CARE HOMES FOR OLDER PEOPLE
Orchard House Nursing Home 35 Hallmead Road Sutton Surrey SM1 1RD Lead Inspector
Alison Ford Unannounced Inspection 13th October 2005 10:30 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 Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 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 Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Orchard House Nursing Home Address 35 Hallmead Road Sutton Surrey SM1 1RD 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) 020 8644 5095 020 8641 4550 Mr Stephen Pittman Emma Jane Langbridge Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (0), Terminally ill (0), Terminally ill over 65 of places years of age (0) Orchard House Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5 in the category of Day Care A variation has been granted to allow one specified service user under the age of 65 to be accommodated. A maximum of eight service users in the TI and TI(E) categories aged 40 or over. Two of the eight service users in the TI category may be aged 35 - 40. Date of last inspection 24th February 2005 Brief Description of the Service: Orchard House Nursing Home is a detached building in a residential area of Sutton. It is registered as a care home providing nursing for up to 44 people over the age of 65 and to provide terminal care for up to eight younger people. Accommodation includes bedrooms on the ground and first floors. A shaft lift provides access to all floors. There are 22 single and 11 double bedrooms. All have hand basins and five have en-suite facilities. Communal areas comprise three lounge diners, which can be divided for differing uses. There is also an additional quiet sitting area. As well as the main kitchen two pantry kitchens are provided which may be available for use by residents. The grounds are wheel chair accessible using a ramp and there is limited off street parking to the front. The garden includes a patio area, lawn and flowerbeds. Orchard House Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes first statutory inspection for the year 2005/2006 and was an unannounced visit taking place over 3 hours. It included a partial tour of the premises and assessment of a sample of staff files and residents care plans. Twelve residents and two relatives were spoken to during the visit and the lunchtime meal was observed. Prior to the inspection comment cards, routinely sent out to services, were received from 3 residents, 4 relatives, 2 care managers and the GP who visits the home. All of the comments made, reflected a high level of satisfaction with the services provided by the home and the staff. What the service does well: What has improved since the last inspection?
Orchard House Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 6 Since the last inspection, the ongoing refurbishment programme has continued and included the installation of new windows to the front of the property, a new shower room and refitting to toilet facilities. Magnetic catches have been fitted to several doors, including all bedrooms, which operate in the event of a fire. This has pleased residents who are now able to have their doors left open without compromising their safety. Staff training has continued and the home continues to exceed the required standard with regard to NVQ qualifications for care staff. There has been additional training for all staff who now have individual training plans in place. Any concerns raised at previous inspections have all been dealt with in the agreed timescales. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Orchard House Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard House Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Residents in this home can be confident that pre-admission assessments are comprehensive and will ensure that the home can meet their identified healthcare needs. This home does not offer intermediate care. EVIDENCE: There is a comprehensive pre-admission assessment tool in use in the home. The care plans, that were seen, showed that this had then been used as the basis to identify the residents subsequent care needs and the support they required. One of the relatives spoken to, during the visit, confirmed that they had been given a great deal of appropriate information prior to admission and that “Matron had been extremely helpful “throughout the process. Care managers comment cards reflected that they felt confident to recommend the home to prospective residents. Orchard House Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 9 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): 7,8,10,11 An individual care plan, which is reviewed regularly, reflects the care being given and ensures that residents changing healthcare needs will be identified. Residents can be confident that they will always be treated in a manner, which ensures that their dignity and privacy are respected EVIDENCE: All residents have an individual care plan, which reflects the care, and support that is currently required. A sample of these were inspected and found to be in good order. They included the pre-admission assessment and the preferred activities of the resident. Standard plans are available for identified problems however they have all been personalised to meet the needs of the individual. Monthly dependency analysis was present, along with waterlow scoring and weight monitoring. Manual handling assessments were seen and there was evidence of input from other members of the primary healthcare team and domiciliary dentists and hygienists and opticians visit the home regularly. One service user had had an accident requiring hospitalisation since the last inspection.
