Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 20/03/07 for Orchard House Nursing Home

Also see our care home review for Orchard House Nursing Home for more information

This inspection was carried out on 20th March 2007.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Visitors are welcomed to the home. Comments from residents and relatives were positive about the care provided at the home. External health professionals are consulted by staff from the home when necessary for the well being of residents. The Pre-admission assessment is comprehensive ensuring that no resident moves into the home without their needs being assessed. Medication management in the home is good ensuring that residents receive their medication as prescribed. Staff are committed to providing good customer care and demonstrated a proactive approach to promoting the health and welfare of residents. Over seventy five percent of care staff have a recognised qualification in care ensuring a consistent quality of care is provided.

What has improved since the last inspection?

What the care home could do better:

Care plans, risk assessment and care records need further development to ensure all resident needs are being met. Record keeping for valuables and money kept by the home for residents is not robust and could potentially expose residents to risk. New Criminal Record Bureau checks are not automatically being carried out by the home for staff that have had a check at a previous home potentially putting residents at risk. Staff require training in basic food hygiene to ensure that they comply with mandatory requirements and ensure that food is prepared in a safe manner. Menus need to reflect what residents are being offered, so that an informed choice can be made by residents. Whilst staff knowledge on what to do in a fire is good not all staff have part took in a fire drill twice a year. Residents must be offered a lockable facility and key to their room records must reflect that residents have been offered these faculties. Prevention of cross infection whilst good in a number of areas needs to be reviewed in others to reflect current good practice. Information and the provision of aids and adaptations need to be reviewed in relation to moving and handling.

CARE HOMES FOR OLDER PEOPLE Orchard House Nursing Home 126 Whitehouse Common Road Sutton Coldfield Birmingham West Midlands B75 6DS Lead Inspector Karen Thompson Key Unannounced Inspection 20th March 2007 08:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard House Nursing Home Address 126 Whitehouse Common Road Sutton Coldfield Birmingham West Midlands B75 6DS 0121 378 0272 0121 378 3220 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) Orchard House (Midlands) Ltd Mrs Deborah Kelly Care Home 31 Category(ies) of Dementia - over 65 years of age (31), Old age, registration, with number not falling within any other category (31) of places Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The Home is registered for the maximum number of 31 people. Registration category is nursing care for reasons of old age and dementia, over 65 years of age. (N), OP, DE(E). Two people who were under 65 years of age at the time of admission can be accommodated and cared for by reason of physical disability. 2PD 29th December 2005 Date of last inspection Brief Description of the Service: Orchard House is an attractive purpose built home situated within a residential area of Sutton Coldfield on the outskirts of Birmingham. The home is registered to provide personal and nursing care for up to 31 persons over the age of 65 years who may suffer from dementia. Communal facilities consist of a main lounge with a large conservatory off, a separate dining room and a large reception area with seating, which is well frequented by residents and visitors. There is a large enclosed rear garden with an extensive paved area where residents can sit during clement weather. There is sufficient off road parking at the front of the premises to accommodate up to nine vehicles. Bedrooms are located on the ground and first floors, they consist mainly of single rooms and some shared rooms are also available. Two single and two shared rooms include en-suite facilities. There are local amenities very close to the home that include a small row of shops and a public house/restaurant is directly adjacent to the home. Another parade of shops is within a short walking distance. Local public transport is accessible including a regular bus service to the city centre. Fees range from £550 to £666 per week. Nursing determinations are refunded in full to the cost payers. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork inspection was conducted by two inspectors over one day commencing at 8.40am on 20 March 2007. The Manager and Owner were present for the duration of the inspection. During the fieldwork, the owner, manager, staff, relatives and residents were spoken to. The feedback from residents and relatives was good and they found the staff helpful and welcoming. During the inspection process the inspectors toured the home, sampled residents files and other documentation. Case tracking was used to determine care for residents from the time of admission to the home plus direct and indirect observation as a number of residents were unable to communicate their views verbally. What the service does well: What has improved since the last inspection? Bedroom furniture has been replaced ensuring that resident live in a pleasant and homely environment. Also in the communal areas of the home new curtains, décor and pictures, furniture, lighting and television have been brought to improve the facilities and services provided to residents. The laundry has had new washing machines and tumble dryer. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 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 DS0000024875.V333746.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1.2.3.4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information available informs prospective and current residents and their relatives about the services and facilities available within the home so they can make an informed choice. The admission process meets the standard, ensuring residents can be confident that their needs will be met on moving into the home. EVIDENCE: The Statement of Purpose and Service Users Guide were readily available to current and prospective residents make an informed decision to move into the home. Both documents met the standard ensuring that residents had the necessary information to make an informed decision as to whether they want to live at the home. