Inspection on 23/11/05 for Orchard Lea

This inspection was carried out on 23rd November 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Orchard Lea 12/06/09

Orchard Lea 17/09/08

Orchard Lea 07/08/07

Orchard Lea 16/06/06

Orchard Lea 07/03/06

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 Unannounced Inspection 23rd November 2005 11:45 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.V252723.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard Lea DS0000039280.V252723.R01.S.doc Version 5.0 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.V252723.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th March 2005 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. Orchard Lea DS0000039280.V252723.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over five hours and staff, residents and visitors contributed with their views on the service provided. Records were looked at as part of the inspection, which included fire, recruitment files and care plans, and the building was inspected by a tour of the building. A number of comment cards completed by residents, visitors and visiting professionals. Out of the twenty-six bedrooms currently in use, twenty two were occupied on the day of the inspection. Eight residents contributed to the inspection. The manager explained that the home is part of a Devon County Council modernisation programme and that the future role of the home is open to public consultation from early December 2005. She advised that care managers are advising all new residents that the service is under review. What the service does well: What has improved since the last inspection? What they could do better: Two recommendations from the last report remain outstanding. One concerns gathering feedback from stakeholders in the community regarding the quality of the service. And the other relates to furniture and fittings available in residents’ rooms i.e. double sockets, comfortable seating for two people. Orchard Lea DS0000039280.V252723.R01.S.doc Version 5.0 Page 6 A requirement was made on this inspection that staff recruitment methods must be more robust. The home needs redecorating and the furnishings renewed i.e. carpets. Further recommendations have been made to improve activities in response to residents’ wishes, improve the quality of the information in care plans to provide continuity of approach by staff. 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.V252723.R01.S.doc Version 5.0 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 Lea DS0000039280.V252723.R01.S.doc Version 5.0 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): EVIDENCE: Key standards will be looked at on the next inspection. Orchard Lea DS0000039280.V252723.R01.S.doc Version 5.0 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): 7,8,10,11 Minor changes to care plans would help ensure a continuity of approach by staff to meet residents’ emotional and psychological needs. EVIDENCE: Three care plans were looked. Two keyworkers were spoken to about residents’ care needs. Within the daily notes for one resident there was the comment that the person was in their usual nervous state at bedtime and this type of comment was repeated in a monthly review. However, there was no guidance in the care plan as to how this should be addressed by staff. Monthly reviews were in place and moving and handling plans were in place with clear instructions. A risk assessment showed that a resident’s bed had been lowered because of risks of falls but did not indicate that this had been in consultation with the resident, which the manager said had happened. Another resident when spoken to raised concern regarding their finances. Their keyworker said this was a current concern for the resident. The manager confirmed this was being resolved but there was no guidance in the care plan as to how staff responded to this concern i.e. reassurance or the action plan to Orchard Lea DS0000039280.V252723.R01.S.doc Version 5.0 Page 10 address the problem. The manager explained a care manager had been asked to visit. However, from observation and discussion with their keyworker, the third care plan did reflect the needs the resident. Care plans recorded health interventions and positive outcomes for all three residents that were case tracked. During the inspection, a GP and a district nurse visited the home. Records also showed that residents have access to a dentist and optician. A comment card from a health professional felt that staff/management take appropriate decisions when they can no longer manage the care needs of a resident, and that usually their specialist advice was recorded in the plan of care. They felt that residents were ‘generally happy’. Through discussion with residents, it was confirmed that they felt their privacy and dignity was respected. For example, staff knocked on doors, visitors could be seen in private and mail was unopened. Comment cards from residents and visitors recorded the same view. There is a telephone booth for private calls. Care plans state residents’ last wishes. Orchard Lea DS0000039280.V252723.R01.S.doc Version 5.0 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 Residents benefit from a welcoming atmosphere for their visitors but activities and trips are limited causing a lack of social and mental stimulation. EVIDENCE: Residents spoken to raised the lack of activities as an issue for them. They spoke of bingo and whist but said it depended if staff had time. Staff confirmed this. During the inspection, residents were observed watching the television, sleeping or looking at books on their own. Several people commented on the lack of trips and one person said that time passed slowly. Another said that they would like more mental stimulation. One person’s care plan recorded that they did not like group activities but did not suggest possible alternatives. Three residents’ comment cards said the home did provide suitable activities and two people said no. Visitors commented on the behalf of two residents that they missed the