CARE HOMES FOR OLDER PEOPLE
Orchard House Nursing Home 35 Hallmead Road Sutton Surrey SM1 1RD Lead Inspector
Alison Ford Unannounced Inspection 19th January 2006 1:30 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.V274344.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 Nursing Home DS0000019111.V274344.R01.S.doc Version 5.1 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.V274344.R01.S.doc Version 5.1 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 13th October 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.V274344.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes second statutory inspection for the year 2005/2006 and was an unannounced visit, taking place over 2 hours following a strategy meeting. It included a partial tour of the premises and assessment of a sample of staff files and residents care plans. Several residents were spoken with during the visit and three relatives that were in the home. As at previous inspections, all of the comments made reflected a high level of satisfaction with the services provided by the home and the staff. Over the course of the two inspections all of those standards considered, by The Commission, to be key to the inspection process have been assessed and this report should be read in conjunction with the one produced following the inspection on 13th October 2005. What the service does well: This home continues to provide comfortable well-maintained accommodation for its residents all of whom expressed their appreciation of the staff saying “how lovely” “ very nice“ and “kind” and “helpful” they were. Staffing levels in the home are always sufficient to allow staff to spend time interacting with residents and supporting them. Comprehensive pre-admission assessments ensure that potential residents healthcare needs can be met and individual care plans detail the support and care that is given. Interventions are regularly reviewed to ensure that they remain appropriate and relatives are encouraged to become involved in this process. Activities for residents are always varied and innovative providing both mental and physical stimulation for them. Since the last visit, several activities and outings to celebrate Christmas had taken place. Favourable comments were received about the food served in the home and the chef is always available to talk to residents about their preferences. Visitors are encouraged and confirmed that they were always made to feel welcome and they enjoyed coming into the home. Orchard House Nursing Home DS0000019111.V274344.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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.V274344.R01.S.doc Version 5.1 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.V274344.R01.S.doc Version 5.1 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 four 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 and interventions that they require. Orchard House Nursing Home DS0000019111.V274344.R01.S.doc Version 5.1 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 An individual care plan, reviewed regularly, reflects the care being given and ensures that residents changing healthcare needs will be identified. EVIDENCE: All residents have an individual care plan, which reflects the care, and support that is currently required. Four 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. Orchard House Nursing Home DS0000019111.V274344.R01.S.doc Version 5.1 Page 10 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, The activities provided within the home are exceptionally innovative and provide daily interest for them. 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. Several residents went out to see the local Christmas lights and had a take -away Chinese meal afterwards. There was a Christmas party, a carol service and both residents and staff joined in to perform a nativity play. A masked ball was held to celebrate New Year and a special lunch provided to mark the occasion. Orchard House Nursing Home DS0000019111.V274344.R01.S.doc Version 5.1 Page 11 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): These standards were not assessed at this visit. EVIDENCE: Orchard House Nursing Home DS0000019111.V274344.R01.S.doc Version 5.1 Page 12 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 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. 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.V274344.R01.S.doc Version 5.1 Page 13 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 Residents can be confident that sufficient numbers of staff are always on duty and they are appropriately trained to meet their healthcare needs however recruitment policies do not always ensure the protection of residents. EVIDENCE: Staff rotas confirmed that the home is always appropriately staffed with both trained nurses and carers. The file of one newly appointed member of staff was seen and a new clearance from The Criminal Records Bureau, a check designed to protect residents, had not been obtained. A requirement was issued to provide evidence that this clearance and any others that had not been undertaken, have been applied for within four weeks. This will be checked at an additional visit. Orchard House Nursing Home DS0000019111.V274344.R01.S.doc Version 5.1 Page 14 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): 33,35,38 Residents feel sure that the home is run in their best interests and that measures are in place to ensure their protection. EVIDENCE: Activity sessions provide an opportunity for residents to discuss their views of the home and the support and care that they receive. The Registered Manager spends a great deal of time in the home and frequently talks with residents and their families and is very involved in their care. A high proportion of the comment cards sent out by The Commission are returned and always confirm residents and their relatives satisfaction with the home. The Registered Provider reviews the provision of care in the home regularly and sends a report of this to The Commission although more detail in this report would make it a more useful measurement of resident’s satisfaction. Samples of certificates of worthiness of equipment in use in the home were seen and were satisfactory. Residents all have relatives or representatives to safeguard their financial affairs and the home does not accept this responsibility.
Orchard House Nursing Home DS0000019111.V274344.R01.S.doc Version 5.1 Page 15 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 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 3 Orchard House Nursing Home DS0000019111.V274344.R01.S.doc Version 5.1 Page 16 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. 1 Standard OP29 Regulation 19(1)(b) Requirement The Registered Provider must ensure that no members of staff are employed without evidence that there has been appropriate clearance from The Criminal Records Bureau. (Immediate requirement issued) Timescale for action 13/02/06 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 OP33 Good Practice Recommendations It is recommended that the outcomes of Registered Provider visits, in accordance with Regulation 26, be reported in more detail. Orchard House Nursing Home DS0000019111.V274344.R01.S.doc Version 5.1 Page 17 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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