Inspection on 30/09/05 for Orchard House

This inspection was carried out on 30th September 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 20/12/06

Orchard House 16/02/06

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 30th September 2005 02:00 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.V255395.R01.S.doc Version 5.0 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.V255395.R01.S.doc Version 5.0 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.V255395.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1. Mrs Morgan commences training in order to achieve NVQ Level 4 in Care and Management within six months, I.e. by 30th September 2005. 15th February 2005 Date of last inspection 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. The service is provided by Shaw Healthcare Limited who were registered as the Providers in June 2004. 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 respite 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 were registered as the Providers. This work has resulted in a high quality environment that is well equipped to suit the needs of the residents. Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two visits on separate days. The first visit took place between 2pm and 6.15pm. The Care Manager had a few days notice because she had not been present during the last inspection and it was important to meet her to discuss various developments. The second visit took place three days later between 5.15pm and 8.15pm. It was unannounced. The Care Manager was present during the first visit. A Senior Care Assistant was in charge of the home during the second visit. Both these senior staff assisted with the inspection. Staff were observed handing over from one shift to another. Two permanent staff and an agency worker were interviewed. Five residents were interviewed and others were met during a tour of the home. Some records and documentation kept at the home were inspected and information contained on the Commission’s file was also referenced. In June 2005, questionnaires were sent out for visiting professionals, staff, relatives and residents to comment on their experience of the service. Sixteen residents, two relatives and one staff questionnaire were sent back to the Commission. Information gathered as part of this exercise has been referenced in writing this report although the small response from relatives and staff was too limited to provide an overall picture. What the service does well: Residents have regular opportunities to meet with representatives of Shaw Healthcare. They feel well consulted and informed about the service they receive. When new residents are admitted to the home the staff receive good information to make sure the resident gets the care they need. People who want to work at the home are carefully vetted to make sure they will be suitable to care for vulnerable people. Agency staff feel they are well supported by the permanent staff and the residents are happy with the care they get from these temporary workers. Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? 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. Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 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.V255395.R01.S.doc Version 5.0 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 the following standard(s): 2 and 3 The admission process is well managed and residents are given clear information regarding the service. EVIDENCE: At the handover meeting staff shared information about a new resident’s background and care needs. A care record contained details of a pre-admission assessment. This provided a comprehensive picture e.g. social background, health issues, preferences e.g. may prefer female carer, difficulties e.g. frustrations at losing independence. The sample record inspected had not been signed or dated. It is important to make sure this is done because the resident or representative should be involved in this work and dating the record confirms how current the details are when they are being referenced in future work with the resident. There was, however, a copy of a service agreement in the care record and this was dated and had been signed by the resident and the Provider’s representative. Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 Page 9 Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Residents are looked after well in respect of their care needs. The staff are given the guidance they need to make sure they work in a safe and respectful manner. EVIDENCE: During the staff handover meeting there were a number of references that indicated thorough attention to emerging health and personal care needs e.g. food/fluid input, medication, review meeting arranged following request from relatives, action taken following fall, skin care, supply of late supper for resident who seemed to appreciate this extra food. A care record included details of personal, health and social needs and preferences. There were records of risk assessments e.g. skin care, nutrition, falls. One of these referred to consultation with family members regarding the use of bed rails. Action plans had been produced as a result of this assessment work. A resident mentioned visits from a district nurse to deal with catheter care. Another resident described how staff were helping her to improve her mobility. Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 Page 11 All residents who were interviewed felt the staff were kind and respectful – ‘very good service’, ‘they’re very kind. Don’t tell us what to do. They consult us’, ‘they do try to please us’. Staff were observed telling colleagues about paracetamol tablets brought in for a resident by a relative. There was also discussion about changes in medication regimes, self-medication risk assessment review. The refurbishment work has resulted in a dedicated secure room and equipment for storage of drugs. This includes a small fridge. Records of temperature checks were being maintained. Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, and 14 Residents are able to spend their days as they wish and have opportunities to participate in social activities. There are a few residents who feel they are not always satisfied with the activities offered at the moment. EVIDENCE: An independent advocate visits the home and supports the residents in their communications with the staff and Provider. This helps them to participate in decisions about the running of the home. There are records of activities offered to residents. It is good that the record is completed even when the resident decides not to participate. This is because the record shows there has been opportunity and choice. A resident spoke about weekly bingo and a planned Xmas shopping trip for the next day. Visits from families and friends were mentioned. One of the records of activities referred to a resident declining an opportunity to join in group exercises and bingo. Given that this resident has communication difficulties it may be that she would feel more comfortable with one to one time. Three of the resident questionnaires indicated that they sometimes feel they would like different social opportunities. A staff member felt that she would like to have more time to socialise with residents. Comments from residents confirm that they do feel able to exercise choice and Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 Page 13 control over their lives. One resident felt safe at the home but was also pleased that he was still able to go into town on his own. Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 There are effective systems for dealing with complaints and ensuring the safety of the residents. EVIDENCE: Since the last inspection the Care Manager appropriately informed the Commission of concerns expressed to her by the relative of a resident. These related to the care offered by an agency worker at the home. The concerns were investigated under the local protocol for the protection of vulnerable adults. The outcome of this investigation indicated that the home’s staff had dealt efficiently and openly with the complaint. Further evidence gathered at this inspection confirmed that agency staff are well informed and supported by the home’s staff so that they know how they should care for each resident. Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 19 and 26 Residents live in a safe and well-maintained environment. Recent refurbishment has provided a modern, clean and hygienic home that residents very much appreciate. EVIDENCE: The accommodation has been completely refurbished since Shaw Healthcare was registered as the Provider of the service. This has resulted in a high quality physical environment throughout the building. Specialist equipment has been purchased to improve the comfort of residents and help the staff with their care work e.g. adjustable, electrically operated beds, replacement bedroom furniture, adjustable bath, lounge chairs of varying height and design. Residents were very happy – ‘Shaw have made the home lovely’, ‘I was in hospital recently and I was happy to come ‘home’’. Two residents who rely on wheelchairs had spacious bedrooms to enable them to move around easily. Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 Page 16 The refurbishment has included attention to hygiene aspects e.g. upgrading of main kitchen including a ‘deep clean’, new fridges, new dishwasher. Kitchenettes have been re-fitted. There are new commodes, sluicing machines, and a cupboard designated for storage of a cleaning trolley. Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 and 30 There are enough staff to meet the residents needs although some staff feel unhappy with the way this is achieved. New staff are carefully vetted to make sure they are suitable to work with vulnerable adults and all staff receive the training they need to keep the residents safe and well. EVIDENCE: There are enough staff employed although there is still a reliance on agency staff to maintain this level. Vacancies are advertised but do not always attract suitable applicants. A resident was sensitive to the time pressures on staff, particularly on Mondays when respite residents are admitted to the home. Arrangements for planning future rotas for the permanent staff have been altered and this was causing some dissatisfaction because staff have less notice of future shifts they will be rostered to work. A staff member referred to regular meetings with the management. This provides staff with an opportunity to raise issues about their working conditions. The use of agency staff is carefully managed to ensure continuity of the service e.g. induction record signed by the agency worker and staff supervisor. An agency worker described how she was given information about each resident when she arrived for work at the home. She considered that staff at the home were very supportive. A resident described the support of an agency worker – ‘marvellous – he’s done everything for me’. Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 Page 18 There is a comprehensive programme of staff induction and ongoing training. This complies with national specifications. A staff file contained details of the application of this programme. There is a thorough recruitment process that is jointly managed by the Provider and Care Manager. Documentation relating to this process was seen in a staff file at the home. Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37 and 38 Residents benefit from a very well managed service that is run in their best interests. EVIDENCE: The Care Manager has considerable practical experience and completed relevant training. She has just started work on a Registered Manager’s Award. This is now the recognised qualification for Care Managers. Residents refer to regular contact with management representatives – ‘there is a meeting with a Shaw representative once a month – they’re very kind’, ‘the District Manager consulted me about the service the other day’. The comments reflected confidence in the organisation’s personnel. A staff member said ‘I’d go straight to Tina (Care Manager) if I had a problem’. The Provider has submitted details of the system for dealing with residents’ money. This has been developed with attention to relevant legislation and good practice guidance in order to protect the residents’ best interests. Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 Page 20 Various policies and procedures were seen in the staff room e.g. tissue viability, sexuality, Protection of Vulnerable Adults (POVA). Staff are required to sign in confirmation that they have read new or revised guidance. A staff programme of structured supervision sessions is in place but this has not been fully implemented recently due to senior staff sickness. This will need to be picked up again now the staffing situation has settled down. A staff member is designated the role of Health and Safety Co-ordinator and is given training to enable her to take on this responsibility. There are internal, regular and extensive audits of all aspects of the service. These include a review of records maintained at the home. Staff receive ongoing training in health and safety aspects e.g. manual handling, infection control, and they are given written guidance for managing health and safety areas. The guidance is subject to regular review to ensure it reflects current legislative requirements and recognised good practice. Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 Page 21 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 x 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 4 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 4 3 x 3 2 3 3 Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 Page 22 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. 1 Standard OP36 Regulation 18(2) Requirement The programme of one to one staff supervision sessions must now be re-introduced. Timescale for action 30/11/05 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 OP12 Good Practice Recommendations It is recommended that resident preferences for social opportunities be reviewed with them, particularly when occasional one to one time with staff may suit them best. These exercises should result in related care plans. Staff should be reminded of the value of dating records of assessment, and obtaining resident/representative signatures to reflect their involvement in the process. 2 OP3 Orchard House DS0000060771.V255395.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN 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 DS0000060771.V255395.R01.S.doc Version 5.0 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. 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