Inspection on 07/08/07 for Orchard Lea

This inspection was carried out on 7th August 2007.

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 16/06/06

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 Sue Dewis Key Unannounced Inspection 09:45 7th August 2007 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.V340153.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.V340153.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 http/www.devon.gov.uk/adoption.htm Devon County Council Vacancy 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.V340153.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th June 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. There is level access into and throughout the building. 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 £570.50. 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. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk . The last inspection report is on display in the main entrance hall Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over nine hours, one day at the beginning of August 2007. During the inspection 3 people were case tracked. This involves looking at peoples’ individual plans of care, and speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process CSCI likes to ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to people living at the home, their representatives, health and social care professionals (including GPs and care managers) and staff. At the time of writing the report, responses had been received from 13 people living at the home, 7 representatives, 2 health and social care professionals and 6 staff. Their comments and views have been included in this report and helped us to make a judgement about the service provided. During the inspection 2 people living at the home were spoken with individually and 5 in a group setting, as well as observing staff and people living at the home throughout the day. We also spoke with 4 staff and the manager. A full tour of the communal areas of the building was made as well as looking at some individual rooms. A sample of records was looked at, including medications, care plans, the fire log book and staff files A Random Inspection was carried out on 27 April 2007. This visit was to check on the progress that had been made to address the requirements and recommendations made at the visit on 16 June 2006. A report of this visit is available on request from the local CSCI office. What the service does well: The home provides a warm and friendly atmosphere and good relationships between those living and working at the home. Staff were seen to treat with dignity and respect and one representative commented via a survey card that ‘My mother always says she is well looked after, how clean everything is and that the food is good’. Staff receive regular training and those that were spoken with were eager to provide a good service. Staff, representatives and those living at the home all Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 6 reported good relationships and representatives said on comment cards that they felt welcome when visiting. The home offers good choices to those living there including, whether to join in with activities, what time they get up and go to bed and what they want to eat. Regular meetings are held at which people can express their views. Health and safety is well managed ensuring that the environment is safe for those living and working at the home. What has improved since the last inspection? What they could do better: The manager should be full time at the home to allow time for further improvements and to ensure longstanding requirements and recommendations are met. The home should not admit anyone to the home whose needs they cannot meet. Therefore they should ensure that thorough assessments have been completed and that they confirm in writing to the person that the home can meet their assessed needs. Consideration should also be given to implementing a system that would record when people have been invited to visit the home and what information they have been given. Care plans should give clear guidance to staff as to how the day to day needs of the people they care for should be met. Any issues identified through daily recordings should be followed up. Moving and handling plans need to be reviewed and updated, all falls and accidents should be appropriately recorded and risk assessments should show control measures that are required. Consideration should also be given to providing training in dealing with death and dying for those staff who wish it. Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 7 Appropriate recordings must be maintained in relation to the administration of medication and the range of acceptable temperatures should be displayed on the medication fridge. A clear record with issues, actions and outcomes should be kept when any concerns are raised. Consideration should be given to upgrading the laundry to provide separate downstairs sluicing facilities for commodes as well providing an ‘in/out flow through’ system in order to minimise the risk of cross infection. The home should also ensure that all bedrooms contain comfortable seating for two people, two double electric sockets and a table to sit at. All staff files must contain the information specified by law, including CRB (Criminal Records Bureau) checks and references. Work should continue to ensure that the improvement in communications between staff and management is maintained. 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. The summary of this inspection report can be made available in other formats on request. Orchard Lea DS0000039280.V340153.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.V340153.