former activities programme. The manager explained that the activities co-ordinator post of twelve hours per week is currently vacant but this will be shortly be filled by an existing member of staff. Residents said their visitors were made welcome and that they had a choice of places that they could see them, including a visitors’ room, which was helpful because of the restricted space within bedrooms. Visitors who contributed on the day of the inspection and those who completed comment cards all said they felt welcomed and could visit when they wanted to. Orchard Lea DS0000039280.V252723.R01.S.doc Version 5.0 Page 12 Residents spoke about getting up and going to bed when they wanted to. Or having their breakfast in their rooms or in the dining room. A resident confirmed that they choose their own clothes and that they could bring in their own possessions. Other residents’ rooms showed that people could personalise them. All five comment cards from residents said they liked the food and other residents in conversation confirmed this and said that there was a choice, and that alternatives were offered. The menu plan shows that residents have the option of fresh fruit throughout the day. Care plans show that residents’ likes and dislikes are recorded. Orchard Lea DS0000039280.V252723.R01.S.doc Version 5.0 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 Residents are clear about what to do if they are unhappy with their care and benefit from staff who are knowledgeable about the protection of vulnerable adults. EVIDENCE: There has been one complaint in the last twelve months, which was partially substantiated and one complaint that is currently being investigated. The outcome of which will be sent to CSCI. Records seen were well kept. Residents spoken to said they would go to the office if they had a problem. Residents’ comment cards all said they knew who to speak to if they were unhappy with their care. However, three out of four visitors were unclear about the complaints procedure. The manager ensured during the inspection that the Devon County Council complaints procedure was more clearly displayed. The complaints procedure is within the Service User Guide in each bedroom. CSCI contact details are also on the board. Two staff who were interviewed demonstrated knowledge of the protection of vulnerable adults and the steps to take if they had concerns about poor practice. Both had received training in this area of care. The manager and a member of staff confirmed that the whistle-blowing policy is kept in the staff room. Orchard Lea DS0000039280.V252723.R01.S.doc Version 5.0 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): 19,20,21,23,24,25,26 The home is clean and odour free but the residents’ environment in places is not homely, and its decoration is poor and carpets tired in appearance. EVIDENCE: Orchard Lea is a purpose built home and has significant advantages due to its level access on both floors and garden, its shaft lift, other pieces of specialist equipment, and the variety of communal and private spaces. Its disadvantage is in being built to environmental standards current some years ago. As a result most bedrooms are small by current standards, which impacts on the furnishings and fittings that can be accommodated. A number of residents have created comfortable and personalised rooms, however, and are supported and encouraged to do so. Orchard Lea DS0000039280.V252723.R01.S.doc Version 5.0 Page 15 Damage to paintwork and plaster caused by wheelchair strikes, the standard of decoration and marked carpets makes the home appear in places as institutional and tired in appearance. As a result the home struggles to achieve a “comfortable and homely” ambience and many areas simply do not. The home is in some need of significant investment in modernisation and refurbishment. There has been an ongoing recommendation to improve the home’s décor. People expressed sadness at the state of the décor. The home has a variety of communal spaces, including three lounges, visitors’ rooms and two dining rooms. One of which is generally used for people requiring more support with their meals. The garden has level access but is not secure. Since the last inspection, six hand washbasins have been added to communal toilets to promote infection control. There are three bathrooms, although staff and residents said that generally the lower larger bathroom is used because of its size and the type of adapted bath. None of the residents’ rooms have an en-suite facility. All have hand washbasins. There are sluices separate from residents’ toilets and bathrooms. The home has ten toilets. Those residents’ rooms which were visited were clean and odour free. Some appeared homely but generally fittings are dated and tired in appearance. The rooms are generally small by current standards and their size prevents two people being able to sit on comfortable chairs. They currently do not have double electrical sockets and storage is limited. There are no double rooms, as three larger rooms are used for people using wheelchairs. Doors have locks fitted to them and there is lockable storage space. The manager confirmed that all radiators and hot water pipes have been covered with windows restricted to promote resident safety. Protected pipework and covered radiators were seen during the inspection. The home was clean and odour free. Residents confirmed that this was always the case, as did visitors. The laundry includes hand-washing facilities with an impermeable finish on the floor, easily cleanable walls and a sluicing facility. Orchard Lea DS0000039280.V252723.R01.S.doc Version 5.0 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 Current staff recruitment practices potentially put residents at risk, although residents benefit from staff who have regular up dates to their mandatory training. EVIDENCE: On the day of the inspection, the manager and assistant manager were on duty, with five care staff on in the morning and four care staff in the afternoon. Four care staff were rostered