Inspection on 17/07/08 for Orchard House

This inspection was carried out on 17th July 2008.

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 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 12/03/09

Orchard House 30/05/06

Orchard House 23/01/06

Orchard House 29/09/05

Orchard House 26/10/04

Orchard House 17/05/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Orchard House 155 Barton Road Kettering Northants NN15 6RT Lead Inspector Ansuya Chudasama Unannounced Inspection 17th July 2008 10:30 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 DS0000012879.V369023.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 DS0000012879.V369023.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard House Address 155 Barton Road Kettering Northants NN15 6RT 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) 01536 514604 01536 485599 daryl.wilson@btopenworld.com rsonshomes@btopenworld.com R Sons (Homes) Limited Mrs Daryll Louise Wilson Care Home 33 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (33), of places Physical disability over 65 years of age (10) Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The total number of service users must not exceed 33 No one falling within the category of PD(E) may be admitted to the home when there are 10 persons of category PD(E) already accommodated in the home. No one falling within category DE(E) maybe admitted into the home when there are 18 persons of category DE(E) already accommodated in the home. 30th May 2006 Date of last inspection Brief Description of the Service: Orchard House is located in a quiet residential area in Barton Seagrave, on the outskirts of Kettering. It is an extended detached property offering accommodation, in 26 single bedrooms and 2 double bedrooms, on the ground and the first floor, which can be accessed via stairs or a lift. Orchard House offers 32 places for older people over the age of 65 who require personal care and support due to age. Its registration includes the capacity to care for older people with physical disabilities and some with Dementia conditions. The service user guide states that the Fees charged for staying at the home range from £330.00 to £450.00 a week. Items not included in the fees include hairdressing, newspapers, private health cost, dry cleaning and TV concessionary licence charge. Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This home has 0 star rating and this means that the people using the service receive a poor service. We inspected the home on the 17th of July 08. This was the first time the inspector had visited the home and the Managing Director gave us a tour of the home. We spoke to the staff and the families of the residents living in the home. We talked to some of the residents, and looked at information about policies and procedures, which tells the staff how to do things in the home. We looked at the training staff do to look after the residents. We looked at information about some of the residents to find out how their needs are being met by the home. This is called case tracking. We watched how the residents and staff in the home got along together. The home sent us a completed Annual Quality Assurance Assessment (AQAA) when we asked for it. The home had a Random inspection carried out on the 26th of February 2008 and the information from this visit is included in this report. The people living in the home are called ‘residents’ as this is what they are referred to in the home. The report will refer to people using the service as residents. What the service does well: These are some of the things that we saw and the people living in the home say: • • • • • • • • ‘Never been sorry since living here’ ‘Its always clean’ ‘Given information about the home’ ‘Food have a choice’, ‘its nice’, and ‘nothing to grumble about’’ ‘‘Visit any time’ ‘Staff are good’ ‘Everything is fine’ and ‘all the girls come here for a laugh’ and ‘very nice girls’ ‘Its my home’ the bedroom DS0000012879.V369023.R01.S.doc Version 5.2 Page 6 Orchard House • • ‘The food is excellent; ‘If I have any concerns I go to the manager’ The staff says they • ‘Like working at the home’ • ‘Look forward to coming to work’ • ‘Lovely team’ • ‘Get supervision and its good’ • ‘Manager is supportive’ • ‘Staff are very good to the residents’ • They go on training to help them understand the needs of the residents We saw the staff and the people in the home getting on well together The staff were talking to the residents in a nice manner and reassured them that they were doing well when being transferred from their chair. The relatives of the residents said that the staff were nice and approachable. It was said that if they had any concerns, they would speak to the relatives What has improved since the last inspection? What they could do better: The home should ensure that: • • • • • • • They have more staff to look after the needs of residents in the home. . Residents involved in their care plans and they are updated to reflect accurate care intervention required Provide structured activities to ensure that satisfactory stimulation and motivation is gained for all people living in the home Update the service user guide Take detailed assessments Have care plans for all the residents living in the home Ensure all care staff have access to residents care plans DS0000012879.V369023.R01.S.doc Version 5.2 Page 7 Orchard House • • • • • • • • • • • Provide regular supervision to care staff Provide training in how to manage challenging behaviours Ensure the hot water is not too hot in residents bedrooms Provide risk assessments for all residents Maintain residents dignity Make the lounge and dining area more homely Ensure that the garden is safe and accessible for all residents Improve the noise of the door bell Provide napkins and material aprons Ensure plastic gloves are locked away safely Ensure corridors are kept clear to minimise risk to residents 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 DS0000012879.V369023.