CARE HOMES FOR OLDER PEOPLE
Orchard House Nursing Home Orchard House Nursing Home Kelfield York North Yorkshire YO19 6RE Lead Inspector
Mary Slattery Unannounced Inspection 30th September 2005 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 DS0000045991.V252685.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Orchard House Nursing Home Address Orchard House Nursing Home Kelfield York North Yorkshire YO19 6RE 01757 248868 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) European Care (SW) Ltd Mrs Vikki Sara Hamblin Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30) Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service Users up to 30 (DE(E)) and 30 (MD(E)) up to a maximum of 30 service users Age range 55 years plus Date of last inspection 26th January 2005 Brief Description of the Service: Orchard House is a care home providing nursing care for people from the age of 55 years with dementia and mental disorder. The home is owned by European Care (SW) Limited and was registered with the Commission in July 2003. Orchard House is located in Kelfield a rural area close to York and Selby and is situated in large private grounds. The accommodation provided is both in single and double bedrooms over two floors and there is a passenger lift for access to the first floor. There is ramped and level access to the home, ample parking for visitors and staff and a large garden area. Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report related to an unannounced inspection carried out on the 30th September 2005. The inspection took five and a half hours plus 2 hours preparation time. A tour of the premises was carried out, which included the service users private accommodation. A selection of the homes’ records were looked at and time was spent observing the activity in the home, talking and listening to service users, staff and visitors. The focus of the inspection was on a number of key standards, inspecting the case records of a number of service users to establish if they corresponded with their experiences of life in the home. The registered manager was available throughout the inspection and the findings were discussed and agreed at the close of the inspection. What the service does well:
Orchard House provides nursing care and accommodation for people from the age of 55 years who have dementia and mental health problems. There was good information about what is provided in the statement of purpose and the service user guide. There was evidence that people are informed about the assessment and admission process, care planning and care reviews and details of the staff that are working in the home. There are good communication systems in place and it was evident that staff work as a team and they confirmed they were well supported by the manager and each other. Good information is gathered about the service users before they are admitted to the home and a care plan is produced to ensure that all staff are fully aware of each individual need and how each need is to be met. Risk is assessed and plans are put in place are put in place to minimise risk yet enabling the service
Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 Page 6 users to remain as independent both physically and mentally as far as they are able. The staff help the service users to make decisions about how their care is to be delivered and family members are encouraged and supported to be involved in their relatives care. There is wide range of activities designed to suit hobbies and interests, and opportunities for service users to keep mentally alert and physically active. Records of all care reviews are kept and details of any contact service users have with external health care professionals. All of the staff have a training and development programme, which includes dementia and mental health conditions, managing aggression and challenging behaviour. The environment is very pleasant and provides the space for service users to move around without restriction but remain safe, there are natural contours for them to follow and interesting pictures for them to look at and enjoy. There was an opportunity to speak to two external health care professionals both have been visiting the home for a number of years and they told me that the service user received good quality care from the staff and that the staff conducted themselves in a professional manner and had a good understanding of the service users needs. What has improved since the last inspection? What they could do better: Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 Page 7 A representative of the proprietor should visit the home at least once each month and produce a report on the conduct of the home and provide supervision and support for the registered manager. 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 DS0000045991.V252685.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. People are provided with considered information about what the service provides. Information is gathered about people before they move into the home to ensure that their needs can be met in a safe way. EVIDENCE: The statement of purpose and the service user guide provides people with details of the service and the facilities. All prospective service users and or their representative are given a copy and copies are available in the entrance hall in the home. A contract and terms and conditions document is agreed with people who are self funding and with placing authorities. Copies of the contract/terms and conditions are kept on the service users files. The policy of the home is that all service users are assessed and the records confirmed that the outcomes of the assessment are discussed and agreed with the service users where possible or their representative.
Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 Page 10 No new service users is admitted to the home without considering if their needs can be met, that the staff have the required skills to provide the care as assessed and the effect it may have on the service user currently living in the home. People are invited to visit the home to look at the facilities and to discuss the services before making a decision to move in. The home does not provide intermediate care. Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9. There are good systems in place to make sure that the service users health and personal care needs are met. EVIDENCE: There is a care plan in place for each service user, which are developed from the assessment and from care reviews. The care plans clearly set out each individual’s personal, social, physical and mental health nursing need. Good risk assessments were in place with clear plans to assist both staff and service users to minimise the risks they take in their daily lives. There was information about the arrangements that are in place for regular contact with external health care professional including their general practitioner and mental health services. Records of any treatments prescribed and administered are recorded and reviewed. The service users have dementia and or mental health problems and are not always able to tell the staff what their needs are and may at times exhibit difficult and/or challenging behaviour. The ways in which they let staff know
Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 Page 12 their needs is clearly recorded and management plans are in place for staff to follow to ensure they receive the attention and care they need. There were no service users who were administering their own medication. The qualified nursing staff are responsible for making sure they receive their medication as prescribed. The system and facilities in place for managing and administering medication was inspected and found to be meeting the requirements. Medication reviews are held on a regular basis with the service users doctor and staff have undertaken medication training. The service users were not able to tell me how they were treated but the staff were seen to treat each person in a respectful way and their personal care needs were attended to in private. Relatives and two external health care professionals endorsed my observations of staff practice. Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The visiting arrangements are flexible enabling service users to keep contact with family and friends. Service users are helped to exercise choice about their daily lives and the food they eat. EVIDENCE: The majority of the service users are not able to make an informed decision about daily living. Part of the initial assessment focuses on gathering information about the past interests and lifestyles of the service users and details about their family and friends. This information helps the staff to put together a care plan, which includes the arrangements to assist people getting up and going to bed, daily living and involvement in a wide range of activities both in the home and in the community in line with each persons social, cultural and religious interests. Around the home are several items of interest for the service users that relate to their generation and interests. Each service user has one to one time with staff and can choose if they wish to join in small group activities.
Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 Page 14 Due to the mental health conditions of some of the service users there can be a lot of noise in the home and to reduce the disturbing effect this may have on people service users have the opportunity to spend peaceful time in their own rooms, walk in the garden or go out with a member of staff. Records of all activities are kept including responses to activities. The care plan records evidenced that nutritional assessments are carried out and where necessary discussion are held with doctors and dieticians to make sure their dietary needs are catered for. The menus are developed to include likes, dislikes and nutritional needs. All of the staff are available at mealtimes to assist the service users and to make sure that the mealtime is a social occasion. Some service users become restless and may move away from the dining room and staff are available to manage this situation and minimise the any disturbance to other service users. Food and drink is made available all day and there are sufficient catering staff to provide this. Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. The home provides people with information about how to make a complaint and all staff are clear about the action to take to protect service users from abuse. EVIDENCE: Information about how to make a complaint against the service is made available to service users, visitors and other stakeholders. The service users are not always able to complain about their care or about how they are treated by the staff. Good records were in place giving information about how service users react to the staff and how they make their needs known. Any changes in behaviour are noted and looked at to establish if they have any concerns and to make sure they are safe. All staff are checked with through the Criminal Records Bureau and POVA prior to taking up their post and they have attended abuse awareness training. Information about how to report abuse is clearly displayed in the staff room. Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 25 and 26. The standard of the environmernt has greatly improved providing people with a bright comfortable and pleasant place to live in. EVIDENCE: The service users bedrooms were personalised with items that reflected their past and present lives and some had family photographs and chosen personal possessions. Some of the bedrooms are shared and there was appropriate screening in place to ensure privacy when personal or nursing care was being delivered. The service users are not always able, by nature of their condition to make an informed choice about sharing private accommodation and arrangements are in place for full consultation with service users and/or their representative before admission to the home. A number of areas in the home have been refurbished and redecorated and further plans are in place for a number of bedrooms and corridors to be redecorated and new flooring laid.
Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 Page 17 The home was warm, clean, bright, hygienic and free from offensive odours and the time of the inspection. Staff are employed to undertake domestic and laundry duties and there were systems in place for the control of the spread of infection. There was good provision of equipment to assist people with their mobility and for pressure relief. A new kitchen has been fitted, a bath hoist fitted in the ground floor bathroom and four new profile beds have been purchased. The work planned is to upgrade the bathrooms on the first floor to provide an assisted shower, a bath and a toilet. The facility would benefit from an assisted bath rather than making good the existing bath. This will provide good assisted bathing facilities for the service users and more space for the staff. One of the ground floor corridors is to be decorated and new flooring laid and the walls are to be decorated with objects of interest to the service users. The registered manager has made representation to the company for new window to be fitted in this area and it is agreed that this would be a benefit heat wise and aesthetically. All the requires safety certificates were in place including a current insurance certificate. Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The number of staff on duty was sufficient to meet the needs of the service users. EVIDENCE: The home employs qualified nursing staff, care staff, domestic and catering staff and a part time admin staff. The qualified nursing staff have the relevant mental health and general nursing qualifications. A number of care staff have achieved NVQ Level 2 and 3 and others are due to commence Level 2. The following training has been achieved, dementia awareness, older persons pathway, nutrition, management of aggression, health and safety in care. All staff have a training portfolio and the qualified nursing staff continue to update their knowledge and skills as required to maintain their registration. Staff are supervised on a regular basis and have an annual appraisal the outcomes of which are recorded. The home has the required numbers of staff on duty during the day and overnight but does not have the required numbers of qualified nursing staff on duty at all times. When there is one qualified nurse on duty the number of care staff is increased by one. Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 Page 19 All staff are subject to TOPPS induction and statutory training, which includes, moving and handling, fire safety, infection control, food handling. A number of the staff records were inspected and the required records were in place, which included a current CRB and POVA check. There were records to confirm induction, supervision and appraisals and a detailed record of all training. Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. The service users benefit from a well managed home where their needs and wishes are put first. EVIDENCE: The registered manager is a qualified first level nurse and has completed the Registered Managers Award. She has managed the home for a number of years and continues to update her practice and skills through training. Staff meetings take place, which provides a forum for the discussion of all aspects of the home and to contribute to its future development regarding care to the service users and their own training needs. Relatives are consulted and their views are recorded as part of quality assurance and quality monitoring system.
Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 Page 21 A number of the service users are supported by the staff with the management of their personal finances and the arrangements that are in place for this support and for the safekeeping of money and valuables were satisfactory and allows service users to have access to their monies at all times. The required records policies and procedures were in place and found to be in good order and up to date and available to the staff. Another manager has carried out the Regulation 26 visits to the home in the absence of the person with line management responsibility for the service. To ensure that the manager receives regular supervision and support from a representative of the proprietor it is important that these visit recommence as soon as possible. The home has a health and safety policy and procedure and staff are subject to health and safety training. Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X 3 3 Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 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. 1 Refer to Standard OP33 Good Practice Recommendations It is recommended that a representative of the proprietor visit the home at least once each month to undertake the Regulation 26 monitoring visits and provide supervision for the registered manager. Orchard House Nursing Home DS0000045991.V252685.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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