Inspection on 16/06/06 for Orchard Lea

This inspection was carried out on 16th June 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 Lea 12/06/09

Orchard Lea 17/09/08

Orchard Lea 07/08/07

Orchard Lea 07/03/06

Orchard Lea 23/11/05

Orchard Lea 30/03/05

Orchard Lea 29/11/04

Orchard Lea 30/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Orchard Lea Orchard Way Cullompton Devon EX15 1EJ Lead Inspector Louise Delacroix Key Unannounced Inspection 16th June 2006 9:30 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 Lea DS0000039280.V292324.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 Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard Lea Address Orchard Way Cullompton Devon EX15 1EJ 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) 01884 33375 01884 33375 Devon County Council Mrs Vivien Elaine McMullen Care Home 26 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (26), of places Physical disability over 65 years of age (5) Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th March 2006 Brief Description of the Service: Orchard Lea is a local authority (Devon County Council) care home which is currently registered to provide accommodation together with personal care to up to 26 older people, up to five of whom may also have a physical disability and up to five of whom may also have difficulties related to dementia. The home was originally built with thirty-six bedrooms. Ten of them are now either used for office space, visitors’ rooms or storage. The building has with level access throughout and from outside. There is a shaft lift between the two floors and adapted bathrooms and toilets accessible to people with physical disabilities. Each floor has its own lounge and dining areas. The first floor has a quiet room. The building incorporates a day centre, and has a small but pleasant garden, which is not secure. The weekly cost is a set fee of £556.57. Extra costs include dry cleaning, hairdressing, dentist, optician and chiropodist (unless NHS funded), private telephone lines, pet costs (if pets are agreed) and newspapers/magazines. The last inspection report was not on display at the home, instead the previous inspection report for November was available. The majority of visitors/relatives said they had access to a copy of the inspection reports. Notes from staff and residents’ meetings showed that the manager has discussed the last inspection report. Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to the inspection, surveys asking people about their views on the service were sent out to health and social care professionals, local GP surgeries, visitors/relatives and residents. An advocate from Age Concern helped some residents complete their surveys. A positive response of seventeen residents’ surveys out of nineteen was returned to CSCI. Seven surveys were sent out to a random selection of staff and four were returned. The home distributed relatives/visitors comment cards and thirteen were returned to CSCI. Six GPs and three health and social care professionals also returned comment cards. All these responses have been collated and included in the report. Two inspectors, Louise Delacroix and Mandy Sharp visited the home and spent approximately six hours completing the inspection. During this time, twelve residents shared their views about the home, four members of staff were spoken to in depth about working at the home, and two other staff members also contributed to the inspection. Two relatives also gave their opinion about the home. The inspection was discussed with the manager at a later date, as she was not on duty at the time. As part of the inspection, six residents were case tracked. This meant that files relating to their care were looked at, and where possible the inspectors met with them. Records were also inspected for residents’ finances, medication, fire, resident and staff meetings, as well as care plans. A tour of the building and gardens also took place, and the residents spent observing and listening to how staff and residents communicated. At the time of the inspection, nineteen people were living at the home, with four of these people staying there on a respite basis. Since the last inspection, managers said that new admissions for people with dementia had ceased as the garden is not yet secure and therefore does not provide a safe environment. As a result of the findings of the last inspection in March 2006, a meeting was held with Devon County Council and an action plan was submitted. There have been some notable improvements to the service provided to residents as a result. The home is currently up for tender, which means that there are plans for another organisation or business to be responsible for running the home, and this has led to feelings of uncertainty about the future for some residents and staff members. Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Four requirements were made on this inspection and they relate to the quality of information in residents’ care plans, improving the accessibility of activities to ensure all residents can participate if they wish to, improving the standard of maintenance and making appropriate checks when recruiting. These all have timescales attached to them, and the expectation is that the home will provide an action plan as to how they will address these. Eight recommendations have been made to improve practice in the following areas; evidencing how prospective residents are involved in their admission, monitoring moving and handling plans, improving communication between staff, and reviewing the skills of staff in caring for people at the end of their Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 7 life. The recommendations also included making the garden secure, improving the quality of the bedrooms and making a minor change to the management of residents’ finances. 