Inspection on 09/06/08 for Orchard House

This inspection was carried out on 9th June 2008.

CSCI found this care home to be providing an Adequate service.

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 06/11/09

Orchard House 17/09/09

Orchard House 16/01/07

Orchard House 05/02/06

Orchard House 22/06/05

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Orchard House Kinnersley Severn Stoke Worcestershire WR8 9JR Lead Inspector Andrew Spearing-Brown Unannounced Inspection 9th June 2008 07:40 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.V365922.R01.S.doc Version 5.2 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.V365922.R01.S.doc Version 5.2 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 01905 371017 awilliar51@aol.com www.orchardhouse.co.uk 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.V365922.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2007 Brief Description of the Service: 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 maximum number of people who can be accommodated under the category of dementia is 30. 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 User’s Guide given to us at the time of our visit. The reader should therefore contact the service directly for up to date details. Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We, the Commission, carried out this key inspection without any prior notice. A key inspection is one in which we look at all the aspects of the service that are most important to people using it. This inspection was undertaken over a period of two days. Both of the visits commenced at or just after 7.30 in the morning. This inspection takes into account information we have received since the last inspection as well as the visits to the home. Sometime before the inspection an Annual Quality Assurance Assessment (AQAA) was completed by the registered manager and her deputy and returned to us. The AQAA is a self-assessment and a dataset that each registered provider is required to complete each year. The AQAA tells us about how providers of the service are meeting outcomes for people who use the service. The AQAA is also an opportunity for people to share with us where they are doing well. We sent out a number of questionnaires to people using the service and some members of staff. Prior to visiting the service we received some of these back. We have included some of the comments obtained within this report. During the inspection, discussions were held with the registered manager, the deputy manager, one of the registered providers, a number of staff members and some people using the service. We had a look around the home and observed what was happening. In addition, we viewed the care documents regarding some people using the service such as care plans, risk assessments and daily records. We also viewed medication records and staff records. What the service does well: Information about the home is available for people to refer to. This information helps people to decide whether they wish to reside at Orchard House. People’s care needs are assessed before they move into the home to ensure that these needs can be met. People are supported by good caring staff. A relative wrote on a survey: Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 6 They treat residents with kindness.’ ‘ All the staff are caring and cheerful, which gives the home a happy atmosphere.’ People receive the medications that are prescribed for them. Meals are good and people enjoy their food. A complaints procedure is available and people are aware of their right to make comments about the service provided. Recently refurbished bedrooms are attractive. People living in the home are able to personalise their own bedrooms. What has improved since the last inspection? What they could do better: More attention needs to be given to reviewing and updating care plans and risk assessments so that staff have clear and current information about how to meet people’s needs. The morning routine needs to be reviewed so that people feel able to get up when they want to and to be offered drinks if they choose to get up early. A review of staff training needs to be undertaken and an action plan drawn up to meet any shortfalls. Some parts of the home are still in need of refurbishment in order to improve the environment in which people live. Some management procedures need to be improved to ensure that a quality service is provided and to ensure that people are kept safe and have all their needs met. Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 8 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.V365922.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3 and 5. Standard 6 is not applicable. Quality in this outcome area is good People who may use the service can look at information about Orchard House and visit the Home before they move in. An assessment is carried out before people arrive at the home, to ensure that staff are able to provide the care people need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A comprehensive Service User’s Guide was made available to us when we visited the home. The guide contains sufficient information to help people decide whether the service is able to meet their needs. The service user’s guide can be provided in large print if required. We were told that plans to develop a DVD guided tour of the home are still being considered. Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 10 We looked at the records of a person who had recently moved into the home and saw that care needs had been assessed prior to the admission. The information available was sufficient to devise an initial care plan. A relative told us ‘My ** has only been at the home for just over one month but I am pleased with the service so far’. One person using the service told us that he was able to visit the home and have a look around before agreeing to move in. Records held confirmed that a visit had taken place. A relative wrote on a survey returned to us: ‘I went round a lot of homes before ** went to Orchard House me and my ** thought this was the best in this area’. The service does not provide intermediate care and has no plans to do so in the future. Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. Quality in this outcome area is adequate People’s needs are assessed and written down in care plans but these are not always detailed enough or an accurate reflection of current needs. As a result there is a risk that people will not always receive safe and appropriate care. Medication is given safely and as prescribed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the care records of four people using the service. Each person had a care plan which was clearly laid out and contained information to assist staff provide care. Care plans contained details about a range of care needs such as one plan stating that staff need to spend time with one person when in the bath due to her getting scared. Care plans contained information about Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 12 end of life wishes. Care plans are reviewed on a regular basis and are reprinted following the review with the amendments in place. Many people using the service would find it difficult to be involved in devising their care plans, so creative ways need to be found to ensure that the approach to care planning is ‘person-centred’. We were pleased to note that the AQAA states that over the next 12 months the home hopes to: ‘Encourage relatives to become more involved in care planning.’ Amendments made when care plans are reviewed do not always provide enough detail about how staff should respond to changing needs. For example one care plan said ‘mobility is slowly getting more restricted . . . taking medication for this and to be monitored over the next few months.’ The same statement appeared in a care plan dated November 2007. We saw no guidance within the review as to how the monitoring was to take place or what the goal was. Risk assessments did not always match the care plan. We saw a risk assessment dated 25/10/06 which said ‘ensure ** uses a frame’, and another which stated that the person may wander at night and may leave the building. The care plan stated that this person no longer used a frame and needed a wheelchair. We were concerned regarding some entries on the daily records which evidenced that the person was ‘non weight bearing’, ‘very heavy’ and ‘hard to lift’. We were informed that although a hoist is available it is not used. We saw staff doing one transfer. It was carried out sensitively and staff communicated with the person concerned throughout. However, the technique used (an underarm lift) was unsafe for both the person concerned and the staff. One carer stated that she believes people get ‘100 care, all here do our best.’ We received very limited information from people who use the service from the questionnaires we sent out. The vast majority were returned completed by a member of staff saying ‘Resident did not understand’ People are able to access health care services within the home and in the local community. We saw pressure relieving equipment in use in one bedroom. This was used to prevent the person developing a sore. The use of this equipment and the involvement of the community nurse was detailed within the care plan. Although we did not note any specific concern regarding the health care needs of people using the service, the lack of drinks provided on waking, as detailed within the following section, was of concern. All personal care, such as when people get up in the morning and the provision of drinks, needs to be responsive to individual preference. Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 13 When we viewed staff assisting people to eat, people were assisted to eat in a caring manner. However, one member of staff was feeding two people at the same time. This practice may be unsafe but also lacked suitable respect for each person’s dignity and a person centred approach to providing care. We assessed the storage, administration and management of medication. One member of staff has delegated responsibility for medication. The records held were in good order. We carried out an audit on some antibiotic medication and found them to balance. Staff need to ensure that they always record the date of opening on items not included in the monitored dose system supplied by the pharmacist. In addition a second signature is needed to verify that handwritten entries on the medication records are correct. Since our last inspection the home has improved the storage facilities for controlled medication. Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. Quality in this outcome area is adequate People using the service are able to participate in a limited range of activities that are on offer both inside and outside the home. They are able to keep in touch with family, friends and representatives. Meals are nutritious and attractive but greater consideration needs to be given to the specific needs of some individuals in respect of food and drink. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following our first visit to the home and some initial concern regarding whether people using the service received a drink on waking or shortly afterwards our second visit commenced at 7.30 am. On arriving at the home, 14 people were sitting in the dining room. We noted that 6 people were either sleeping or had their eyes closed. Another 3 people were sitting in one of the lounges, one of whom was asleep. Three night carers were on duty. A carer told that they had got the first person up at 5.45 a.m. Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 15 There was no evidence to suggest that anybody had received a drink even though people had been awake for up to 1¾ hours. We asked staff whether people had received a drink. One carer did not understand what we were asking but another replied ‘no’. Carers stated they were too busy to get drinks and that the day staff did drinks when they came in. Prior to the day staff coming on duty somebody in the lounge asked for a drink. The night carer called through to a colleague saying that the person wanted a drink. At 7.50am, a member of staff came on duty and started to distribute mugs and beakers of tea. This member of staff said making tea was always her first job and stated that ‘people are got up early.’ We asked one person who uses the service about the early morning routine in the home. The person concerned confirmed that she/ he had got up early that morning (personal choice). The same person also told us ‘we don’t get a drink until 8.00am’. We were concerned that some people might be getting up earlier than they would like to because of the morning routine and then not being able to get a drink unless they were able to ask. We brought our findings to the registered manager and the deputy manager. Both agreed that this was not acceptable practice and undertook to address the matter. The menu was on display in the dining room. Lunch was roast pork and stuffing with roast potatoes, boiled potatoes, cabbage, swede and carrots. Afterwards people were able to choose between apple turnover with cream or fruit coulis or gateaux or ice cream. One person said that the ‘food is first class’ another person said that it is ‘quite good.’ We asked some staff for their opinion on the food provided, one person stated ‘very good’. A relative stated on a survey form that the food is ‘excellent’. We saw limited information regarding activities within the home. They are mainly listening to music or watching DVD’s. Other occasional activities consist of walks in the garden, manicures and hairdressing. A hairdresser was visiting the home during this inspection. A mini bus was recently replaced by a people carrier which enables small groups of people of have trips out such as shopping in Upton-Upon-Seven. One visiting professional believes that the service needs to incorporate more activities to keep people’s minds stimulated. Representatives from a number of different churches maintain contact with people using the service to ensure that religious needs are met. Although we did not manage to consult any visitors during this inspection we have no reason to believe that people are not welcome at any time. The Service User’s Guide states ‘Visitors are welcomed into the home, we only ask Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 16 that you avoid lunchtimes as this is one of our busiest times of the day.’ A visiting professional told us that the home is ‘very friendly and open to visits.’ Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is good Information about making a complaint is available and people are aware of their right to make a complaint. There are procedures in place to help ensure that people are safeguarded from the risk of neglect or abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure is displayed within the home. Additional information about complaints is included within the Service User’s Guide. The information within the guide needs to be amended to not only reflect our new address but also to reflect that a complaint can be referred to us at any stage. Information on the Clients Complaints Procedure is detailed but also needs to be amended. We asked some people using the service what they would do if they were unhappy with the service provided. One person said ‘don’t know, haven’t given it much thought’ while somebody else was confident that ‘staff would listen if unhappy.’ Another person said ‘I can’t complain at all about this place.’ A relative said ‘I’ve never had need to complain. I can always speak to them if I have any worries.’ Since the last key inspection we have received two anonymous complaints about the service provided at Orchard House, primarily in relation to night staff Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 18 duties. These were sent to the registered provider to investigate under their own complaints procedure. We received a reply in response to these concerns which indicated that they had been addressed in an appropriate manner. Information was available in the home to help staff, and, others what should be done if there was any suspicion of neglect or abuse. The AQAA states: ‘Training in the Protection of Vulnerable Adults is undertaken by all staff and updated annually.’ Training records were not being maintained in such a way that this could be confirmed, but there was evidence that at least 4 staff had been trained in June 2007 and July 2008. This training needs to be monitored better in future. Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. Quality in this outcome area is good People live in a clean and pleasant home. Improvement to the environment would further enhance people’s experiences within the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As part of the visit we viewed communal areas of the home and a small number of bedrooms. On the ground floor the home has a large dining room and two lounges. Some of the chairs in the lounge are new while others are showing signs of wear and tear. The carpet in the larger lounge was stained in places. The dining room needs to be redecorated. The furniture in the dining room is satisfactory and the lighting is domestic in appearance. Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 20 Some communal toilets appear ‘tired’ and are in need of refurbishment. Other communal facilities are fully tiled for easy cleaning. The laundry is also fully tiled. We saw a bar of soap, nail clippers and a disposable razor in one bathroom. These items pose a risk of cross infection and should not be stored in communal areas. Staff had disposal gloves available to them and we saw staff changing them as required. We are not aware of any outbreaks of any infections within the home. The home offers a mixture of both single and double accommodation. We were shown a recently refurbished bedroom. This room was particularly attractive with matching curtains and bed linen. We viewed some other bedrooms all of which were clean and contained personal items belonging to people residing within the home. The bed linen was clean. Windows have restrictors in place although the screw on one was working its way out. The registered provider needs to keep the suitability of window restrictors under review to prevent either accidental or deliberate falling to the ground. A certificate awarded by the local district council was displayed. The home was assessed as ‘very good’ in March 2007 in relation to food hygiene. Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. Quality in this outcome area is adequate Recruitment procedures help to safeguard people from the risk of unsuitable staff being employed. There are sufficient staff on duty to ensure that people using the service have an appropriate level of support. However, staff training is not recorded and monitored well enough to assure people using the service that the staff have necessary knowledge and skills to provide safe and effective care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We viewed the current weeks rota. Usually six carers are on duty between 8.00 in the morning and 5.00 in the afternoon. After 5.00 pm the staffing levels reduce to five carers. The night shift is covered by three carers and other people on call as necessary. We asked for evidence of staff training. As no matrix was available and some certificates were not at hand the registered manager requested information from the training provider. These records showed that during 2007 training had taken place covering medication, health and safety, infection control, dementia awareness and safeguarding. On examining the information from the training provider it was evident that some staff no longer working at the Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 22 home. For some training it was not possible to establish who had attended. Staff who responded to our survey stated that they had received training that is relevant to their job and keeps them up to date with new ways of working. In order to establish the training needs of staff a full audit of training undertaken should happen. Following the audit the registered manager should carry out an action plan in order to address any shortfalls found. At the time of this inspection a total of 14 carers were employed at Orchard House. We were told that 2 people have undertaken a level 3 NVQ (National Vocational Qualification) and 2 have undertaken a level 2. Therefore 29 of staff have achieved this training which is less than the 50 necessary to meet the National Minimum Standard. Recruitment procedures were found to be generally satisfactory. However, the registered manager was not aware that CRB (Criminal Records Bureau) checks are not transferable. We also discussed the need to ensure that references are obtained and that information regarding referees and employment history matches. One relative said ‘Orchard House are friendly, kind and treat the residents with dignity, kindness and cheerfulness’. Another commented ‘The staff are always cheerful and helpful when I visit my mother or speak to them on the phone’. Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38. Quality in this outcome area is adequate The home is managed in a way which usually meets the needs of people who use the service. Monitoring by the management is not always robust enough to ensure that good quality outcomes are maintained in all aspects of the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager informed us that she has the City and Guilds Advanced Management in Care qualification. The National Minimum Standards say that registered managers should hold both a care and a management qualification. The manager informed us that she does not intend to seek Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 24 further qualification, having worked in care for a considerable period of time and gained considerable experience, but she is prepared to undertake other relevant training. Prior to the inspection we requested the completion of the AQAA (Annual Quality Assurance Assessment). This document was returned to us as required and gave us the information we asked for. We were informed that a Quality Assurance system is not yet in place although there are plans to introduce one. This is a priority, so that the service can monitor the standards of care provided and assess the outcomes for people using the service. Orchard House does not hold any money in safe keeping on behalf of people using the service. A certificate showing details of the home’s public liability insurance and the certificate of registration was displayed in the hallway. The registered manager told us that she is aware that, following some slippage, the formal supervision of staff needs to be improved. Having a system in place for this helps to ensure that staff have suitable support and enables standards of care to be monitored and developed. The registered manager is aware that we need to be informed of certain events in the care home that affect the well being of people using the service. We have received a number of notifications since the last key inspection. We are not aware of any incidents when we were not suitably informed. We viewed some records and servicing certificates to demonstrate that equipment and the building is safe. The majority of these were available and evidenced that checks had taken place. No evidence regarding the most recent servicing of portable hoist or the hoists over the baths could be found. Records to indicate hot water temperatures delivered to bathrooms were not available. The last one was dated 07/07 therefore a year ago showing water to be too hot. Assurance was given that new valves were fitted to safeguard people against potential scalding. Fire records are maintained. A fire risk assessment dated March 2007 was seen to have some actions needed with no indication that they had happened. Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 25 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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 x X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations The reviewing of care plans should ensure that they reflect both changing care needs and changing situations to ensure they read accurately. Systems should be in place to ensure that risk assessments are up to date and that they provide staff with strategies to reduce the risk of injury. People using the service should be able to access drinks throughout the day and at times convenient to them. A system should be in place to ensure that staff recruitment systems are always robust enough to ensure that no new members of staff are employed in the home prior to having the documents referred to in schedule 2 which match information upon the application form. DS0000018668.V365922.R01.S.doc Version 5.2 Page 27 2 OP8 3 4 OP12 OP29 Orchard House 5 6 OP30 OP33 An audit of training undertaken by staff should be done and an action plan devised as a result of the findings. The current quality assurance system should be reviewed to ensure that it takes into account the experiences of people using the service. Window restrictors in use should be kept under review to ensure they are suitable and well maintained in order to keep people safe from injury. 7 OP38 Orchard House DS0000018668.V365922.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V365922.R01.S.doc Version 5.2 Page 29 - 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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