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Inspection on 21/02/07 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 21st February 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

Care plans provide information, which showed clearly how resident`s needs are met. Residents felt the care provided is of good quality. Staff team members are provided with a range of training opportunities, which help to ensure the continued development of services provided.

What has improved since the last inspection?

The acting manager has been successful in her application to be the registered manager for the home. The manager has developed a system, which ensures all staff members receive supervision on a regular basis. Risk assessments have been completed and are reviewed to ensure that equipment provided helps to safely meet the physical needs of residents at the home. One bathroom has been adapted to meet resident`s needs more effectively and some decoration has been completed in communal and working areas of the home.

What the care home could do better:

Communal toilets on both floors of the home are clean and safe to use but would benefit from being redecorated.

CARE HOMES FOR OLDER PEOPLE Orchard House Nursing Home Grosvenor Road Mablethorpe Lincs LN12 1EL Lead Inspector Roger Harrison Key Unannounced Inspection 21st February 2007 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 Nursing Home DS0000061935.V324296.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 DS0000061935.V324296.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard House Nursing Home Address Grosvenor Road Mablethorpe Lincs LN12 1EL 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) 01507 472203 Orchard House Nursing Home Ltd Mrs Susan Izzard Care Home 52 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (47), of places Physical disability (9) Orchard House Nursing Home DS0000061935.V324296.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the registration the following placements are allowed: 7 PD aged 40 years and over accomodated in Rooms 1, 2, 3, 8, 9, 47, and 48. 2 PD (Respite only) aged 25 years and over accomodated in Rooms 6 and 16. 3 DE(E) aged 60 years and over. 28th November 2005 Date of last inspection Brief Description of the Service: Orchard House is a large detached residence with a new extension situated in large grounds. The grounds are largely laid to lawn and there are pleasant and landscaped seating areas for service users. The home is situated 500 yards from the town centre of Mablethorpe and there is good access to public transport and local community facilities. The home provides nursing and personal care to 52 older people and has nine beds, which may be used for younger adults who have a physical disability. Accommodation is provided on ground and first floor levels and there is a passenger lift. There are 44 single and 3 double bedrooms provided, 9 of which are en-suite. There are a variety of lounges, a large dining room and conservatory. The home is appropriately adapted to meet the physical needs of older and disabled people including lifting appliances and assisted bathing. The statement of purpose sates that the home’s aims are to provide an ever improving and caring service within the community that reflects their commitment to treat clients as individuals. The manager confirmed that charges made by the home on 21/02/07 currently range from: £380.00 - £633.00 p.w. Orchard House Nursing Home DS0000061935.V324296.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken by an inspector reviewing all the previous Inspection records available, looking at information provided by the Manager about Orchard House Nursing Home and through undertaking a visit to the home, with the inspector using a method of inspection called “case tracking”. This involved identifying individual residents who currently live at the home and tracking the experience of the care and support they have received during the time they have lived there. The inspection visit was also used by the inspector to check that information provided by the manager matched the individual experience of residents. This was done by talking to the deputy manager, looking at information on care plans and files, and to talking to residents, and care staff while observing day-to-day care practice within the home. What the service does well: What has improved since the last inspection? The acting manager has been successful in her application to be the registered manager for the home. The manager has developed a system, which ensures all staff members receive supervision on a regular basis. Risk assessments have been completed and are reviewed to ensure that equipment provided helps to safely meet the physical needs of residents at the home. One bathroom has been adapted to meet resident’s needs more effectively and some decoration has been completed in communal and working areas of the home. Orchard House Nursing Home DS0000061935.V324296.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 DS0000061935.V324296.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 DS0000061935.V324296.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): Standard 3 [Standard 6 N/A]. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager and senior care team assess residents needs, and provide information to confirm that their needs can be met before any admission to the home takes place. EVIDENCE: Before the inspection visit took place the manager and residents sent written comments to the inspector saying that they had received enough information about the home before moving in, which helped them to decide it was the right place for them. The manager confirmed she uses an assessment pack and undertakes an assessment visit before any move to the home takes place and that the homes user guide and statement of purpose are available to inform potential residents about the home. Orchard House Nursing Home DS0000061935.V324296.R01.S.doc Version 5.2 Page 9 During the inspection visit the deputy manager provided a copy of the assessment pack used and said she encourages visits to the home in advance of any move. Trial periods are used alongside reviews, which are recorded and kept with the assessment and care plan to check that the care team can meet any additional needs not identified on admission. The care plan for one new resident contained all the new assessment details and information to show how needs identified will be met. When asked if the care team had completed an assessment of need before moving into the home One resident said “Matron came to visit me in hospital to discuss my move” and another said “Yes and the home had all the nursing care I required”. Orchard House Nursing Home DS0000061935.V324296.