Inspection on 18/07/07 for Orchard House

This inspection was carried out on 18th July 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Orchard House 22/07/08

Orchard House 11/05/06

Orchard House 20/10/05

Orchard House 12/04/05

Orchard House 04/11/04

Orchard House 19/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Orchard House 107 Money Bank Wisbech Cambridgeshire PE13 2JF Lead Inspector Janie Buchanan Key Unannounced Inspection 18th July 2007 08:30 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 DS0000024295.V339556.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 DS0000024295.V339556.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard House Address 107 Money Bank Wisbech Cambridgeshire PE13 2JF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01945 466784 01945 588856 Ranc Care Homes Limited Ms Sharon Almey Care Home 67 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (37), Mental disorder, excluding learning of places disability or dementia (5), Old age, not falling within any other category (30), Physical disability (10) Orchard House DS0000024295.V339556.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age range of residents with mental disorder (MD) and dementia (DE) and physical disability (PD) is 58 years to 64 years only 11th May 2006 Date of last inspection Brief Description of the Service: Orchard House is owned by Ranc Care Homes Limited. The company also owns three homes in Kent and two 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. The weekly charge varies from £330 to £707, depending upon a resident’s needs. A copy of the most recent inspection report is available in the entranceway to the home. Orchard House DS0000024295.V339556.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place on the 18 July 2007 and was unannounced. The inspector spoke with four residents, one visiting relative, the manager and three members of staff. A tour of the home was undertaken, and a range of documents was viewed. Information was also provided from the home’s annual quality assurance assessment. Eight completed comment cards from residents and their relatives, requesting feedback about the service, were also received. These respondents were generally satisfied with the quality of the service they received at the home but four people raised concerns about the lack of staff available and residents having to wait for a long time for help to go to the toilet. What the service does well: What has improved since the last inspection? Opening restrictors have been placed on all upstairs windows to ensure the safety of residents. 45 specialist beds have been purchased which will make it easier to care for those residents who are nursed in bed. A new comprehensive medication auditing system has been introduced at the home that will ensure that residents’ medication administration is regularly checked and monitored. Fiddle boards have been placed along long corridors in the dementia care unit to provide stimulation and interest for residents who spend a lot of time walking up and down these corridors. Questionnaires about the home are now sent to a range of health care professionals who regularly visit. This will ensure that objective feedback about the quality of the service can be collected and used to improve it. Orchard House DS0000024295.V339556.R01.S.doc Version 5.2 Page 6 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 DS0000024295.V339556.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 DS0000024295.V339556.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): 1, 3, 5 Quality in this outcome area is good. Information about the home is available to help prospective residents choose if it is where they want to live and residents are assessed to ensure their needs can be met at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a Statement of Purpose and Resident Guide that give comprehensive information about the home and the services it offers. All residents are assessed fully by one of the management team before moving in, and pre-admission information for two recently admitted residents was viewed by the inspector. The manager has begun to encourage prospective residents to visit the home and stay for a meal so they have the opportunity to experience life at the home and what it offers. This is good practice. Orchard House DS0000024295.V339556.R01.S.doc Version 5.2 Page 9 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 adequate. Residents are not involved in the planning of care that affects their quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents care plans were viewed and the information they contained was generally detailed, up to date and reviewed regularly. Residents’ needs in relation to, amongst other things, their communication, moving and handling, nutrition and pressure prevention care were clearly recorded. However, there was very little evidence that residents actively participate in the drawing up and reviewing their plans of care. None of the residents spoken to were aware of their plans and none of the plans viewed had been signed by the resident to indicate that they agreed with its contents. Residents’ health needs are monitored and each month their temperature, blood pressure, pulse and respiration are taken. Food, fluid and turning charts are implemented for residents when needed. However it was noted on one turn chart that the resident had not been turned between 6:10 am and 