Inspection on 21/11/06 for Orchard Lodge

This inspection was carried out on 21st November 2006.

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

The inspector 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 Lodge 08/07/08

Orchard Lodge 09/05/07

Orchard Lodge 02/02/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Orchard Lodge 30/32 Gordon Road Seaforth Liverpool Merseyside L21 1DW Lead Inspector Mrs Margaret Van Schaick Unannounced Inspection 21st November 2006 09:15 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 Lodge DS0000063169.V299391.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 Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard Lodge Address 30/32 Gordon Road Seaforth Liverpool Merseyside L21 1DW 0151 920 9944 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) Mrs Miljana Kiss Margaret Elizabeth Lovett Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26), Physical disability (5) of places Orchard Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The service may accommodate up to 26 service users The service should employ a suitable qualified and experienced manager who is registered with the Commission for Social Care Inspection The service may accommodate up to a maximum of 26 service users within the category of OP The service may accommodate up to a maximum of 5 service users aged 55 years and over, within the category of PD 2nd February 2006 Date of last inspection Brief Description of the Service: Orchard Lodge is a privately owned care home registered for 26 older people personal care only. The home is adjacent to a dual carriageway in a residential area of Bootle. The home is close to main bus routes and there are local shops nearby. The main shopping area, library, restaurants and train station are a short ride by car, or alternatively there is regular public transport. The home was originally two buildings, which have been combined to create a large converted care home. There is a large day room, a separate dinning room and a small tiled smoking room at the rear of the home. The home has twenty single bedrooms and three shared bedrooms. A passenger lift accesses all floors and a call bell system is fitted throughout the home to include bedrooms and communal areas. There is a patio area at the front of the house and a small garden to the rear. Weekly fees are £355.50 Orchard Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over two days lasting 11 hours. This was the key unannounced inspection to be carried out as part of the regulatory requirements. As part of the inspection process all areas of the home were viewed including most of the residents bedrooms. Care records and other residential home records were inspected also. Discussion took place with the registered manager and deputy manager. One to one conversations took place with 3 staff. Several residents were also spoken with. Three residents were interviewed in private and their views obtained on how the home was run and the care and support provided. Residents views were also obtained through Have your say about…. questionnaires, which were sent to the home prior to inspection. Some of these were returned to the Commission prior to the inspection. The views of which were positive. Their comments are included in this report. Three residents care plans were ‘case tracked’ (looking at all information with regard to care for the individual resident) and three staff files were examined, which included the training files. What the service does well: Orchard Lodge provides a caring, and ‘homely’ environment, which ensures residents, settle down to a routine that is suited to them. Residents interviewed have been very complimentary about how the home is run with their comments including, “I love it here, everything, the atmosphere, staff are very helpful” and Margaret (manager) and Sheila (deputy) are very nice, all are very nice, we get looked after, they are nice to all the residents”. Residents stated, “the food is very good with fresh vegetables and fruit, we also get some home baking now and again”. The home generally practices good planned admissions, which ensures residents are assessed prior to admission Interview notes are made during staff interviews, which is good practice. Orchard Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 6 There is documented evidence that where bed rails are used they are reviewed on a regular basis What has improved since the last inspection? What they could do better: Not all healthcare needs are identified or addressed in care plans therefore this may compromise residents’ health. Medication is not always signed for therefore the assumption is that the medication was not given as prescribed placing residents at risk. The local pharmacy has issued a staff handbook for care staff to work through to ensure a better understanding of medication administration therefore this needs to be commenced soon. The home needs to ensure all pre admission assessments are signed and dated. The homes policies and procedures need to be improved to ensure that residents are protected. There is no ‘whistle blowing’ policy in place. This needs addressing to ensure staff can raise concerns if wished. The complaints book is blank despite there being recent concerns raised by a resident’s relative. The home needs to address the issues raised in this report to ensure that residents are living in a comfortable and safe environment. Staff files need to be audited to ensure all induction/training records are up to date and the recruitment process needs to be improved to ensure residents are safe. Many of the staff has not attended training for infection control, manual handling, health and safety and first aid. Staff supervision needs to be signed Orchard Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 7 Some staff application forms are incomplete and do not have enough information in place. References are not dated therefore it is difficult to know if they were checked prior to commencement of work 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 Lodge DS0000063169.V299391.