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The homes care planning system does not provide staff with the information they need to meet the resident’s needs. EVIDENCE: Most of the families of the residents living in the home had visited the home prior to making a decision to live there. A copy of the service user guide was looked at in detail. However the information on ‘external inspections’, ‘about our facilities’, ‘staff members’, and complaints needed reviewing because the information had changed since the guide was last reviewed in April 05. Information on resident’s views about the service needs to be included in the Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 10 guide. We did not see a copy of the contract in the files of the residents files looked at. But family’s informed us that they had signed a copy of the contract. One resident’s file inspected showed that the manager had completed a basic assessment for this person but not all the sections were completed. The assessment did not include all the information stated in standard 3. A basic care plan from the funding authority was received on the day the resident was admitted to the home. Those residents who had families were asked by the home to do a personal profile about the person, and this was good as it gave more information about the person. However not all families had completed these profiles. The home had not generated a care plan as stated in standard 7. Information read in the residents file stated that the person had challenging behaviours. It was also said that the person was aggressive and had hit out at staff. This behaviour was observed during the inspection when the person was observed shouting at other residents, and one person was attacked. This person and some of the other residents were observed to be frightened. A care plan review dated 3/6/08 talked about a community psychiatric nurse monitoring the person’s behaviours and stated that staff should ensure a daily routine for the person. However the home did not have their own care plan document telling staff how to care for the resident. We spoke to the care staff about care plans and it was stated that they did not write, read or had seen residents care plans. It was stated that the team leaders on each shift discussed the information about the residents to them. The staff also said that they asked the shift leader about information about residents to make sure what they were doing was right. The staff spoken to had not done any training on how to manage challenging behaviours and they were not sure if any guidelines were written down to explain how to manage this person’s behaviour. Information read in the file also stated that the person was unsteady on their feet and used a walking stick. However the person was not observed using a walking stick on the day of the inspection. In the review it stated that the person used their walking stick to hit other people. There was no information in the file to say why the resident was not using their walking stick. Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Systems were not in place to ensure residents are protected by the homes policies and procedures for dealing with medicines. EVIDENCE: One person’s file inspected showed that the person did not have a care plan setting out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and the social care needs of the resident needs to be met. There was no information recorded to state how the staff were to manage the personal care needs, and aggressive behaviours displayed by the person. This was observed on the day of the inspection. Daily notes read showed that there were incidents of the resident being aggressive to staff and residents (see choice of home). Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 12 The care plan review read for the person stated in the action plan that the person needed to be engaged in activities to prevent the person from going to bed and sleeping at the wrong time. We did not observe any staff undertaking any activities with this person. There were no risk assessments seen for this person in their file. The needs of the resident were not being reviewed on a monthly basis to reflect the changing needs of the person. There was no evidence to show that the residents or their representative were being involved in drawing up their care plan. Another care plan seen had information from the funding authority but some sections were not completed and this was very basic. Information read on falls stated that the person needed to perform mobility exercises. However this was not observed on the day of the inspection and no information read in the file stated that this was happening. Risk assessments were seen for falls, hot water, bathing, and walking to the garage. These risk assessments needed to be more clear and needed to include the information on the five steps to risk assessments. One relative spoken to stated that the staff were nice. They visited the home regularly and the staff called the GP for their relative when needed. A health professional was spoken to and it was stated that they did a lot of work with the care staff last year to ensure they used the equipment properly. It was said that the staff were always pleasant when they visited the home. We were informed that the residents sometimes wore other people’s clothes and they sometimes had their clothes go missing. The home had two medication trolleys, one was kept in the dinning room and this was fixed to the wall. The other trolley was kept in the medication cupboard and this was not attached to the wall. The medication cupboard was very small and to access the room, the