Inspection on 20/12/06 for Orchard House

This inspection was carried out on 20th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 16/02/06

Orchard House 30/09/05

Orchard House 15/02/05

Orchard House 06/09/04

Similar services:

Westmead

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

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

CARE HOMES FOR OLDER PEOPLE Orchard House The Walk Withington Herefordshire HR1 3PR Lead Inspector Wendy Barrett Unannounced Inspection 09:30 20 December 2006 th 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 DS0000060771.V309591.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 DS0000060771.V309591.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard House Address The Walk Withington Herefordshire HR1 3PR 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) 01432 850671 Shaw Healthcare Ltd Mrs Tina Jane Morgan Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Orchard House DS0000060771.V309591.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th February 2006 Brief Description of the Service: Purpose built as a residential home in the 1970s, Orchard House is situated in the village of Withington, approximately 5 miles from the city of Hereford. The home is just off the main A4103 Hereford to Worcester road and it is situated in large gardens. There is a good-sized car park at the front of the building. Shaw Healthcare Limited, who was registered as the Provider in June 2004, provides the service. Orchard House aims to provide personal care in a homely setting for up to 28 older men and women who have care needs arising from the normal ageing process. Twenty of these places are in two self-contained living units on the first floor. There is a passenger lift so that residents don’t have to use the stairs. The two units are for permanent care. Eight places offer interim placement care and this service is based in a separate ground floor living unit. The accommodation and facilities have been substantially upgraded since Shaw Healthcare Limited was registered as the Provider. Residents who are admitted for permanent care receive a copy of the home’s Statement of Purpose and Service User Guide. Short stay residents who are on interim placement are made aware of copies of the relevant information that is displayed in the home. The Provider and local authority also hold ‘focus’ group meetings with residents every three months. The purpose of these meetings is to familiarise residents with the provider organisation and its aims and objectives. Information received by the Commission in October 2006 did not specify the scale of charges – ‘controlled by Herefordshire Council’. Additional charges were listed. These included charges for hairdressing, chiropody, toiletries, personal newspapers and magazines and some transport. Orchard House DS0000060771.V309591.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information used to write this report was obtained from the Commission’s service file and from an unannounced inspection visit to the home. Survey forms were sent to the home for distribution to residents, relatives and involved health/social care professionals. Seven resident and one G.P. survey forms were returned with comments about the service. What the service does well: What has improved since the last inspection? The Provider has employed more relief staff so that the Care Manager can make sure there are enough staff on duty to care for the resident group. There is also continuing work to try and recruit more permanent staff at the home. Orchard House DS0000060771.V309591.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 DS0000060771.V309591.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 DS0000060771.V309591.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): 1,2,3,4,5 and 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents have the information they need to decide whether the home will suit them. They are happy with the way they are introduced to the home. The staff carefully consider all potential admissions so that they can assess if they can meet the potential resident’s needs. EVIDENCE: There is good information available to describe the service. This includes an Interim Placement Service User guide. The documents were updated in August 2006. A resident in the Promoting Independence unit had signed a Resident Agreement. The document explained the terms and conditions of the placement. Information relating to fees charged for permanent residents was not made available for inclusion in this report. The Service User Guide for the Orchard House DS0000060771.V309591.R01.S.doc Version 5.2 Page 9 Promoting Independence unit states ‘Herefordshire council contract all the Interim Placement beds at Orchard House’. A relative was visiting during the inspection visit. She was very happy with the way her father had been introduced to the home and the resident also confirmed his satisfaction. They were particularly grateful that a larger bedroom had been allocated when it became clear the first room would not have enough space for the resident to move around safely. A sampled care record contained written evidence of a thorough pre-admission assessment. Staff had obtained the information they needed to decide if they would be able to respond to the potential resident’s needs and expectations e.g. the amount of help required with daily living tasks, leisure interests. There were examples of special assessment methods being applied in identifying any risk areas that may require extra attention e.g. nutritional needs, risk of falls. Orchard House DS0000060771.V309591.