommodated with mental needs is 30. The home is an adapted country house with a purpose built extension situated in a rural setting about six miles from Worcester city. There is a local pub but no other amenities within walking distance. However there is a regular local bus service. Accommodation is on two floors and access is by a passenger lift and a stair lift. Handrails are also fitted to assist mobility. On the first floor there are 16 single bedrooms 8 of which are ensuite and 6 shared rooms, 2 of which are ensuite. On the ground floor there are 4 single bedrooms, all ensuite and 2 shared rooms. In addition there are 3 assisted bathrooms and seven separate toilets throughout the home, two communal lounge areas and a separate dining area. There is an accessible and well-maintained garden for the residents to sit in. The registered providers are Mrs Susan Harris and Mr Anthony Gordon Williams. Mrs Lavinia Rachel Williams is the registered manager. Information provided to the Commission for Social Care Inspection (CSCI) on 14.11.06 by the registered manager quotes the monthly fees as £1900. Extra charges are made for Hairdressing £4.50 - £23, private chiropody £6 and newspapers, sweets and toiletries at market prices. Fax; 01905 371 017 Email; topcare37@aol.com Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection incorporates information received by the Commission for Social Care Inspection since 05.02.06 and the information obtained during fieldwork on 16.01.07. The fieldwork took place over 8 hours during which the inspector spoke to three residents, three relatives, four staff and the home manager. Documents were assessed and a partial tour of the premises was also undertaken. Prior to the fieldwork the home was asked by the Commission for Social Care Inspection (CSCI) to complete and return a pre-inspection questionnaire and to distribute questionnaires to the residents, relatives and health care professionals seeking their opinions of the service. To date 5 responses have been received from residents, 4 from relatives and 2 from health care professionals. The focus of this inspection was on the key National Minimum Standards and the requirements and recommendation that arose out of the previous inspection. What the service does well: What has improved since the last inspection? Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 6 Following the last inspection the home was asked to make improvements in some areas. Health and safety has been improved as all risk assessments are now signed by a senior member of staff, self-closing fire doors have been repaired and now shut sufficiently for the latch to engage and the lock on the fire exit door in the laundry has been changed so that a key is not necessary. A quality assurance program has been devised so that the quality of the service can be monitored and continuously developed for the good of the residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 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 DS0000018668.V326883.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (An intermediate service is not offered by this home and therefore standard 6 is not relevant) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is provided so that people are helped to make a decision regarding the home. Assessments are undertaken to ensure the home is able to provide the care a person needs before they are offered a place in the home. EVIDENCE: The responses in questionnaires and the people who spoke to the inspector confirmed that they had received the information they needed to help make a decision regarding the home. Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 9 Three care records were assessed. Someone from the home had visited prior to admission to ascertain what care was needed and to assess if the home could meet the person’s needs. The pre-admission assessment was well documented and included gender issues. Copies of the Terms and Conditions of Residence and contracts were included. Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are pleased with the personal and health care that they receive and it meets their needs. EVIDENCE: The documents that were assessed contained detailed individual care plans that had been reviewed each month. Risk assessment had also been drawn up, supported by care plans where necessary and reviewed appropriately. There was little documentary evidence that residents, or with their consent their relatives, had been involved in drawing up the care plans. However relatives confirmed that they were kept well informed and it was observed that communication between the home and the relatives was very good. It was suggested that all discussions and communications concerning care issues should be recorded in the daily records. Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 11 Health care visits by doctors, district nurses, opticians and dentists were recorded and relatives confirmed that they had been informed. Relatives and health care professionals commended the standards of care. Comments made in questionnaire responses by relatives included; I cannot praise the home enough. It is such a comfort to know my relative is being so well cared for. I find all the staff kind & caring and always with a smile. I cannot thank them enough. Medication storage was assessed and found to be well maintained however storage facilities for controlled drugs did not comply with the Misuse of Drugs (Safe Custody) Regulations 1973 and other medication that was no longer needed was not securely stored. There was a discrepancy when the stock of two antibiotics was audited. It would appear that the administration procedure had not been correctly followed. The manager undertook to investigate