trolley had to come out. The door of the cupboard opened out ward into the corridor. A risk assessment needs to be undertaken for this activity to ensure no one hurts themselves on this door. It was said that shift leaders gave out medication. The medication records seen showed that staff used the abbreviation ‘x’ and ‘o’ in recording for medication but did not state what this meant. There were gaps in the medication that was not signed for and we were not sure if the person had been given medication or not. The medication records received did not always state how many tablets were received and the person receiving them was not signing these forms. One resident rang out of their tablets for two days. The CSCI were not informed of this incident and there was no information recorded to state what action the home took to monitor that this would not happen again. Social Services were not informed of this incident under safeguarding of vulnerable adults procedures. One person had 11 bottles of the same medicine. There were also other medication where the residents had more medication than was Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 13 needed. A bottle of medication was counted and it stated that the bottle should have had 56 tablets but there were 95 tablets counted. Temperatures of medication kept in the cupboard were not being maintained. The home had controlled drugs and these were dated from May 2007. The home needs to check to ensure that the controlled drug cupboard complies with the misuse of drugs regulations 1973. We were informed that the residents some times did not get their morning medication after 11-15 am. It was said that this was not long before they were ready to get the lunchtime medication. We were informed by the home under regulation 37 of the Care Homes Act in June 08 of an incident of a resident being given the wrong medication. One bedroom had the door wide open and this room was visited, the room had had plastic gloves, and incontinent pads on top of the cupboard. This did not preserve the resident’s privacy and dignity. People walking pass could see into the room. The inspector was informed that the door of the bedroom was kept open because the staff could keep an eye on the residents. The washbasin water was tested in this room and it was very hot. The staff spoken to stated that they closed the door when they undertook personal care with the residents. The fluid and turning chart were seen. The chart needs to state the amount of fluids taken and how often this needs to be done. Information needs to be recorded regarding the amount of food eaten than saying ‘dinner’. Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 14 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 adequate This judgement has been made using available evidence including a visit to this service. Residents are not offered sufficient opportunities for activities to meet their needs. EVIDENCE: We sat with the residents in the main lounge. When the front door bell rang, the sound of the doorbell also rang in the lounge and the noise was very unpleasant and did not feel relaxing and homely. It was stated that the residents living in the home got used to the noise after they had been at the home for a while. The layout of the main lounge was not very homely and some people spoken to on the day of the inspection commented on this. We observed plastic gloves on handrails, radiators, and there was a hoist kept at the end of one corridor with a trolley with incontinent pads, and towels. Again this was not very dignified for the residents living on this floor. We also saw a broken door Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 15 near the trolley. The service user guide stated that the home provided a comfortably furnished ‘quiet area’ at the end of the east Wing. This area was observed and needed decorating. It was not safe for residents to use the area safely due to having a hoist, a broken door and a trolley in the corridor. A risk assessment needs to be carried out for this area. The lounge had a TV in one corner and only a few residents could sit round this area. We were told that a few residents watched what they wanted to and controlled the TV. A few residents sat on the opposite side where there was another TV but we were told that this TV was not used. The people who sat on these sides had the view of the garden and natural light from outside. The other side of the lounge was not as pleasant as sitting near the windows; this side had less natural light and wheelchairs and zimmer frames were stores at one corner of this area. The people on this side of the lounge could not see the TV. The home did not have another lounge area where the residents could listen to music. We observed when families visited; there was not enough room for them all to sit together. The seating area had to be rearranged so they could all sit together. The home had a conservatory and we were told that this had been completed around 7 months ago. It was said that this was being used for meetings and by staff. One family spoken to stated that they used the room for celebrating their relative’s birthday and it was said that this was lovely. The residents were not observed using this room. We were told that this room was going to be used as a music and activities room for resident’s but it was not said when this was going to happen. The conservatory was very hot in side and the reasons for this was that the door and windows were closed. We were told that the home was going to get some blinds to offer protection from the sun. Some residents did not have any contact with staff unless they were being taken to the lounge or given a drink. This was because the staff were very busy. It was good to see families of some residents speak to residents in the lounge. CD’s made