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 Lea DS0000039280.V292324.R01.S.doc Version 5.2 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 Lea DS0000039280.V292324.R01.S.doc Version 5.2 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): 1,2,3,5,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Written information about the home is clear and enables residents to be informed about what to expect from the service. Minor changes to the admission process would help ensure that the home can demonstrate that residents are fully involved at all stages of the admission process. EVIDENCE: The home’s statement of purpose has been revised and contains comprehensive and accurate information. On the day of the inspection, service user guides were seen in residents’ rooms, which means that residents know what to expect at the home. Nine residents said via their comment cards that they had not received a contract but several felt their families might have seen one, while four said they had and a further four did not answer the question. During the inspection as part of case tracking, six residents’ files were looked at and five had a Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 10 signed contract in place. Staff and the manager explained that residents’ files are currently being updated in line with the home’s action plan. Assessments had taken place covering the needs of residents but there was nothing on file to show that the residents had been assessed by the home prior to moving in, either by visiting the home or meeting a staff member either in their own home or hospital. Staff confirmed that the home does take emergency admissions, and this was reflected in a resident’s comment that their admission was needed urgently. The manager explained that information was gathered from the care management team from telephone calls and written information, and if there were any queries then the prospective resident would be visited. However, there is no formal way of recording this assessment by the home. If the manager or a deputy does not meet and assess prospective residents before they move into the home, the home cannot demonstrate that they can meet their care needs. Currently, there is a resident who has been identified as being inappropriately admitted to the home. Residents were asked through surveys and during the inspection about how they decided if the home was the right place for them. Some residents said that they were just ‘deposited’ by their family or they thought their family had visited on their behalf. Some people said during the inspection that they could not remember visiting but staff said that some people visited before moving in, and that occasionally people were assessed prior to moving to the home. Others were very satisfied that they had been admitted to the home. The residents’ comment cards asked people if they had received enough information about the home before they moved in to enable them to make an informed choice. Ten people out of seventeen said ‘no’, and made comments such as ‘did not know anything about the home’. A resident confirmed that they had not received any written information about the home. The manager said that letters are sent to people confirming their stay and information is included in this letter and a template for this was seen, a visitor said that they had received a letter from the manager confirming their relative’s stay at the home and providing suitable information about the home e.g. mealtimes. The home does not provide intermediate care. Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There have been notable improvements to the quality of residents’ care plans, although some further work would increase their effectiveness even further by providing clearer guidance to staff. Residents’ health and personal needs are well cared for with their individuality recognised through all stages of their life. There are good medication practices in the home. EVIDENCE: There has been a general improvement in the structure of the care plans but further work is still needed to improve the quality of the information and the effectiveness of guidance varied. Staff explained that the new care plan system have been completed by residents’ keyworkers. This role means that there is an allocated member of staff for each resident who has detailed knowledge of their care needs and preferences, as well as being a link for families and other visitors. This was evidenced by good quality social histories about residents. Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 12 One member of staff explained clearly what it meant to be a keyworker and said how she spent extra time with the resident she was keyworker to, and making sure she arranged things that she liked doing. Senior staff said they had supported keyworkers to complete the care plans through training. Six care plans were looked at. Two did not fully reflect the current needs of residents, who had both recently deteriorated in their physical health. Two care plans identified areas of concern but did not give solutions. For example problems identified were ‘skin prone to pressure sores’, ‘sometimes shows signs of frustration and agitation’, and difficulty in behaviour and communication. A third plan described inappropriate behaviour but still did not give enough guidance as to how staff should respond. Three other care plans described the resident’s needs very well. There were a