Inspection on 22/07/08 for Orchard House

This inspection was carried out on 22nd July 2008.

CSCI found this care home to be providing an Adequate service.

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 18/07/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Orchard House 107 Money Bank Wisbech Cambridgeshire PE13 2JF Lead Inspector Janie Buchanan Unannounced Inspection 22nd July 2008 09:30 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.V368831.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.V368831.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 Ltd 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.V368831.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 18th July 2007 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 residents’ needs. A copy of the most recent inspection report is available in the entranceway to the home. Orchard House DS0000024295.V368831.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. For this key inspection we (CSCI) looked at all the information that we have received, or asked for, since the last key inspection. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Surveys returned to us by people using the service and from other people with an interest in the service: ten of these were received. What the service has told us about things that have happened in the home, these are called ‘notifications’ and are a legal requirement. • • We also visited the home and talked with 8 people living there and four members of staff. We toured the premsies and viewed a range of documents and policies. We also observed a lunchtime meal at the home. An expert by experience (ex by ex) was part of our inspection: an ex by ex is someone who has experience of using social care services. During this inspection the ex by ex looked at activties, staffing levels and interaction with residents, and mealtimes. Her feedback is included in this report. What the service does well: What has improved since the last inspection? Orchard House DS0000024295.V368831.R01.S.doc Version 5.2 Page 6 The home has built a sensory garden to give residents access to fresh air, natural sunlight and sensory stimulation. 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.V368831.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.V368831.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 we viewed pre-admission information for two recently admitted residents. The deputy manager told us that family members of these residents visited the home prior to the residents moving in so they could assess its facilities. One resident told us: ‘we were shown all round the home and all our questions were answered’ Orchard House DS0000024295.V368831.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 and reviewing of their care and language used to describe them by some staff is demeaning. 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, as was the action to be taken by staff to meet them. However, there was very little evidence that residents actively participate in the drawing up and reviewing their plans of care, despite this being a requirement made at the last inspection. We sat and went through one residents’ care plan with her. She was very able to understand it and agreed it was a good reflection of her needs. However she told us she had never seen it and staff had never discussed it with her. Another, very able and articulate resident also told us that he had never seen his care plan. Staff reported that residents rarely see their plans and showed surprise at such a suggestion. Orchard House DS0000024295.V368831.R01.S.doc Version 5.2 Page 10 Interactions between staff and residents observed by our expert by experience were warm, respectful and encouraging. However some of the language used by staff to describe residents did not maintain their dignity with them being referred to ‘feeders’. We overheard two members of staff continually calling everyone ‘sweetheart’ or ‘darling’ rather than by their own name. 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, these charts were not very detailed and did not give a comprehensive picture of what food was actually eaten each day. Some days staff had forgotten to fill in the charts, and other days the chart showed that residents were only getting 400-600 mls. of fluid a day which is not enough to keep an older person properly hydrated. We checked medication storage and recording on the upstairs unit. This was good; with MAR sheets signed correctly, controlled drugs stored and signed for and the medication trolleys neat and in good order. The use of strong antipsychotic drugs such as Haloperidol had also been reviewed regularly. Orchard House DS0000024295.V368831.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 and visiting entertainers. On the day we visited residents were making cards and there have been recent outings to the Rose Fair and for a fish and chip meal. Our expert by experience commented: ‘there was a varied and interesting programme of activities at the home; some of which were for group participation and others for one-to-one interaction. The two coordinators had their work cut out and clearly rose to the challenge of keeping boredom at bay’. One relative we spoke to that day told us that his father greatly enjoyed the musical entertainment provided. Dolls and cuddly toys are available on the dementia care unit and some residents were clearly enjoying holding, cuddling and nursing them. Family members are made to feel welcome and one told us: ‘We can have a free meal with our mum if we want it’. Orchard House DS0000024295.V368831.R01.S.doc Version 5.2 Page 12 We had lunch with the residents. Our ex by ex described it as such: ‘My lunch was unappetising at best, atrocious at worst. The ‘cheese and vegetable country bake’ (images of cheesy-topped crumble on a selection of freshly prepared vegetables, probably in a light sauce, or some such…) turned out to be no more than a pre-packed, frozen burger and was the highlight of the meal. The baby carrots were tinned and tasted most un-carrot-like, and the leeks were grey with overcooking. This was followed by tinned fruit salad and ‘cream’. One relative also told us ‘better quality food is needed’. We observed one member of staff assisting a resident to eat their lunch. This was done well, with her taking her time and explaining to the resident what the food was and encouraging him gently and successfully to eat more. Orchard House DS0000024295.V368831.