by families for the home to play for their relatives to help maintain their memory was not being played by staff as they were very busy. The staff spoken to said that they visited residents with the menu and they choose the meal for lunch. It was said that the staff helped the resident’s with dementia by looking at a booklet, which informed them of the food the residents like. The residents spoken to stated that they enjoyed the food. This was also observed on the day of the inspection and we were told that they all enjoyed the food. A family member had also in the past had lunch with their relative and it was stated that ‘it was very nice’ and they ‘have choices with food’. It was said that the staff were very helpful and the relative seems quite happy. We also observed staff being kind to the people in the dining room, however staff need to offer drinks to residents more than once and this is especially when the drink jugs are not laid on the table. Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 16 The dinning room was cluttered with two paper shredders and two TV’s, and there were books on the carpet. A computer and a chair were at one corned and there were toys and games on the floor. The room also had a photocopier, a picture on the floor, and a medication trolley at another corner of the room. The wallpaper also needed painting or replacing as signs of wear and tear were showing. We observed that there were no napkins on the table, and not all table had salt and pepper on the table. Plastic blue aprons were being used as bibs. These could be replaced with material ones, as these preserve’s the person’s dignity. The inspector observed a member of staff standing in the middle of two beds, feeding two residents in a bedroom at the same time. This is not good practice and does not maintain the residents dignity. We were told that the home does have church services multi denominational services for individuals this occurs every 2 to 4 weekly, depending on when the church can attend. One resident had Holly Communion every Sunday. It was also said that the home some times had people come from the outside and played the piano. On the day of the inspection the weather was sunny and lovely. We did not observe any residents sitting in the garden. We did observe staff sitting outside in the garden. The doors leading to the garden were locked. We were told that the reason for this was that the home did not have enough staff and they would therefore be unable to keep an eye on the residents when out doors. We also observed that the furniture in the garden was not suitable for the needs of the residents living in the home. The chairs were unsteady and not safe and the ground was not even. We were told that if residents sit down all day in the room, they become stagnant and this was not good for them. It was said that in the past the home used to do gardening with some residents but this stopped. The service user guide stated that the home had an activities organiser and the resident’s preference for activities would be discussed when drawing up their care plan. Evidence showed that the home did not have an activities person and resident’s files seen had not had this information recorded. We were told that the residents needed activities for stimulation. Evidence showed that at present this was not happening. Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 17 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 adequate This judgement has been made using available evidence including a visit to this service. Incorrect information in the complaints procedure in the service user guide means that the residents and their families do not have the correct information about how to make a complaint. EVIDENCE: The home had a complaints policy. Some of the residents spoken to were mentally alert and knew how to complain to the staff and the manager if they were unhappy. The relatives spoken to state that if they had any concerns, they would speak to the staff or the manager. Information about making complaints was recorded in the service user guide. However the information needed to be recorded in full so the residents know the procedures the home will follow with time scales. The correct address of the CSCI also needs to be recorded. The telephone and address of Northamptonshire County Council Social Services department needs to be recorded in the complaints procedure. Staff said that they had completed the in house training in understanding safeguarding of vulnerable adults procedures. No safe guarding referrals had been made to the CSCI or the Social Services safe guarding team. Incidents Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 18 about residents being aggressive to other residents need to be reported to Social services Safe guarding team and CSCI. The incident about a resident not receiving their medication for two days due to running out of medication should have been reported to both CSCI and to social services. Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 19 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 adequate This judgement has been made using available evidence including a visit to this service. The home’s premises were adequately decorated to provide comfort and safety for resident but it detracted from a homely environment for people to live in EVIDENCE: We were given a tour of the home by the Managing Director of the home. It was discussed that some areas of the home had been painted in the home. New hall carpet had been replaced, some bedrooms had new carpet and some rooms were decorated. It was said that the central wing was going to have new wallpaper. One bedroom was converted to a shower room and the front Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 20 bay windows were renovated. Information read in the AQAA stated that the home had built a conservatory and ‘made it a relaxing room leading into a paved garden area’. The residents were asked to choose mural and colour schemes. However the residents were not using this room at the time of the inspection. At present the room was used for meetings, and special occasions. The proprietor told us that this room would be used for listening to music and other activities to meet the needs of the people with dementia. (see section on social activities). We discussed the garden not being safe, attractive, and accessible to the people living in the home. The proprietor informed us that they had put in a bid for funding to do the garden up to meet the needs of the residents. It was explained that part of the garden would be ring fenced and the grounds made even with activities that the residents would be able to access safely. The home was waiting to hear if they had been awarded this funding. The home’s main lounge had wheelchairs and zimmer frames stored at one side of the lounge. These need to be stored in a more suitable place. A risk assessment also needs to be undertaken for this. Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 21 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 adequate This judgement has been made using available evidence including a visit to this service. The staffing numbers on duty is not meeting the needs of the residents living in the home. EVIDENCE: The staff, families of residents and the residents spoken to stated that the home was short staffed. This was also observed on the day of the inspection. We were told that around 7 residents needed the assistance of two staff. A senior support worker informed us that they were on call in the home to give advice to staff but they were not on duty. The home needs to ensure that all staff working in the home have their hours documented on the staff working rota. The staff rota seen was difficult to understand because letters were abbreviated. We were therefore unable to know what time the staff started and finished work. The staff working rota must have the times the staff are working at the home and what the abbreviations stand for. Staff spoken to stated that they had one day induction and they had shadowed a member of staff for a few days. Evidence showed that the home undertook Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 22 the relevant information when recruiting staff, and this was confirmed by talking to staff. However evidence showed that when staff had a protection of vulnerable adults (POVA) first check, they did not always shadow a member of staff when working in the home. The staff training records provided after the inspection showed that most of the staff had done mandatory training, however there were some staff who had not completed training in dementia care, adult abuse, dealing with death, infection control, food hygiene, learn direct induction, epilepsy awareness, working with aggression, palliative care, continence care. The training matrix showed that not many care staff had achieved NVQ Level 2/3 training. We were told after the inspection that two people had completed NVQ level 4 and one of this person’s was the manager. It was said that two people were on the NVQ level 4 programmes and one person was waiting for funding. Two people had completed NVQ level 3 and 4 people were on NVQ level 3 and 5 people had completed NVQ level 2. 6 People were doing NVQ level 2 and 4 people were doing NVQ support services and one person had completed this. The staff spoken to on duty stated that the training provided was good at the home. Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 23 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): 31,33,36,37,38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The health and safety of the residents are not protected but management had good understanding of the areas that needs to improve to run the home in the best interests of the people living in the home. EVIDENCE: We were informed that the manager was off sick and a senior member of staff was on call to give advice to staff. The managing director of the home assisted with the inspection. We were informed at a later date that the home was Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 24 being managed by the deputy manager in the absence of the manager who was still off sick. We had a long discussion with the managing Director regarding some of the concerns observed at the inspection. We were told that the home wanted to improve the concerns discussed. It was also stated that the concerns raised would be completed before the next inspection. Staff spoken to stated that the manager was supportive but we were also told that the manager does not keep staff information confidential. We observed plastic gloves on handrails, radiators, and there was a hoist kept at the end of one corridor with a trolley with incontinent pads, and towels. Again this was not very dignified for the residents living on this floor. We also saw a broken door near the trolley. The service user guide stated that the home provided a comfortably furnished ‘quiet area’ at the end of the east Wing. This area was observed and needed decorating. It was not safe for residents to use the area safely due to having a hoist, a broken door and a trolley in the corridor. A risk assessment needs to be carried out for this area. We had asked for the analysis of the information received from the resident’s surveys to be sent to CSCI. This information was not available on the day of the inspection. The home send us resident’s questionnaires dated September 2006 and some did not have any date recorded on the form. The information and rating system was difficult to understand. An analysis of this survey was not provided. We were informed that the home had recently