Inspection on 20/10/05 for Orchard House

This inspection was carried out on 20th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Orchard House 22/07/08

Orchard House 18/07/07

Orchard House 11/05/06

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 Announced 20th October @ 09:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Orchard House Address 107 Money Bank, Wisbech, Cambridgeshire, PE13 2JF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01945 466784 01945 588856 Ranc Care Homes Ltd Sharon Wilson Care home with nursing 67 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (37), Mental disorder, excluding learning of places disability or dementia (5), Old age, not falling within any other category (30), Physical disability (10) Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The age range of residents with mental disorder (MD) and dementia (DE) and physical disability (PD) is 58-64 years only Date of last inspection 12/04/2005 Brief Description of the Service: Orchard House is owned by Ranc Care Homes Limited. The company also owns three homes in Kent and one in Essex. It is a purpose built home providing residential and nursing care and is registered for 67 places.On the ground floor the home has twenty-six single bedrooms with en-suite facilities and two double rooms. The first floor is designated for residents with a diagnosis of dementia. Nursing staff are always on duty and are supported by a team of care staff and other domestic and catering staff. Three day-care staff provide social activities for the residents. Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s second inspection for the year 2005/6 and was conducted by 2 inspectors and was announced. One inspector interviewed 4 members of staff, one visiting relative, a student nurse on placement at the home, the manager, the nursing operations director and the senior sister. The other inspector spent the morning interviewing 6 residents and two visiting relatives. A brief tour of the home was undertaken and a range of documents was viewed. The inspectors also received 12 comment cards, requesting feedback about the home, completed by residents and their relatives. Most respondents indicated that they were generally satisfied with the overall service provided at Orchard House. However one respondent complained about the length of time it took staff to answer her aunt’s call bell and another raised a variety of issues concerning the care of his father. These were discussed with the manager. What the service does well: What has improved since the last inspection? What they could do better: All residents must be issued with a contract of residence so that they are fully aware of the terms and conditions of their stay at the home. The manager, too, must be issued with an employment contract, given that she has been in this post for a considerable length of time. Care plans should be made more accessible to residents so that they are fully aware of what information is held Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 Page 6 about them and can actively contribute to it. More should be done to promote real choice for residents at mealtimes in regards to what, and how much, they eat. The manager must ensure that any employee who is unsuitable to work with vulnerable adults is referred to the Protection of Vulnerable Adults list. 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. Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,5 Information about the home is available to help prospective residents choose if it is where they want to live. Each resident should be issued with a contract at the point of moving into the home so that they are fully aware of the terms and conditions of their stay there. EVIDENCE: The home has a Statement of Purpose and Resident Guide that give good information about the home and the services it offers. All residents are assessed fully before moving in, and appropriate pre-admission assessments for three recently admitted residents were viewed by the inspector. Families and prospective residents are able to visit the home to assess its suitability and a copy of the most recent CSCI inspection report is available in the entrance hallway of the home. It was of concern to note that local authority funded residents had not been issued with individual contracts. These should be issued to all residents and clearly set out the terms and conditions of their stay at the home. Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 Residents health and personal care needs are met by the home, and monitored closely by staff. EVIDENCE: Three residents’ care plans were viewed and the information they contained was generally satisfactory. Residents’ needs in relation to a number of areas including their mobility, diet, and personal hygiene were clearly recorded, with evidence that they were reviewed regularly. One of these residents has dementia and the inspector was particularly impressed by the information contained in the plan about this resident’s life history in relation to their childhood, adolescence, adulthood, middle age and later years. The plans also contained comprehensive risk assessments for each resident. Ways of making this information more accessible to residents and their advocates (where appropriate) was discussed with the manager. All residents are registered with one of three local GP practices, a chiropodist visits weekly and dental, optical and psychiatric support for residents is available when necessary. Relationships between staff at the home and a local district nursing practice are reported to have improved. Residents are weighed regularly and their nutritional risk assessed monthly. Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 Page 10 Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,15 The range of activities available in the home is excellent providing residents with variety, social interaction and stimulation. EVIDENCE: The home continues to provide a varied and well-publicised programme of activities for its residents, facilitated by three dedicated activities coordinators. There have been recent trips to Hunstanton and Sandringham and on the day of inspection itself there was a live singer providing entertainment for residents in the afternoon. It was also ‘Silly Hat’ day at the home and many staff were wearing brightly coloured and unusual hats. Residents told the inspector that they particularly enjoyed the cooking sessions and church services that take place. The inspector had lunch with residents. This consisted of pork chops with potatoes, peas and carrots, followed by a dessert of treacle sponge and custard. An alternative menu was available. Residents made many positive comments about the quality of the food served at the home. However, it was disappointing to note that the courses were served fully plated up, thereby denying residents choice in how much and what they actually wanted to eat. This practice is a little institutionalised and the manager should consider at least serving gravy and custard in separate dishes. A number of residents Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 Page 12 required help to eat their food, and staff did this slowly, sensitively and discreetly. Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Complaints are taken seriously, and dealt with appropriately and staff have good knowledge of adult protection issues. 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 number of complaints received by the Commission for Social Care Inspection about the home has reduced considerably since the last inspection. The home has a satisfactory adult protection procedure in place- ‘Elderly Abuse Policy’ (22/06/04)- but this should be updated to include specific local reporting guidelines and procedures. Twelve staff attended recent training in the protection of vulnerable adults and staff showed good knowledge about the different types of abuse and symptoms to look out for. Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,23,25,26 Residents live in a comfortable and safe environment where there are good infection control measures in place to protect them. EVIDENCE: The premises were observed to be generally well maintained, comfortable and in good decorative order. Eight bedrooms have been redecorated since the last inspection and a ramp has been built to assist residents in accessing the garden. New specialist scales to monitor residents’ weight have also been purchased. Procedures are in place for the control of infection. Plastic gloves and aprons are available for staff to wear, liquid soap and paper towels are available in bathrooms and toilets, and extra control measures are in place for residents with MRSA. Staff wear tabards when serving lunch. There are appropriate laundry and sluicing facilities in the home and access to the main kitchen is restricted. Many domestic staff have achieved their NVQ level 1 in cleaning. The inspector was pleased to note that there were no strong and offensive odours present on the dementia care unit. Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 Page 15 Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Residents’ needs are adequately met by the number of staff and residents are protected by the home’s recruitment procedures. EVIDENCE: Staffing levels are satisfactory. There are two nurses and 10 carers on each morning to support 64 residents (currently) and two nurses and seven carers in the afternoon. Additional staff are on duty at peak times during the day and one resident has a dedicated member of staff to meet her needs throughout the day. During the night two nurses and four carers are available. Staff turnover at the home has been unusually high with a total of 23 leaving in the last year. Of these 4 had been dismissed due to poor care practices and a number of overseas adaptation nurses had left to take up nursing posts. The manager reported that other staff had left due to their dislike of new and improved practices of the home. There is evidence to suggest that the staffing group is now more stable and the use of agency staff has reduced. The inspector received a number of complimentary comments about the staff from residents’ relatives including: ‘we are very happy with all the care given to mum, we could not ask for better’ and ‘the members of staff are friendly, hardworking and my husband is well taken care of’. Training is good and 20 staff have an NVQ level 2 or above in care. Training records showed that, in addition to mandatory training, staff had undergone training in continence management, dementia care, and basic nursing skills. Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 Page 17 Personnel files for three recently recruited members of staff were viewed and all contained appropriate references, CRB and POVA checks. However, it was of concern to note that the home had not fulfilled its responsibility to refer a member of staff who had been dismissed for consideration for inclusion on the Protection of Vulnerable Adults register. Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,26,38 The manager is competent and experienced in the care of older people and there are good systems in place to consult with residents about the quality of service they receive. EVIDENCE: The manager holds a number of qualifications in care and has recently started a Diploma in Dementing Illnesses. She continues to work hard in improving care practices at the home and staff reported her to be approachable and supportive. Regular staff and residents’ meetings are held and all staff receive supervision and appraisal. 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 inspector suggested that this survey also be extended to seek the views of the varying health care professionals who regularly visit the home. Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 Page 19 A number of records in relation to health and safety (fire, portable appliance testing, water temperature records, gas, emergency lighting and hoist servicing) were viewed by the inspector and found to be in good order. Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 1 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x 3 x 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x x 3 x 3 Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 5(1)(b) and (c ) Requirement All residents must be issued with a contract that states the terms and conditions in repsect of accommodation and services provided at the home. Timescale for action 1 December 2005 2. 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. 4. Refer to Standard 15 18 18 33 Good Practice Recommendations Residents should be offered more choice in the amount they are given to eat, and foods such as custard and gravy should be served separately. The homes Elderly Abuse Policy should include details of local reporting procedures and guidelines. Staff who may be unsuitable to work with vulnerable adults should be referred for consideration for inclusion on the Protection of Vulnerable Adukts register. The views of stakeholders in the community (GPs, nurses, chiropodists) should be sought as part of the homes qaulity assurance and monitoring systems. Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 Page 22 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Orchard House 20051020 Orchard House X10015 AI Stage 4 S24295 V250885 I53.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!