2.45 pm, despite his care plan stating he should be turned every two hours. Although staff were recording the amount of fluid he took, they were not adding up the Orchard House DS0000024295.V339556.R01.S.doc Version 5.2 Page 10 total he was receiving each day and therefore could not have a clear idea of his intake. A new medication auditing system has been recently introduced which closely monitors how medicines are ordered, administered, recorded, stored and disposed of. This audit is comprehensive and will ensure residents receive their medications safely and correctly. All residents who completed the questionnaire stated that they received the care and support they needed, in a way that they liked from staff. Interactions that were observed between staff and residents during the inspection were respectful, supportive and appropriate. Orchard House DS0000024295.V339556.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. Social activities are well managed and provide stimulation and interest for people living in the home This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs specific staff to provide activities for residents. As a result there is a busy and well-advertised programme in place. In addition to daily activities such as games, quizzes, newspaper readings and craft, there are regular church services, visiting entertainers and a residents’ cooking club. Residents’ craftwork was on display in the entrance hallway of the home. On the day of inspection itself residents on the dementia care unit were making lavender bags and those downstairs were participating in a church service. One resident commented: ‘Activities are first class. Staff try to cater for all residents and should be praised’. One resident told the inspector how she had greatly enjoyed a recent band that had performed at the home. The home also produces a monthly newsletter for residents and their families that gives details of forthcoming events, residents’ birthdays and staff news. Residents are supported to maintain important relationships. The home currently accommodates a couple. Although they live on separate units, every day staff ensure that the husband is taken down to his wife’s unit so he can spend time with her. One relative told the inspector that he visits his wife Orchard House DS0000024295.V339556.R01.S.doc Version 5.2 Page 12 every day and is always made to feel welcome by staff. He commented; ‘I feel at home here.’ Comments about the quality of the food were very mixed. Some residents stated it was good but others that it had gone downhill recently and was sometimes served cold. Two residents commented that the portions were too big and one relative stated; ‘the food is quite good but I do take things in for my husband to eat as they don’t get any fresh fruit’. Lunch on the day of inspection consisted of mince and onion pie or salad. Orchard House DS0000024295.V339556.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. Residents have access to a complaints procedure and their complaints are handled appropriately This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has its own complaints procedure that is advertised in its Statement of Purpose and Service User Guide and is on display in the main entrance to the home. The home’s complaints book was viewed and two complaints concerning staff attitude and the quality of care received had been recorded and investigated appropriately. All but one the respondents who completed CSCI’s residents’ survey said that they knew how to complain if needed. The Commission for Social Care Inspection has not received any complaints about the home since the last inspection. The home has a satisfactory adult protection procedure in place- ‘Elderly Abuse Policy’ (22/06/04) and includes local guidelines. One of the management team has attended a three-day key practitioner course in adult protection. Orchard House DS0000024295.V339556.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 26 Quality in this outcome area is adequate. Residents live in a clean and comfortable environment, however the strong smell of urine makes some areas of the home very unpleasant to be in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The premises were observed to be clean, bright and well maintained, with good quality furnishing and fittings in place. Residents’ rooms were comfortable and personalised. The home has a range of aids and equipment such as grab rails, hoists and raised toilet seats available that promote residents’ safety and independence. The manager continues to improve the environment of the dementia care unit: interesting reminiscence posters decorate long corridor walls and fiddle boards have been put up recently to provide interest and stimulation for residents who wander along the corridors. Residents have access to a sizable garden, allowing them exposure to fresh air and sun and the home has recently been awarded a grant to make this area safer and more accessible for residents. A number of specialist beds have been purchased which will make it easier to care for those residents who are nursed in bed. However, some areas of the home smelled awful and made it very unpleasant Orchard House DS0000024295.V339556.R01.S.doc Version 5.2 Page 15 to be in, in particular bedrooms 8, 64 and 66. One relative commented: ‘Sometimes the smell of urine is quite strong’. Orchard House DS0000024295.V339556.