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 Lodge DS0000063169.V299391.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home generally practices good planned admissions, which ensures residents are assessed prior to admission. OP 3 was assessed. OP6 is not applicable EVIDENCE: Two of the most recently admitted residents’ pre admission assessment records were examined. One resident’s relative visited the home on their behalf and was given information with regard to the services provided at the home. The prospective resident was then invited to visit the home in the company of their relative. The manager was able to assess the prospective residents needs during this visit and gain further information from the relative also. This information gathered during the assessment process was then used to form the initial care plan. The local authority was also involved in the assessment of needs and the funding of care. Orchard Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 10 Another resident recently admitted was on an emergency basis and the admission went ahead without the manager assessing the prospective resident prior to admission. This resident has been admitted on a temporary basis for respite. Information with regard to the residents needs was gained from a close family member. Residents confirmed through discussion with the inspector that they had met the manager prior to being admitted to the home. Residents’ comments include, “We were invited for a visit and to meet other residents and could visit anytime, uninvited, to view or talk to staff and residents and join in any activities before deciding to move in”. Another resident stated, “I was admitted from hospital so my daughter chose the home, and I like my bedroom”. Pre admission assessment details are in place for another resident but there is no date or signature to identify whom carried out the assessment or when. Other residents files looked at contained documented information with regard to the assessment process including copies of social work assessments. A copy of the discharge planning nurse assessment is in place in one resident’s pre admission notes. Orchard Lodge DS0000063169.V299391.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not all healthcare needs are identified or addressed in care plans therefore this may compromise residents’ health. Medication is not always signed for therefore the assumption is that the medication was not given as prescribed placing residents at risk. OP7,8,9,10 were assessed. EVIDENCE: Three of the residents care files including care plans were case tracked (this is when all information regarding the residents care is examined) The staff that set them up has signed residents care plans but some of the residents have not signed to agree their care. This needs to be addressed to include all residents and where they are unable to sign, their relative could do so on their behalf. Orchard Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 12 The three care plans viewed contained information regarding most of the residents’ healthcare needs and how staff are to meet them. A summary of needs was evidenced in all three care files. Brief personal profiles are also in place, which is good practice. It is evident that in most areas the home have addressed the needs of the residents but there are some areas in some of the care plans viewed that have not been looked at including, hearing loss and nutritional needs. One resident has no record of their weight since admission therefore this needs addressing. One resident who suffers from episodes of confusion as evidenced in the daily evaluation record has not had this addressed in the care plan. None of the care plans were signed and agreed by resident or their relative. Residents interviewed stated, “senior staff discussed my care but I have not signed the care plan”. Residents were happy that their care needs were being met and stated, “I am very happy here and very well looked after, I see my GP now and again, just when needed and “if necessary my family are notified as well”. Risk assessments are in place for residents who smoke, are at risk of falls, or use bed rails. The GP record is blank in one residents file and following discussion with the manager the previous record has been archived therefore it was recommended that the most recent visit should be recorded on the present record. There is documented evidence that residents access other services including health care professionals such as chiropody, optician and the district nurse. At present the home is fortunate to receive free chiropody care for residents but the service is limited. Therefore the manager is advised to access private chiropody for residents who wish or need it. Residents who have diabetes have free chiropody. Staff records daily evaluation entries and there is evidence that manual handling records are reviewed for residents whose mobility has deteriorated. The manager advised that she checks stock prior to requesting the monthly medication and then views the prescriptions before sending them to the chemist. The manager needs to monitor the medication and Marr sheets on a regular basis to ensure sufficient stock is in place and that staff are administering the medication to the residents as prescribed. A record of this audit needs to be kept. Medication records for several of the residents’ evidence missing staff signatures therefore it is assumed that staff has not administered medication on these days. There is no reason recorded for the absence of signatures. When questioned senior staff advised that it may have been that the medication was not in stock. Medication is not always recorded clearly, which could cause confusion for staff therefore this needs addressing. The medication trolley is secured to a wall when not in use and is tidy and uncluttered. Medication viewed was in date and the daily medication was mostly in blister pack format. Orchard Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 13 Medication documentation contains residents’ photos for easier identification. Stock delivered is documented, signed and dated. Residents interviewed with regard to medication stated, “staff give me my medication and it is given on time”. The home has shared bedrooms but there are no screens in the bedrooms to ensure the resident have their privacy and dignity maintained. Orchard Lodge DS0000063169.V299391.