CARE HOMES FOR OLDER PEOPLE
Orchard House Weston Drive Market Bosworth Warwickshire CV13 0LY
Lead Inspector Helen Abel Unannounced 4th April 2005, 10:00am 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 Version 1.10 Page 3 SERVICE INFORMATION
Name of service Orchard House Address Weston Drive Market Bosworth Warwickshire CV13 0LY 01455 292988 01455 292988 None Mr John William Nunn Mrs Barbara Elsie Nunn Mrs Sharon Heather Turner Care Home 30 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) Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (5), Physical disability of places over 65 years of age (5) Orchard House Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date imposed 1/4/02No one under the age of 55 years may be accommodated in the home in category PD Date Imposed 22/8/02No more than 5 people who fall within categories PD or PD (E) may be admitted in the home when there are already 5 persons within those categories/ combined categories already accomondated within the home. Date of last inspection 6th December 2004 Brief Description of the Service: Orchard House is one of fifteen homes owned by Mr and Mrs Nunn. The Registered Providers set up the Broadoak Group of Care Homes in 1986. Mr and Mrs Nunn have 17 years experience in providing nursing and residential care. Orchard House is set on a quiet residential road in Market Bosworth. The home is a modern building set on one level surrounded by pretty garden areas, which are maintained by a gardener and enjoyed by service users. The accommodation comprises of single rooms and double rooms all with en-suite facilities. The home provides care for 30 service users. Orchard House Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 5 hours. The Registered Manager was present throughout the inspection. A full tour of the building took place, with care records, policies and procedures inspected. Five service users were interviewed and three visitors were spoken to. What the service does well:
It is evident from observations and the care practices that service users are treated with dignity and respect and their privacy upheld. Service users religious preferences are catered for with religious services held in the home. A range of both indoor and outdoor activities is available to meet the recreational interests of service users. Family and friends of service users confirmed the home was good and staff were approachable. Choice is offered to service users throughout all aspects of their life at the home. All meals are prepared by the home’s cook and are varied and nutritious and tailored to service user’s wishes. Good examples given to the Inspector were as follows: Service users spoken with confirmed a choice of meals was available and the food was good. A service user confirmed a roast meal was her favourite. She asked for new potatoes with her meal and this was promptly provided. The complaints procedure is available to service users, relatives and visitors. Robust policies and procedures are in place for protecting adults. The home provides a safe clean comfortable environment throughout. Bedrooms are personalised and suit individual needs. Staff are adequately deployed to meet the needs of the service users. Robust recruitment policies and procedures support and protect service users including a certified training programme for new staff. Individual staff training programmes are in place ensuring staff are competent to do their jobs. Regular Resident’s Meetings are held with minutes kept. Service users’ suggestions around mugs and cups and portion control were highlighted and subsequent changes made by the home. The Registered Manager holds some finances on behalf of service users with clear records kept. All the relevant checks around health and safety are up to date and recorded. Fire drill training is due for staff the week of the inspection. Orchard House Version 1.10 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Orchard House Version 1.10 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 Version 1.10 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 & 3 The Statement of Purpose / Service User Guide has improved and is now comprehensive and available to service users. Good progress has been made with assessments undertaken for new service users including respite care. EVIDENCE: The Statement of Purpose / Service User Guide contains the most current inspection report and all the required information. This document is available in the office area. Assessments of new service users including a respite service user were in place. The Registered Manager confirmed developing an adapted version for respite/short term care service users. Orchard House Version 1.10 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) 7,8,9 and 10 Service user’ health care needs are reflected in individual care plans. Requirements regarding specialised training around catheter care remain outstanding and have the potential to place service users at risk. Diabetic health checks required to be implemented. Medication management in the home has improved with senior staff receiving accredited medication training. Service users are treated with respect and their privacy is upheld. Improvement required for upholding individual’s dignity around environmental aspects. This shortfall demonstrates institutional practice. EVIDENCE: The home’s care plans were examined and were comprehensive easy to read and follow. Reviews of care are regular with clear records held. The Registered Manager agreed to make positive changes around aspects of report writing of individual care needs. Service users are weighed regularly with records held for weight gain and loss. Records confirm service users have access to hearing and sight tests. The Registered Provider is required to arrange diabetic annual health checks for two service users in line with the National Institute of Clinical Excellence.