sent out questionnaires to residents but the information had not all been received. The home needs to ensure that a quality assurance system is undertaken that is easy to understand and where residents are not able to give information due to their disability, then their representative should be consulted when completing the questionnaire form. The analysis needs to be included in the service user guide in a format that is easy for the residents to understand, and it needs to state how many people had completed the questionnaires. The home were not reporting all regulation 37 notifications and making referrals to Social Services safe guarding team. The staff were not getting regular supervision to monitor their practice. The staffing hours showed that the needs of the people are not being met. The accidents and incidents that occurred at the home were not always being reported to the relevant agencies under regulation 37 of the Care Standards Act and under safe guarding procedures. (see section on concerns and complaints). As detailed in the staffing section, some staff in the home had not received training in food hygiene, fire awareness and infection control Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 25 The risk assessments needed reviewing and undertaking to ensure that the residents and staff were safeguarded from potential risks Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 26 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 2 3 1 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 1 X 1 Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 27 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 OP38 Regulation 13 Requirement To ensure the health and safety of resident’s hot water temperatures must be monitored and maintained and be set close to 43.c to minimise risk of scalding to residents. This timescale of 29/02/08 was not met. 2 OP3 14 Assessments of peoples needs must be completed in full and linked to the care plans to make sure that their needs are met in full. Management must demonstrate the home’s capacity to meet the assessed needs (including specialist needs) of all individuals admitted to the home. A care plan containing sufficient information that is clear must be in place for each assessed need and kept up to date when changes occur, to ensure people receive the care and support that they require. To review all risk assessments DS0000012879.V369023.R01.S.doc Timescale for action 29/09/08 29/11/08 3 OP3 12,16,23 29/10/08 4 OP7 15 30/10/08 5 OP7 13 28/11/08 Page 28 Orchard House Version 5.2 around the following: wandering, supervisions, risk of falls including epilepsy, and making hot drinks. To be undertaken for all residents. This would ensure residents are safe and well cared for. This time scale of 11/3/08 was not met. 6 7 OP7 13 13 Risk assessments must be undertaken for all residents admitted to the home Medication administration and records for individuals must be complete, accurate and up to date to ensure that medication is given safely and correctly to meet individual health needs This time scale of 28/02/08 was not met 8 OP10 12(4)(a), People must always receive the support needed to maintain an acceptable level of care to ensure they can live their lives in a dignified manner. People living in the home must be provided with stimulation and social and emotional support to enable them to receive sufficient support to maintain a satisfactory level of social and emotional wellbeing. Incidences of safeguarding must be reported in accordance with local policy to safeguard the people living at the home. The premises must meet the needs of the people in relation to their age and physical limitations There must be sufficient staff on duty to be able to meet the needs of the people living at the home at all times. The staff working rota must have DS0000012879.V369023.R01.S.doc 30/11/08 28/10/08 OP9 29/10/08 9 YA12 12(1)(a), 12(4)(b) 16(2)(m) &(n) 30/11/08 10 YA17 12(1), 13(6) 23 18,19 29/09/08 11 12 YA19 YA27 30/12/08 30/10/08 13 YA27 17 30/11/08 Page 29 Orchard House Version 5.2 14 YA28 7, 9, 19 Schedule 2 24(1), (2) &(3) 15 YA33 16 YA38 13,37 17 OP38 13 the names of all the staff working on the day. The working hours also needs to be recorded as stated in the report to ensure accurate records are kept and the needs of the people living at the home are met An experienced staff must supervise staff with a POVA First Check until they receive their CRB clearance. This is to protect the people living at the home. Provide a clear quality assurance system that is easy to understand on an annual basis and ensure the analysis from this process is displayed so the residents and their families can view it to find out how the home is meeting the needs of the people living in the home. Accidents and Incidences must be reported in accordance with the homes policy, to the relevant agencies and under regulation 37 to CSCI To ensure the health and safety of resident’s hot water temperatures must be monitored and maintained and be set close to 43.c to minimise risk of scalding to residents. This timescale of 29/02/08 was not met. 29/09/08 30/11/08 30/10/08 29/09/08 18 YA38 13 Ensure that plastic gloves are locked away safely to ensure that the people living in the home are kept safe 29/09/08 Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 30 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 OP19 Good Practice Recommendations A programme of maintenance to include upkeep of designated bathroom doors, and fire doors. This would ensure residents live in a safe well maintained home. Orchard House DS0000012879.V369023.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 DS0000012879.V369023.R01.S.doc Version 5.2 Page 32 - 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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