Inspection on 05/02/06 for Orchard House

This inspection was carried out on 5th February 2006.

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 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 22/06/05

Orchard House 06/10/04

Orchard House 01/06/04

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Ravenhurst

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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 Roy Buckland Unannounced Inspection 5th February 2006 10:00 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 DS0000018668.V282165.R01.S.doc Version 5.1 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 DS0000018668.V282165.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Orchard House Address Kinnersley Severn Stoke Worcestershire WR8 9JR 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) 01905 371445 Mr Anthony Gordon Williams Mrs Susan Harris Mrs Lavinia Rachel Williams Care Home 39 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (39), of places Physical disability over 65 years of age (39) Orchard House DS0000018668.V282165.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd June 2005 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 DS0000018668.V282165.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a Sunday morning until lunchtime. The inspection consisted of a brief tour of the building, examination of 3 residents’ care plans, records relating to health and safety and other management documents. At the time of the inspection the home had no vacancies and all the residents were present. Four residents, three relatives and one member of care staff were spoken to during the visit. What the service does well: What has improved since the last inspection? Records relating to resident’s activities and risk assessments included more information. Orchard House DS0000018668.V282165.R01.S.doc Version 5.1 Page 6 Suitable locks had been fitted to residents’ bedroom doors. Matters concerning the building relating to health and safety had been attended to. 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 DS0000018668.V282165.R01.S.doc Version 5.1 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 DS0000018668.V282165.R01.S.doc Version 5.1 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): 1,2,3,4 Information about the home is available to help prospective residents make a decision about where to live. 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 service users guide was given to individual prospective residents or their relatives. 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. Orchard House DS0000018668.V282165.R01.S.doc Version 5.1 Page 9 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 DS0000018668.V282165.R01.S.doc Version 5.1 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): 7,9,10 There is a clear care planning system in place. There are policies and procedures in place that ensure medications are dealt with correctly. Service users feel that they are treated correctly. 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. General risk assessments were kept in the care plan including risk assessments for skin care and nutrition. One resident who had displayed challenging behaviour had an individual risk assessment put in place, and instructions given to staff as to how to manage the behaviour. A risk assessment for the use of bed rails had been signed but some others had not. The inspector observed the administration of the lunchtime medications. Orchard House DS0000018668.V282165.R01.S.doc Version 5.1 Page 11 Each of the residents and their relatives consulted by the inspector reported that they were treated with respect. Orchard House DS0000018668.V282165.R01.S.doc Version 5.1 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, 15 The service users found that the lifestyle in the home suited them well. Service users generally maintained contact with some relatives and friends. 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. Participation of each resident in these activities was recorded. However where the record showed that a resident had participated in few activities it was not possible to determine if this was through choice or lack of opportunity. Residents’ relatives who spoke to the inspector stated that they enjoyed their visits to the home. 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. Orchard House DS0000018668.V282165.R01.S.doc Version 5.1 Page 13 Some residents needed help to eat their meals and this was provided appropriately. Orchard House DS0000018668.V282165.R01.S.doc Version 5.1 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 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 complaints received by the home and actions taken. The Commission for Social Care Inspection had received one complaint since the last inspection regarding the behaviour of a member of staff and the home had dealt with this appropriately. Orchard House DS0000018668.V282165.R01.S.doc Version 5.1 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, 20, 21, 23, 25, 26 Whilst the environment was predominately safe and well maintained there were deficiencies concerning hot water temperature and some fire door closures. The communal facilities were safe and comfortable. Residents found that the premises suited their needs. EVIDENCE: The inspector visited all communal parts of the premises, which were found to be pleasant and clean. The hot water supply to one bath was found to be above the recommended safe temperature. A record of water temperature checks had not been kept. Two self-closing fire doors did not latch shut, consequently the pressure differentials that occur during a fire could cause them to open. Two fire exit doors adjacent to the laundry were controlled by locks that could delay opening in an emergency.. Orchard House