Orchard House Version 1.10 Page 10 Managers and senior care staff are all undertaking medication training and reported how useful this was. A recommendation was made around the drugs return book in order to develop the current system. A service users selfmedicating risk assessment was at the point of being completed for a new service user. Her medication was held in a locked facility in her room. A GP attended a Monday morning clinic at the home and visited service users in their rooms safeguarding their privacy. The Registered Manager confirmed the Registered Provider has not provided glass tumblers for service users to drink from. Numerous requests for this purchase have been made. Instead brightly coloured (child-like) plastic cups are used for cold drinks. This aspect demonstrates institutional practice providing the service user group with the same standard cups regardless of their abilities. Failing to treat individual service users in a dignified manner The Registered Manager reported many of the service users enjoy an alcohol drink and are able to use the appropriate beverage glasses for this activity. Orchard House Version 1.10 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) 12,13,14, & 15 Service users within the home are able to exercise choice and control over their daily lives maintain contact with family and friends. Meals offered are balanced and of a high standard. Service users have their social cultural religious and recreational needs met. EVIDENCE: A catholic service is provided in the home monthly and is utilised by service users of different faiths. A Craft lady comes to the home once a month and undertakes a range of activities with services users ranging from planting bulbs, making plant pots, to glass painting. Staff confirmed they recently made gifts of Easter baskets with chocolate eggs with the service users. Some were displayed in the lounge. Regular trips out are arranged by the Registered Manager with a trip in June scheduled to Bradgate Park, and Woodlands Garden Centre in July. Several family and friends of service users confirmed the presentation of meals was good and staff were approachable and will listen to any concerns. Overall they felt the level of care was good. Orchard House Version 1.10 Page 12 Service users are consulted about their chosen clothes, daily pursuits and refreshments and meal choice. A service user with limited communication was observed being offered a meal choice by a staff member. The service user made her decision known by quietly communicating her choice. Meals provided are freshly prepared and cooked with fresh products obtained from the local outlets, the butchers supplies sausages, bacon and free-range eggs. Special diets are catered for. When service users are unwell an alternative meal is provided. This maybe a light soup, sandwich as the service user requests. Orchard House Version 1.10 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 handled objectively and service users are confident that their complaints will be listened to and acted upon. Policies and procedures are in place ensuring a proper response to any suspicion or allegations of abuse. EVIDENCE: The complaints procedure is displayed by the front door and a copy of the complaints procedure is held in the Statement of Purpose/Service User Guide. Service users confirmed they felt able to complain if they were not happy with things. Policies and procedures around protecting adults are held in the home. Further guidance for staff is available in the staff Induction and through National Vocational Training Qualification training. Orchard House Version 1.10 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) 19,20,23,25.26 Improvements have been made to the environment around heating and hot water temperatures ensuring safety to service users. The home provides a safe clean comfortable environment throughout. Bedrooms are personalised and suit individual needs. EVIDENCE: The home is safe, clean and fresh throughout with maintenance generally up to date. The Registered Provider is looking to upgrade the windows throughout the home this year. This is due to some of the windows being cold and draughty. Service users are able to bring in their own pieces of furniture. Bedrooms are personalised and individual and suit their needs. The fire and environmental health authorities visited the home in 2004 and have confirmed safety aspects are in place. Fail safe devices are in place to prevent risks of scalding with regular monitoring of hot water temperatures held. The laundry area is clean and well organised with printed guidance around good hygiene practice displayed.
Orchard House Version 1.10 Page 15 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 Staff are adequately deployed to meet the needs of the service users. Robust recruitment policies and procedures support and protect service users including a certified training programme for new staff. Individual staff training programmes are in place ensuring staff are competent to do their jobs. EVIDENCE: Staff rotas were examined and staffing levels discussed. They meet the needs of the service user group. A service user spoke about staff being available to run errands at the shop and was very happy with her keyworker. New staff receive a 6 week certified staff induction that equips them with core skills in care practices. Completed inductions packs were evident. Staff recruitment records were in order with criminal record checks kept up to date. Staff receive ongoing training in manual handling, medication management, infection control and others. Training records confirmed this. Food hygiene training is also provided. The Registered Manager is pursing arrangements for a staff member to receive specialist training in food hygiene. Orchard House Version 1.10 Page 16 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) 33,35,38 Service users are regularly consulted about life in the home. Service users finances are safeguarded with robust policies and procedures. The home promotes the health, safety and welfare of the people using the service. EVIDENCE: Regular Residents Meetings are held with minutes kept. Service users suggestions around mugs and cups and portion control were highlighted and subsequent changes made by the home. The Registered Manager holds some finances on behalf of service users with clear records kept. All the relevant checks around health and safety are up to date and recorded. Fire drill training is due for staff the week of the inspection. One outstanding requirement from the last inspection of the 4th December 2004 around checking for Asbestos is still to be met by the 31st May 2005. Orchard House Version 1.10 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4
COMPLAINTS AND PROTECTION 3 3 x x 3 x 3 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 Standard No 16 17 18 Score 3 x 3 x x 3 x 3 x x 3 Orchard House Version 1.10 Page 18 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 8 Regulation 12 Requirement To make proper provision for the health and welfare of service users. To organise diabetic health checks for the identified service users. The Registered Provider is required arrange a competent person to undertake a check for asbestos and produce a report/risk assessment to this effect.(Previous timescale 31st may 2004 from inspection of the 4th December 2004) The Registered Provider is required to make suitable arrangements to ensure that the care home is conducted in a manner which respects the dignity of service users.To provide glass tumblers to service users for mealtimes (in line with individual risk assessments). Timescale for action 4th May 2005 2. 12 38 31st May 2005 3. 12 10 31st May 2005 Orchard House Version 1.10 Page 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 8 Good Practice Recommendations It is recommended the Registered Manager look to arrange catheter care training by the Community Health Service team. (Remains outstanding since the last inspection of the 6th July 2004) To set up a carbon copy drugs return book 2. 9 Orchard House Version 1.10 Page 20 Commission for Social Care Inspection 5 Smith Way Grove Park Enderby Leicestershire LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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