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is little evidence that individuals thinking of moving into the home are encouraged to visit, and a limited assessment of the support they require does not ensure that the home can appropriately meet their care needs. The home does not provide intermediate care. EVIDENCE: Three files were inspected, including that of the most recently admitted individual. The home still does not have a system to record that people who are thinking of living at the home have been invited to visit, when the visit took place and what information was provided to them about the home. Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 10 Two of the three files contained evidence of some form of pre-admission assessment. The forms used for this assessment are the same as those used for the ‘holistic care plan’ completed when individuals have been admitted to the home. This form is a mixture of what the individual can do and what the home will need to do for them. Two people that were spoken with said that they had visited the home before they moved in. None of the others could remember if they had. However, the form does not state where the individual was when the assessment was made or what the outcome of the assessment is. Therefore there is no record of whether the home is able to meet the needs of the individual, and if not, why not. This also means that the home cannot confirm to the individual that the home can or cannot meet their assessed needs. The acting manager said that care managers discouraged her from visiting individuals to assess them prior to them being admitted into the home. She said that this was the reason some individuals were not assessed by the home prior to their admission. The home must ensure there is a complete assessment obtained and must ensure that they do not admit anyone whose needs they cannot meet. The home does not provide intermediate care. Orchard Lea DS0000039280.V340153.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are not well formulated and do not give clear information to enable staff to meet the health and social care needs of individuals. Neither is there evidence that any identified healthcare needs have been followed and acted upon Individuals are treated with dignity and respect and there are good relationships between those living and working at the home. Though medicines are stored securely they are not always administered appropriately, which could put people at risk. Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 12 EVIDENCE: Three care plans were looked at. The care plan format has not changed since the last visit, and many of the problems identified then remain the same. Several forms within the care plan are very basic and some were not fully completed. For example, the ‘care plan ownership’ forms were not signed in two files. Moving and Handling assessments were very basic and still contained no evidence of a review. Risk assessments were poorly completed, they highlighted risks but gave no indication as to what should be done to control and minimise the risks. Daily recordings did not show that needs identified in the care plan had been met. For example one care plan said that cream should be applied to feet am and pm, but there was no record that this was done. Pink sheets for recording health issues and daily record sheets are kept separately from the care plans and this could be why issues are sometimes not picked up or recorded. Though care plans do identify some care needs of the individual they give very little direction to staff on how these needs are to be met. A ‘dependency profile’ was completed for two of the individuals and partly completed for the third. One of these profiles showed that the individual’s hearing had deteriorated over a period of several months, but there was no evidence that this had been investigated further. Another file showed a marked difference between the profiles and the monthly assessments, and again there was no evidence that these matters had been investigated further. Falls recorded in daily notes have not been recorded in the accident book and there is no record of any follow up action having been taken. This means that some injuries could get worse, or the cause of the injury may not be found, which might place people at risk. There was evidence on the ‘Pink’ sheets that health care needs are referred to GP’s and district nurses who visit regularly, but there is the potential for concerns to be missed and therefore put people at risk because of the lack of thorough records. One relative also commented via a survey card ‘I feel my dad should get more check ups by his doctor. I am afraid he is not the type to tell you if he is not well so feel regular checks by the doctor would be a good idea’. Medication is stored in a locked trolley in a locked room. There is a small fridge in this room where medication that needs to be refrigerated can be stored. The temperature of the fridge is recorded, though the limits are not specified which Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 13 means there is no way of knowing if the fridge is working within the permitted temperature range. The member of staff helping us gave good descriptions of how medications are accepted into the home, returned and administered. However, there were several gaps on the MAR (Medication Administration Record) sheets where no codes or signatures had been entered. This places people at risk of not receiving their medication. A checklist for assessing competence for self medicating is completed for all individuals. However, only people assessed as being completely capable are able to self medicate. There is no procedure for people to be encouraged and helped to manage their own medication. Staff were seen offering personal care in a discreet and respectful manner. They were also heard to speak with and about individuals in a respectful and appropriate way. People spoke highly of the staff and the way that they were cared for. One person commented via a survey form ‘good home and good staff, well looked after don’t think we could do any better’. Concerns had been raised at the previous visit about the lack of staff training in caring for those who are dying. There has been no staff training in this area since that visit. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to improve the care planning process, to seek the views of health and social care professionals to introduce a monthly medication audit. Orchard Lea DS0000039280.V340153.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers a suitable range of activities and entertainments to stimulate and occupy individuals. Links with visitors are good, giving opportunities to support and enrich individuals’ social life. Menus provide nutritious variety and choice for individuals. EVIDENCE: The home now employs an activities organiser for 12 hours each week. She said that she spent time with people finding out what they would like to do. Things that people are now able to take part in include Bingo, trips out and gentle exercises. She is able to find library books for people who wish to stay Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 15 in their own rooms and has arranged visits from the PAT (Pets As Therapy) dogs and their owners. Several people living at the home said that they enjoyed the activities on offer and one said that they often played cards and did gentle exercises. Others said that did not want to join in with activities and enjoyed watching the TV or chatting amongst each other. One representative commented via a survey card that their father ‘enjoys the outings they take him on’. A ROVI (Reablement Officer for the Visually Impaired) has visited the home to assess and enable someone who is visually impaired find their way around the home. People living at the home and their visitors said that they were always made welcome. One visitor commented via a survey card that ‘I feel very welcome whenever I or my family visit. We are greeted as part of the home family, always with a hot drink and a cheerful face.’ The activities organiser also arranges meetings, at which, people who live at the home are asked for opinions on the way the home is run, and if they would like anything to change. The minutes from these meetings were seen, and some people remembered attending them. Individuals are also asked for their opinions through the key-worker system, whereby each individual has a specific member of staff that they can discuss concerns with and who is responsible for some aspects of their personal care. Menus that were seen showed a balanced and nutritious variety of meals on offer. Individuals are offered a choice at all meal times and we were told by several people that the cook comes and asks them each day what they want to eat. Though people said that they generally enjoyed the food, one person commented via a survey card that ‘meals vary they can’t always please everyone’. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to find out more about what people living at the home want from it, circulate information about activities on a more individual basis and compile a regular newsletter Orchard Lea DS0000039280.V340153.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are generally dealt with appropriately though more thorough recordings would improve this area. Individuals are protected by staff who are able to recognise abuse and know their duty to report poor practice. EVIDENCE: The Devon County Council complaints procedure is clearly displayed around the home. The procedure is also contained within the Service User Guide and CSCI contact details are displayed on the main entrance hall notice board. People who were spoken with during the visit knew who they should raise any concerns with. A complaints file is kept, but this contained no entries since 1999. A record should be kept of all concerns raised and the outcomes recorded, so that the home can show that it deals with all concerns appropriately. No complaints have been received by the Commission since the last visit. Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 17 Staff records show that staff receive regular training in recognising and dealing with POVA (Protection Of Vulnerable Adults) issues. Staff that were spoken with were able to describe differing types of abuse and were clear about who concerns should be raised with, both within and outside the home. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to have the topic of POVA as a standing item at staff meetings to ensure staff are kept up to date on the topic. Also to have the complaints procedure on the agenda of all the meetings for people living at the home and their representatives, so that everyone is aware of the procedure and that the home encourages people to complain if they are not satisfied. Orchard Lea DS0000039280.V340153.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home generally provides individuals with a clean, safe, comfortable and homely place to live. EVIDENCE: Orchard Lea is a purpose built home and therefore has the advantage of level access on both floors, a large garden, a passenger lift, a the variety of communal and private spaces and several pieces of specialist equipment. There is a large and pleasant bathroom with a modern accessible bath. Seated scales have recently been purchased to enable those who cannot stand to be Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 19 weighed more easily. There are several mobile hoists around the home, and each person who needs to use the hoist has their own separate sling. Though the home has a pleasant garden it has still not been made secure, which means that any vulnerable people have to be accompanied if they wish to go outside. The main lounge downstairs was quite comfortable and reasonably decorated and there has been some recent general improvements to the whole of the home, including several