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Orchard Lodge provides a caring, and ‘homely’ environment, which ensures residents settle down to a routine that is suited to them. OP12,13,14,15 were assessed. EVIDENCE: Many of the residents are able to go out to shop or with their friends/relatives. One resident attends a local afternoon club regularly. The local sheltered housing residents visit the home occasionally especially when entertainment/parties are going on. Activities available for residents include bingo, exercise class, sing a long, carpet bowls, dancing, pub visits, pet therapy, musicians and access to the local community centre. Residents’ comments include “there are lots of things to do and join in if you want to, you are encouraged to take part in all activities”. Orchard Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 15 Relative’s comments include, “there is plenty to do and residents can join in activities if needed and are encouraged to interact and socialise”. Other residents comments include, “day trips are organised as well” and “the atmosphere is calm and friendly and relatives are welcome at all times”. Other residents comments include, “The general ‘sphere’ is one of complete care and attention and the wellbeing of all concerned”, “I am very happy here and very well looked after”, “this is a home from home”, the owners are lovely, kind and very caring. Residents interviewed stated, “we get looked after, staff help and a lady helps me, I prefer a lady”. The local church visits the home fortnightly and offers communion to the residents who wish this service. Daily routines are flexible. The inspector viewed the most recent review of care for one of the residents whose review was requested by the manager as their care needs had changed. The resident wished to move to another bedroom and this was accommodated. There are new menus in place which offer residents choice at each mealtime. Relatives comments included, “food is excellent and well presented, choices are available if needed” and “the meals are very good, smashing meals, we get enough to eat, sometimes too much”, and “the food is very good, a choice is available, we get fresh fruit and veg and we get some home baking now and again”. Mealtimes are set but breakfast is flexible to suit residents’ wishes. Residents interviewed stated, “my family visit occasionally, they can visit at any time” and “I get up later recently, although it’s fairly early, and retires to be between 10 and 11pm, when he’s ready. Orchard Lodge DS0000063169.V299391.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The homes policies and procedures need to be improved to ensure that residents are protected. OP16,18 were assessed EVIDENCE: The home has a complaints procedure in place. Residents interviewed stated, “I don’t know about the complaints procedure”, therefore this needs addressing to ensure that residents are aware of how to complain if need be. Relatives comments include, “the manager is most helpful and kind and staff very caring” we have no complaints at all” A complaints book is in place but this is blank. Concerns/complaints raised by residents/relatives needs to be entered into the complaints book and a record should be made of the investigation into the complaint and the outcome for the resident/relative. A complaint raised with the Commission has been investigated. There are some requirements and recommendations that have been made by the Commission and these are highlighted in this report. Orchard Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 17 The home needs to implement a ‘whistle blowing’ policy to ensure staff has a system of raising concerns in place. Financial records are held though there is insufficient detail in how the residents spend their money. This needs addressing. The manager is advised to ensure all financial transactions are recorded with receipts and records held. The manager is advised to audit the residents financial records on a monthly basis with documented evidence showing the monies are monitored. Residents with larger sums of money should have bank accounts to ensure security. Relatives may be able to help to set these up or the local advocacy service could be approached. The home does not have a valuables book in place therefore this needs addressing. Orchard Lodge DS0000063169.V299391.