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 9 Only part of the current certificate was displayed prominently on entering the home at the start of the inspection. On informing the management team of the need to ensure the entire certificate is displayed, this was done during the inspection. This ensures that prospective and current residents are aware of the conditions of registration, which the home is required to work within. The pre-admission assessments meet the standard ensuring that no resident moves into the home without their needs being assessed. Contracts provided to residents met the standard ensuring residents are aware of the rights and obligations of both themselves and the home. The home is registered to care for residents with dementia and staff have received training in this specialise from an external educational organisation. This ensures an awareness and understanding of staff of the needs of residents with cognitive impairment. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7.8.9.10.11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Medication systems were of a good standard ensuring residents’ receive their medication as prescribed. Personal care needs are being met but some development of care records is needed to encourage a more individual approach. EVIDENCE: Staff write up a care plan for residents following admission to the home outlining how the residents’ needs are to be met by staff. Care plans were based on the activities of daily living and used a core care-planning format. Whilst this covers a wide range of needs, the plans were not individualized to the residents’ personal condition or current circumstances. There was however indication of involvement of the resident or their representative in the care planning process. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 11 Changes in residents needs are evaluated and acknowledged in the evaluation, does this is not always lead to a re-assessment and ultimately a change in care planning strategies as to how care will be delivered. Evaluation of care planning strategies is the tool which the effectiveness of the nursing care provided can be measured to determine effectiveness and consequently determine if any changes are required. Care plans did not acknowledge gender specific issues, which need to be discussed with residents and recorded in the care planning progress. This allows residents to express their preferences and ensure these are met by a staff member of the gender of their choosing. Care planning was discussed in some length during the inspection. Bedrails were in use in the home and whilst having the consent of residents and relatives to be in place did not have a formal research based risk assessment to determine their use. Bedrails were in place for residents experiencing cognitive impairment which is not considered good practice and an alternative should be considered. The use and introduction of high low beds was discussed with the manager and proprietor during the inspection as a possible alternative for resident experiencing confusion. The home had information from the Medical Devices Agency on bedrails. Bedrails are checked regularly and bumpers were observed to be in place to ensure that the equipment is safe. Evidence was forwarded post inspection from the proprietors to demonstrate that the home would be introducing a recognised bedrail risk assessment and this fast response is to be commended. Moving and handling assessments were observed in residents bedrooms which contained information for staff but did not state what sling size was to be used for residents. The individual sling size needs to be recorded so that staff have comprehensive instructions on how to move residents safely. A number of residents remain for a substantial amount of time in bed but are not allocated their own individual slide sheets. Staff informed the inspectors that slide sheets are cleaned but the risk of cross infection will be considerably reduced if each resident has their own slide sheet. Turn charts for residents who sat out during the day did not indicate when a change or relieve of pressure took place. If it is assessed that residents require turning to relieve pressure during the night then this must continue during the day. Pressure area care was discussed during the inspection with the management team. Residents informed the inspectors that they are offered a cup of tea at 7am in the morning. This helps to promote good hydration for residents and is a positive aspect of maintaining residents physical and psychological well-being. Food, fluid and turn charts were in place but were not consistently completed on all occasions. Food supplements prescribed to residents were not always being recorded on their food chart. Records need to be comprehensive to ensure residents’ care can be monitored and the effectiveness of this care measured. Nutritional risk assessments were observed to be in place for residents along with skin integrity risk assessments. These assessments are reviewed on a monthly basis. Pressure ulcers are graded but it was not Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 12 apparent what system of grading staff were using. The Care Manager must ensure that all staff are using the same grading system and that this is recorded on the format they us so no misunderstanding occurs. A purple syringe was observed in a mug in one resident’s bedroom. These syringes could be used on a number of occasions but need to be discarded after a week of use. The purple syringes are used in the administration of medication and flushing of enteral PEG feeds. The Care Manager informed the inspector that these syringes are changed every Monday. The health needs of residents are met by a variety of external health professionals. A number of grades of care staff within the home are trained to take residents’ blood. This service provided by the staff at the home ensures monitoring or concerns about a resident’s condition are not delayed by referrals to external health professionals and the resident can be treated swiftly and appropriately. Medication is stored in a locked room in locked cupboards and locked medication trolleys, thus ensuring medication is