couple of incidents where a bruise or a ‘sore’ had been noted in care notes but it was not clear what had happened once it had been reported by the care staff to the officers in charge. This means that some injuries could get worse, or the cause not found out which might place residents at risk. Some staff raised concerns that they did not feel competent to assess the moving and handling needs of residents. These are written by keyworkers but are not signed off by a moving and handling assessor. Each care plan looked at had an assessment in place. A member of staff wrote in their survey ‘Get the managers to be more involved with service users’ plans, especially the moving and handling document – as we as care assistants are expected to fill this out’. In comment cards, fifteen people said they always received the care and support they needed and two people said they usually did. Comments included, ‘always look after me well – do not let me down’ and that the care was ‘very good’, although one person commented on behalf of their relative that their care plan was not looked at the beginning of their stay. Ten visitors said they were satisfied with the care their relative/friend received at Orchard Lea. Five GPs out of six respondents said that staff demonstrated a clear understanding of the care Twelve residents said they received the medical support they needed and two said usually did, while three did not answer. Five GPs said that the home communicated clearly and worked in partnership with them but one felt this wasn’t the case. One GP said that ‘It has got much better recently’. All residents spoken to during the inspection were extremely positive about the way in which they were cared for, e.g. in a manner that respects their dignity. The responses from the survey said that sixteen people felt that staff listened and acted on what they said. Despite this overall positive response the comments varied and included ‘they are truly the most wonderful care staff anyone can wish for’ and ‘staff usually kind to me’. People also said ‘I have to make them listen!’ and ‘never expect them to’. During the inspection, several Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 13 residents said they had never heard or seen any acts of unkindness by staff. Staff were seen responding appropriately and sensitively to residents’ individual needs, particularly at a meal time and when a member of care staff helped a new resident settle in on their first day. A speech and language therapist was visiting a resident, and staff were very good at making sure they followed her instructions. The district nurse said that the home did not manage resident’s insulin for those who were diabetic. The medications and records were looked at and were satisfactory. The ‘last wishes’ of residents are recorded sensitively in their care files, and the questions asked are well worded. A member of staff raised concern that not all staff feel confident in the care of people who are dying, and that some people who are less experienced need more support and counselling. They were not aware of any training in this area for care staff. Two other members of staff felt confident in this area and talked about making sure last wishes were carried out, that people were never left on their own, adequate pain relief and to involve the family as much as possible. One said ‘ Residents should be treated as how you’d wish your Mum to be treated’. The district nurse who was visiting felt that staff at the home were very good at caring for people who were dying. She said that the staff all cared very much about the residents and ‘ that was the most important thing’. She also felt that staff were now very proactive in calling in for help when they needed advice from the nursing team. Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. Further improvements to the range of activities and the support offered would help ensure all residents can participate. The home has a welcoming atmosphere where choice is promoted and residents’ benefit from good food in a relaxed and supportive environment. EVIDENCE: Since the last inspection, an audit has been completed to identify residents’ interests and an advert has been placed to recruit an activities coordinator. All the people spoken to during the inspection said that they were satisfied with what was on offer; trips seemed particularly popular. Some people said they preferred their own company, and enjoyed listening to music and audiotapes in their rooms. For example, ‘I have been on visits out, but generally like to stay in and read, watch television or chat’. However, responses from residents’ surveys showed that for people with a physical disability and/or a sensory loss their involvement in activities was often restricted. Many people spoke about enjoying the garden, and were seen doing so during the inspection with staff offering hats and sun cream. Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 15 Residents said that their visitors were welcomed and they could see them in a variety of places, including in private. Eleven visitors responded to a CSCI survey about their views on Orchard Lea. Ten visitors said they were welcomed at the home at any time, but one person said they weren’t. All said they could visit in private and ten said they were kept well informed. Their comments included, ‘my mother is continually voicing her praise of the care and attention she has always received from staff’ and ‘I find the staff very helpful. The home is run very well and my father is happy’. One resident has been enabled to attend various activities out of the home and said ‘ there was plenty to keep me occupied’. Talking books and library tapes were updated regularly. The current activities organiser provides two days of activities a week and the care staff are responsible for the other days. She said that the day trips out are particularly successful and she is making up a memory box of memorabilia for the residents to be able to enjoy. She said that some residents have helped to plant courgettes in the garden recently. Spiritual and religious needs are met by a monthly Communion service and a Sunday service, where each week either a Methodist, Baptist or Church of England representative visits the home. Another resident said that ‘ the best decision I made was to stay here’ and that the staff were very good and let them make choices and do as they pleased. They added ‘ I’ve come a long way since I’ve been here’ Throughout the inspection, staff were seen and heard offering choice and listening to residents. This is a significant improvement since the last inspection. The manager and officers-in-charge explained that they have spent more time on observing staff and their style of working. Records show that some staff have needed to be reminded about good practice and offering choice, although care staff perception has been that contact with officers-incharge has not increased. A lunchtime meal was observed in the lower dining room. The tables were attractively laid with fresh flowers, tablecloths and with condiments, and the menu was clearly displayed. The atmosphere was calm and unhurried, with staff supporting residents sensitively to maintain their dignity. Choice was offered during the meal and everybody spoken to praised the quality of the food. Comments included ‘I love the food…I am never hurried’, ‘wonderful meals. Lovely food’ and ‘plenty to eat’. One resident knew exactly what was for lunch that day and explained how they could choose whatever they liked for breakfast. Two residents had lunch in the upstairs dining room and again the staff member helped the residents with the meals in a sensitive and kind way. Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents are confident about how to raise concerns and staff are fully aware of adult protection procedures and their role to promote good practice within the home. Improvements to how the home manages complaints will ensure that residents and families can be confident that complaints will be addressed. EVIDENCE: In response to a CSCI survey residents said they generally knew who to speak to if they were unhappy. One comment included, ‘everyone is approachable’. Fourteen people said they knew how to make a complaint, one said they didn’t know how to and two left the question unanswered. People said, ‘I have nothing to complain about’, ‘would talk to relatives’ and ‘would tell person looking after me’. The Devon County Council complaints procedure is clearly displayed. The complaints procedure is within the Service User Guide and CSCI contact details are also on the main entrance hall notice board. Regular residents’ meetings also enable residents to raise general concerns. In the last twelve months, a complaint was made to CSCI about the home. This complaint had four components relating to poor communication, lack of dignity and no continuity of care, all of which were upheld. The third component relating to a lack of care when a resident was ill was partially upheld. As a result two requirements were made relating to the quality of care Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 17 planning and maintaining residents’ dignity. There have been improvements in both of these areas. However, initially the commission (CSCI) were not satisfied with how the complaint was investigated by the home. Four staff who were interviewed demonstrated knowledge of the protection of vulnerable adults and the steps to take if they had concerns about poor practice. They had received training in this area of care and this has recently been updated by a discussion group after watching a video on this subject. The manager has written an action plan that all staff will have refresher training in this area of care. Minutes from staff meetings and discussion with staff confirm that the home’s action plan is being carried out, although some staff respondents to the CSCI survey perception was of little change and one said ‘None of the managers come onto the floor to observe us except if doing their duties but they do not really observe us closely’. Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 18 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): 19,24,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Steps are being taken to improve the home to make it a more attractive and homely place to live but currently the environment still appears institutional, tired and worn in appearance, although staff work hard to keep it clean and odour free. EVIDENCE: Orchard Lea is a purpose built home and has significant advantages due to its level access on both of its floors, garden, its shaft lift, other pieces of specialist equipment, and the variety of communal and private spaces. The home has a garden but staff confirmed that it was not secure, which means any vulnerable residents have to be accompanied outside. The home is in some need of significant investment in modernisation and refurbishment. There has been an ongoing recommendation about improving the facilities in residents’ rooms, which in the last inspection was changed to a Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 19 requirement. Staff expressed sadness at the state of the décor. The home has a tired and worn appearance. In places, woodwork/paintwork is scratched and