for the evening and then later two awake night staff and one sleeping member of staff. Additional workers consist of kitchen and domestic staff. Staff on duty confirmed these numbers. Care staff were described by a visitor as ‘excellent, kind, patient and understanding’. Residents said staff were ‘good’ and several commented that they were very happy living at the home. The pre-inspection questionnaire shows that agency staff are used but the manager said that where possible the same staff are provided by the agency for continuity. One resident commented that there were ‘lots of different faces to get used to’ but none of the residents spoken to or who responded via five comment cards raised staffing as a problem. They felt well cared for and six visitors’ comment cards said they were satisfied with the care. A relative said ‘ the staff are kind and considerate’. A majority of the care staff have worked at the home for many years. Orchard Lea DS0000039280.V252723.R01.S.doc Version 5.0 Page 17 The pre-inspection questionnaire states that only 30 of care staff have an NVQ 2 or above. The National Minimum Standard states that this should be a minimum of 50 by 2005. Three staff recruitment files were looked at. They all contained photos, job application forms, appropriate identification documents, two written references or confirmation that these have been seen. However, one person had brought with them a CRB from a previous external job. Since the introduction of the POVA list, CRBs are not portable. On the files for three recent members of staff there was no verification that a POVAFirst check had taken place to enable them to start work without a current CRB being in place. Records showed that these care staff had started work before their CRB had been returned. Most of the recruitment process, including POVA and CRB checks is managed centrally. Two members of staff spoke about their recent training, which included first aid, food hygiene, moving and handling, as well as training in the needs of people with dementia. Staff spoke positively about the training on dementia, which the manager explained was an introductory session. There are hopes that this topic will become part of the training package provided by Devon County Council. Orchard Lea DS0000039280.V252723.R01.S.doc Version 5.0 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): 32,33,36,38 Minor changes to the quality assurance system will provide a fuller picture of the service and care the home is providing to residents. The residents benefit from a home where regular safety checks are maintained. EVIDENCE: The home currently has a manager, three assistant managers and three relief managers. Two visitors commented that there was always a different face in the office and were unclear as to which person the manager was but said that they were always kept informed of events in their relatives’ lives. Residents tended to speak about going to the ‘office’ with problems rather than specific people. Another person responding in a comment card felt ‘the senior staff do not seem to communicate always to hand things over…senior staff member (s) either do not know what the problem is or the problem has been resolved without them knowing’. In a follow up call, the person said that the quality of the communication depended on who was on duty. The manager said that sometimes information had to be sought from care plans, which could take Orchard Lea DS0000039280.V252723.R01.S.doc Version 5.0 Page 19 time rather than it being instantly to hand. There are plans to address communication issues within the home. A resident spoke about the residents’ meetings that are held at the home. They felt that this enabled residents to voice their views but expressed concern that so few people attended. The minutes are on display on a main notice board. Two other residents said they knew about the meeting but chose not to attend. A quality assurance system is in place but the views of stakeholders in the community i.e. GPs have not yet been collected, although the manager said this was work in progress. The two staff interviewed both felt well supported with regular one to one supervision sessions. 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. 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. Residents were seen with mobile call bells in reach and staff were heard checking with residents that their call bell was accessible. The pre-inspection questionnaire records that maintenance safety checks are up to date i.e. gas and electricity. While the accident records that were looked at were appropriately completed and record outcomes. Orchard Lea DS0000039280.V252723.R01.S.doc Version 5.0 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 x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 3 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 3 3 x 3 2 3 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 x 3 2 x x 3 x 3 Orchard Lea DS0000039280.V252723.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 19 (1) 1-9 Schedule 2 Requirement Staff records must contain 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. Timescale for action 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Care plans should provide guidance to staff to meet the emotional and psychological needs of residents in order to work towards continuity of approach, which can then be reviewed. Residents should be consulted about their interests and a regular programme of activities and trips should be drawn up, which is based on this consultation. If residents do not enjoy group activities/trips then alternatives should be DS0000039280.V252723.R01.S.doc Version 5.0 Page 22 2 OP12 Orchard Lea 3 4 5 OP19 OP24 OP33 offered. The décor of the home should be homely and well maintained. 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 view of stakeholders in the community (e.g. GPs, chiropodist, voluntary organisation staff) should be sought on how the home is achieving goals for service users. 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