Inspection on 20/07/06 for Orchard House (Sawston)

This inspection was carried out on 20th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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) 12/04/06

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 20th July 2006 9:00 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.V300799.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 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.V300799.R01.S.doc Version 5.2 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 12th April 2006 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. Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An inspection was carried out on the 20 July 2006. It was unannounced and undertaken by Shirley Christopher, regulation inspector and Cathryn Bramham, regulation manager. All of the key standards were assessed. Evidence of compliance was requested to check that the home had met the requirements made at the last inspection carried out on the 12 April 2006. The home are working towards meeting the requirements and in most instances had achieved full compliance. The care plans are being reviewed gradually to ensure that the acting manager has sufficient time to go through each plan with the key worker, to make sure they are updated fully. The inspectors were pleased with the progress made by the home. During the inspection a number of residents and staff were spoken to including, domestic staff, laundry staff, the administrator, care staff and the assistant manager who was in charge of the shift. A full tour of the home was conducted with the exception of the kitchen. Some documentation was inspected and this will be discussed in the relevant sections. The acting manager has been in post since the beginning of the year and has made many improvements. The advertisement for a permanent manager has gone out. The staffing situation in the home is good and several posts have been recruited to subject to the appropriate checks being received. The homes manager completed a pre inspection questionnaire which was returned on the 13 July 2006. Only a few relative comment cards have been received by the CSCI and the reasons for this should be considered by the home. What the service does well: Orchard House provides accommodation, which is divided up into individual self contained units, comprising of a lounge/dining room, individual bedrooms and a kitchenette, where light meals and drinks can be prepared. Fundraising efforts continue to improve the gardens and create better accessibility to residents. The gardens are pleasant and most residents are able to access them safely. The atmosphere in the home is relaxed and staff meet residents needs in a time of their choosing. Additional staff are available to assist at meal times. Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including discussion with staff, residents, management and the inspection of some records. The home makes information about the service available to residents before admission and residents needs are kept under review, following assessment. Staff receive appropriate training. EVIDENCE: The service user guide, statement of purpose and last inspection report are available at reception. Evidence was provided that the home are able to meet the needs of the existing residents, but this must be kept under review, as concerns about existing staffing levels were expressed by some staff working at the home. Evidence was provided that staff receive training appropriate to meeting the needs of residents and are being supported in developing care plans. Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 Page 9 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): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has made using available evidence including inspection of care records, and discussion with care staff and residents. Some direct observation took place. Improvements in care documentation was noted, but this needs to improve further to demonstrate more accurately the high levels of care being provided. EVIDENCE: Four care plans were inspected and improvements were noted. The manager has confirmed that work on improving the care plans is ongoing. Evidence of regular review were noted. Not all care plans had been signed and dated. In one instance there was evidence of weight loss and the nutritional assessments stated weight weekly. This resident was still being weighed monthly. Risk assessments were in place, but evidence of frequent review was poor. It was noted in some instances that care plans gave general rather than specific information and in some cases very little personal details like preferred routines or specific night time needs. Social care needs were poorly recorded in some instances, but the home has recently employed an activities coordinator and it was expected that separate records relating to social needs would be kept, where they are not already. It was also noted in a relatives meeting, that Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 Page 10 relatives had been asked to give a life history for their relative, where this information was not already available. A good social history was noted on at least one file. The assistant manager stated that care plan reviews were being set up between key workers and relatives, to ensure involvement and consultation. The daily notes maintained on each resident were satisfactory, but the entries should be signed by the person making them and not by all the staff on shift. Medication was observed in part, whilst it was being administered by the assistant manager. She confirmed that all staff administrating medication receive appropriate training. The administration of the mornings medication took from 8.30 to 11.00 am. This was questioned in terms of whether it was the best use of the assistant managers time, or could more staff be trained and assessed as competent to administer medication. Medication should be administered according to the prescribed time. No sooner was the morning medication given, then the lunch time medication was due. Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 Page 11 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): 12,13,14,15 Quality in this outcome area is satisfactory. This judgement has been made using available evidence including discussion with care staff, residents and through the inspection of documentation. The home employ someone to specifically assist with activities, ( a person has been recently recruited to this post) replacing several part time staff. Social activities/ life stories are recorded well in some instances, but are being incorporated into every care plan. EVIDENCE: Some residents were spoken to and there was general observation made of the interactions between staff and residents. Care was being provided in a relaxed, appropriate way. Residents who were able commented positively on different aspects of the home and said they were able to get up and go to bed at a time of their choosing. They were being encouraged to take adequate fluids in the hot weather. Residents were complimentary about staff and some residents commented on the activities, and attended the day centre. One lady said she did not go to the day centre because she was in a wheelchair and thus relied on staff for her mobility needs. Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 Page 12 The kitchens were not inspected on this occasion, but the menus were displayed and food was said to be of a good standard. The main meal is served at lunch time and at least two main choices are available. Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 Page 13 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 the available evidence including records and staff training files. The home keep a record of complaints/ compliments and these are satisfactory. EVIDENCE: The home has had a number of complaints/ compliments. All are appropriately recorded and where it is a complaint it is dealt with within appropriate timescales. Training in the protection of vulnerable adults is provided and is supported by policies and procedures . Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 Page 14 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 discussion with staff and residents, the pre inspection questionnaire and a tour of the building. The environment is fit for purpose and was cleaned and maintained to high standards. The domestic arrangements must be kept under review. EVIDENCE: The home was cleaned to a high standard on the day of inspection. This included the external grounds. There were two domestic staff on duty and holiday cover was not being provided. One of the domestics was on lighter duties because she was pregnant. The domestic staff spoken to was working extremely hard and her role involved shampooing residents carpets, some nearly every day. The maintenance man also assists. Domestic staff are expected to assist at mealtimes. Domestic duties also include cleaning the day centre. The home must ensure that sufficient numbers of staff are on duty at all times. Some staff spoken to stated that they had not had training in Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 Page 15 infection control. This must be provided. The home has recently had an outbreak of infection, which lasted several weeks. They should review their polices and procedures accordingly. The laundry facilities were adequate, but the home must ensure that adequate temperatures are maintained. The laundry room was unattended and doors propped open which contravenes health and safety. However the area was poorly ventilated and the vents were said to be broken. On the dementia care unit, the assisted bathroom was being used to store wheelchairs and walking frames, some of whom belonged to residents no longer living at the home. Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 Page 16 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 the available evidence including discussion with staff, the pre inspection questionnaire and staff files. Staff are appropriately vetted and staff training and supervision records were good. Training in infection control must be provided. EVIDENCE: Staffing levels were being appropriately maintained, with three staff working on the dementia care unit throughout the day as required. There was one bed vacancy on the dementia care unit. A full time administrator, two domestics, a laundry assistant and an activities co-ordinator are in post. On the day of inspection an assistant manager was in charge and confirmed that the acting manager, works about two days a week at the home. The position of permanent manager has been advertised. The only other vacancies were for relief staff, who had been interviewed, but were waiting for appropriate checks to be received. Staffing allocation sheets have been introduced. It was noted in the relative meeting minutes that relatives had praised staff for their hard work. A number of staff files were inspected and provided evidence that staff had received the appropriate mandatory training. Training records on individual files showed that some staff had received training in the provision of dementia care. Training in food hygiene which was outstanding for some staff at the last Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 Page 17 inspection was scheduled for the 28 July 2006. Training in the management of falls, communication skills, managing challenging behaviour and activities had also been provided to some staff. Evidence of staff induction was provided, but this was not the case for one member of staff who had been working with POVA 1st clearance, but without confirmation of CRB. This was in place a month after her employment. The manager rang the following day to confirm records were available, but evidence of which should be kept on file. Several staffing files were inspected and provided evidence of all the appropriate checks in place before the employment of new staff. Supervision is held at regular intervals and notes were comprehensive. Annual staff appraisals are also conducted. Staff are properly vetted before an offer of employment is made and all pre requisite checks were on file. Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 Page 18 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): 31,35,36,37,38 Quality in this outcome area is good. This judgement has been made using the available evidence including discussion with staff, the pre inspection questionnaire and maintenance records. The home was maintained to high standards and the records inspected were up to date ensuring the health and safety of staff, residents and visitors. EVIDENCE: Some maintenance records were inspected and were satisfactory. Evidence of a recent fire drill was seen and the fire servicing and testing were up to date. The emergency lighting records were satisfactory. Portable appliance testing records were seen. Maintenance records for equipment such as wheelchairs were seen and the weekly and monthly checklists for maintenance were in place. Two residents finances were inspected and were accurately maintained. Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 Page 19 Evidence of the homes own internal quality monitoring process was not seen on this occasion, but evidence was seen of staff induction, training, supervision and meetings. Evidence of residents reviews and relatives meeting minutes were seen and issues raised were being dealt with Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 Page 20 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 x 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 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 3 3 2 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 X X X 3 3 3 2 Orchard House (Sawston) DS0000015174.V300799.R01.S.doc Version 5.2 Page 21 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. Evidence must be provided that service users and, or their representatives are consulted about their plan of care and any revisions made to it. This was a previous requirement and the timescale of 30/05/06 has not been fully met, although it was recognised that the home are in the process of auditing all the care plans. A new time scale has been given. 2. OP8 12(1)(a) The registered person must 15/08/06 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. This was a previous requirement which has been DS0000015174.V300799.R01.S.doc Version 5.2 Page 22 Timescale for action 30/09/06 Orchard House (Sawston) carried forward, (timescale of 30/05/06 has not been met.) because instructions of weekly weights were not being followed on one care plan inspected. A new time scale has been given. 3. 4. OP9 OP26 13(2) 13(3) Medication must be administered 30/08/06 according to the times given, (where reasonably possible.) Appropriate measures must be in 30/08/06 place for the control of infection and must include training for all staff. Sufficient numbers of domestic staff must be employed and adequate arrangements put in place to cover weekends and staff holiday/sickness Areas of the home must be maintained at an adequate temperature and the propping open of fire doors is not an appropriate measure to be taking if a room is too hot. 5. OP38 23(1)(c) 01/08/06 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.V300799.R01.S.doc Version 5.2 Page 23 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.V300799.R01.S.doc Version 5.2 Page 24 - 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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