Inspection on 26/01/06 for Orchard House Care Home

This inspection was carried out on 26th January 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 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 Care Home 18/11/08

Orchard House Care Home 21/11/07

Orchard House Care Home 18/01/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Orchard House Care Home 46 Easthorpe Street Ruddington Nottingham NG11 6LA Lead Inspector Mrs Gillian Adkin Unannounced Inspection 26th January 2006 09:30 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 Care Home DS0000008728.V274636.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 Care Home DS0000008728.V274636.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Orchard House Care Home Address 46 Easthorpe Street Ruddington Nottingham NG11 6LA 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) 0115 921 7610 Cfnursinghome@aol.com Ruddington Care Homes Mrs Angela Cooper Care Home 26 Category(ies) of Dementia (26), Old age, not falling within any registration, with number other category (26) of places Orchard House Care Home DS0000008728.V274636.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The area identified in the garden must be properly secured to ensure that residents are safe and secure. (This condition can be removed once the matter is satisfactorily resolved) This matter has now been resolved and garden is now secure. Service users shall be within category OP (26) Service users shall be within category DE (26) 2. 3. Date of last inspection 11.08.05 Brief Description of the Service: 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 10 minute walk. Up to 26 service users falling within the categories of old age and Dementia can be accommodated at the home in single bedrooms, 19 of which have en suite The home has a stairlift in place in order that service user who are unable may access the second floor facilities. There are large,secure and very pleasant gardens to the rear of the property and a car park to the front. The home and grounds are easily accessible to service users. Orchard House Care Home DS0000008728.V274636.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was inspected against the Regulations, as in the Care Standards Act 2000.This was the first inspection for the new owners. This was an unannounced inspection, which took place over one day and commenced at 09.30 am on 26/01/06.The inspection took 5.5 hours. The Acting care manager facilitated the inspection and was supported by the Managing Director. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting three residents and tracking the care they received. This inspection report additionally addresses specific areas where requirements and/or recommendations were identified at the previous inspection. During this inspection a tour of the accommodation occupied by those case tracked took place along with other areas of the home as deemed necessary and the inspector viewed internal records, and care plans. The inspector spoke to residents, care and ancillary staff. A number of relatives were available during this inspection for comments. Additionally discussion took place with the visiting hairdresser. There were 24 residents accommodated at the time of this inspection. Conversation with some of the service users tracked was limited due to communication difficulties, however other comments were received about the service which are detailed below Typical comments included: “ I have chosen my lunch already” “We routinely offer choices of food to service users ” “I feel part of my mothers life still, its very important for me to be able to visit when I like” “Communication is very good in the home I would recommend the home to others” “I am not aware that some records are held electronically” Orchard House Care Home DS0000008728.V274636.R01.S.doc Version 5.1 Page 6 “Four of us have recently attended a Dementia Care Mapping course but have not as yet done any mapping” “We have a handover at the beginning of each shift” “We rarely use agency staff” “We use the daily diary to communicate any issues relating to a resident, all staff are expected to read this including ancillary staff” “ We observe staff at work and they are very discreet when asking personal questions” “We have been involved in the settling in process and are fully informed” What the service does well: What has improved since the last inspection? What they could do better: The registered manager must seek advise about the use of bleach for removing stains from Commode pots and must ensure that staff are fully aware of their responsibilities when using hazardous substances. Orchard House Care Home DS0000008728.V274636.R01.S.doc Version 5.1 Page 7 The registered manager must ensure that appropriate risk assessments are undertaken for electrical items which are accessible to service users such as the bread maker and the hot trolley currently stored in the lounge and dining room respectively. The registered manager is recommended to develop a policy regarding the storage of information particularly as the home use an electronic system for storage of personal details (in accordance with the Data Protection Act 1998) 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 Care Home DS0000008728.V274636.R01.S.doc Version 5.1 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 Care Home DS0000008728.V274636.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Assessment procedures and the involvement of relatives or representatives ensures that persons moving into the home are confident that their needs will be met. EVIDENCE: Three service users files were case tracked and all three files contained a comprehensive assessment of needs. A new assessment proforma has been put in place to identify mental health issues prior to admission. Service users and relatives were able to confirm that an assessment had been undertaken prior to admission. Orchard House Care Home DS0000008728.V274636.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): 7.8.9.10 Comprehensive care plans and associated risk assessments, are in place, this ensures that staff are fully aware of residents needs and are able to meet individual needs and provide a measurable standard of care. Medication is well managed however the policy must be updated to ensure that administration of medicines is appropriate and reflects specialist needs. EVIDENCE: All of the three service user files inspected were comprehensive, reflective of needs and contained relevant risk assessments. An electronic system is in place and care plans are regularly evaluated. Discussion with staff and observation during inspection identified that care records are freely available for staff to refer to and staff when questioned were fully aware of service users identified needs. The deputy manager stated that it is considered important for all staff to be aware of the needs of service users and any changes are recorded in a daily diary, which all staff including ancillary staff are encouraged