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. Training for staff is good, however poor recruitment practices put residents at serious and unnecessary risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are two nurses and 10 carers on each morning and two nurses and seven carers in the afternoon to support 67 residents. Additional staff are on duty at peak times during the day. During the night two nurses and four carers are available. Despite this, however, it was of concern to note the number of comments received about staffing levels at the home. These included: ‘ there is not enough staff and the residents seem to sit on their own for hours, they have to wait a long time to be taken to the toilet’; ‘A long wait sometimes, especially the toilet’; ‘sometimes at week-ends there are staff shortages’. One member of staff reported that the home was short-staffed about two to three times a week. Comments about staff received from both residents and relatives were mostly positive and included: ‘ staff are extremely attentive’; ‘care staff should be praised, they all do a great job’. However one resident reported that staff sometimes handled her roughly, another stated: ‘some staff are not nice’ Staff training is good with nearly 50 holding an NVQ level 2 in care. Staff also receive training specific to the needs of residents such as dementia care and palliative care. Orchard House DS0000024295.V339556.R01.S.doc Version 5.2 Page 17 The personnel files for two recently employed members of staff were checked. The following worrying issues were noted: • • • References for one member of staff had been written by her sister and the other by her friend Although a CRB check had been received for one member of staff, information about the this person’s inclusion on the POVA list had not been requested There were two new members of staff present at the home on the day of inspection. Both were still awaiting the CRB checks and one was in the home, without even a POVA check having been completed These deficiencies seriously put residents at risk. Orchard House DS0000024295.V339556.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is adequate. Feedback about the quality of the service residents receive is regularly sought, however staff supervision is poor and there is no opportunity to discuss their care practices or their training needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager holds a number of qualifications in care and continues to work hard to bring about a number of changes in care practices. Feedback about the service is actively sought via a ‘Residents and Relatives Satisfaction Survey’ which asks for comments about the quality of the environment of the home, the staff and food. The scope of this feedback has been extended to include a range of health care professionals that visit the home regularly such as GPS, district nurses, a chiropodist and a speech therapist. Supervision for staff remains poor and not all receive it regularly despite this being a requirement made at the last inspection. Two members of staff had Orchard House DS0000024295.V339556.R01.S.doc Version 5.2 Page 19 only received one supervision in the last six months and another had not received any supervision whatsoever as she had, apparently, refused to attend. This is unacceptable. Secure facilities are provided for safe-keeping of residents’ money and a sample of residents’ cash sheets and receipts were checked. These were in good order. A number of records in relation to health and safety (fire, portable appliance testing, and lift and hoist servicing) were viewed by the inspector and found to be in good order. Staff confirmed they had undertaken training in fire safety, moving and handling, health and safety, and food hygiene. No major health and safety hazards were viewed around the home, apart from a number of laundry basket holders being stored in one of the residents’ toilet thereby preventing them from accessing the room safely. Orchard House DS0000024295.V339556.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x 3 x x x 2 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 1 x 3 Orchard House DS0000024295.V339556.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2)(b) Requirement Timescale for action 01/09/07 2. OP26 16(2)(k) 3 OP27 18(1)(a) 3. OP29 7,9,19 Residents must be involved in drawing up and reviewing their care plans so they can participate in, and agree, how they are to be helped. The home must be kept free of 01/08/07 offensive smells so that residents can live in a pleasant environment. Staffing levels at the home must 01/09/07 be reviewed to ensure there are enough staff available to meet residents’ needs promptly. POVA, CRB check and two 18/07/07 appropriate written references must be obtained before an employee commences work to ensure that only suitable people have contact with vulnerable adults. Timescale of 11/05/06 not met. The CSCI is seeking further legal advice in view of this continued breach. Staff must receive regular 01/10/07 supervision so that their working practices are monitored and their training needs identified. DS0000024295.V339556.R01.S.doc Version 5.2 4. OP36 18 (2) Orchard House Page 22 Timescale of 01/08/06 not met RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Orchard House DS0000024295.V339556.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office 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. 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