stored safely. The medication trolley was found to be organized, clean and tidy allowing staff to locate and dispense medication in a timely manner to residents. Prescribed creams are not kept in residents’ bedrooms. The inspectors were informed these are given out to staff at the beginning of each shift to administer as prescribed to residents. Screening was observed in double bedrooms so that privacy can be maintained. Staff interaction with residents was positive and dignified. Staff have attended training so that they can verify when a resident has died, this ensures that relatives can be informed of an expected death without the formality of waiting for a doctor. Staff have been nominated to attend the end of life training. They are looking to adopt the Gold Standard Framework model. This end of life model is being adopted throughout the Primary Care Trust and is a recognised care model for staff to provide good care for residents at this stage in their life. Following the attendance of this course it is expected that care plans will evolve to recognise end of life care, as at present information is instructive only in relation to funeral directors and the kind of service required. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Activities are provided for part of the week but further consideration needs to be given to residents with cognitive impairment so that they’re needs are fully meet. EVIDENCE: Visiting is flexible enabling relatives to visit at a time that suits them and allowing residents to maintain contact with them. Relatives were observed in both residents own bedrooms, allowing for privacy and in communal areas. Residents are able to bring personal items of furnishings etc into the home in order to personalise their rooms and make them more homely. The care planning documentation does not demonstrate that residents’ wishes and preferences have been acknowledged recorded example of when a residents wishes to get up or go to bed. Staff were able to demonstrate that they were aware of residents’ choices and preferences but these were not being reflected in the care planning process. The care plan is a document that informs staff what is required by a resident to meet their needs. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 14 The inspectors were shown an activities folder, which included a number of recent activities such as a cheese and wine party and Valentines events. A number of Easter cards were being displayed around the home; which the inspectors were told had been made by the residents. A number of vases containing fresh flowers were observed throughout the home. The inspectors’ visit took place following Mothering Sunday and it was nice to see that residents were able to place flowers in the communal areas as well as their rooms. Staff informed the inspectors that no activities take place at weekends. Residents meetings discussed activities and suggestions were made and records kept. The provision of activities will need to be reviewed with residents to ascertain what they would like and when. They need also to focus on the provision of activities for residents with cognitive impairment to ensure that residents’ are assured one to one time. One relative commented that the home being next to a public house was a bonus as this allowed them the freedom to leave the home for a short period with their relative and enjoy the normality of a quiet drink. The home employs separate catering staff that provide three full meals per day. There is a four-week rotating menu, which is based around a traditional British food. Fresh fruit was available in the home for residents. Pureed or soft diets are presented with each item of food pureed separately. This ensures that each individual food item’s taste is maintained. Residents and relatives comments in relation to food was positive. On the day of the inspection the menu board’s second option did not match up with what was being provided to residents. This was explained to the inspectors as a misunderstanding, however staff serving the food appeared not to have questioned this and this may confuse residents. Residents can have wine with their meals as part of their fees Staff were observed to assist residents discreetly and sensitively during the serving of lunch. A variety of utensils and plate guards were available to residents, which were observed to be used at lunchtime thus promoting and maintaining the independence of residents. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16.18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and concerns are managed effectively and thus residents and relatives can be confident that their concerns will be listened to and addressed appropriately. EVIDENCE: The complaints procedure met the standard. The home has had no complaints since the previous inspection. The Commission has received no complaints about the home. Staff were able to demonstrate that they were aware of good customer practice to ensure that concerns are listened to and managed professionally. The Commission prior to inspection received a compliment regarding the home. The Adult protection policy and procedure met the standard. Policies and procedures in relation to risks and restraint met the standard. Staff chatted to during the inspection were able to demonstrate a good understanding of adult protection and the appropriate action they would take to maintain this. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19.21.24.25.26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is furnished and decorated to a good standard but improvements are required in some areas to ensure the home meets the needs of all residents. EVIDENCE: The home was clean and warm on the day of the inspection. The home has two part-time maintenance operatives and was generally well maintained. The home has an enclosed garden to the rear of the property with a large paved area. A slope with a path leads down to the lawned area of the home. Residents wound need to be assisted to access some parts of the garden safely. On arrival to the home it was observed that an alcohol hand gel dispenser was available to all those who entered and left the home. This is good cross Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 17 infection practice. The inspectors were also informed that staff are issued with individual tottles of alcohol gel, which they can use throughout the day whilst attending to