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There home needs to address the issues raised in this report to ensure that residents are living in a comfortable and safe environment. OP 19,26 have been assessed EVIDENCE: Residents interviewed stated, “I like my bedroom” and “my room is clean enough, everywhere gets cleaned”. Another resident’s comments include “the house is clean and very inviting and the staff are superb”. A tour of the home took place and included most of the residents’ bedrooms. Bedroom 5 needs the armchair replacing. Bedroom 3 ‘s headboard is unstable and the wallpaper is ripped. Bedroom 1 has no safety catch on their window. Bedroom 8 has no catch on the window and this shared room has no screen to ensure residents privacy. Orchard Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 19 Bedroom 9’s window needs replacing and the manager advised that the builder has already been in to assess the cost. This bedroom also needs the sink unit to be repaired/replaced and the wallpaper is ripped. Bedroom 11 and 12’s sink units need redecorating. Bedroom 12 has no safety catch in the window. Bedroom 13’s bedside table needs replacing. Bedroom 14 needs redecorating. The deputy manager advised that bedroom 16 is to have a new carpet. Bedroom 18’s sink unit needs replacing. Bedroom 21’s curtain rail is falling off. Bath panels need replacing on the ground floor bathroom. The deputy manager advised that this is planned already. The flooring has recently been replaced and it is easier to keep clean. A maintenance record book is in place and evidences jobs that need doing and his signature is evidenced following completion. The maintenance person is employed on ‘as and when’ needed basis. The call bell system was checked during the inspection and the manager has advised that the home were having problems on and off. The manager advised that the provider is at present requesting quotations for the work from businesses with regard to replacing the system. Part of the recent complaint raised by a relative was their concerns that the call bell system was faulty therefore this needs to be addressed as a matter of priority. Meantime the call bell system needs to be monitored and checked on a daily basis to ensure it is working. Documented evidence should be implemented that this check is in place. The manager will have to set up an action plan as to how staff deal with any breakdowns as otherwise residents can be placed at risk. Residents who smoke are able to use the conservatory. All fire exits are clear and easily opened. The inspector viewed the most recent environmental health report from October 2006 stating, “the home was well managed”. The kitchen has recently been fitted out this year and despite the cook being off sick was clean and organised throughout the inspection. Records are kept of food temperatures and fridge/freezer temperature records are monitored. Senior staff attended the FSA (food standards agency) training day and the home is now using the daily, weekly and monthly diary to ensure their recommendations are carried out, which is good practice. The food store contains various and plenty of food for residents’ meals. The premises were generally clean during the inspection except for the sluice. Residents’ comments include, “I am not really happy about using the same toilet as the men, the men don’t shut the door, or flush the chain and sometimes they leave a mess on the seat or the floor”. The toilets need to be monitored on a more regular basis. A domestic is employed for 30 hours each week. The home does not employ a laundry person. Care staff manages residents’ laundry. The use of care staff in the kitchen in the morning and laundry throughout the day may put residents at risk from infections. Therefore it is imperative that care staff that cover the kitchen duties do not attend to residents personal needs during this time. Orchard Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 20 A clean uniform is to be used in the kitchen and changed for personal care to reduce the risk of infection. The laundry is in the basement and the washing machine has a foul laundry facility. The laundry has two tumble driers and an easily cleaned floor. The basement area has cracked tiles on the floor therefore this needs to be addressed to ensure good hygiene and staff safety. Rubbish from recent building work needs to be cleared from this area. Policies and procedure are due to be updated with regard to control of infection. Infection control training has not been set up therefore this needs addressing. The home has an approved clinical waste contract. A sluice facility is in place but is not very hygienic therefore this needs addressing. Pipes in the sluice room need redecorating. Through discussion with staff it is apparent that protective clothing is available and one carer interviewed stated, “I have a white overall, plastic aprons and gloves, which are always available”. There is a garden area to the rear of the building with seating suitable for residents and their visitors’ use. Grounds are safe and tidy. Orchard Lodge DS0000063169.V299391.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff files need to be audited to ensure all induction/training records are up to date and the recruitment process needs to be improved to ensure residents are safe. OP 27,28,29,30 has been assessed. EVIDENCE: Residents commented, “sometimes the home is short of staff but the staff are lovely and do the best they can” One member of staff stated, “it’s a relaxed atmosphere, the attitude of staff is friendly to residents, carers give support to the residents, they are always chatting with them and residents confide in them if they are worried”. The staff rota evidences all staff employed at the home. Two care staffs are on duty from 8am-8pm, one carer 8am-2pm, two carers 2pm-8pm and two carers overnight. The cook works from 9.30-5.30pm. The manager is on duty five days 8am-4.30pm and the deputy three days from 8am-8pm. A domestic is employed to work 30 hours over five days. The care staff assists in the kitchen up to 9.30am and also assist with the laundry. Orchard Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 22 Six care staff are enrolled for the NVQ Level 2 training and two for the Level 3 with one carer already holding the NVQ Level 2 qualification. Three staff files including training records were viewed at this inspection. Application forms and interview notes are in evidence in all three files. One application has not sufficient information therefore this needs addressing to ensure a full history of the applicant is viewed prior to offer of employment. Where there are gaps in employment history these need to be explained. The practice of recording interview notes is good. CRB and