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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are well met. Medication management is satisfactory although it would be strengthened if staff had more guidance about administering medication prescribed ‘as required’. EVIDENCE: Every resident has a written plan of care. This is based on assessment work by the staff e.g. a care assistant described her involvement in writing a social history to help staff get to know the individual resident. Professional methods of assessing potential risk areas are used e.g. skin viability, nutritional needs. The staff complete a written record of the care provided to each resident during each shift period. This includes reference to things such as any G.P. Orchard House DS0000060771.V309591.R01.S.doc Version 5.2 Page 11 contact, attention to continence care. A survey form from a visiting G.P.stated ‘good home. Well managed’. The plans of care are reviewed every month to be sure they are up to date and take into account any changes in a resident’s condition. When residents have particular disabilities the care plans reflect the special needs that arise e.g. the care plan of a blind resident referred to the need to avoid moving furniture so that the resident wouldn’t be confused by any new layout of their physical surroundings. Staff and residents were observed respecting this special need at lunchtime during the inspection visit. It was recognised that a blind resident should not be asked to sit at a different dining place because this would be difficult for her to adjust to. Staff who handle medication receive training so that they can manage this task safely. A resident’s relative was aware that, although her father continued to manage his own medication, the staff kept any eye on him to make sure he was managing safely. Written evidence of this type of assessment was seen in a care record. Medication is securely stored and audited. A sample stock balance of a controlled drug matched the balance recorded in the medication records. Staff monitor the movement of medication through the home so they can quickly identify any discrepancies e.g. there are records kept of the date new stock is brought into use. It was noted that some medication is prescribed ‘as required’. When this is the case the staff should have written guidance to help them decide when to administer the medication. This is particularly important when the medication is a tranquilliser because inappropriate use should be avoided whenever possible. All the resident survey forms that were returned indicated satisfaction with the way staff respected their privacy. Orchard House DS0000060771.V309591.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to follow their preferred daily routines. The staff have time to help them pursue their leisure interests and keep in touch with their relatives. The residents enjoy their meals and staff ensure any special need or preference is taken into account when meals are planned. EVIDENCE: An activities organiser is employed at the home so that residents’ social care needs are not forgotten. The care plans contain records of activity opportunities for each resident and an activity programme was displayed at the home. A sample record listed something for most days e.g. quiz, musical entertainment, shopping expedition, church service. A resident was taken into town on a Christmas shopping trip during the inspection visit. The relative of a short stay resident was pleased that he had received a birthday cake from the home. A blind resident confirmed her preference for Orchard House DS0000060771.V309591.R01.S.doc Version 5.2 Page 13 spending time listening to her radio in her bedroom. She did have talking newspaper tapes and also mentioned how staff keep her in touch with her family by relying messages to her. She didn’t want a telephone in her bedroom because she didn’t think she would be able to use it. The residents are satisfied with their meals and information seen in care records confirms that staff take into account dietary needs and preferences. A blind resident had a purpose designed mug and plate to enable her to manage without staff assistance. National Minimum Standard 15 was fully inspected at the last inspection and was satisfactory. Orchard House DS0000060771.V309591.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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the information they need to raise any concerns or complaints. When this occurs the Provider and Care Manager make sure the issues are properly investigated and any necessary action is taken to put things right. The staff receive training and written guidance so that they understand how to keep the residents safe from any abuse. EVIDENCE: There is a complaints procedure in the Statement of Purpose and the home keeps a record of any complaints received. The Provider’s representative audits the record during visits to the service. The Commission has received one complaint about the service since the last inspection. The Provider and Care manager responded well to a request for further information regarding the concerns raised and no further investigation was required. An adult protection policy had been reviewed in May 2006 so that staff had up to date guidance about protecting the residents form any abuse. The policy includes a whistle blowing procedure. This information gives staff guidance about the most effective way to raise any concerns they may have regarding resident safety. Related training had been provided during the past year and Orchard House DS0000060771.V309591.R01.S.doc Version 5.2 Page 15 there were plans to provide more of this in the next year. The Provider had also arranged to provide training for the Care Manager in Care Advocacy. Residents indicate confidence in the staff. A care record referred to involvement of an independent advocate so that the resident had extra help in representing herself. Orchard House DS0000060771.V309591.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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ accommodation is good quality and comfortable. The premises are well maintained to keep residents safe and to reduce any risk of infection. EVIDENCE: The premises have been subject to major refurbishment since the Provider’s registration. This has resulted in a high standard of furnishings and facilities. Unfortunately, the original design of the building did not provide for en-suite facilities. However, at the time of the inspection visit there were two examples of residents with particular mobility difficulties being allocated larger bedrooms so they would be more comfortable. The daughter of one of these residents said she was very grateful for this attention to her father’s comfort. Orchard House DS0000060771.V309591.R01.S.doc Version 5.2 Page 17 The Provider responded promptly to recommendations from the Fire Officer to make the building safe and general maintenance and servicing of equipment and essential services is well addressed. Staff were observed making use of a hoist to help a resident move around. This was done efficiently but sensitively. It was also noted that residents in wheelchairs were also using footrests to avoid any injury. At the time of the inspection visit the home was clean, warm and odour free. It was very attractively decorated for the Christmas festivities. Residents are able to bring in personal items so that they could feel more at home. A care assistant spoke about training she has received to help her work safely and hygienically. This included infection control, food hygiene and health and safety. Staff were observed wearing appropriate protective clothing as they went about their work. Orchard House DS0000060771.V309591.