Inspection on 18/11/08 for Orchard House Care Home

This inspection was carried out on 18th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orchard House Care Home 21/11/07

Orchard House Care Home 18/01/07

Orchard House Care Home 26/01/06

Orchard House Care Home 16/03/05

Orchard House Care Home 16/11/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Orchard House Care Home 46 Easthorpe Street Ruddington Nottingham NG11 6LA     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Karmon Hawley     Date: 1 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Orchard House Care Home 46 Easthorpe Street Ruddington Nottingham NG11 6LA 01159217610 Telephone number: Fax number: Email address: Provider web address: debbie@ruddingtonhomes.co.uk Name of registered provider(s): Type of registration: Number of places registered: Ruddington Care Homes care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Service users shall be within category DE (26) Service users shall be within catgory OP (26) Date of last inspection Brief description of the care home Orchard House is an adapted and extended period property situated in the village of Ruddington on the outskirts of Nottingham and situated on a bus route. Local amenities including, shops, banks, library and the local doctors surgery are within a ten-minute walk. The home is registered to provide care and accommodation for up to twenty-six older people who may also be diagnosed with some form of dementia. Each bedroom accommodates one person and nineteen bedrooms have en-suite facilities. The home has a stairlift for people using the service that have some mobility problems and are unable to walk the stairs safely. There are large, attractive gardens to the rear of the property and a car park to the front. The home and grounds are easily accessible to service users. The weekly fees for care and accommodation at the home range from £400 - £691, depending on the accommodation and level of assessed need. Care Homes for Older People Page 4 of 25 Over 65 0 26 26 0 Brief description of the care home Inspection reports are available to people using the service and other stakeholders by request. Reports of their own quality audits are distributed to people using the service and relatives. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people living at the home and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. One regulatory inspector conducted the unannounced visit over 1 day, including the lunchtime period A review of all the information we have received about the home was considered in planning this visit and this helped decide what areas were looked at. Care Homes for Older People Page 6 of 25 The main method of inspection we use is called case tracking which involves selecting the care plans of 4 people and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. The manager, members of staff visitors and people who use the service were spoken with as part of this visit. We undertook a partial tour which included looking at the bedrooms of those people who we case tracked and communal areas of the home The service returned its annual quality assurance assessment when we asked for it. This gave us up to date information about the service, the facilities and staff. It also outlines the developments that have taken place over the last year and the plans for improvement. What the care home does well: What has improved since the last inspection? 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured that their needs will be assessed and they staff can meet these before they make a decision to move into the care home. The care home does not offer intermediate care services. Evidence: The manager visits people in the community to carry out an assessment to see if staff can meet their needs before a decision to move into the care home is made. There are copies of this assessment available within peoples files examined. People may also visit the home and spend time there to get a feel for what it would be like to move into the care home before they make a decision. The terms and conditions of admission now have a section for people to sign to confirm that they agree to and accept these terms before they move into the care Care Homes for Older People Page 10 of 25 Evidence: home. The care home does not offer intermediate care services. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are treated with respect and are supported to ensure that their personal and health care needs are met. Evidence: Plans of care are in place for highlighted needs to ensure that staff have sufficient information to meet peoples needs. These are updated as needed when there are any changes in care so that continuity is maintained. Peoples personal preferences are also noted in plans of care so that people get care in their preferred way. People using the service told us that their needs are met and that staff cared for them appropriately. Staff spoken with are able to discuss peoples personal care needs. Risk assessments are in place for identified needs, however within one plan where a person presented a risk of aggression, the action that staff are to take to reduce and manage the risk had not been documented. However on speaking with staff they are able to discuss the action that they would take to deal with this situation. Also where a person is using bed rails there is no risk assessment in place for entrapment, however Care Homes for Older People Page 12 of 25 Evidence: the person did have bumpers on the rails and staff spoken with are aware of the risks and the action that they should take to keep them safe. People using the service are supported and enabled to access specialist services such as the doctor, district nurse and optician as needed. The