marked, the carpets in the corridors are very marked and wearing thin, and the flooring is scuffed in the front hallway and in one of the dining rooms marked. As a result the home struggles to achieve a “comfortable and homely” ambience and many areas simply do not. A visitor commented ‘None of this makes for an air of homely comfort but adds up to an atmosphere of communal institutionalism’. Another visitor said ‘ the care was fine- it’s just that the home could do with some tidying up of the décor and the flooring’. During this inspection, woodwork was being repainted, which a number of residents commented positively on, and the manager explained in a later phone call that funding has been released for communal carpets to be replaced, including in the upper dining room, and that the flooring in the entrance hall will be improved. The lower lounge and upper dining room are due to be repainted and where possible the manager said residents would be consulted. New furniture is also planned for the dining room. Several residents praised the handyperson who they said would always help with repairs or putting up shelves. A number of bedrooms are small by current standards, which impacts on the furnishings and fittings that can be accommodated. Those residents’ rooms which were visited were clean and odour free. Some appeared homely but generally fittings are dated and tired in appearance. Bedroom furniture is utility in style and marked, this includes fitted wardrobes and sink units, and some flooring needs replacing i.e. thin carpet tiles or lino. Where possible the manager has tried to brighten rooms with colourful curtains. There are no current plans to refurbish the bedrooms. On the day of the inspection, the home was clean and odour free. In a response to a CSCI survey, fourteen residents said the home was always clean and fresh, and two people said it was usually. Comments included, ‘beautiful’ and ‘spotless’, although one visitor said the toilets sometimes smelt. A resident said that the toilets were kept very clean and maintained during the day. This was the case on the day of inspection. Staff were observed wearing appropriate protective clothing to help prevent cross infection. A resident remarked, ‘Laundry excellent. Beds changed very frequently’. The laundry has one industrial washing machine and tumble dryer, and the systems in place for the laundry were good. One resident was pleased that they could still make their own bed each day, although staff would make it for them once a week when all the sheets were changed. One of the domestic staff on duty was working very hard to keep the home as clean as she could, she explained that there is a cleaner in every day. Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 20 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 a visit to this service and has taken into account that the home cannot currently improve its recruitment process, as it has not recruited any new staff. The staff group are well trained and are employed in sufficient numbers to meet the needs of residents. EVIDENCE: The home was well staffed on the day of the inspection with five care staff and an officer-in-charge, plus domestic staff in the morning, and four care staff in the afternoon with an officer-in-charge. In the evening, the rota showed the same numbers for the afternoon. In response to a CSCI survey, ten residents said that staff were always available when they were needed and seven said they were usually available. The home currently uses two agencies to supplement their staffing group but aims for continuity of carers where possible. A senior member of staff explained that no new members of staff had been recruited since the last inspection. Therefore a previous requirement for improved staff recruitment procedures could not be inspected. Agency staff are now wearing photo identity badges. The home is to be commended as fifty percent of its permanent staff team hold an NVQ 2 in care, which shows training is promoted. Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 21 Staff interviewed were positive about the training offered to them and one spoke positively about the chance to complete long distance training in the care of people with dementia. One member of staff said that now there are better handovers for the staff between shifts meaning that everyone knows what is happening at the home. Four individual staff records showed that training was up to date in areas such as moving and handling, food hygiene, first aid and an introductory course on dementia awareness. Everyone who returned a survey said that their induction training had been relevant to the client group. Residents comments about the staff included, ‘the staff are first class and attend to my every need at all times’, ‘always come when needed’ and ‘sometimes busy when needed but always come when they can’. Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 22 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): 31,32,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is evidence that communication between different staff groups is improving, which benefits residents’ well being, although there is still further work to be done in this area to ensure a positive working atmosphere. Generally residents’ finances are safe guarded. Residents’ safety is protected by a well run home, with records that demonstrate up to date safety training and checks. EVIDENCE: The manager has worked at the home for a number of years and updates her training, and has taken positive action to respond to areas of serious concern highlighted in the last report. Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 23 Staff who were interviewed and who responded to the CSCI survey commented that they felt the officers-in-charge should spend more time out of the office and become more involved with the residents. One person said that they felt the quality of information in handovers had improved since the last inspection and another said that communication had got better but there was still room for improvements. Respondents to the survey were more critical and made comments such as ‘the managers could come onto the floor more of their own free will, not just when we call them for an emergency’, ‘better communication between staff – officers. Officers need to take prompt action when information is relayed to them’ and ‘I do not feel that we get enough support from the duty officers’. It was explained that staff and residents’ meeting are held regularly to gain feedback about the service, questionnaires are due to be sent out which an advocate for the residents confirmed, and the manager recognises this is particularly important during times of change. Minutes from meetings were seen. Residents’ personal money is held in a bank account and the manager explained a clerk works out the individual interest. On the last inspection, receipts were seen for deposits, withdrawals and items bought. Entries in records were double signed. On this occasion, the balance was checked and found to be correct but the balance on individual residents’ accounts could not checked. The four staff interviewed both felt well supported with fairly regular one to one supervision sessions and regular staff meetings. Minutes for staff meetings were seen and the dates showed that they are a regular occurrence. According to the pre-inspection questionnaire a large number of the staff group have a qualification in first aid. Two staff who were interviewed confirmed that they had received first aid training, which had been up dated. Fire records were checked and were up to date and showed that staff have received their required fire training at appropriate intervals. When questioned the domestic had a very good understanding of fire safety procedures at the home. The manager promotes fire awareness at each staff meeting, which was described by staff and recorded in the minutes. This is a good achievement for such a large staff group, and the home also records that agency staff are familiarised with the fire routine, which is good practice. The pre-inspection questionnaire records that maintenance safety checks are up to date i.e. gas and electricity. The hot water in one bathroom was found to be slightly hotter than recommended but this has been monitored since the inspection and found to be correct. The manager said they will ensure that the temperature is checked regularly. Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 24 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 HOICE 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 2 x 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x 2 x 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 x 2 3 x 3 Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 25 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 The registered person shall prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. (Care plans must provide clear guidance to staff as to how to meet the physical and psychological needs of residents in order to work towards continuity of approach, which can then be reviewed. The previous timescale of 31/5/06 has not been met). The registered person shall…provide facilities for recreation including, having regard to the needs of service users. (Activities must meet the needs of all residents, including those people with a physical disability or a sensory loss). The premises must be kept on a good state of repair and reasonably decorated. (This requirement’s previous timescale of 30/6/06 has not yet run out). Staff records must contain DS0000039280.V292324.R01.S.doc Timescale for action 31/07/06 2. OP12 16 (2) (n) 31/07/06 3. OP19 23 (2) (b) (d) 31/08/06 4. OP29 19 (1)1-9 31/07/06 Page 26 Orchard Lea Version 5.2 Schedule 2 confirmation that the employee does not appear on the POVA list if they start work before a current CRB check is in place. All new external staff must have a CRB for their role at Orchard Lea. CRB check are no longer portable. (This requirement has been carried over from the last report as no new permanent staff have been appointed). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP5 Good Practice Recommendations The home should record their assessment of prospective residents. The home should consider a system to record that prospective residents have been invited to visit, when the visit took place and what information was provided to them about the home. Moving and handling plans should be reviewed and signed off by the home’s moving and handling assessor. The home should review the skills of the staff team to meet the needs of people who are dying, and provide training where gaps in knowledge are identified. The garden should be made secure for the protection of vulnerable residents. Residents’ rooms should be able to provide comfortable seating for two people; at least two accessible double sockets and a table to sit at. The communication and interaction between care staff and officers-in-charge should continue to be improved to create an open, positive and inclusive atmosphere. 3. 4. 5. 6. 7. OP7 OP11 OP19 OP24 OP32 Orchard Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Lea DS0000039280.V292324.R01.S.doc Version 5.2 Page 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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