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. We checked the home’s complaints log and a recent complaint from a relative concerned that their mother was still undressed at 11 in the morning had been recorded, investigated and responded to appropriately. CSCI has not received any complaints about the home since its last inspection Staff receive training in protecting vulnerable adults and those we talked to showed a satisfactory awareness of the different types of abuse an older person can face and reporting procedures. We spoke with a local social worker that takes the lead on adult protection who told us that the home ‘were brilliant’ at reporting incidents and always responded quickly to events such as incidents of aggression between residents. Orchard House DS0000024295.V368831.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 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. However, some areas of the home continue to smell bad, in particular the dementia care unit where strong offensive smells were noted in the entranceway, small lounge and room 64. The deputy manager told us that the carpet was about 11 years old and was partly the cause of the smells. Our ex by ex commented: ‘The other big negative about the building was the wholly unacceptable, overwhelming and offensive odour upstairs in the dementia unit’. Orchard House DS0000024295.V368831.R01.S.doc Version 5.2 Page 15 We entered one room that was clearly signposted as a bathroom. This room was full of wheelchairs and hoists and access to both the toilet and sink were blocked. This can only be confusing for residents with dementia. Orchard House DS0000024295.V368831.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): 27,29,30 Quality in this outcome area is adequate. Residents are looked after by caring staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We received many positive comments about staff at Orchard House including ‘staff are friendly and fun’ and ‘staff have a caring attitude towards patient and relatives. They are always smiling and jolly and always communicate and available to talk about the patients progress’. 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. However, several staff told us that there were not enough of them on duty at any one time and that an extra person on each shift would have allow better monitoring, especially of dementia residents, but also of those who needed help to change position frequently, whether upstairs or down. We sat for over a period of 20 minutes (between 11.10am and 11.30am) in the small second lounge on the dementia unit without any staff checking on the residents there during that time. More frequent checks should be provided, given that none of these residents were able to call for help easily, and one resident’s skirt kept riding up as she wriggled in her chair. We checked the personnel files of two recently appointed members of staff. The home had obtained proper CRB checks before employing them, however Orchard House DS0000024295.V368831.R01.S.doc Version 5.2 Page 17 one member of staff was employed with only one written reference having been obtained. This reference was from a friend, despite the staff member having worker at two care homes previously. Orchard House DS0000024295.V368831.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. Residents live in a home where staff feel supported however their supervision is poor and there is no opportunity to discuss and monitor their care practices or their training needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is a registered nurse and holds a number of qualifications in care. Staff told us they felt supported by the management team, especially when they were experiencing personal problems. However, requirements to provide regular supervision continue to be ignored and the management team showed a poor understanding of the importance of good supervision for staff and its role in monitoring their working practices, identifying their training needs, dealing with problems and giving staff a chance to air their views. Orchard House DS0000024295.V368831.R01.S.doc Version 5.2 Page 19 Feedback about the service is sought via residents and visitors’ questionnaires, although none have been sent out since July of last year so residents and relatives have not had a chance to give their views of the service. The home holds money for some residents. We checked the account sheets and receipts for 3 residents and these were adequate bar a few minor discrepancies. We viewed a number of records in relation to health and safety (fire, portable appliance testing, and lift and hoist servicing). These showed that the home regularly services and maintains its appliances. However a gas safety certificate was issued over 4 years ago (17/05/04) and night staff do not regularly practice fire drills so they know what the procedure is in the event of a fire. Orchard House DS0000024295.V368831.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 1 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x 3 x x x 2 STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 1 x 2 Orchard House DS0000024295.V368831.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 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. Previous timescale of 01/09/07 not met. New timescale given 2 OP26 16(2)(k) The home must be kept free of 01/10/08 offensive smells so that residents can live in a pleasant environment. Previous timescale of 01/08/07 not met. New timescale given 3 OP27 18(1)(a) Staffing levels at the home must 01/09/08 be reviewed to ensure there are enough staff available to meet residents’ needs promptly. Staff must receive regular 01/10/08 supervision so that their working practices are monitored and their training needs identified. DS0000024295.V368831.R01.S.doc Version 5.2 Page 22 Timescale for action 01/10/08 4 OP36 18 (2) Orchard House Previous timescale of 01/10/07 not met. New timescale given 5 OP38 23 (4)(e) Night staff must regularly rehearse fire drills so they know what to do in the event of a fire 01/09/08 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 More should be done to make the new sensory garden an interesting and stimulating place for residents Orchard House DS0000024295.V368831.R01.S.doc Version 5.2 Page 23 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 DS0000024295.V368831.R01.S.doc Version 5.2 Page 24 - 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!