new carpets, some redecoration and the refurbishment of the dining areas. Most of the bedrooms are small by current standards and this affects the amount of furnishings and fittings that can be accommodated. Therefore there is still not enough space to provide comfortable seating for two people, at least two accessible double electric sockets and a table to sit at. The rooms that were looked in were clean and odour free. Some appeared homely and personalised but generally fittings are dated and tired in appearance. Bedroom furniture is utility in style and marked, including fitted wardrobes and sink units, and some flooring is in need of replacement. Where possible efforts have been made to brighten rooms with colourful curtains. There are no current plans to refurbish the bedrooms. One person spoken with in their bedroom, said that though it was small, they had been able to bring in a few things to make it more homely. The manager said that they had concerns about the security of the building, as the front door had always been left open, allowing anyone free access to the whole home, if there were no staff in the area. However, there were also concerns that if the door was kept locked it would delay any emergency exit that may be needed. The manager has sought the advice of the crime prevention service and the fire service, and is hoping to improve the general security. The home was clean and free from unpleasant odours throughout. Liquid soap and disposable towels were seen in all toilets as well as hand sanitising gel. Staff said that disposable gloves and aprons are easily accessed when needed. There is a large laundry room with specialist equipment and an impervious floor covering. Much effort is taken to ensure all items are laundered appropriately and that each person gets their own laundry back in a reasonable timescale. However, there is no ‘in-out flow through’ system in operation and the only sluice for commodes is in this area. This means there is a risk of infection from cross contamination. The AQAA (Annual Quality Assurance Assessment) submitted prior to the Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 20 inspection indicates that in order to improve the service the home intends to continue with the redecorations, establish a Health and Safety group and improve the general security of the building. Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are well trained and are available throughout the day and night in sufficient numbers to meet the needs of the current individuals. The procedures for the recruitment of staff are not robust and do not offer full protection to individuals living at the home. EVIDENCE: On the day of the visit there were five care staff on duty till 2pm then four until 6pm then three until the two night staff came on duty. At all time throughout the day there was an assistant manager on duty. There was also a variety of ancillary staff, including an activities organiser, a cook and domestics. Staff from the home no longer provide night time cover to the bungalows situated next to the home. All those living and working at the home felt that the numbers of staff available were sufficient to meet the needs of individuals. People said that there were Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 22 always plenty of staff about and were very complimentary about the staff with one person saying ‘you can’t fault it here’. Staff said and records confirmed that there was a good range of training on offer, including Moving and Handling, POVA, infection control, fire procedures, managing dementia and safe handling of medications. Staff also have the opportunity to obtain NVQ (National Vocational Qualification) level 2 and 3. Currently 14 of 27 staff have NVQ level 2 or above with a further 2 working towards this. The files of three members of staff were looked at including that of the most recently employed. As at the previous visit were a requirement was made, the files do not contain all the required information. Although the newest member of staff was not working unsupervised, there was no CRB (Criminal Records Bureau) check, their references had not been received and their most recent employer had not been asked for a reference. One of the other files was also lacking references. The AQAA (Annual Quality Assurance Assessment) submitted prior to the inspection indicates that in order to improve the service the home intends to ensure all required documentation is maintained, update induction material and encourage more NVQ participation. Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of a full time registered manager prevents the home from being well managed resulting in practices that do not always promote and safeguard the health, safety and welfare of the individuals. EVIDENCE: A new manager has been appointed but is not yet registered. They have so far worked hard to improve the home, but they are now only part time at the home as they are also covering the management of another home. They said Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 24 that they felt that this had hampered their efforts at improving Orchard Lea due to the limited amount of time they could spend there. One staff commented via a survey form that they felt they would like to see ‘more Indians and less chiefs’ and another felt that the ‘officers are far to much removed from the client they don’t know what we have to do or how long things take they don’t know our jobs’. However, another commented ‘I believe in all honesty that the management are supportive of both staff and clients’ and others that were spoken with, also felt that the management was supportive of them. There has been uncertainty about the future of the home for some time and there were several comments on survey cards about this. The manager hopes that things will improve now that now a decision has been made and more information