Random inspection report
Care homes for older people
Name: Address: Orchard House Orchard House Kinnersley Severn Stoke Worcestershire WR8 9JR zero star poor service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sarah Blake Date: 0 6 1 1 2 0 0 9 Information about the care home
Name of care home: Address: Orchard House Orchard House Kinnersley Severn Stoke Worcestershire WR8 9JR 01905371445 01905371017 awilliar51@aol.com www.orchardhouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Anthony Gordon Williams,Mrs Susan Harris care home 39 Number of places (if applicable): Under 65 Over 65 0 39 0 dementia old age, not falling within any other category physical disability Conditions of registration: 39 0 39 Age: Physical disability (PD) age 55 and above. The maximum number of service users who can be accommodated is: 39 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 39, Old age, not falling within any other category (OP) 39, Physical disability (PD) 39 Date of last inspection Care Homes for Older People Page 2 of 11 Brief description of the care home Orchard House is registered to provide residential care for up to 39 older people who may have a physical disability or a dementia type illness. The home is an adapted country house with a purpose built extension situated in a rural setting. The home is about six miles from Worcester city. There is a local pub but no other amenities within walking distance. There is a regular local bus service. The home has ample car parking both at the front and side of the building. Accommodation is on two floors. People are able to access the first floor by means of a passenger lift, a stair lift or by using the stair cases. Handrails are fitted to assist mobility. On the first floor there are 16 single bedrooms, 9 of which have en-suite facilities, and 6 shared rooms, 4 of which have an en-suite. On the ground floor there are 7 single bedrooms, all of which have en suite facilities, and 2 shared rooms. There are 3 assisted bathrooms and 7 separate toilets throughout the home. People using the service have access to two communal lounges and a separate dining area. There is an accessible and well-maintained garden for people to sit in. Information regarding the current level of fees was not included within the copy of the Service Users Guide given to us at the time of our visit. The reader should therefore contact the service directly for up to date details. A copy of this inspection report is available to view at the home. Care Homes for Older People Page 3 of 11 What we found:
At the last key inspection carried out on 17 September 2009, we found areas of concern which put people living at the home at high risk of poor outcomes. We therefore made two requirements with a short timescale for compliance. This was because we had concerns that people living in the home may have been put at risk or not have their needs attended to correctly. We carried out this inspection to check what action the owners of the home had taken to comply with these two requirements. We will be returning to the home to check on the other requirements made at the inspection of 17 September 2009 at a later date. This report is set out using the topics from the requirements as headings. Two inspectors visited the home unannounced to carry out this inspection. RISK ASSESSMENT FOR USE OF BED RAILS: At the key inspection in October 2009, we saw that two people had bed rails on their beds. Records showed that written risk assessments had not been carried out. The use of bed rails is potentially dangerous, due to the risk of entrapment, so we made an immediate requirement that the home must carry out risk assessments for the use of bed rails. The deputy manager subsequently sent us copies of the risk assessments. These had been fully completed and explained clearly what the risks were and how they should be managed. We looked at the bed rails on one persons bed and confirmed that the risk assessment was accurate. We saw records which showed that staff are now carrying out weekly assessments of the bed rails to make sure that they are safe to use. This is good practice. We therefore consider that this requirement has been met. ENSURING THAT PEOPLES MOBILITY NEEDS ARE MET: At the key inspection, we found that staff at the home were using potentially dangerous techniques to assist people with their mobility. We made a requirement with a timescale of 28 days that the home must ensure that an effective system is in place to manage peoples mobility needs. We looked to see how staff were assisting people who needed help to mobilise. We saw two staff transferring a person using the stand-aid hoist. The staff positioned the sling incorrectly, and, as the hoist was raised, the person was leaning back and could not hold onto the hand rail of the hoist. As the hoist was raised higher, the sling began to ride up under the persons armpits, and their arms and shoulders began to move upwards. The sling was seen to be placing stress on the armpits, and this put the person at risk of fracture or dislocation. We have referred this to the Local Authority under its procedures for the protection of vulnerable adults, as we consider that this technique puts the person at a high risk of injury. We wanted to see if the home had assessed this persons mobility needs. Records showed that there was no assessment in place for the use of the stand-aid hoist and no
Care Homes for Older People Page 4 of 11 instructions for staff to tell them how to use it safely. We spoke to a senior carer, who said that the staff should have used the sling hoist, which is used to transfer people who are not able to bear their own weight. There was no assessment in the persons records for the use of the sling hoist. This means that there were no instructions for staff to know when to use it and how to use it safely for this person. We saw a carer wheeling someone into the lounge in a wheelchair with no footplates. Footplates should be used to support feet, as dangling legs and feet can easily catch and be damaged. The weight of hanging legs can also cause people to slide forwards off the chair and can set up shearing forces in the skin that can lead to deep pressure damage or cause spasms, pain or discomfort. The wheelchair was tipped backwards to an angle of approximately 45 degrees, so that only the two back wheels were in contact with the floor. This is dangerous as the wheelchair is then unstable and can easily tip over. The carer then pushed the wheelchair near the sling hoist, at which stage the persons feet were dragging on the floor. The padding on the footplate mounting on one side of the wheelchair had become loose, and bare metal was exposed. This put the person at risk of injury from the edges of the metal mounting. We saw that the person was then transferred from a wheelchair onto an armchair using the sling hoist. We saw that staff carried out this technique safely and reassured the person throughout the transfer. When we looked at the persons records, we saw that there was no assessment in place for the use of the hoist. We saw other examples of poor practice in the management of peoples mobility needs during the inspection, and we consider that this requirement has not been met as per timescale of 6 November 2009. This has been referred to the Regional Enforcement Team to consider what further action may be undertaken. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2.
Care Homes for Older People Page 5 of 11 Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 7 15 (1) You must ensure that 23/11/2009 peoples mental health needs are fully assessed and that care plans explain clearly how these needs will be met. This is so that people can be confident that their mental health needs will be met. 2 8 12 (1) You must ensure that an effective system is in place to manage peoples mobility needs. This is so that people are not at risk of harm or injury. 22/10/2009 3 9 13 (2) You must ensure that records of the receipt, administration and disposal of medication are accurate. This is so that people can be confident that the home manages medication safely. 23/11/2009 4 10 12 (4) You must put an effective 23/11/2009 system in place to ensure that the home is conducted in such a way that people are treated in a manner which respects their privacy and dignity at all times. This is so that people can be Care Homes for Older People Page 7 of 11 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action confident that the service will promote and respect their dignity. 5 12 12 (1) You must ensure that the 23/11/2009 activities provided by the home meet peoples individual physical and mental health needs. This is so that people are able to take part in social and leisure opportunities which meet their needs. 6 18 19 (1)(b) You must obtain in 23/11/2009 respect of all persons employed at the home all of the relevant information and documents as required by Regulation 19(1)(b) and paragraphs 1 - 9 inclusive of Schedule 2 of the Care Homes Regulations 2001 prior to them commencing employment. This is so that people can be confident that only suitable staff are employed at the home. 7 30 12 (1) You must ensure that 23/11/2009 staff have the skills and knowledge necessary to provide care which meets the needs of the people living at the home. This is so that people can be confident that they will be cared for by staff who are trained and competent to do their jobs.
Care Homes for Older People Page 8 of 11 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 8 38 13 You must ensure that an 23/11/2009 effective system is in place to ensure that all parts of the home are safe for people who live there, within a risk management framework. This is so that people can be confident that they are not at risk of harm or injury. Care Homes for Older People Page 9 of 11 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 10 of 11 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
