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Inspection on 04/02/09 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 4th February 2009.

CSCI found this care home to be providing an Good service.

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

The people living in the home live in clean, comfortable, well maintained and safe accommodation. They are well cared for by a well managed, educated, committed and competent care team. Those people who were spoken with expressed satisfaction with the care and service provided by the home. All people are assessed before entering the home and there is a recreational and activity programme provided which provides stimulation. There is a thorough assessment and review of care with wherever possible the involvement of each person and or their relative/family. There is a comprehensive programme of education provided which ensures that staff know how to care and support the people living in the home.

What has improved since the last inspection?

They have opened the new 10 bed self contained Bramley Suite in March 2008 for people who have a dementia. Although this is in the main home it has its own staff who have undertaken the Certificate in Dementia Care. They have appointed a new activities co-coordinator for 23 hours a week. They have improved the range of activities provided in the home as a result of discussions with the people living in the home. They have introduced new care plans which are more person focused. They have included a behavioural response assessment tool to their existing assessment form to ensure they gather effective information efficiently. This is used primarily in the assessment of the people in the Bramley Suite. They have introduced a CheckIT system which provides an electronic recording of night checks and maintenance routines. It allows the management to analyse the information every day and to address any inconsistencies. They have installed a hand sanitising station at the reception to address cross infection The rear garden has been landscaped and new garden furniture has been bought They have redecorated 12 bedrooms in the last 12 months. They have increased the amount of training provided to meet the diverse needs of the people living in the home and further developed the skills of the staff. As a result of this 80% of care staff have obtained a nationally recognised qualification.

What the care home could do better:

There were no requirements as a result of this inspection. The management teamacknowledge that the home is going through a period of change and want to further introduce more person focused care. They intend to review and train staff about introducing a more person centred approach to care. They further want to train staff to recognise issues about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We noted that the information for people living in the home did not have details of our Cambridge Regional office address and phone number. However the management team agreed to address this immediately. We have recommended that they address the issue of choice in care plans. They carry out regular quality assurance monitoring audits and surveys. They continue to be proactive and keen to introduce new methods and approaches to care and support. The management team told us that they wanted to develop dignity in care champions in the home in line with the NHS Dignity in Care campaign.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Orchard House Nursing Home Grosvenor Road Mablethorpe Lincs LN12 1EL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tobias Payne     Date: 0 4 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Orchard House Nursing Home Grosvenor Road Mablethorpe Lincs LN12 1EL 01507472203 01507473248 juliet@orchardhouseltd.wanadoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Orchard House Nursing Home Ltd Name of registered manager (if applicable) Mrs Susan Izzard Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 52 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE Physical Disability Code PD Date of last inspection Brief description of the care home Orchard House Nursing Home 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 the people who live in the home. Care Homes for Older People Page 4 of 29 care home 52 Over 65 0 52 0 52 0 52 Brief description of the care home 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. On the day of our inspection visit there were 47 people living in the home. 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. In March 2008 they opened a new self contained 10-bed Bramley Suite offering person-centred care to people with a dementia. It has its own communal areas, separate staff, conservatory and enclosed safe patio for people to sit. The statement of purpose states that the homes aims are to provide an ever improving and caring service within the community that reflects their commitment to treat people as individuals The fees at our inspection visit on the 4/2/2009 ranged from £351 to £452 a week for people with a contract with care funded by Lincolnshire County Council. For those people who were self funding fees ranged from £414 to £528 each week. Extras were for hairdressing which ranged from £6 to £25, chiropody £7, toiletries and personal newspapers and magazines. Information about the home including a copy of the last inspection report, the statement of purpose and service users guide can be obtained from the management of the home. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was unannounced and started at 8.30 am. It was undertaken using a review of all the information available to us about Orchard House Nursing Home. It took place over 6 hours. We spoke with 8 people living in the home, 4 visitors, 5 staff, the General Manager, Director of Operations and Training and the Clinical Manager who is the acting Manager for the home. The main method of inspection was called case tracking. This involved selecting 2 people and tracking the care they received through the checking of records, discussion with them, the care staff and observation of their care. We also examined the annual quality assurance assessment (AQAA) that was sent to Care Homes for Older People Page 6 of 29 us by the manager before this key inspection. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the home. It was very clear, accurate and detailed. What the care home does well: What has improved since the last inspection? What they could do better: There were no requirements as a result of this inspection. The management team Care Homes for Older People Page 8 of 29 acknowledge that the home is going through a period of change and want to further introduce more person focused care. They intend to review and train staff about introducing a more person centred approach to care. They further want to train staff to recognise issues about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We noted that the information for people living in the home did not have details of our Cambridge Regional office address and phone number. However the management team agreed to address this immediately. We have recommended that they address the issue of choice in care plans. They carry out regular quality assurance monitoring audits and surveys. They continue to be proactive and keen to introduce new methods and approaches to care and support. The management team told us that they wanted to develop dignity in care champions in the home in line with the NHS Dignity in Care campaign. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at this home receive clear information to enable them or their relatives/advocates to make an informed choice as to whether or not they wish to live in this home. Where a person is referred to the home they receive a comprehensive assessment to ensure that their needs can be met. Evidence: There was a statement of purpose and service users guide. This was available in two separate folders. The management told us that wanted to make the information available in the future in different formats such as tape/CD to meet the diverse of the people. There was a detailed admission procedure, which described the needs of the people coming into the home. The acting manager or in the case of people who have a dementia the Director of Operations and Training assesses each person to ensure that Care Homes for Older People Page 11 of 29 Evidence: they can meet their needs. As a result of this written confirmation would be sent to show that the home was able to meet their needs. Each person had terms and conditions when being admitted to the home. This was clearly outlined in the statement of purpose and service users guide. The home did not provide intermediate care. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is clear care planning system in this home. This and the homes internal audit system ensures that the health and welfare needs of people living in the home are fully met. People are encouraged to make decisions for themselves and be independent with the support and guidance of staff. Medication is safely given by nurses and senior care staff who know what they are doing and are safe in their practise. Evidence: Each person had a care plan describing their care and support. The care plan had been produced wherever possible with the involvement of the person, their family/advocate and other relevant people. The management team told us that they were in the process of introducing a more simple but individual method of recording care and support. The aim being to make care more person centred. To enable this to happen staff would receive training before it was introduced. We saw records for 2 people. Each person in the main home had a separate file with a photograph, admission checklist, admission information, moving Care Homes for Older People Page 13 of 29 Evidence: and handling assessment, pain chart, body map, risk assessment, family and social background, care plans, progress reports, weight, nutrition, dietary, oral health and other assessments as required to meet the needs of the person. The care plans were preprinted with space for the name of the person to be hand written. These care plans had goals and needs, desired outcomes and ways of achieving this. However where the person had specific care and