Inspection on 12/04/06 for Orchard House (Sawston)

This inspection was carried out on 12th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Orchard House (Sawston) 03/06/08

Orchard House (Sawston) 20/07/06

Orchard House (Sawston) 18/11/05

Orchard House (Sawston) 20/07/05

Orchard House (Sawston) 28/02/05

Orchard House (Sawston) 28/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Orchard House (Sawston) 191 High Street Sawston Cambridgeshire CB2 4HJ Lead Inspector Shirley Christopher Key Unannounced Inspection 12th April 2006 10:30 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 (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Orchard House (Sawston) Address 191 High Street Sawston Cambridgeshire CB2 4HJ 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) 01223 712050 01223 712052 home.saw@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged Care Home 35 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (13), Old age, not falling within any other of places category (20) Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The minimum daytime staff to resident ratio will be 1:5 for those residents in DE (E) category 18th November 2005 Date of last inspection Brief Description of the Service: Orchard House is situated in the village of Sawston, with easy access to local facilities, and road and rail links to the City of Cambridge, Linton and Haverhill. Orchard House provides residential accommodation for up to thirty-five service users over sixty-five. Their current registration certificate enables them to provide accommodation for up to fifteen people with dementia. There is a purpose built unit on the ground floor. The first floor is for service users who need residential care. There is a third unit offering respite care. On the same site there is a purpose built day centre, which can be used by the home, and by older people from the local community. The home has transport for the benefit of the day service. On the same site is a sheltered housing unit, which provides independent accommodation to more able service users. Accommodation is managed by a housing society and care needs are met by Methodist Homes for the aged. This service is managed separately from Orchard House and is subject to separate registration with the CSCI as a domiciliary care provider. The home provides accommodation, which meets the National Minimum Standards in terms of room sizes. The home has thirty-five single bedrooms, some of which on the first floor offer en-suite accommodation. The home has accommodation on two floors, which is accessed by stairs of a lift. Keypads are fitted on the internal doors of the dementia care unit to provide some security. The current fees at the home are £443.00 residential bed without en-suite and £455.00 with en-suite. The fees in the dementia care unit are £513.00 without en-suite and £525.00 with en-suite. Additional charges are made for chiropody, hairdressing and toiletries. The home is registered to accommodate two people under 65 with dementia, but only has one person under 65. An amended certificate will be sent out shortly. Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two additional inspections have been made to the home since the 18 November 2005. Members of the public may request a copy of the reports from the CSCI office in Fulbourn. A notice was served on Methodist Homes in January 2006, in accordance with regulation 43 of the Care Home Regulations 2001. This notice detailed breeches in respect of regulation. This was fully complied with. A specialist pharmacist inspection was also carried out in February 2006, a number of requirements were made and a follow up pharmacy inspection will be undertaken. Since the statutory inspection in November 2005, the Registered Manager has left and there is a temporary manager in post. She was spoken to, as was the service manager, the deputy manager and the care staff on duty. A number of residents, relatives and visitors were spoken to. A number of records were inspected and the findings are summarised in the relevant sections. A pre inspection questionnaire, service user and relative questionnaires were left at the home to be circulated, completed and returned to the CSCI by the end of July 2006. A requirement regarding staffing numbers has been carried forward from the last inspection report and the manager must review the current staffing levels and provide a copy of the review undertaken to the CSCI, by the end of May 2006. A review of the existing residents needs should be carried out and additional resources made available if required. What the service does well: The home is light, bright and airy. It is purpose built and the environment is clean and well maintained. Methodist homes offer respite care, residential and dementia care provision. There is also a day centre on site, which was well utilised on the day of inspection. On the same site is a domiciliary care provision, where residents live in their own independent accommodation, but may still take advantage of communal facilities, including meals cooked in the main kitchen in Orchard House kitchen and served to residents in both the residential and domiciliary care provision. Separate dining areas are provided. Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 Page 6 The home actively fundraises to pay for future social activities and events for residents. There is a committee made up of relatives and they have a particular interest in raising funds for a gardening project. What has improved since the last inspection? What they could do better: Four care plans were inspected and did not always provide comprehensive information of how to meet the residents’ needs, or their preferred choices in terms of their routine, likes and dislikes. Records relating to health are kept separately. Records did not demonstrate that all health care needs are always met, or that appropriate action/ referrals are made when necessary, such as in the case of recorded weight loss. The home notify the CSCI of all residents accidents in any given month. These forms do not always indicate what measures have been put in place to reduce or eliminate further occurrences. A number of residents are particularly prone to falls and no evidence was seen of how the home had attempted to reduce the risk or if they had been referred to other health care professionals such as the falls prevention coordinator, or GP for further assessment. The number of accidents being recorded could be indicative of inappropriate staffing levels within the home. Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 Page 7 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 (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 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 (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 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): 1,2,3,4,5 Quality in this outcome area is ‘good’. This judgement has been made using available evidence including: Discussions with care staff, and the manager. An inspection of staff files, looking at the service user guide, statement of purpose, contracts and pre admission assessments. The home has satisfactory systems in place to ensure that they are appropriately assessing residents before admission and are able to meet their needs. These needs must be kept under regular review and the home must continue to demonstrate how they are able to meet them. EVIDENCE: The manager confirmed that the statement of purpose and service user guide has been updated and copies of these are made available. The inspection reports are available in the reception area. A copy of the contract issued to all residents was seen and was satisfactory although they did not all include the room to be occupied. Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 Page 10 A pre admission assessment is completed by the home and copies of other agencies assessments are sought where appropriate. The home is able to meet a range of needs and most staff spoken to had completed all the appropriate induction and training in both core and specialist subjects. Food hygiene and first aid was outstanding for some staff. Most staff had received training in dementia care and Parkinson’s and the home is well supported by the District nursing services. Current staffing levels must be kept under review according to the dependency levels of the existing service users. Residents may get to know the home before admission through attendance at the day centre or through respite care. A trial period is offered. Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 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): 7,8,10 Quality in this outcome area is ‘adequate’. This judgement has been made using available evidence including: Speaking to service users, relatives/visitors, staff, through observation and looking at service user records. Record keeping in this area is poor and a number of areas particularly risk assessments, accident records and planned interventions must be appropriately recorded and evaluated. EVIDENCE: Care plans are available for residents and are kept on the individual units. Health care records are kept separately in the office downstairs. This arrangement should be reviewed. The office is locked when unattended and access to it restricted. It is not clear if care staff have access to all the relevant information about the residents including the pre-admission assessments and data about falls, weight and visits by other health care professionals. A number of the care plans seen were adequate and had been reviewed monthly and gave clear information about the residents main needs and included a life story and residents’ choices, preferences, likes and dislikes. However other care Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 Page 12 plans were missing some vital information. One care plan did not record the next of kin’s phone number, or the name of the GP. Her preferred routines were not recorded and there was little evidence of her involvement in social activities/ events other than visits from relatives, or listening to television or music. Social histories/ life stories were not on all the files seen and there was no evidence that relatives or residents had been involved in their care plans or subsequent reviews. Under daily routines it stated in one care plan that “full staff assistance is required”. The care plan did not indicate how care staff are encouraging a resident’s independence or promoting existing skills. Care plans do not clearly describe what staff intervention should be or if the intervention is appropriate. For one resident there were no risk assessments in place and there was no description of what her ‘normal patterns of behaviour’ were or how staff should manage these. Care staff spoken to stated that she required a lot of supervision, and when left unoccupied engaged in ‘inappropriate’ activity, which may put herself or others at risk. Care staff understood the needs of the residents very well and demonstrated warmth and empathy in meeting their needs, but gaps in record keeping would clearly disadvantage new staff or agency staff who would not have sufficient written information to meet residents needs. Other health care records contained a number of gaps. Risk assessments did not always identify areas of concern. Accident records did not state what actions had been taken following a fall or the measures put in place to reduce the risks. Referrals to the GP and falls prevention coordinator should be considered. Some evidence was provided of multi disciplinary involvement. Gaps in dental and chiropody services were identified. A number of weight records were examined and showed monthly weight records. A nutritional assessment is also completed, but in a number of instances the guidance on these forms had not been acted upon, where it stated weigh more frequently or refer to dietician, and give supplements when required. One lady had not been weighed on admission and had been identified at moderate risk, (poor appetite and difficulty in swallowing.) These should be linked to care plans. Medication was not checked on this occasion, as there was a specialist pharmaceutical inspection in February 2006 and will be a second inspection to check compliance. On the day of inspection the mornings medication was still being given out at 11.00 am on the dementia care unit. Care staff administer medication but not until they have completed an internal induction programme and external medication training from Boots. Residents spoken to felt that care was delivered in an appropriate way and their dignity was maintained. An observation of the mealtime on the dementia care unit reinforced this. The atmosphere was calm and relaxed. Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 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): 12,13,15 Quality in this outcome area is ‘adequate’. This judgement has been made using available evidence including: Speaking to service users, relatives/visitors, staff, through observation of the meal time, on both floors and looking at service user records. The home provide adequate social activities to residents, through the employment of two activities officers and having a day centre on site. EVIDENCE: The home employs two people who are responsible for providing activities and a activities timetable is available. The staff responsible for providing activities were not on duty on the day of inspection. Most of the residents on the residential unit were attending the day centre downstairs or the communion service being held on the dementia care unit. There were a number of visitors in the home. The home actively fundraise for social activities and trips out. The manager stated that the activities officer had asked all the residents about their life stories/histories and their interests and hobbies. This information was not available on all the care plans inspected and those that were showed little involvement in social activity, other than visits from relatives, music and television. Some of the care staff stated that there was little time to provide Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 Page 14 social activities because of the length of time spent of physical care. This could be recognised as providing important social interaction. Visitors are welcome and make an important contribution to the home. They participate in relatives meetings and fundraising activities. The main meal is prepared in a central kitchen. Outside caterers are employed and stated that they get regular feedback about the quality/quantity of food. There is a menu displayed, but most residents spoken to did not know what they were having and no choice was offered other than those on special diets. Food choices/ preferences were recorded as part of the care plan. The meal served was attractively presented and hot. A drink was available on the table. Those requiring assistance and supervision with their meals received appropriate support. Residents spoken to were complimentary about the food and said they were offered choices and could have a cooked breakfast in the morning and often had a hot alternative in the evening. Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 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): 16,18 Quality in this outcome area is ‘good’. This judgement has been made using available evidence including, discussion with the manager and looking at the complaints records, and staffs training files. Adequate procedures are in place, for the protection of vulnerable adults. EVIDENCE: The home has had a number of complaints since the last inspection. These had been appropriately recorded and responded to within the given timescale. Training on the protection of vulnerable adults is provided to all care staff and forms part of their induction. Training is provided in house and evidence of this was seen. Methodist homes are putting together a comprehensive training policy and linking it to relevant policies and procedures such as the no secrets policy. Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 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): 19,20,21,22,23,24,25,26 Quality in this outcome area is ‘good’. This judgement has been made using available evidence including: a tour of the home, and an inspection of some records. The environment is fit for purpose and accommodation is both comfortable and well maintained. EVIDENCE: The home was clean and maintained to high standards on the day of inspection, with no obvious hazards identified. The home has employed additional domestic staff. On the day of inspection there were two domestics and a full time maintenance man who was assisting with cleaning the carpets. Bedrooms are individualised and well decorated. Photographs and names are on bedroom doors. The laundry room and kitchens were not inspected. Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 Page 17 The home have recently acquired a number of hospital beds and servicing records for the hoists and lifts were up to date. Bathrooms are fully equipped and adapted for those with mobility difficulties. Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 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): 27,28,29,30 Quality in this outcome area is ‘good’. This judgement has been made using available evidence including: Discussion with care staff and the manager and looking at staff files and the staffing rotas. Evidence was also gathered through observations. The existing dependency levels of residents must determine staffing levels and this must be kept under review. Staff employed receive good training opportunities and formal induction and supervision. EVIDENCE: Minimum staffing levels are being maintained as demonstrated by staffing rotas, which have been reviewed and a shift allocation sheet put in place. There is a minimum of three staff on the dementia care unit a ratio of 1 staff to 5 residents and a minimum of two staff, sometimes three on the residential floor. There were two resident vacancies on the dementia care unit. Staff felt that their numbers were at times insufficient to meet the needs of residents and the manager was asked to keep the residents needs and staffing ratios under review. Additional staff are employed at the home including domestic and a maintenance man. Staff work together, for example the maintenance man was cleaning carpets and the domestic staff assist care staff with residents’ meals. New staff are supported through an induction programme and are expected to complete workbooks linked to relevant care standards. These are signed of by Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 Page 19 an assessor and further training needs identified. These were not available for inspection, because staff keep them until they are completed. Four