to read. Orchard House Care Home DS0000008728.V274636.R01.S.doc Version 5.1 Page 11 The deputy manager stated that a good rapport exists with the General Practitioner (who service users referred to) and Community nurses who visit the home to provide nursing care. Evidence of relatives input in care plans was seen and confirmed by them. It was noted that the home had experienced difficulties with one service user in relation to compliance with medication. A disclaimer notice had been signed by relatives to allow crushing of medication. Although the home had taken some measures to ensure the medication was safe to use when crushed, no reference was made to this in the medication policy or authorisation by an appropriate person included, furthermore no risk assessment had been undertaken or agreed to by the individuals General Practitioner. The home has recently added the Dementia Care category to its existing categories and therefore the registered provider must ensure that appropriate arrangements are made to ensure that any arrangements for administering medication in any other formula other than its original form must be fully explored and formally agreed with the General Practitioner and Pharmacist. The medication system was inspected and was found to be well managed and appropriately administered. Discussion with service users and relatives demonstrated that they are treated with respect. Staff were observed working and were noted to be respectful. One relative stated, “When visiting the home I have observed staff discreetly ask residents if they would like to go to the bathroom” Another relative stated that her mother was “extremely well looked after and her needs were met in a dignified and respectful manner” Orchard House Care Home DS0000008728.V274636.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): 12.13.14 The lifestyle experienced and the ability to maintain essential links is achieved by flexible routines and an excellent programme of activities. This ensures that resident’s needs and preferences are considered and result in a fulfilling lifestyle. EVIDENCE: Several examples were found to demonstrate that the quality of life experienced by service users in the home is of a good standard. Service users were noted to be relaxed and appeared to be happy and content with their lifestyle. One service user said, “She enjoyed sitting next to the birdcage and talking to the birds”. Another service user said she enjoyed the “soft music played after lunch” Excellent examples were found of how service users are engaged in meaningful activities, which were relevant to social history and past life. The activities organiser was found to be innovative and had arranged appropriate activities, which were apparently enjoyed by those service users accommodated. Orchard House Care Home DS0000008728.V274636.R01.S.doc Version 5.1 Page 13 This includes making bread which service users confirmed was “most enjoyable and reminded them of their childhood” Service users are also encouraged to attend external trips and photographs were seen of recent events in the home. The home has an extensive garden area, which is utilised in the summer for external activities, and relaxing, a number of relatives confirmed that they also enjoyed this aspect of life in the home. Staff were observed offering choices to service users during this inspection and confirmation was obtained from a relatives that where her mother “did not like the food she had previously chosen an alternative was always offered” One service user spoken with confirmed, “He had chosen his lunch but could not remember what he had chosen” A relative stated that “he considered the care was very much person –centre and that although his relative had not been in the home long felt that he was settling well” Visitors to the home confirmed with the inspector that they were made welcome in the home without undue restriction. Orchard House Care Home DS0000008728.V274636.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): 16.18 Complaints are taken seriously and acted upon. Staff have a reasonable level of understanding regarding the prevention of abuse, this would be strengthened by provision of formal training to ensure that the risk of abuse to service users is minimised. EVIDENCE: The home has a clear complaints procedure, which is included in the service user guide. Service users who were able indicated that they would refer all complaints to the registered manager or deputy manager. The homes records were inspected and no complaints were recorded in the file. Although when questioned staff had a good working knowledge of adult protection issues and how to report incidents, some were not familiar with the whistle blowing policy and stated that the last formal training received was approximately two years ago. This was confirmed when inspecting training files and no evidence was found to confirm if this training was planned for this year. The home has been issued with the Nottingham City Council multi agency policy and the deputy manager stated that this is used in discussion with staff.The registered provider must initiate adult protection training for all staff. Orchard House Care Home DS0000008728.V274636.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): 19.26 The home is clean, comfortable and premises are well maintained resulting in a comfortable living environment for residents. Risks associated with use of chemicals must be appropriately addressed to prevent accidents occurring and service users being placed at risk of harm. EVIDENCE: During a brief tour of the home it was noted that all areas were well decorated and furnished, clean and tidy and free from any offensive odours. Service users and their relatives confirmed that the home is always very clean and homely. There were ample numbers and choice of bathing and toilet facilities ensuring that all service users needs could be met. The samples of bedrooms seen were well laid out and had been personalised by the service user to make the space “their home”. Orchard House Care Home DS0000008728.V274636.R01.S.doc Version 5.1 Page 16 It was noted during the brief tour that a bathroom on the upper floor which is currently unused was being used for the soaking of stained commode pots, the home does not currently have a bedpan washer /disinfector. Pots were being soaked in bleach. Risk assessments had been put in place but the door of the bathroom was unlocked and accessible to those service users who reside on the top floor. The home has recently registered for the Dementia category and it was noted that risk assessments, which are developed by an external organisation, do not include ingestion as a hazard or service users as likely to be harmed. The registered manager must therefore seek advise about the use of bleach for removing stains from commode pots and must ensure that staff are fully aware of their responsibilities when using hazardous substances. Risk assessments must be amended more frequently and according to risks presented by individual service users. Orchard House Care Home DS0000008728.V274636.