Inspection on 07/03/06 for Orchard Lea

This inspection was carried out on 7th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 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 Unannounced Inspection 7th March 2006 10:45 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.V276770.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 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.V276770.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd November 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 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.V276770.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over four and a quarter hours with two inspectors. Residents, staff, the manager and visitors gave their views on the service. A tour of the building took place and records were looked at including statement of purpose, medication and care plans. There were twenty people were living at the home, which included four short stay people. One inspector spoke to nine residents in depth, (records for three of these people were then looked at), one relative and one staff member. The second inspector spoke to three members of staff, one resident and the manager and looked at records relating to the care of residents. Since the last inspection a complaint was received by CSCI. There were four areas of concern identified and three were upheld with the fourth partially upheld. The inspection focussed on key National Minimum Standards, which had not been inspected at the previous inspection or those, which were the subject of previous requirements and/or recommendations, and the above complaint. What the service does well: What has improved since the last inspection? What they could do better: Requirements have been made to improve increase specialist training for the care of people with dementia, improve the quality of care plans to include guidance on health, social care and well-being, and to maintain residents’ dignity and offer choice. Further requirements were made because potential adult protection issues were not appropriately addressed; the environment is poorly maintained and staff recruitment is not robust. Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 Page 6 Recommendations have been made relating to training, improving emergency admission procedure, medication, furnishings for residents’ rooms and securing the garden. A formal meeting has taken place with the providers to discuss the findings of this inspection. During this meeting the providers were co-operative, and committed to improving practice at the home. They have produced a comprehensive action plan to address the requirements and recommendations made in this report. 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.V276770.R01.S.doc Version 5.1 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.V276770.R01.S.doc Version 5.1 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): 3,4,6 The home’s assessment process does always not ensure that the home can meet residents’ needs. EVIDENCE: Discussion took place with staff about pre-admission assessments for prospective residents. Sometimes the home staff do not visit prospective residents before admission and this means that the staff rely upon the assessments completed by care managers. Staff said information is gathered over the phone but is not recorded in any set format, and the home cannot always show why a placement was agreed. The home takes emergency placements and staff said this sometimes resulted in inappropriate admissions, which the manager said was the case with one current resident, whose care needs could not be met. The home is registered to care for people with dementia. Training so far has been one-day introductory sessions, which on the last inspection staff were positive about. Currently relief managers and line managers are attending a Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 Page 9 three-day course in dementia care. All three care plans looked at by one inspector contained minimal references to mental health needs and there were no action plans detailing how staff meet these needs. The approach by some staff is task orientated rather than focussing on the individual needs of residents. The home has a dementia category as part of its registration but current practice at the home does not reflect this specialist area of care. The home does not provide intermediate care. Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 Page 10 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 The care planning process is poor, meaning that staff are not always fully aware of residents’ needs and how they can be met, in particular physical and mental health needs. Generally medication is well managed. Personal support is not always given in a way that promotes residents’ dignity and independence. EVIDENCE: A carer was asked to describe the needs of several residents; their reply was very general relating to personal care. When asked for more detail about one resident’s needs, they replied that the person hadn’t been at the home for long and then confirmed that the resident had lived at the home for two months. This means that this carer did not know the resident’s individual needs. Care plans did not contain enough information about how to care for individuals’ needs- information was sometimes sparse and not detailed Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 Page 11 enough. One resident had swallowing difficulties and had a poor appetite, but these needs and how to meet them was not written down. There were two residents who had behaviour that was challenging to staff but there was no clear guidance about what staff should do to manage the situation and prevent risk to staff and residents. The quality of the care plans was variable with some providing good details about mobility and risk assessments. Health care needs of residents were recognised but again most care plans did not fully describe the plan of care or record any progress made - for example in one case a pressure ulcer. No alterations had been made to this care plan since the resident spent all day in bed - meaning that staff could not be clear about what care to give. Another example was a resident with continence problems and the care plan just stated ‘ wears pad and has catheter’. Three care plans contained no social histories or information about how to meet residents’ obvious mental health needs. Plans were reviewed but it was not clear if residents had been involved in this. Important information was not recorded in the care plans despite being highlighted in staff supervision notes as needing action. One plan said ‘feeling a bit upset at lunch’; there was no further action or information. The manager was aware of one resident’s history of anxiety but the care plan did not provide guidance how to support the resident. Some residents were unable to use the call bell due to capacity but no action was detailed in the care plans to address this. Medication was assessed. All but one staff have had medication administration training and a drug round was observed with no problems. Hand written alterations to medication charts had not been signed by two members of staff to help prevent mistakes. There was photographic ID for all residents and MARS sheet documentation was correct, as was storage. Time was spent in the upper dining room to observe the interaction between staff and residents. The atmosphere in both dining rooms was generally subdued. Some music was put on in one, but without the residents being consulted. There was a forty-minute delay for one resident between being sat at the table and being served a meal. In both dining rooms, staff concentrated on serving meals and drinks and there was minimal interaction with residents, who appeared withdrawn. Residents were not offered a choice of drink, although at one point, a carer shouted across the room to another carer, ‘Did he want lemonade?’ Extra food was added to a resident’s plate without the resident being asked. Thought has not properly been given to how residents experience their mealtimes, and how it should be a social and pleasurable occasion. Instead, the residents’ needs for interaction and communication were not met. Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 Page 12 One resident said ‘they are very good here’ and another said staff were ‘quite jolly but not very business like’. Some of the staff member’s communication skills were poor, and at times these staff members’ attitude did not value the dignity of residents. For example, one resident said they needed the toilet and was told to ‘eat her dinner’ with the staff member walking off. One resident said to a staff member ‘you’re not listening to me’ but the staff member had walked off. Another said that staff were kind but did not talk very often. A fourth resident said that staff don’t want to listen and show no respect by talking over their head. A carer was heard to ‘tut’ when a resident did not want a cup of tea saying ‘after all my effort’. Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14 Social activities are not well managed or creative, nor do they provide daily variation and interest for people living in the home. Residents are not encouraged to maintain their independence through being given choice and control over their lives. EVIDENCE: There was no formal activity programme. One resident was heard to comment to another that they were ‘bored to tears enough to drive them crazy, with nothing to do’. One relative said that the ‘girls were very nice’ and that their relative was well cared for and they pop in to check them but that there was nothing to do especially in the mornings. There were no records that social and leisure needs were being consistently met appropriately for every resident. In a resident’s care plan, the only recorded activity was ‘outside for a sit and talk’, which had taken place five months earlier. Another plan had no activity records since last October. One resident said that staff ‘often get together and talk amongst themselves’. One member of staff has responsibility to provide 2 days of activities a week. Instances were seen where residents’ social wishes and interests were ignored leaving them under-stimulated, despite care plans recording these wishes or Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 Page 14 interests. One resident whose care plan states that they do not like the television was sat very close to the loud television whilst trying to do a puzzle. Members of staff did not do anything about this although they knew he did not like the television. Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Poor care planning means that residents and staff are not always fully protected from potentially abusive situations. EVIDENCE: Since the last inspection, a complaint has been received 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 planning and maintaining residents’ dignity. As well as a further three recommendations, which all related to improving guidance for staff in care planning. There was no clear guidance in care plans where there have been concerns raised by staff about inappropriate behaviour displayed by residents. This could lead to staff and residents being placed in a vulnerable position with insufficient guidance for staff to follow to protect themselves and other residents. Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 No improvements to the décor have been made and therefore the home does not provide the residents living there with homely and comfortable surroundings. 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. Its disadvantage is in being built to environmental standards current some years ago. 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. 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. Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 Page 17 The home has a garden but staff confirmed that it was not secure, which meant any vulnerable residents had to be accompanied outside. 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. Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 Staff are employed in sufficient numbers to meet the needs of residents. EVIDENCE: The staffing levels on the day of the inspection were five care staff in the morning, four in the afternoon and according to the rota, four staff in the evening and two waking night staff. There was also a deputy manager, the manager, a kitchen assistant, a cook, a domestic on duty and an activities worker. The manager and a senior member of staff explained that no new members of staff had been recruited since the last inspection in November 2005. Therefore a previous requirement for improved staff recruitment procedures could not be inspected. However, the home is currently using agency staff as part of the staff team and discussion took place around how agency staff’s identity was checked when they arrived at the home. There was a lack of clarity as to whether agency staff wore photo ID badges. Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 Page 19 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): 35 Residents’ financial interests are safe guarded. EVIDENCE: Residents’ personal money is held in a bank account and the manager explained a clerk works out the individual interest. Receipts were seen for deposits, withdrawals and items bought. On the whole entries were double signed. The manager explained that they spot-checked the figures. Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 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 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 1 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 1 X X X X 2 X X STAFFING Standard No Score 27 3 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 3 Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 Page 21 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. 1. Standard OP7 Regulation 15 (1) Requirement The registered person shall prepare a written plan as to how the service users’ needs in respect of their health and welfare are to be met. (Care plans must give clear guidance to reflect the changing needs of the resident, with clearer outcomes as a result of a review). The registered person shall prepare a written plan as to how the service users’ needs in respect of their health and welfare are to be met. (Care plans must provide guidance as to how staff should respond to known physical and mental health needs to ensure continuity of approach) (Care plans must record health interventions and outcomes) Timescale for action 31/05/06 2. OP8 15 (1) 31/05/06 Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 Page 22 3. OP10 12 (4) (a) 4. OP12 16 (2) (n) 5. 6. OP14 OP18 12 (3) 13 (6) The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner, which respects the privacy and dignity of service users. Residents must be consulted about their interests and a regular programme of activities and trips drawn up, which are based on this consultation. If residents do not enjoy group activities/trips then alternatives should be offered. The registered person shall take into account residents’ wishes and feelings. The registered person must make arrangements, by training staff or by other measures, to prevent residents being harmed or suffering abuse or being placed at risk of the above. 30/04/06 30/04/06 30/04/06 30/04/06 7. 8. OP19 OP29 (Ensure care plans and guidance are up to date) 23 (2) (b) The premises must be kept on a (d) good state of repair and reasonably decorated. 19 (1) 1-9 Staff records must contain Sch. 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 checks are no longer portable. (This requirement has been carried over from the last report as no new permanent staff have been appointed). 30/06/06 31/05/06 Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 Page 23 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. 3. 4. 5. 6. Refer to Standard OP3 OP4 OP9 OP19 OP24 OP29 Good Practice Recommendations The emergency admission procedure should be reviewed to ensure that the home can meet prospective residents’ needs. On-going training in the care of people with dementia should be provided for all care staff. Hand written transcriptions onto the MARS sheet should be signed by two staff members. 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 identity of agency staff should be verified i.e. they should be wearing photo ID badges. Orchard Lea DS0000039280.V276770.R01.S.doc Version 5.1 Page 24 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.V276770.R01.S.doc Version 5.1 Page 25 - 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!