is available. The manager said and minutes confirmed that separate meeting are held regularly for all those who live and work at the home, in order to gain feedback about the service. Changes made following these include revised menus and more activities and entertainment. Questionnaires are due to be sent out again to all parties with an interest in the home, and Devon County Council are introducing a new quality assurance system. An Age Concern advocate visits the home to assist anyone living there with any concerns they may have. A representative of the registered company (Devon County Council) should visit the home unannounced, at least once a month. Only two such visits have been made since February 2007. People living at the home who do not wish to manage their own finances are able to have them managed through Devon County Council’s ‘suspense account’ system. Individuals are able to access their money at any time, through a ‘pool’ of money held at the home. Individual accounts are maintained for each person and receipts and signatures are obtained as necessary. Staff reported that they had regular one to one supervision sessions and records confirmed this. However, several staff also commented via comment cards that they would like more ‘on the job’ supervision of their work. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit, provided evidence that Orchard Lea complies with health and safety legislation in relation to maintenance of equipment, storage of hazardous substances, health and safety checks and risk assessments. The fire logbook, record of fire safety training and accident and incident records were found to be accurate and up to date. So that the risk of burning from hot surfaces is minimised, all radiators within the home are covered. All windows above ground floor level are fitted with Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 25 restrictors, in order to minimise the risk of anyone falling from these windows. Thermostatic valves are fitted to all hot water taps that people living in the home have access to, so that the risk of scalding is minimised, Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 26 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 2 X 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 X 3 X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 3 X 3 Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? 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. Standard 1. OP3 Regulation 14 (1)(a) Requirement The home must not admit anyone without their needs having been fully assessed and the home having assured itself that it can meet the needs of the individual. Timescale for action 30/09/07 2. OP3 14 (1)(d) The home must not admit anyone 30/09/07 without having confirmed in writing to the individual that it can meet their needs. Care plans must provide clear 31/12/07 guidance to staff as to how to meet the health and social care needs of people in order to work towards continuity of approach, which can then be reviewed. (Previous timescales of 31/05/06, 31/07/06 and 31/05/07 have not been met). Medication records must be signed or coded appropriately each time medication is offered to the individual. This is to make sure that people living at the home are protected by safe medication practices Staff files must contain all documents specified in Schedule 2, DS0000039280.V340153.R01.S.doc 3. OP7 15 (1) 4. OP9 13(2) 30/09/07 5. OP29 19 Schedule 2 31/12/07 Orchard Lea Version 5.2 Page 28 6. OP33 26 including references and CRB checks (previous timescale of 31/05/07 not met). This is to ensure that all staff working at the home are suitable to do so. A representative of the registered 30/09/07 person must visit the home unannounced, at least once a month and prepare a written report of the visit 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 OP5 Good Practice Recommendations You should consider a system to record that individuals thinking off moving into the home have been invited to visit, when the visit took place and what information was provided to them about the home (recommendation first made 16/06/06) Moving and handling plans should be reviewed and signed off by the home’s moving and handling assessor (recommendation first made 16/06/06) You should ensure that all falls and accidents are recorded on the appropriate forms You should ensure that any risk assessments undertaken also clearly show the control measures that have been put in place to minimise the identified risk. You should ensure that any healthcare needs identified in daily records are followed up and action taken if required You should ensure that the range of acceptable temperatures is displayed on the medication fridge You 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 (recommendation first DS0000039280.V340153.R01.S.doc Version 5.2 Page 29 2. OP7 3. 4. OP7 OP7 5. 6. 7. OP7 OP9 OP11 Orchard Lea made 16/06/06) 8. OP16 You should ensure that a record is kept of all concerns raised so that any action that has been taken and the outcomes can be clearly identified You should ensure that the garden is made secure for the protection of vulnerable people (recommendation first made 16/06/06) You should ensure that bedrooms contain comfortable seating for two people; at least two accessible double electric sockets and a table to sit at (recommendation first made 16/06/06) You should consider upgrading the laundry facilities in order to minimise the risk of cross infection You should ensure that the communication and interaction between care staff and officers-in-charge continues to improve, to create an open, positive and inclusive atmosphere (recommendation first made 16/06/06) 9. 10. OP19 OP24 11. 12. OP26 OP32 Orchard Lea DS0000039280.V340153.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V340153.R01.S.doc Version 5.2 Page 31 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!