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): Standard 7,8,9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s health and personal care needs are set out in an individual care plan. Resident’s health needs are met. The manager has policies and procedures in place, which staff follow in order to support residents with their medication needs. Residents are treated with respect and supported to maintain their dignity. EVIDENCE: During the inspection visit care plans were selected which contained assessments of physical needs. Care plans described each resident’s physical need and there was information available to show that reviews of care plans and risk assessments are carried out monthly. Information available with the care plans showed that the manager consults and works with community health nurses, doctors and Social workers to help support residents safely. Orchard House Nursing Home DS0000061935.V324296.R01.S.doc Version 5.2 Page 11 Residents said that they felt supported with their health care needs and that the support is provided in a way, which respects their right to privacy. Examples of this were; staff being observed using sensitive and quiet communication, Keeping a focus on talking with one resident at time, Offering and providing private space in which to deliver personal care and using a key worker system to enable care staff to focus on individual needs. This was also helped through the use of additional clear and brief laminated care plans located in residents rooms which highlighted how needs must be met, which both residents and staff members could use as a reference. One resident said “The staff are really good because they know a thing or two about my care needs, it’s written down so they know what to do”. The manager confirmed that the home has a policy and procedure for helping residents with their medication needs and that residents are supported to self medicate whenever possible. On the day of the inspection visit all residents needed some level of support with their medicines. Medicines were stored safely and put in a locked mobile trolley when being used. The manager said that only those senior staff members who had received training were responsible for supporting and giving medication to residents. A record of training achieved was available on the senior staff members file on duty. Medication records are kept with the medicines and are used to show when medicines have been given. These records were fully up to date. Orchard House Nursing Home DS0000061935.V324296.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a range of activities, which they said meet their individual and group needs. Residents have regular contact with family and friends and are supported to have control over their lives. Residents receive a varied, balanced and nutritious diet. EVIDENCE: Information provided by the manager before the inspection visit showed that staff time is made available to plan and provide a range of activities including; entertainers, a visiting library, clothes parties, walks, outings, games, music and musical evenings. Activities are offered to residents on a weekly basis. The deputy manager confirmed that the home has recently started to employ an activity worker who provides specific activity time for twenty hours a week at the home. The deputy manager said that the time available will be used to develop activities and social care plans “with” rather than “for” residents in order to create more choice and flexibility in the way activities are offered. Orchard House Nursing Home DS0000061935.V324296.R01.S.doc Version 5.2 Page 13 Residents said they currently choose to either get fully involved in the arranged activities or to make alternative arrangements. One resident stated that; “There are activities here which I can join in with if I wish to do so” and another commented that “There’s plenty to do here, we’ve got the freedom to get involved or not as we wish”. Throughout the inspection visit residents were observed undertaking group activities with staff, receiving visitors, going out for walks, talking together, watching the large wall mounted television, making plans to see the hairdresser, who regularly visits the home, or taking private time in their own rooms as they wished. Care plans contained details about each residents dietary needs and the cook said she knows all the likes and dislikes of each resident. The cook said that she arranges to meet with any new resident to discuss their dietary needs and provided a record of residents likes and dislikes which she said she uses to plan menus. Main meals are provided at set times but both the cook and residents said that if they wanted anything to eat at any time they could ask and it would be provided. Menu plans are produced by the cook and show that a variety and choice of meals are provided to residents daily, including those with special dietary needs. Menus for each day are available for all residents to see in advance of any meal. Residents said they felt the meals are good and that they could eat them either in their room or in the communal dining areas. Two residents commented together that “The meals here are the best, and if there is anything we fancy we just let the cook know and she gets what we want” Orchard House Nursing Home DS0000061935.V324296.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager and care team take complaints seriously and wherever possible involve residents and carers in resolving issues as soon as they are evident. The Care team know how to act in order to protect residents from abuse. EVIDENCE: The manager has produced a complaints policy and procedure. There is a copy of the compliants procedure on display at the entrance to the home and residents said they felt happy to raise any concerns thay may have with the Manager. The manager keeps a record of any formal complaints received and confirmed that she has receieved no formal complaints since the last inspection. The manager said she would provide a written response to any complaint and always attempts to meet with individuals to try to resolve matters informally whenever concerns are raised. During the inspection visit one resident said she felt happy to raise any issues of concern with either the manager or deputy manager. One general concern was raised about the availability of staff members when help is needed. The deputy manager aranged to meet with the resident and was able to respond and resolve the concern raised, arranging to review the action agreed together Orchard House Nursing Home DS0000061935.V324296.R01.S.doc Version 5.2 Page 15 with the resident. The resident said “I feel much happier and that I have been listened to, I know I can always talk to them when I have reason to” Residents made positive comments about the manager and how she responds to concerns. One resident said “There is always someone on duty to talk to if we have any worries”. One family carer said, “My mother doesn’t really know because she gets confused but if I am aware of anything I act on her behalf”. The deputy manager confirmed she provides training regarding adult protection for new staff during their induction and using NVQ training. The training officer confirmed that she plans to provide specific adult protection training as part of the annual training plan for the year, which was available to show dates planned. The deputy manager also confirmed she has a copy of the local authorties adult protection procedures and guidance for staff reference. three staff members described the action they would take to ensure that residents are protected from abuse, which showed that they have a good understanding of the importance of ensuring residents are safe from harm. Orchard House Nursing Home DS0000061935.V324296.