staff files were inspected and contained all the required information. Evidence of supervision was seen. The manager confirmed that there is a probationary period of six months, with reviews after two, four and six months. There are also annual staff appraisals. Interview notes are kept. The home has a number of staffing vacancies, covered in house, or through agencies. These posts have been filled subject to appropriate checks being received. Evidence of staff training was provided and included core training and specialist training. The latter included training in understanding Parkinson’s disease, the prevention of falls and dementia care. Although care staff cover most of the basic training, no evidence was seen of first aid or food hygiene. The manager confirmed that all deputy managers will have the appointed person first aid updated and all care staff will get basic first aid training. A lot of training is completed in-house and training certificates issued, but these do not include details of what is covered on the course. Evaluation of the effectiveness of the training and what knowledge has been achieved since the training has been provided should be evidenced. Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 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, 37,38 Quality in this outcome area is ‘good’. This judgement has been made using available evidence including: Records and discussion with all staff. The home has a good quality assurance system in place and systems for appropriate staff induction, supervision, and training. EVIDENCE: A temporary manager has been in post, since the end of December 2005. Three assistant managers support her. They have delegated responsibilities for areas of work and for specific units. The acting manager is very experienced and a qualified nurse. Staff meetings, unit meetings and relatives meetings have been held. Methodist homes do an internal quality audit every three months, looking at different areas of practice and how the standards are being met. In the example seen including physical care standards, choice, risk assessments and care plans, links had been made with the findings of the Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 Page 21 inspection report and had involved detailed work, including care staff involvement. An action plan had been devised. This system appeared to be in its infancy, but is a good comprehensive system. Other evidence of quality assurance came from staff/ relatives meetings, staff appraisals and supervision, which went into good detail and clearly described staffs training and developmental needs. Other records including maintenance records were inspected and were mainly up to date. Water temperatures are taken monthly, servicing records inspected were up to date. Moving and handling assessments were in place. Risk assessments were poor and accident records gave insufficient detail. Fire records were adequate although there has not been a fire drill this year, the last being 15/07/05. This is unacceptable. Some of the fire servicing and maintenance records were not recent, and the manager though Herewood housing are now responsible for this. This must be clarified and records brought up to date. Emergency lighting is being tested three monthly and should be monthly. Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 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 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 x 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 2 2 Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Service users must have a comprehensive care plan in place, which addresses all their needs in respect to their health and welfare. Timescale for action 30/05/06 2. OP8 13(1)(b) 3. OP8 12(1)(a) 4. OP8 13(4)(c) Evidence must be provided that service users and, or their representatives are consulted about their plan of care and any revisions made to it. Service users must receive 30/05/06 necessary treatment, and advice from other health care professional where necessary. The registered person must 30/05/06 promote and make proper provision for the health and welfare of service users. Weight loss must be monitored and the advice followed on the nutritional assessment forms. The registered person must 30/05/06 ensure that unnecessary risks to service users are identified and where possible eliminated. Particular attention must be given to the prevention of falls. Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 Page 24 This was a previous requirement and there was insufficient evidence at this inspection that the timescale of 30/11/05 has been fully met. 5. OP27 18(1)(a) Staffing ratios must be kept under review according to the assessed needs of the service users and the skills mix of staff must be appropriate to their needs. This was a previous requirement and there was insufficient evidence at this inspection that the timescale of 30/11/05 has been fully met. In order to comply the manager must enclose a copy of a review of the current staffing levels/dependency levels of residents’ needs, which establishes if staffing levels are adequate. Care staff must have appropriate training in basic first aid and food hygiene. The registered person must supply the CSCI a copy of any review it undertakes with regards to improving the service it provides. This was a previous requirement. The timescale of 30/12/05 has not been met. 8. OP37 17(1) Sch 3 The registered person must 30/05/06 ensure adequate records are kept in accordance with Schedule 3 of the Care Home Regulations 2001. The timescale of 30/11/05 has not been fully met. A new Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 Page 25 30/05/06 6. 7. OP30 OP33 13(4)(c) 24(2) 30/05/06 30/05/06 timescale has been given. 9 OP38 23(4) a to e The registered person must ensure that all servicing and maintenance records are up to date. And all care staff participates in regular fire evacuations. 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Orchard House (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 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 (Sawston) DS0000015174.V288459.R01.S.doc Version 5.1 Page 27 - 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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