Inspection on 22/06/05 for Orchard House

This inspection was carried out on 22nd June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Orchard House 06/11/09

Orchard House 17/09/09

Orchard House 09/06/08

Orchard House 16/01/07

Orchard House 05/02/06

Orchard House 06/10/04

Orchard House 01/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE ORCHARD HOUSE Kinnersley Severn Stoke Worcestershire WR8 9JR Lead Inspector Annie OMara Unannounced 22 June 2005 - 7:00 a.m. 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 E52 S18668 Orchard House V235217 220605.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Orchard House Address Kinnersley Severn Stoke Worcestershire WR8 9JR 01905 371445 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) Mr Anthony Gordon Williams Mrs Lavinia Rachel Cartwright CRH 39 Dementia - over 65 Old age Physical disability - over 65 30 39 39 Category(ies) of DE(E) registration, with number OP of places PD(E) ORCHARD HOUSE E52 S18668 Orchard House V235217 220605.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6 October 2004 Brief Description of the Service: Orchard House is registered to provide residential care for up to 39 service users who may have a physical disability and/or mental health needs associated with old age. The maximum number of people who can be accommodated with mental needs is 30. The home is an adapted country house with a purpose built extension situated in a rural setting about six miles from Worcester city. Accommodation is on two floors and access is by one passenger lift and one stair lift. On the first floor there are 16 single bedrooms 8 of which are ensuite and 6 shared rooms 2 of which are ensuite. On the ground floor there are 4 single bedrooms all ensuite and 2 shared rooms. There are 3 assisted bathrooms and seven separate toilets throughout the home. There are two lounge areas and a separate dining area. There is an accessible and well maintained garden for the residents to sit in.There is a local pub but no other amenities within walking distance. There is no regular local bus service. ORCHARD HOUSE E52 S18668 Orchard House V235217 220605.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place in the morning until mid afternoon on a weekday. The inspection consisted of a brief tour of the building, examination of residents care plans, staff files and other management documents. Five residents were spoken to during the visit. What the service does well: What has improved since the last inspection? What they could do better: The information provided about the home needs to be updated to help prospective residents make up their minds as to whether they wish to live at the home. Some improvements are needed to provide a full written record of care received. Any health and safety concerns in the home need to be recognised and the risks, assessed. Due to the specialist needs of the residents there are some restrictions in the home which need to be shown to be in their best interests. The provision of activities in the home needs to be reviewed to ensure that all residents have access to meaningful occupation. The registered manager needs to introduce a method of checking that the service provided continues to meet the needs of residents. ORCHARD HOUSE E52 S18668 Orchard House V235217 220605.doc Version 1.40 Page 6 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 E52 S18668 Orchard House V235217 220605.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 E52 S18668 Orchard House V235217 220605.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, 4. Information about the home is available but is not given out routinely and is in need of up dating. It does not provide an accurate picture of all the services offered at the home to help prospective residents or relatives make an informed choice about whether they would wish to live there. Arrangements are in place to carry out a full assessment of residents needs to ensure the home is suitable for them and can meet their care needs. EVIDENCE: The statement of purpose and service users guide did not contain all the information required for prospective residents to be able to make an informed choice about moving in to the home. The service users guide was not given to individual prospective residents or their relatives but was available on the notice board. Each individual was given a statement of terms and conditions. Thorough assessments were carried out on residents prior to their moving into the home, and, due to the specialist needs of the residents, relatives and friends were consulted. The registered manager was aware of the limitations of the service in providing for residents with very challenging behaviours and appropriate referrals to more specialised services had been made. ORCHARD HOUSE E52 S18668 Orchard House V235217 220605.