support needs they could be handwritten and made very individual. We saw that on the Bramley Suite this had been developed further to make care more person centred. Each person had 2 files one with risk assessments, nutrition and weight record. The other needs, behaviour, response, assessment and personal inventory. Care plans included all aspects of daily living and clearly identified their individual needs and choices. An example we saw was when they were putting a persons care plan together they noted that the person had stated I do not want to be a baby and wear a nappy. As a result of this staff had respected the persons wishes and we saw this was done in personal and sensitive manner. We saw that care plans were reviewed each month. Records were signed and dated. We discussed with the management team introducing the system used on Bramley Suite throughout the home as they were more individual. They agreed to consider this. We did not see a great deal of information in the care records about choice and decision making in the main house. However we could see that this was identified in the care plans on the Bramley Suite by a new detailed questionnaire about each persons likes and dislikes and choices. We however saw this taking place throughout the home by the way staff made contact with the people living in the home and their response. The people told us they had choice concerning their interests activities and lifestyle. Where required, people living in the home were referred to GPs, Community Nurse, Community Psychiatric Nurse, Tissue Viability Nurse, Continence Nurse, Physiotherapist, Opticians, Dentist and Chiropodist. The home had Link Nurses who specialised in tissue viability and continence. They met up with other nurses and promoted up to date practise in consultation with the NHS Lincolnshire (Lincolnshire Teaching Primary Healthcare NHS Trust). We were told us that progress is being made to develop and achieve a Gold Standard Framework for terminal care and after care. This work would be assessed by the Macmillan Nursing Service. People are encouraged to self medicated but on this inspection we were told that each person needed a degree of assistance in order to ensure that they took their medication in line with the prescribed directions. Nurses and senior care assistants administered medication. There was a policy and procedure for medication. The management assessed each person before they were considered safe to administer medication. Records we saw were clear, and well maintained. The acting manager Care Homes for Older People Page 14 of 29 Evidence: monitored the records every month People we spoke with were satisfied with the way staff cared for them and had confidence in the staff. We saw throughout our inspection staff attended to the people in a warm, friendly manner, knocking on doors before entering their bedrooms and asking whether they needed any help. We also noted there was a lot of laughter between staff and the people living in the home. A person told us when I came here 8 days ago I was not eating and could not walk. Since coming here I have regained my appetite, and started to walk with assistance. The staff have been kind and helpful. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities are varied, well managed, creative and provide stimulation and interest for people living in the home. Visitors are made to feel welcome and supported. People enjoy varied and nutritious meals. Evidence: When admitted to the home details were obtained of each persons interests. There was a written programme of activities, which was displayed on the notice boards throughout the home and there was also a monthly newsletter giving details of activities available. Social activities were provided by an Activities Co-coordinator. Activities took place Wednesday, Thursday and Friday in the morning and afternoon. They ranged from one to one contact, games, arts and crafts, Bingo, quizzes, music and film shows. In addition there was a holy Communion service every month and other denominations could be arranged at request. We visited the Bramley Suite and saw the staff involving the people in a quiz with the active involvement of the people. Each had a social profile, social assessment, activity information and what they like to do. They also had a record of activities provided. We spoke with 4 visitors who told us they could visit whenever they wished and always received a warm and friendly Care Homes for Older People Page 16 of 29 Evidence: welcome. The home had a mini-bus for larger groups or longer excursions. There were 2 cats and a rabbit which the people living in the home enjoyed having the contact. The people living in the home were offered 3 main meals a day, plus snacks. Menus were on a four-week rota. Fresh fruit and vegetables and meat were bought. East Lindsey District Council awarded the home 3 stars (excellent) in May 2007 following an inspection, in recognition of the catering service provided. The Catering staff were aware of the dietary needs of the people living in the home and provided soft, liquidised, low fat and diabetic options. Meals were served in the dining rooms with tables with clean table cloths or in their bedrooms on a tray. We saw staff were assisting those people who needed assistance in a dignified and sensitive manner. All the people we spoke with were complimentary about the food. The menu was displayed on the walls of the dining rooms. Comments included we get lovely food, well cooked and presented and since he has come here he has gained his appetite and put on weight. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to make a complaint and feel that staff will listen to their views. The care team know how to respond to a complaint and how to act in order to protect people from abuse. They are protected from abuse by correct and safe recruitment procedures. Evidence: Each person received a copy of the complaints procedure in the service users guide. The information was also in the statement of purpose. We noted that the information did not have details of our Cambridge Regional office address and phone number. However the management team agreed to address this immediately. No complaints had been received by the home or the Commission since the last inspection. We and the home had received no safe guarding issues. None of the people living in the home or staff had any complaints about the home and felt they could discuss any concerns with staff or the management. Staff also knew what to do if they received a complaint from a person living in the home. All staff were correctly recruited including a check by the criminal records bureau (CRB). During their induction each member of staff received information about abuse. Two staff were asked what abuse was and all knew their role and what to do if abuse Care Homes for Older People Page 18 of 29 Evidence: was suspected. Staff also received regular refresher training to ensure their knowledge was up to date. People we spoke with told us if I have any worries I can approach the staff or manager and discuss it with them and If I have an questions staff are willing to answer them and I have no concerns whatsoever. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in clean, comfortable, well maintained and safe accommodation. Evidence: The home employed a maintenance person and had an ongoing maintenance programme. Redecoration had been carried out since the last inspection. During our visit we walked around the home and found all areas of the home were clean, tidy and well maintained. People told us I like my bedroom, it is clean, comfortable and well maintained and my clothes are looked after well and washed well. The rooms had names on the doors to help identify who lived in them. Locks were available to enable the people to be private if they wished. Mobile telephones were located throughout the home, which helped when individuals wanted to make a private phone call. The home provided an assisted special bath, showers and had grab rails, raised toilet seats and shower seats. All bathrooms, toilets and en-suite facilities were wheelchair accessible. There were a variety of hoists and alternating pressure mattresses. Care Homes for Older People Page 20 of 29 Evidence: People we spoke with told us they were satisfied with the decoration and cleanliness of the home. They also spoke of how they liked their bedrooms. They were encouraged to bring into the home small items of furniture, television, pictures and personal items. There was a separate laundry with commercial washing equipment. We saw records which showed that the fire equipment had been tested, serviced and call bells were tested and found to be in working order. Fire training had also been provided and there was an up to date fire risk assessment. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a safely recruited, well-trained, supported staff team available who have the skills to meet the varying needs of the people living in the home. A wide range of inhouse training and National Vocational Qualification training is provided. Separate staff are provided for nursing/care, housekeeping, catering, laundry, maintenance and activities. Evidence: People we spoke with felt the home was adequately staffed with people who were experienced and competent to care for the people living in the home. A separate team of staff is provided on the Bramley Suite. People we spoke with did not express any worries about the level or availability of staff. During our inspection visit we saw staff attended to the needs of the people promptly and in a calm and friendly manner. People told us, they have time to give me the care I want and all the people are very nice. The management told us they monitored the dependency and varying needs of the people. We examined the files for 2 members of staff. Records were clear, detailed and showed that staff were safely recruited in line with the regulations. This included a Care Homes for Older People Page 22 of 29 Evidence: check by the Criminal Records Bureau (CRB). Each person received an induction programme then a more comprehensive nationally recognised induction. There continued to be a wide range of training provided. This included formal training in care to National Vocational Qualification standards (82 of the staff had achieved NVQ level 2 and a further 7 had achieved NVQ level 3). in addition 8 staff were being trained to NVQ level 3 and 2 housekeeping staff had obtained NVQ level 2. Training over the last year had included, health and safety, duty of care, common law, anatomy and physiology, risk assessment, moving and handling (very comprehensive covering all aspects and use of aids and equipment) and dementia awareness. We were told that dementia training was being addressed further by staff going on advanced training to further develop their skills and approach. The Director of Operations and Training is a qualified trainer and co-ordinates the training provided. Further training would cover safe handling of medicines, cancer awareness and health and safety. We spoke with 4 members of staff who told us we have more time for the residents, it is all about them not us, I look at the person not the illness as a result they respond better, we do not talk down to them, we give them time to respond and we do not rush them and I have learnt so much about how to approach people and the training has given me confidence. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and staff benefit from the positive leadership of the management team. Management record systems show that peoples health, welfare, safety and choices are promoted. The management team ensures that the people living in the home have the opportunity to voice their views and opinions. The management uses feedback from questionnaires from a number of sources and quality assurance systems to make improvements. Evidence: Since the last inspection a management review had taken place. Which, as a result had created a Clinical Manager who was also the acting manager. This person was a registered nurse with many years of care and managerial experience and had a management qualification. She had been employed at Orchard House for 13 years and had held a number of positions within the home. We noted that we had not yet received an application for her to be the registered manager and discussed this during our inspection. We were told one would be sent immediately. She was supported by a Care Homes for Older People Page 24 of 29 Evidence: General Manager/ Administrator who had been employed at Orchard House since September 2006. In addition there was a Director of Operations and Training who had been employed at Orchard House for 12 years and had held a number of positions within the home, working as a registered nurse, training co-coordinator and operations co-coordinator. Regular staff meetings were held. They told us that they felt valued and supported. We saw staff attended to the people in a confident, knowledgeable, and sensitive manner. There was a relaxed atmosphere. People told us, I am very happy here, I love being here, the staff are so kind and helpful, the staff are marvellous and this place is fantastic and I am very satisfied. Visitors told us I have seen such an improvement in my husband and I am very satisfied Staff told us I like working here, the way we work is friendly and professional and we are more of a team and I feel valued. The management told us that all the people were encouraged and supported to manage their finances with help from families and using private arrangements. Some of the people had asked for help to manage their weekly allowances and the management provided records, which were kept by the home administrator to show that they are managed in a structured way. Financial records were kept and a random sample checked during the inspection visit showed that records were fully up to date. The company had comprehensive quality assurance procedures. We saw that they had received 16 completed surveys from the people living in the home in June 2008 which resulted in positive responses. The responses were analysed and the report showed overall staff were polite, professionally dressed and the people were happy. The people living in the home asked that care plans were explained to them and this was being addressed. In addition, a recent food survey in November 2008 received 21 replies. A management meeting was to take place in the future to discuss the results and future improvements concerning choice. The management carried out internal audits of medication and care plans every month The company had comprehensive health and safety policies, which also included detailed and up to date risk assessments. There were regular tests of the fire system as well as regular fire drills and monthly monitoring of hot water temperatures. There were also infection control policies and staff made use of hand sanitiser throughout the home to further prevent infection. Care Homes for Older People Page 25 of 29 Evidence: The home had a range of policies and procedures and these were regularly reviewed and updated. Records we looked at showed that equipment was regularly checked and serviced and there were systems to monitor any maintenance issues. We found records throughout our visit were available, well maintained and up to date. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The management should in their review of the care record system ensure that choice for all the people living in the home is fully reflected in all the individual care plans. Care Homes for Older People Page 28 of 29 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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