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): Standard 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a well-maintained comfortable and safe environment. EVIDENCE: Information provided by the manager before visiting the home and a tour of the building confirmed that parts of the home have been refurbished since the last inspection, including one bathroom, which has been turned into a walk in “wet room” with access shower for ease of residents. The home was well decorated on both floors and private, bathing and communal areas were set out in a way, which encouraged residents to use them safely. Orchard House Nursing Home DS0000061935.V324296.R01.S.doc Version 5.2 Page 17 Communal toilets are provided on both floors of the home. These were clean but would benefit from being redecorated. The deputy manager confirmed that these facilities are to be decorated as part of the ongoing environmental improvements being made in the near future. This will also include the replacement of some carpets in resident’s rooms. Resident’s rooms had names on the doors to help identify who lived in them. Locks were available to enable residents to be private if they wished. Rooms were well personalised and clean. Mobile telephones were located throughout the home, which the deputy manager and residents said helps when individuals want to make a private phone call. Residents commented on the cleanliness of the home, and one resident said, “The home is always clean and the cleaners are here every day”. Fire equipment had been tested and serviced and call bells were tested and found to be in working order. Fire training has been provided for all staff and staff team comments confirmed that they know how to act to protect residents in the event of a fire. Orchard House Nursing Home DS0000061935.V324296.R01.S.doc Version 5.2 Page 18 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): Standard 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of safely recruited care staff available at the home with appropriate training and skills to meet the needs of residents. EVIDENCE: Before carrying out the inspection visit the manager provided information, which included staff rotas for January 2007. Information provided showed that staffing levels are balanced using a shift system. This includes a night care team for the home. During the inspection visit the deputy Manager provided staff files, which showed that references and checks are completed to make sure recruitment is carried out safely. Staff members said that they had received an induction before being allowed to provide support without supervision and one staff member said “It was mainly practical but I found this the best way to learn the job, I was showed how to provide safe care and the training here has helped me to develop” The deputy manager provided training records to show that staff members are supported to undertake NVQ training using two staff NVQ assessors and a designated training officer. The training officer is a qualified trainer who Orchard House Nursing Home DS0000061935.V324296.R01.S.doc Version 5.2 Page 19 provides a range of other courses such as; moving and handling, dementia care, fire safety and medicine management training. Staff confirmed that training is used to update skills as needed. Residents said they trusted the staff team and one resident said, “They are a great gang, they know our needs and there is nothing they wont do to make sure we are okay” Orchard House Nursing Home DS0000061935.V324296.R01.S.doc Version 5.2 Page 20 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): Standard 31,33,35,36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager and deputy manager work together to ensure family carer views are sought, listened to, and acted upon. Staff supervision is undertaken regularly with records maintained. The manager safeguards resident’s financial interests. EVIDENCE: Since the last inspection the deputy manager has applied for, and been successful in becoming the registered manager for the home. The manager has a deputy in place and a training officer who helps provide support with arrangements for staff development. The deputy manager confirmed that she used to be the registered manager for the home and that both she and the Orchard House Nursing Home DS0000061935.V324296.R01.S.doc Version 5.2 Page 21 manager work well together as a team. In the managers absence the deputy manager was able to provide all the information requested. The acting manager confirmed that resident’s views are sought about how the home should develop. This is done by randomly sending questionnaires out to six residents and carers each month. The feedback received has helped the management team to identify areas that need to improve, one of which was to increase the range of activities at the home by employing a dedicated activities person within the staff team. Residents said they felt this was a real improvement. Staff team members said they receive supervision and a record sheet used by the manager and senior staff showed how records are used to identify developments and training needs. Supervision records are kept separate to staff files to make sure confidentiality is maintained when needed. The manager confirmed that all residents are encouraged and supported to manage their finances with help from families and using private arrangements. Some residents have asked for help to manage their weekly allowances and the manager provided records, which are kept by the home administrator to show that they are managed in a structured way. Financial records are kept and a random sample checked during the inspection visit showed that records are fully up to date. Residents said that this arrangement helps them to access their money when they need it. One resident said, “It works well because if I need any money its always there”. Overall, written and verbal comments received from residents and family carers before and during the inspection visit confirmed that the home is managed by a team who keep residents best interests at the centre of the work they do. Orchard House Nursing Home DS0000061935.V324296.R01.S.doc Version 5.2 Page 22 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 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 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 4 X 3 X 3 X X 3 Orchard House Nursing Home DS0000061935.V324296.R01.S.doc Version 5.2 Page 23 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. 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 DS0000061935.V324296.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 DS0000061935.V324296.R01.S.doc Version 5.2 Page 25 - 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. 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