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, There is a clear care planning system in place but more attention needs to be placed on risk assessing care and health needs as residents’ wellbeing is not protected in all areas. EVIDENCE: There were care plans in place which were reviewed regularly and up dated. They provided information for staff as to how residents’ care needs would be met. There was evidence of residents receiving regular and appropriate attention from the primary healthcare team. A G.P. who was spoken to said that he had no concerns about the care received by the residents and staff adhered to any instructions left by him. General risk assessments were kept in the care plan but there were no risk assessments for skin care or nutrition. One resident who had displayed challenging behaviour had not had an individual risk assessment put in place, or instructions given to staff as to how to manage the behaviour. A specialist review had been held to ensure the continued safety of the resident. A risk assessment for the use of bed rails had not been signed. ORCHARD HOUSE E52 S18668 Orchard House V235217 220605.doc Version 1.40 Page 10 The daily records written for each resident, including any meaningful activities undertaken were not kept in sufficient detail to show how residents spend their time during the day. ORCHARD HOUSE E52 S18668 Orchard House V235217 220605.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 There is little written evidence that residents are able to take part in daily meaningful activities which is detrimental to their quality of life. The meals provided are of good quality and offer a variety of choice. EVIDENCE: Given the nature of some of the residents specialised needs, providing activities for any length of time can be problematic. There were a number of visiting musicians who provided entertainment and some physical exercise for the residents although it was not recorded consistently who had taken part in them. In-house activities were not recorded and it was therefore difficult to assess whether they were appropriate. One resident who was spoken to said that he would enjoy gardening and this was recorded in his care plan, but there was no indication of him participating in any such activity. All the residents spoken to said they enjoyed the food provided in the home and the meal observed on the day of the visit was of good quality and quantity. Some residents were helped to eat their meals appropriately, although it was noted that a member of staff was helping several residents at a time and moving from table to table, cutting up food. This was not relaxing for the residents and did not help them to maintain their independence or dignity. ORCHARD HOUSE E52 S18668 Orchard House V235217 220605.doc Version 1.40 Page 12 ORCHARD HOUSE E52 S18668 Orchard House V235217 220605.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 The home has a clear complaints procedure which can be accessed by relatives to ensure that the welfare of residents is protected. EVIDENCE: There was a complaints procedure in place which was easy to read. There was a record kept of the four complaints received by the home and actions taken. The Commission for Social Care Inspection has received one complaint since the last inspection regarding communication in the home. ORCHARD HOUSE E52 S18668 Orchard House V235217 220605.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, 26 There is evidence of improvement within the environment to provide the residents with a comfortable home. However, systems in place for risk assessing the environmental hazards are inadequate and could place residents at risk. EVIDENCE: The registered providers continue to up-grade the décor and fabric of the home and a record is kept. Strip lights throughout the communal areas of the home did not have covers on them which could be a risk if they shattered. One of the stair lifts has been removed from the staircase. There is a risk of residents falling down the stairs, as the top of them is open. There was no risk assessment in place. There were no small tables in the lounge areas for residents to put drinks on. It was explained by the registered manager that they were a tripping risk to the residents. However, this does make the room look very functional and there is nowhere for residents to put drinks or to play any activities which require the use of a table. ORCHARD HOUSE E52 S18668 Orchard House V235217 220605.doc Version 1.40 Page 15 Not all of the requirements from the last inspection have been actioned. Approved locks on residents’ bedroom doors have not been fitted and they have a keyhole lock which can be activated from the outside. Toilet areas visited upstairs were locked. It was explained that residents have placed objects including paper towels in the toilet causing damage. Where there are areas that are not accessible to residents the reasons do need to be recorded and risk assessed. One toilet did not have a soap dispenser. The pleasant garden areas were accessible by ramps. Chairs, tables and umbrellas were provided for the residents to make the most of the good weather. The laundry area has been upgraded and new equipment provided to ensure better infection control measures. Staff were observed to carry out good hygiene practices during the inspection. ORCHARD HOUSE E52 S18668 Orchard House V235217 220605.