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff to meet the residents’ needs. Staff are carefully selected to be sure they will be suitable to work with vulnerable adults. They receive very good training opportunities to help them work efficiently although there should be more care staff with a national vocational qualification. EVIDENCE: There have been difficulties recruiting staff at Orchard House for some time. This is why agency staff have to be employed at times to maintain satisfactory staffing levels. The Provider regularly advertises any vacancies and there is no indication that resident care is compromised by this situation. There was a satisfactory level of staff on duty during the unannounced inspection visit and they had time to go about their work in an unhurried manner. Observations indicated that residents were receiving good support from staff to meet their needs e.g there was time to take a resident Christmas shopping on the day of the visit. A care assistant and agency domestic agreed that their workload was manageable and a resident felt the staff were meeting her needs well. Orchard House DS0000060771.V309591.R01.S.doc Version 5.2 Page 19 A care assistant said that she was working towards a National Vocational Qualification. There will need to be more work to achieve the recommended 50 of care staff with this qualification. The Provider offers staff very comprehensive training programmes that cover health and safety and relevant care practice e.g. annual manual handling refresher training, training in promoting independence for staff who work on the special unit. The staff also have the support of a sessional occupational therapist and physiotherapist on this unit so that residents receive the professional help they need with their preparation to move home or to other care settings. A sampled recruitment record confirmed that staff are selected carefully and all the required checks are made of their suitability to work with vulnerable adults e.g. Criminal Records Bureau checks. Orchard House DS0000060771.V309591.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): 31,33,35,36 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The Provider and Care Manager have the necessary skills and ability to run the home in a way that offers residents a high standard of care that suits their needs and expectations. The management closely audit the performance of the service and promptly respond when they recognise a need for additional work to maintain and/or improve the high standard of the service. EVIDENCE: Orchard House DS0000060771.V309591.R01.S.doc Version 5.2 Page 21 The Provider organisation supports the Care Manager in ensuring the home is run safely and effectively e.g. recommendations for attention to fire safety doors had been promptly addressed, manager training to familiarise her with new fire regulations, additional ‘bank’ staff to help maintain adequate staffing levels, quarterly internal audit exercises with summary reports displayed in the home, ‘focus’ group meetings with residents to help them understand about the Provider organisation and its aims and objectives. The Provider also offers staff training opportunities that go beyond those required under health and safety legislation e.g. all levels of staff were due to receive training regarding the purpose of individual supervision sessions, the administrator was very pleased to be given an opportunity to achieve a national vocational qualification in administration. She had already been on a ‘public relations’ course. A care assistant was aware that one to one supervision sessions should take place every 6-8weeks but did not think this always happened. She did, however, feel well supported through regular staff meetings and also mentioned that staff can request additional meetings when the need arises. Some residents rely on the Provider to take care of their personal savings. A sample of money balance sheets confirmed that two staff sign to confirm any transactions and there is a limit on the amount of cash that can be kept in the home. Additional amounts are kept in a corporate account that is organised so that it is kept separate from any business accounts and protects individual balances. The administrator was aware that new residents are now encouraged to ask their relatives to provide any help needed in managing personal money. This is a more acceptable approach and efforts to reduce the Provider’s involvement in safekeeping residents’ personal money should continue. Summary reports of internal audit exercises were displayed at the home. The exercise includes consultation with residents and relatives. Reports of monthly visits to the service by the Provider’s representative confirm a good oversight of all aspects of the service. A pre-inspection questionnaire confirms implementation of relevant policies and procedures to comply with legislative requirements e.g. health and safety, employment, protection and rights. Some of these had been revised in 2006 as part of an ongoing review programme to make sure the guidance is up to date. Staff have ready access to these documents. At the time of the inspection visit the Care Manager was undertaking a review of the fire risk assessment following receipt of training on new fire regulations. Orchard House DS0000060771.V309591.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 4 3 4 3 3 4 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 x 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 2 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 x 3 2 4 4 Orchard House DS0000060771.V309591.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. Standard Regulation Requirement Timescale for action 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 2 3 Refer to Standard OP9 OP28 OP36 Good Practice Recommendations When medication is prescribed ‘as required’ the staff should be given specific guidance to help them know when to administer the medication to the individual resident. The number of care staff who have a national vocational qualification should be increased. Staff should receive more regular one to one supervision sessions. Orchard House DS0000060771.V309591.R01.S.doc Version 5.2 Page 24 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 DS0000060771.V309591.R01.S.doc Version 5.2 Page 25 - 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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