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): 27.29 The needs of residents are safely met by thorough a robust recruitment and selection process and adequate numbers of suitably skilled and trained staff. EVIDENCE: The inspector undertook a calculation of staffing hours and it was demonstrated that the home were meeting the recommended hours as in the Department of Health Residential Forum guidance. The calculation of hours excluded the deputy manager’s rostered hours, which were additional and supernumerary. Adequate numbers of hours are supplied for ancillary staff including activities personnel. Relatives spoken with all stated that the home is always well staffed and service users needs are attended to in a timely manner. The deputy manager stated that the staff group was stable and that there were no staff vacancies. An additional member of staff has been employed since the home has added the DE category of registration. Three members of staff were selected for inspection of their personnel file. The home keeps staff files in a central administration office and although able to look at one complete file and all CRB disclosures the remaining files were not able to be inspected due to the deputy manager not having full access. Orchard House Care Home DS0000008728.V274636.R01.S.doc Version 5.1 Page 18 Staff records inspected included all required information as detailed in Schedule 2 of the Regulations and included training evidence and supervision records. Sufficient evidence was found in staff files to demonstrate that training supplied was appropriate and readily available to staff. The deputy manager had completed a Dementia Care mapping course, staff records confirmed they also had received this training. One staff file contained a transferred CRB; the registered provider was able to confirm that a new CRB had been applied for. Orchard House Care Home DS0000008728.V274636.R01.S.doc Version 5.1 Page 19 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): 33.36.37.38 The health, safety and welfare of service users is protected by systems and procedures being in place. The home is run to ensure that the best interests of service users are safeguarded. A system of risk assessment is undertaken but evidence indicated weaknesses in review, this potentially puts service users at risk of harm. EVIDENCE: Inspection of fire records took place and it was noted that six monthly fire drills and annual training takes place for staff. Fire systems are routinely inspected; this was well evidenced in files. Water temperature records were also inspected and although undertaken regularly (monthly) records were unclear, and following discussion with the maintenance person appeared to be ambiguous. Orchard House Care Home DS0000008728.V274636.R01.S.doc Version 5.1 Page 20 It was recommended that the current documentation used for recording water temperatures be reviewed to ensure that figures quoted are accurate, conclusive and unambiguous. A tour of the premises identified that although generic assessments are undertaken and reviewed annually. Risks associated with use and storage of the hot trolley and bread maker, which are kept in the dining room and lounge, had not been independently assessed in relation to those service users who wandered freely around the home or may come into contact with the equipment. It was recommended that risk assessments must be reviewed and be reflective of individual risk particularly in relation to those persons who may be confused or disorientated. Staff training records inspected indicated that fire training had been undertaken. Discussion with staff indicated that nursing staff regularly supervised them; this was evidenced in internal records inspected. A formal Quality Assurance policy /system is in place, this was evidenced through discussion with staff, relatives and service users (where practicable) One relative stated that they received an annual questionnaire, which asked for opinions on the service. The relative’s weekly forum is another good example of how the home seeks to gain views and to help improve the service. Staff confirmed that their views are regularly sought. All records inspected were considered to be well maintained, appropriately managed and stored effectively, it was recommended that relatives and service users are made aware that some of their records are stored electronically. The home use an IT package called “Cool Blue” all records are updated electronically. Orchard House Care Home DS0000008728.V274636.R01.S.doc Version 5.1 Page 21 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 3 3 2 Orchard House Care Home DS0000008728.V274636.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP26OP38 Regulation 13(3)(4) Requirement The registered manager must seek advise about the use of bleach for removing stains from Commode pots and must ensure that staff are fully aware of their responsibilities when using hazardous substances. The registered manager must ensure that appropriate risk assessments are undertaken for items which are accessible to service users such as the bread maker and the hot trolley currently stored in the lounge and dining room respectively. The registered provider must ensure the safety of service users by reviewing the current system of administering medication (by crushing of tablets). Any formal arrangements made with an appropriate professional must be fully documented within a care plan. The registered provider must provide adult protection /abuse training for all staff without DS0000008728.V274636.R01.S.doc Timescale for action 01/03/06 2 OP38 13(4) 01/03/06 3 OP9 13 01/03/06 4 OP18 13(6) 01/03/06 Orchard House Care Home Version 5.1 Page 23 delay. 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 OP9 Good Practice Recommendations The registered manager is recommended to update the medication policy to reflect the new categories of registration. The policy should include reference to the crushing of medication and covert administration. It is recommended that advice be sought from other appropriate professionals who may previously have undertaken this task. The registered manager is recommended to develop a policy regarding the storage of information particularly as the home use an electronic system for storage of personal details (in accordance with the Data Protection Act 1998) It is recommended that suitable arrangements are made to ensure that all files including staff files are available at all times for inspection. It is recommended that the current documentation used for recording water temperatures be reviewed to ensure that figures quoted are accurate, conclusive and fully understandable. 2 OP37 3 4 OP29 OP38 Orchard House Care Home DS0000008728.V274636.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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. 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