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, 28, 29, 30 There has been considerable improvement in maintaining the staffing levels necessary to meet the residents care needs. Good employment practices ensure that staff are thoroughly checked prior to employment, providing good protection to the residents. EVIDENCE: The rotas indicate the home maintains good levels of staffing throughout the waking day and night. The rotas do not show the designations of staff on duty. Induction training is in place for staff and regular up dates are held. The home is working towards providing the required number of NVQ qualified staff. The file of the most recently employed member of staff was in order and contained the required information and checks, thereby providing protection for the residents. Specialist training had also been undertaken including, diabetic care, dementia care, and care of the dying. ORCHARD HOUSE E52 S18668 Orchard House V235217 220605.doc Version 1.40 Page 17 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, 36 The home does not have a formal quality assurance program that measures its success in meeting the aims, objectives and the statement of purpose of the home. This could mean that the service does not continue to develop to meet the residents changing needs. EVIDENCE: The registered manager and deputy manager are both very experienced and knowledgeable about the resident group. The registered manager has not yet undertaken the training she needs to bring her current qualification in line with the Registered Managers Award. There was no overall quality assurance system in place for the regular auditing of all aspects of the service provided. The importance of planning, seeking feedback from residents, relatives and others who visit the home and reviewing the service was discussed. While some aspects are audited this is not used to form part of a formal plan to develop the home. ORCHARD HOUSE E52 S18668 Orchard House V235217 220605.doc Version 1.40 Page 18 Staff receive regular supervision and appraisals which highlight areas for training. Outstanding requirements from the previous report include up-dating the risk assessments for the home, and providing a certificate of electrical safety for the building. In addition, the fire safety risk assessment needs to be up-dated to include the “spent” extinguishers and immediate action to be taken to ensure the safety of the residents in the event of a fire. The front door was locked with a key and is a designated fire exit. Fire safety checks were carried out appropriately. Immediate requirements were left in respect of these matters. ORCHARD HOUSE E52 S18668 Orchard House V235217 220605.doc Version 1.40 Page 19 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 2 3 3 4 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 x 1 x x x x x ORCHARD HOUSE E52 S18668 Orchard House V235217 220605.doc Version 1.40 Page 20 yes 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 1 Regulation 4, 5. Requirement The statement of purpose and service users guide must be updated to contain all the required information in Schedule 1 and Standard 1. Daily records kept in respect of the residents must include details of how they have spent their days and any activities they have taken part in. Risk assessments must be put in place for nutritional and skin care needs. Individual risk assessments must be put in place for residents who have challenging behaviours and information given to staff as to how to manage them. Timescale of 31st December 2004 not met. Risk assessments must be signed. A daily program of meaningful activities must be drawn up and made available for residents. All strip lighting in the areas used by residents must have covers on them. The staircase in the house must be risk assessed and the fire safety officer contacted for Timescale for action 31st August 2005 2. 7 15 31st August 2005 3. 4. 8, 38 8, 38 13 13 31st August 2005 31st August 2005 5. 6. 7. 8. 8, 38 12, 19, 38 19, 38 13 16(2)(n) 23(2)(p) 23(1) 31st August 2005 31st August 2005 31st August 2005 31st August 2005 Page 21 ORCHARD HOUSE E52 S18668 Orchard House V235217 220605.doc Version 1.40 9. 10. 20, 38 21,10 23(2)(i) 23, 12 11. 24, 10 23 12. 13. 14. 15. 16. 17. 24, 38, 10 33 38 38 38 38 23 24 13 13 23(4) 13, 23(4) 13 advice as to how it can be made safe without interfering with fire safety. Tables for residents use must be provided in the lounge areas and a risk assessment carried out. Where residents are restricted from parts of the building this must be risk assessed and the reasons put in the service user guide. All bedroom doors must be fitted with the recommended single action locks as they become vacant. Timescale of 31st May 2005 not met. All bedroom doors must have the keyhole locks removed. A quality assurance program must be introduced in line with Standard 33 and Regulation 24 A certificate of electrical safety must be sought. The fire extinguishers must be replaced and a risk assessment carried whle this is being done. The lock must be removed from the front door which acts as a fire exit. General risk assessments for the home must be undertaken. Timescale of 31st December 2005 not met. 31st August 2005 31st August 2005 31st December 2005. 31st August 2005 30th September 2005 30th September 2005 Immediate Immediate 31st August 2005 18. 19. 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 15 Good Practice Recommendations Management of mealtimes and how esidents are helped to E52 S18668 Orchard House V235217 220605.doc Version 1.40 Page 22 ORCHARD HOUSE 2. 3. 28 31 eat should be undertaken. Arrangements should continue to ensure that 50 of staff are qualified to NVQ level 2 by 2005. The registered manager should pursue the training necessary to achieve the registered managers award. ORCHARD HOUSE E52 S18668 Orchard House V235217 220605.doc Version 1.40 Page 23 Commission for Social Care Inspection The Coach House, John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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. 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