Orchard House Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 10 There was evidence that appropriate pressure relieving devices are used in the home and the majority of residents that have pressure sores are admitted into the home with them. During the inspection, staff were observed treating residents in a very kind and respectful manner and residents commented that they were “ helpful” “lovely” and “very kind “. Residents all looked appropriately dressed and happy; those in bed looked comfortable and commented that “they felt cared for”. Palliative care is provided in the home and it is participating in a community programme “The Gold Standard Framework” designed to offer the best possible care to people nearing the end of their lives and their relatives. Support is received from a local hospice, with which the home has strong links, and monthly meetings occur between the home, the GP and the palliative care team. All trained staff have had some degree of training in palliative care and there are training sessions and weekly meetings for all staff to enable them to provide this care. The home has recently changed its contract to dispose of waste medication, in line with current legislation. It was recommended that they write a policy outlining how the process will be undertaken in the home to safeguard both staff and residents and this has apparently been done since the inspection. Orchard House Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 11 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): 12,13,14,15 The activities provided within the home are suited to the resident’s preferences and abilities, and provide daily interest for them and visitors are always welcome, so that links with friends and families can be maintained and encouraged. A nutritious appealing and wholesome diet helps to add variety to resident’s days and, to maintain some independence, they are supported to exercise as much choice over their lives as they can. EVIDENCE: This home provides itself on offering a wide range of activities, which are suitable for the client group some of which are very innovative. Recently they have included a “holiday at home day “ simulating being on holiday and including a puppet show, entertainers and a fish and chip lunch and cream tea. There has also been a “pub afternoon” with a ploughman’s lunch and a “cockney night” with musical entertainment. On the day of inspection an exercise session was taking place in the lounge. Residents are encouraged to make choices where it is possible while allowing daily routines to occur. There are links with local churches, and schools and
Orchard House Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 12 relatives and friends are encouraged to visit. They are encouraged to bring in personal items from home to personalise their rooms. The lunchtime meal was served during the inspection; it was well presented and portions were large. A choice was available. All those spoken to confirmed how much they enjoyed the food. Orchard House Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 13 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 Residents in this home are confident that any concerns or complaints that they might raise would be dealt with promptly and so they feel reassured that they are protected from abuse and neglect. EVIDENCE: The complaints book was seen and the one complaint had been dealt with appropriately by the home. The Commission for Social Care Inspection had received one complaint since the last inspection however this was totally unsubstantiated. The residents and their relatives, spoken to during the inspection, were aware of the complaints process however they were confident that Matron would deal with any concerns, as they arose. The home has an Adult Protection Procedure, which has been seen at previous inspections and files of newly appointed staff showed evidence that Criminal Records Bureau clearance had been obtained. No members of staff have been referred for inclusion on the Protection of Vulnerable Adults Register. Orchard House Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 14 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 This home offers an extremely well presented, well-maintained and clean environment, which meets the needs of its residents and allows them to live in a comfortable homely atmosphere. EVIDENCE: The home is situated in a residential road close to local amenities. It is well maintained with an ongoing refurbishment programme and presented in good decorative order. New windows have recently been fitted to the front of the property and magnetic door closers have been put onto bedroom doors to ensure the safety of residents in the event of a fire. Furniture and furnishings are homely and adaptations have been made throughout the home to ensure that it meets the needs of the residents. The range of communal space means that there can be different activities happening throughout the home at the same time. There is a large rear garden which is well used during the summer months and parking facilities to the front.
Orchard House Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 15 Resident’s bedrooms are light and airy, all of them have washbasins and shared rooms have privacy screens available. Residents have been encouraged to personalise their rooms with items from home to make their surroundings more familiar and to retain their individuality. The home was, as usual, very clean and free from malodour Orchard House Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 16 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): 27,28,29,30 Residents can be confident that sufficient numbers of staff are always on duty and they are appropriately trained to meet their healthcare needs. The homes robust recruitment policies ensure the protection and support of its residents. EVIDENCE: Staff rotas confirmed that the home is always appropriately staffed with both trained nurses and carers. Training for staff in this home is given a high priority; all staff now have an individual training profile and carers have completed an NVQ qualification are undertaking it. Other recent training has included courses in health and safety, food hygiene, and palliative care issues. The trained nurses are all undertaking an assessor’s course. The files of three newly appointed members of staff were seen and contained all of the required documentation. Orchard House Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, The home is managed by a suitably qualified and very experienced person who ensures that there is an open and inclusive atmosphere, which allows residents and staff to express their views and makes them feel valued. EVIDENCE: The manager of this home is a registered nurse and has been employed there for some time. She has undergone additional training to equip her for her role and is currently undertaking the Registered Managers Award. Many of the residents that were spoken to during the inspection commented on her kindness and capability. Orchard House Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 18 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 X 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X X Orchard House Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 19 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. 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. Refer to Standard Good Practice Recommendations Orchard House Nursing Home DS0000019111.V252827.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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