manager stated that the staff have a good relationship with the district nurses and that they assist them in getting all the equipment that they need. During the tour of the care home we saw that specialist equipment, such as a hoist, mattresses and beds are available for people using the service. One person spoken with said that they could see the doctor at any time if they needed to and another spoke of how the staff had called the ambulance for them following an accident. Staff who administer medication have been trained to do so and the records that we examined are clear and up to date. Medication that has been administered has been signed for to ensure that people using the service receive their medication as prescribed. However handwritten entries have not been signed by two members of staff to show that these have been checked as correct against the prescription. The manager carries out audits on the medication practices to ensure that these remain at the required standard. One person using the service told us that the staff look after their medication for them and give it to them when they need it. Staff spoken with are able to discuss how they ensure that peoples privacy and dignity are maintained and they gave us examples such as making sure that people are covered when offering personal care, knocking on doors before entering and making sure that they take peoples choices and preferences into account. People using the service told us that staff are kind and respectful at all times and we saw staff treating people using the service with respect during our visit. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported and enabled to lead a satisfying life of their choosing and maintain contact with people that are important to them. Evidence: Three activities coordinators are employed to deliver a wide range of activities such as arts and crafts, reminiscence, floor games and bowls to people using the service. The activities coordinator spoken with told us that as well as group activities time is spent on an individual basis with people so that activities are appropriate to peoples needs. The activities coordinator and people using the service are developing life history books so that people can look at these and remember events in their lives, their family and friends. There is a religious ceremony once a month, which staff said is popular with people using the service. People using the service expressed the following opinions; the staff are nice and friendly, I can have a chat, play bingo and do other stuff, I enjoy listening to the Care Homes for Older People Page 14 of 25 Evidence: music, I take part in activities, I am very happy and settled here. We made posters this morning, I did the one that says make do and mend, I also coloured in pictures of leaves. I enjoy the quizzes and games; there is enough to do to occupy us, staff are very nice here, they help you, the activities person is nice, he is absolutely very good, I enjoy it here. Staff spoken with said that the routine of the care home is flexible and people may choose how they spend their time. People using the service confirmed this and one person said, I like a bit of peace and quiet, so I sit here, I can choose where is sit and what I do. During our visit the physiotherapist offered services to people, which they said that they enjoyed. We saw people laughing and joking and talking with each other and staff. So that people can maintain contact with people that are important to them there are no restrictions on visiting and visitors may be received in private. People using the service confirmed that people can visit when they like and that they are made welcome. One person said, my son visits, he is liked by everyone, he is made welcome. We can go out if we want but I prefer to stay here. A varied menu with choices at each meal is on offer to people using the service. Special diets such as diabetic diets are also catered for. People using the service told us, the food is nice and there are choices if we want them, the food is good there is plenty to eat. I like bacon I can have it for breakfast or tea and the food is good here. Staff are able to discuss the special diets such as diabetic diets that may be required and the reason why. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are assured that their complaints will be dealt with and that they are protected from abuse. Evidence: So that people know how they can make a complaint if they need to, the complaints policy is on display and is available within the service user guide. The service has received two complaints since the previous inspection in regard to the use of incontinence pads, and a person having a bruise. There is evidence within the complaints file to show us that these have been investigated and resolved. Staff spoken with are able to discuss how they would deal with a complaint to make sure that this is acted upon and resolved. One person using the service told us, the staff are very nice and helpful, they are good to us, I would soon speak up if I was unhappy, I speak on behalf of others who cant speak for themselves, and another said, I do not have any complaints, I am happy here however if I did I would talk with the manager, she is very approachable. Staff have undertaken training in safeguarding people from abuse and when spoken with are able to express their understanding of their roles and responsibilities in Care Homes for Older People Page 16 of 25 Evidence: keeping people safe. People using the service express that they feel settled and safe living in the care home. Care Homes for Older People Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service live in a well maintained home that is clean and comfortable. Evidence: We saw a maintenance and refurbishment plan which outlines the work that has taken place and the work that is planned for the future to ensure that people live in a comfortable and well maintained environment. All areas of the care home accessed on the day of the visit were clean and tidy. One person using the service said that they felt that staff worked hard to keep the home clean. There are various seating areas around the care home that people may access if they wish, and the conservatory overlooks a well maintained garden. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are supported by sufficient numbers of staff who are well trained to meet their needs. Evidence: The duty rotas examined show us that there are sufficient numbers of staff employed to meet the needs of people using the service. Staff spoken with confirm that there are enough staff available and they feel that the staff team work well together. People using the service also feel that there are enough staff available to help them when they need it and one person said, I am settled here, they help us and we help them, I feel welcome. To ensure that all new staff are aware of their roles and responsibilities when they first start working at the care home, they undertake an induction. Within staff files examined we saw evidence that this is taking place. One staff member spoken with confirmed that all new staff undertake an induction with senior members of staff. The Annual Quality Assurance Assessment told us that six members of staff have attained the National Vocational Qualification (a nationally recognised work and theory based qualification) level 3 and six members of staff have attained level 2. One member of staff spoken with confirmed that they have undertaken this training. Care Homes for Older People Page 19 of 25 Evidence: The company employ people with a Criminal Record Bureau check that has not been done by them whilst waiting for a new one to be processed by themselves. They had been informed that this was acceptable by another source, however legislation states that this is not acceptable. We saw in staff personnel files that all other documentation required by law such as references and proof of identity to ensure that people are protected from unsuitable people being employed has been obtained. Staff spoken with confirmed that they have undertaken a Criminal Record Bureau check, (a check to see if a person has a criminal record or conviction) Staff have undertaken compulsory training such as manual handling, dementia care and infection control, so that they have the necessary knowledge and skills to care for people using the service. Staff files examined confirm that training has taken place and staff spoken with told us that they felt supported in their training and development. They are able to discuss how they care for people using the service and two people using the service told us that they feel that staff are well trained to care for them. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service live in a care home that is well managed where they are enabled to have their say in how the service is run. Evidence: The manager is registered with us to run the care home. She remains up to date with training so that she has the necessary skills and knowledge to run the care home. Staff spoken with said that the manager is approachable and always available should they need her. One person using the service said, matron is good I can talk to her but I leave her to get on with her work, it is well run and managed staff are very well trained, I am a nurse myself so I have very high expectations, and another said the manager is nice I would talk to her if I was unhappy. People using the service and their relatives are enabled to have a say in how the care home is run and managed by way of questionnaires and reviews. Questionnaires are sent on an annual basis and the responses from the last one are mainly positive. Care Homes for Older People Page 21 of 25 Evidence: Comments such as, staff are always willing to stop and discuss any issues or concerns even when they are very busy, there is always a fast response to any concerns even when they are very busy, and the staff do a fantastic job were expressed. There is also a support group for relatives to attend should they wish, where again an opportunity to express views and opinions is given. Staff meetings are held on a regular basis where the quality of the service is discussed. The annual quality assurance assessment told us that routine maintenance and servicing is taking place. When we visited the care home we saw that the electric and gas certificates are in date to show that this has been carried out. Fire alarm tests and drills take place as required to ensure that the systems are working as they should. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R 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, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 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, Care Homes 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 1 7 13 Risk management plans must be in place for all highlighted needs. This will ensure that people using the service remain safe. 20/01/2009 2 29 19 People must not be employed without a new POVA 1st in place. This will ensure that people using the service are protected from unsuitable people being employed. 03/01/2009 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 1 9 Handwritten entries on medication charts are signed by two members of staff to show that these have been checked as correct against the prescription. Care Homes for Older People Page 24 of 25 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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