the matter. It was seen that the Medication Administration Sheets were being maintained and staff records demonstrated that they were receiving appropriate training. An assessment of the daily records maintained by care staff discovered them to be weak and uninformative. The purpose of these documents is to record what has happened to each individual during the day so that other staff are well informed and a record is maintained of all events and concerns. This is especially important when residents have difficulties with communication and memory. The records did not reflect the care service that the staff provided. It was observed that residents were treated courteously and kindly. Their records were stored securely. The manager said that mail was delivered unopened and assistance given if required. One resident had a private phone in her bedroom and there were facilities to enable other residents to make and receive calls in private if they wished. The locks on bedroom doors had been disabled as it was considered that the residents would be unable to use them safely. Double bedrooms were fitted with privacy curtains. There was limited information available regarding residents’ care wishes when their life came to an end. It is acknowledged that this is a sensitive subject. However the staff cannot meet resident’s wishes if they are not known. Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have opportunities to join in group and individual activities in the home and community. Links are maintained with families, friends and faiths. Residents are able to enjoy a choice of good meals and they are treated respectfully. EVIDENCE: The residents’ questionnaire responses indicated that that there were activities arranged in which they could take part. Comments made included; I think they could do more. I prefer not to join in. There are often activities but I don’t always want to join in. Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 13 Entertainment and activities were in progress during the day of the inspector’s unannounced visit. Residents were heard and seen to enjoy themselves. All residents except one were English and were either Roman Catholic, belonged to the Church of England or of no identified faith. There were no language difficulties. The pre–inspection questionnaire, completed by the manager, indicated that religious services were held in the home and visits to churches were arranged for those who wished to attend. A resident told the inspector that she enjoyed the music and the service. The questionnaire also indicated that a wide range of in house and community activities and events were arranged however there were no records maintained of residents’ individual participation or rejection. Residents are encouraged to make choices in their daily life. One person told the inspector that he liked to be his own ’gaffer’ and do things his way. Visitors were observed to come throughout the day. Residents were able to sit with them in their rooms, the lounges or the dining room. Refreshments were offered and they were made welcome. The sample of menus indicated that residents were offered a choice of good nutritional meals and the residents confirmed personally and in the questionnaires that they enjoyed their food. Residents said; The food is good. Alright. Especially as you don’t have to get it yourself. Very good. A relative stated in the questionnaire; My mother is well fed and very well cared for. A menu choice was displayed in the dining room and it was confirmed that selections were made each morning. The Cook confirmed that he had full information regarding the residents’ dietary needs and likes and dislikes. Staff were observed assisting residents with their food and drinks where necessary. Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have the information they need so that they can raise their concerns. Staff are trained and aware how to respond when in receipt of complaints or concerns so that issues are raised and addressed in the best interests of the residents. EVIDENCE: A copy of the complaint procedure was displayed on the notice board and contained in the Statement of Purpose and Service Users’ Guide. These were available to all residents and their relatives. Neither the CSCI nor the home had received any concerns, complaints or allegations of abuse since the last inspection. The questionnaires that were completed and returned indicated that people knew how to raise their concerns. Residents said they knew how to make a complaint and who to speak to. The staff listened and acted on what they said. Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 15 The staff, their records and the pre inspection questionnaires indicate that an acceptable recruitment process was used and staff were appropriately checked before they were appointed. The staff and manager confirmed that training in the Protection of Vulnerable Adults was undertaken by all staff and updated annually. The staff who spoke to the inspector confirmed that they knew the action they should take if they received a complaint or had cause for concerns. Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are able to live in a clean, well-maintained house that suits their needs and requirements. Systems are in place to manage the risks of cross infection and therefore protect the people in the home. EVIDENCE: A partial tour of the building was undertaken and it was found to be clean and tidy. It appeared well maintained, furnished and decorated. Residents stated in the questionnaires that the home was always clean and fresh. Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 17 Residents’ bedrooms had been personalised according to their wishes with familiar photographs, pictures and items. Communal bathrooms and toilets were fitted with special aids to assist those with mobility difficulties. It was observed that the rooms were equipped with bars of soap and fabric towels. This is contrary to the usual practice of liquid soap and disposable towels. The manager explained that as a large number of the residents had dementia illnesses a risk assessment had identified a greater risk to the house and residents if the latter were used. In one bathroom a cupboard contained personal toiletries and a prescribed cream. Personal toiletries and creams should always be returned to their owner’s room and stored securely. The manager acknowledged this and that the cupboard should have been locked. The issue was addressed immediately. The kitchen and laundry were clean and tidy and well organised. Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient suitably recruited and trained staff are available to provide the care the residents need. EVIDENCE: The manager said that the staff team was composed of English, Chinese, and Filipino people; both male and female. Oral and written communication skills were acceptable. People recruited through an agency and those recruited in England had all been processed through an acceptable recruitment procedure. Checks had been undertaken and references had been taken up. Those who spoke to the inspector and their records confirmed this. The sample of duty rotas seen indicated that sufficient staff were available to meet the needs of the residents. This was confirmed by the people who spoke to the inspector and by the questionnaires that were completed and returned. The deputy manager confirmed that he had successfully undertaken the Registered Manager’s Award and 7 care staff had National Vocational Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 19 Qualifications to level 2 or above. This is 50 of the staff team as recommended in the National Minimum Standards. The staff and their records confirmed that they were well trained and the manager confirmed that everyone received an update in all core training (health and safety), every year, which was certificated. The staff spoke confidently and competently of their roles and responsibilities. The questionnaire responses gave positive views regarding the staff. One relative commented; Orchard House are friendly, kind, and treat the residents with dignity, kindness and cheerfulness. Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed with attention to the health and safety of everyone. EVIDENCE: The manager of the home was well qualified and experienced in her role. The atmosphere was both positive and supportive. Relatives, residents and staff related well to each other and the atmosphere was lively and friendly. Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 21 The manager demonstrated that the home had developed their own quality assurance system and it was about to be piloted. This successfully met the requirement made in the previous report. Questionnaires had been distributed by the home to residents, relatives and stakeholders seeking their views of the service. The responses provided information that would be used in the annual audit and development plan for the home. The manager confirmed that the home held no personal monies for residents. If they required any personal items these were purchased for them and they or their representative were then invoiced for the cost. The manager stated that all staff received regular supervision (1:1) support six times a year. The staff confirmed this and considered it to be valuable. Records had been maintained. The pre inspection questionnaire indicated that systems and equipment in the home were being appropriately serviced and maintained. Health and safety monitoring was continuously addressed. The Fire Log contained a Fire Risk Assessment for the home that was due to be updated. The manager said that a professional firm was to be employed to undertake this work. Fire safety checks of the systems and equipment were regularly carried out and serviced and all staff participated in fire safety training every three months. A requirement was made in the previous report that the temperature of water from bath hot water taps must be checked at least once a week to ensure that it did not exceed 43C. A record had now been maintained of these checks but no action appeared to have been taken when the temperature exceeded the guidance. Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 Requirement Arrangements for the recording, handling, safe keeping, safe administration and disposal of medication must be complied with. All parts of the home to which residents have access must be as far as is reasonable free from avoidable risks. Timescale for action 22/01/07 2 OP38 13 (4) 30/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP37 Good Practice Recommendations Daily records should be maintained for each resident that contain a detailed account of activities and events that impact on their well being. Storage of unwanted medication should be secure and storage of controlled drugs should comply with the Misuse of Drugs (Safe Custody) Act 1973. DS0000018668.V326883.R01.S.doc Version 5.2 Page 24 2 OP9 Orchard House 3 OP11 The wishes of residents, or with their consent their representative, should be obtained regarding their end of life care and death. The record of activities in which residents have participated should include activities that have been offered but declined. Hot water to baths and showers should be maintained at no higher than 43C. 4 OP7 5 OP38 Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Orchard House DS0000018668.V326883.R01.S.doc Version 5.2 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!