residents. The health protection unit audited the home last year and the report was positive about infection control measures within the home. The report did state however that “polythene gloves should not be used”. These were nevertheless still found to be in use at the time of the Commission inspection. Only latex or vinyl gloves should be in used as these offer sufficient protection to both staff and residents. Liquid soap in some areas of the home is being dispensed from bottles which are topped up by staff from larger containers. The Commission contacted the Health Protection unit post inspection about this practice and they only recommended liquid soap from cartridge dispensers as this reduces the possibility of cross infection. The sluice room contained a pot dispenser for the cleaning of commodes which again is a good infection control practice. The sluice room however had shelves where cleaned commode pots could be stored whereas ideally this should be racking to allow the pots to dry more efficiency. The shower room was visited which has level floor access, allowing for accessibility. However, a sign was observed on the shower stating “out of order”. The inspectors were informed that this was due to be repaired soon. Bathing facilities being out of use for excessive period of time serious infringes upon residents privacy and dignity. Two items of furniture were observed being stored in one of the bathroom areas, which has an impact on the accessibity for residents. Aids and adaptations are available throughout the home. A number of residents were visited in their bedrooms and a variety of beds were observed thoughout the home. The home has a significant number of ordinary divan beds. These beds are not adjustable and do not allow for safe manual handling practices to be carried out if a resident requires hoisting in and out of the bed. The home needs to consider the appropriateness of the beds being provided as positioning residents in bed is difficult, a backrest is need for residents requiring nutrition whilst in bed. All bedrooms are fitted with a lock but there was not evidence that residents had been offered a key to lock their bedroom door. This was discussed during the inspection and the owner forwarded evidence following the inspection that they would be recording in the care plan that this facility had been offered. No lockable facilities were available to residents in their bedrooms which was again discussed at the inspection and evidence forwarded post-inspection that this would be discussed with residents. Some bedroom furniture had recently been replaced ensuring residents live in a safe homely environment. The Commission was informed post inspection that an audit of commode furniture provided in bedrooms had been completed and fifteen new commodes had been ordered. Bedrooms were personalized with residents’ own possessions, ensuring that the individuals’ identity is maintained. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 18 Legionella prevention and testing was taking place thus reducing any potential risk to residents. The Laundry contains two washing machines and two tumble dryers which meet the standard. Residents clothes were observed to be nicely laundered. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27.28.29.30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a core of committed, dedicated and well-trained staff. Recruitment practices need to be more robust so that residents are not placed at the risk of harm. EVIDENCE: On the day of the inspection 31 residents were living at the home. Rotas supplied during the inspection demonstrated that there were not always two trained nurses on duty during the daytime. The Rotas also demonstrated that trained staff do not have any time between shifts to handover information. The rotas demonstrate that over seventy five percent of carers have NVQ 2 or equivalent and above. Small samples of staff records were inspected in order to review recruitment procedures. It was found to be satisfactory with the exception of Criminal Record Bureau checks. In a number of instances these had not been redone for new employers and the inspectors were unable to see all of the disclosure. The home had a copy of the Commissions guidance in relation to recruitment and it is expected that all CRB checks be carried out by the care home, as these checks are not portable. In exceptional circumstances the home may carry out a POVA first check whilst waiting a full CRB disclosure. The Commission at each inspection visit would expect to view a complete CRB disclosure for all staff employed since the last inspection. Following this the Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 20 disclosures can destroyed. The home needs to keep a record of the CRB disclosure number on the staff file as evidence that a check has been carried out. The home does have an induction programme for new staff which meets the Skill for Care Council standard. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31.32.33.35.38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well managed, providing good outcomes for people living there. EVIDENCE: The Care Manager has many years experience in running a care home. Good interaction was observed between residents and the Care Manager. Residents, relatives and staff spoke positively of the ethos of the home. Comments included “organization first class”, “atmosphere is homely”, “staff are approachable”, and “happy staff”. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 22 The home sends out questionnaires twice a year to residents as part of their quality assurance. Residents meetings are held, areas of the home such as cleaning and so forth are audited for quality six monthly. Policies and procedures are reviewed. The results of these quality audits and measures need to be developed into a yearly plan for publication for residents and relatives to see. Record keeping for residents’ money needed to improve. A number of items were found not been recorded appropriately so staff were unsure about who they belonged to. Systems for managing residents’ money and valuables requires further development to ensure that it is robust and protects residents. Since the inspection the Commission has been informed that a new system has been put in place and a policy and procedure has been drawn up for staff. The quick response to this is to be commended. Hot food probe testing records, which indicates whether food has reached a temperature to minimize the risk of infection, was not taking place for all foods served to residents. The fridges contained a number of items, which required refrigeration on opening and were only deemed safe for a set period after this. Items in the fridge had not been dated on opening therefore possibly compromising the well being of residents. The inspectors were informed that only staff working in the kitchen had obtained a food hygiene certificate. The inspectors were informed that part of the staff introduction involves familiarisation with good food hygiene. Staff later informed the inspectors that if residents required food when kitchen staff were not available they would prepare a light snack for them. It is a requirement that all staff handling food attend a recognised food hygiene safety course. COSHH data sheets were found in a number of places around the home and were accessible to staff. This demonstrates staff have access to this information. Also there were no risk assessments in place for COSHH items to indicate that any acknowledged risks from such products had led to practices to reduce the risk to both staff and residents. The owner stated that this takes place at induction that staff sign to say they have read the product and risk assessment information in relation to COSHH items One resident was observed being transported in a wheelchair, which did not have any footplates in place. This places the resident at potential risk of bony injury. The home has a fire risk assessment. Changes to the City’s fire service provision was discussed with the Care Manager and Owner and the possible need to review their risk assessment in light of these recent changes. Fire drills were taking place but these need to be increased to ensure that all staff attend a drill at least twice a year. Fire alarm testing is taking place on a regular basis. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 23 Lift servicing and testing was taking place and records to demonstrate this were forwarded following the inspection. Hoisting equipment was being serviced and maintained on a regular basis. This ensures the well being and safety of residents and staff. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 2 X X 2 Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15 18(1) Requirement The registered person must: • Care plans must be based on individual needs choices and preferences Ensure the care plan for each resident outline in detail the action required by staff to meet all the residents needs. Care plans must be reviewed monthly and updated where there are any changes. Timescale for action 30/07/07 • . • 2 OP8 12(1) Training should be given in the care planning system where required. The registered person must ensure: • All staff use have detailed instructions for manual handling, which includes sling size. • All residents who requiring moving in bed have an individual slide sheet that is suitable for their needs. DS0000024875.V333746.R01.S.doc • 30/07/07 Orchard House Nursing Home Version 5.2 Page 26 3 OP8 17(2) The registered person must ensure the: • Record of food/fluids for all residents is in sufficient detail for anyone inspecting to determine if they are receiving a nutritious diet. • Turn chart records are comprehensive to demonstrate what care has been given to resident throughout the day The Registered person must review the provision of activities for residents to ensure they meet the needs of and in consultation with residents The registered person must provide: • Lockable facilities for all residents if they require on unless their risk assessment indicates otherwise. A record of this conversation must be kept on the residents file. Residents must be consulted about holding their own keys and if they do not hold a key for any reason this must be recorded in their file The Registered Person must: • Cease using polythene gloves when dealing with bodily fluids. • Audit provision of liquid soap dispensers in the home and replace with cartridge type dispensers. The Registered Person must audit type of bed available to residents and whether these meet the needs of the residents and manual handling DS0000024875.V333746.R01.S.doc 30/06/07 4 OP12 16(2)(m) 30/07/07 5 OP24 12(4)(a) 30/08/07 • 8 OP26 13(3) 30/06/07 10 OP24 16(2)(c) 30/08/07 Orchard House Nursing Home Version 5.2 Page 27 11 OP27 18(1)(a) requirements. From this audit a plan of replacement must be drawn up. The Registered Person must 14/06/07 • Ensure that there is sufficient time for trained staff to handover information between shifts. The registered person must ensure • a CRB check is obtained for all staff before they commence employment in the home. • All staff working at the home must have a CRB that has been carried out by the home. The registered person must ensure: • Records must be maintained for all money held in the home on behalf of residents. There must be two signatures for all transactions made on behalf of residents ideally one being the residents. Receipts must be available for all deposits and withdrawals. 30/06/07 12 OP29 19(4) 13 OP35 18(1) 30/06/07 • • 14 OP30 18(1) 15 OP38 23(2)© Records must be kept of all valuables deposited by residents for safe keeping with the home The registered person must 30/07/07 ensure all staff undertake basic training in respect of basic food hygiene records must be retained home. The Registered Person must 14/06/07 ensure that all wheelchairs have footplates and that these are DS0000024875.V333746.R01.S.doc Version 5.2 Page 28 • Orchard House Nursing Home 16 OP38 13(4) 17 OP38 23(4)(e) used whilst transporting resident. The registered person must undertake risk assessments in respect of chemicals and fire with appropriate action plans to reduce risk. The Registered Person must ensure that all staff take part in a fire drill twice a year. 30/06/07 14/07/07 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 2 Refer to Standard OP15 OP33 Good Practice Recommendations The Registered Person must ensure that residents are offered a choice of meals that is consistent with what is provided The Registered Person must draw up an annual development plan based on their quality assurance finding which is accessible to resident and representatives. Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Orchard House Nursing Home DS0000024875.V333746.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!