DS0000018668.V282165.R01.S.doc Version 5.1 Page 16 Strip lights throughout the communal areas of the home had been fitted with covers . One of the stair lifts has been removed from the staircase. Gates had been installed to eliminate the risk of residents falling down the stairs. unfortunately the gates are unsightly but the inspector is unable to offer any alternative suggestions unless an up to date risk assessment should show that the current residents are not at risk of falling down the stairs. There were no small tables in the lounge areas for residents to put drinks on. Since the previous inspection such tables have been provided but, although substantial, they have broken when it had proved impossible to dissuade some residents from sitting on them. Approved locks on residents’ bedroom doors had been fitted. Some toilet areas visited upstairs were locked but this did not concern the inspector because they were adjacent to bedrooms that had en suite facilities. The pleasant garden areas were accessible by ramps. The laundry area had been upgraded and new equipment provided to ensure better infection control measures. The residents and their visitors consulted by the inspector had no criticisms relating to the premises. Orchard House DS0000018668.V282165.R01.S.doc Version 5.1 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, 30 There are sufficient staff to meet service users’ needs. Core training for staff is provided regularly. EVIDENCE: In addition to the deputy manager there were 5 care staff on duty at the time of the inspection. The residents and their visitors who the inspector consulted stated that staff were readily available to attend to residents needs. Staff training records showed that external trainers regularly visited the home, the member of staff spoken to by the inspector confirmed that she had received induction and training in the most important topics. The home was experiencing some difficulty in attaining 50 of NVQ2 qualified staff because several staff were from overseas and they will not be eligible for the training until they have been resident for two years. Orchard House DS0000018668.V282165.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 36,38 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. Those records examined by the inspector were well maintained. Fire safety was taken seriously but the fire procedure was incomplete. EVIDENCE: The registered manager and deputy manager are both very experienced and knowledgeable about the resident group. The registered manager has still to undertake some additional training she needs to bring her current qualification in line with the Registered Managers Award. Orchard House DS0000018668.V282165.R01.S.doc Version 5.1 Page 19 There was no overall quality assurance system in place for the regular auditing of all aspects of the service provided. The registered manager intends to research the various systems available with a view to purchasing a suitable package. The member of staff spoken to by the inspector confirmed that she attended regular supervision and staff meetings. 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 had been carried out. Deficiencies concerning fire extinguishers had been corrected and the front door lock replaced with one linked to the fire detection system. The current record of fire safety checks was up to date but the fire evacuation procedure did not include transferring the service users to warm shelter after evacuation. Apart from in exceptional circumstances the home does not have dealings with residents’ personal monies, consequently residents usually rely upon a relative or a professional representative to assist them in controlling their monies. Accident records were kept in the victim’s file, this made it difficult to identify trends. Orchard House DS0000018668.V282165.R01.S.doc Version 5.1 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 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 2 3 3 x 3 x 2 3 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 3 x 2 Orchard House DS0000018668.V282165.R01.S.doc Version 5.1 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 2 3 4 Standard OP8 OP19 OP19 OP25 Regulation 13 23 23 13 Requirement All risk assessments must be signed by a senior member of staff. Self-closing fire doors must shut sufficiently for the latch to engage. Fire exit doors (laundry) must not be controlled by key operated locks. The temperature of water from bath hot water taps must be checked at least once a week to ensure that it does not exceed 43C. A record must be kept that these checks have been carried out. A quality assurance program must be introduced in line with Standard 33 and Regulation 24 Timescale for action 28/02/06 28/02/06 31/03/06 28/02/06 5 OP33 24 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000018668.V282165.R01.S.doc Version 5.1 Page 22 Orchard House 1 2 3 4 5 Standard OP7 OP31 OP31 OP31 OP38 The record of activities in which residents have participated should include activities that have been offered but declined. The registered manager should pursue the training necessary to achieve the registered managers award. A quality assurance program must be introduced in line with Standard 33 and Regulation 24 Copies of accident records should be kept in a dedicated file. The fire evacuation procedure should include the location of premises where the residents can take shelter after evacuation. Orchard House DS0000018668.V282165.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Worcester Local Office 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. Extracts may not be used or reproduced without the express permission of CSCI Orchard House DS0000018668.V282165.R01.S.doc Version 5.1 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. 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