POVA checks are in place for three. All three files contain two written references for each staff but one staff file does not evidence the dates of the written references. One file does not evidence the date employment started. Two staff files evidence staff induction and one staff file does not evidence staff induction has taken place but during discussion with the member of staff the inspector was able to verify an induction has taken place. Staff supervision is evidence in staff files and staff interviewed confirmed this. Pre employment health questionnaires were evidenced in some staff files. Training attended by some of the staff, this year includes induction in care, manual handling, food hygiene, health and safety, medication administration, POVA, oral health and NVQ training at Level 2. Staff interviewed confirmed they had received induction to their position, stating, “Sandy (previous cleaner) trained me to do the job, the induction was four hours and when my CRB and POVA came through I worked with Sandy for 2 weeks for 30hours” and “I did all the health and safety checks, like bins and read through the handbook, signed off each chapter and ticked them all off”. “I was told about fire checks and exits and asked to report any faults/hazards, definitely had enough training to do the job”. Other staff interviewed stated, “I have attended training in POVA, Dementia, medication, induction, and my first aid training is due”. Through discussion with the inspector it was evident that the training for POVA had been understood. Staff interviewed stated, “I like working here, all the residents and staff are nice, I have never seen anybody not be nice to the residents”. Some of the mandatory training is out of date therefore this needs addressing as a matter of priority to ensure the safety of residents and staff Orchard Lodge DS0000063169.V299391.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. That all staff attends up to date mandatory training on a regular basis so that the health and welfare of the residents and staff are promoted and protected. OP31,33,35 38 were assessed. EVIDENCE: The registered manager has been in post for approximately eighteen months now. Her qualifications include the institute of leadership management, and the RMA (Registered Managers Award) gained 2 years ago. The registered manager has continued to update herself by attending courses including mandatory training. Orchard Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 24 Residents interviewed stated, “Margaret (manager) and Sheila (deputy) are very nice, all are very good, we get looked after, they are nice to all residents”. Staff interviewed stated, “I have no problems with the manager, she’s brilliant, Sheila (deputy) as well” and “I would be confident to approach senior management and confident that the manager would investigate any concerns”. Quality assurance systems are in place, which include staff meetings, residents meetings, staff surveys and residents’ surveys. All surveys have been analysed and the results from both residents and staff are positive. The inspector viewed the results. Brief notes are available for the most recent residents meeting in September 2006. The home has been awarded an external quality rating in August this year. The most recent audit of the home took place in October this year. Environmental Health visited in October this year and the report commented the home was well managed. The Proprietor visits the home at least monthly and produces written reports, which were viewed by the inspector. This is good practice. Staff interviewed stated, “I like the owners”. The manager stated, “I meet with the proprietor regularly to discuss all developments, training and physical changes to the home”. Financial records are held for residents’ monies. The records are not detailed enough. The records do not always evidence what residents monies are spent on. Some expenditure is for hairdressing but the home is advised to keep records that are clear, identifying all monies spent, with receipts held. The financial records need to be audited on a monthly basis with records kept. The home also needs to have a valuable book to ensure a record is kept of anything that may be held on a residents behalf, however short a time. For residents who have larger sums of money held should have a bank account. Help should be sought from residents relatives or an advocacy representative where needed. Certificates with regard to electrical, fire and gas safety are up to date. These were viewed during the inspection. Employers insurance is in date to September 2007. Fire equipment checks, fire drills/training, weekly fire alarm tests, emergency lighting is checked with records kept. The home is having some problems with the call bell system and has had some replacement of equipment this year. The provider is looking to upgrade the entire system. One of the bathrooms is out of order due to a faulty hoist ‘chair’ therefore it is out of use at present, awaiting repair/replacement. Pre set valves are not fitted to the hot water system therefore the home should think about putting these in place to ensure resident safety. Meanwhile all hot water temperatures should continue to be monitored and safety systems/notices in place where residents/staff may be at risk from scalds. Water temperatures are checked weekly with records kept. One boiler has been replaced last year and two boilers have been replaced in the home last month. Orchard Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 25 The cooker has been replaced last year also. A maintenance person is employed by the home and the maintenance record evidences each job done. Not all mandatory training is up to date therefore this needs addressing to ensure safe working practice. Accident records were viewed and are correctly completed. The manager was unaware if the home was tested for legionella therefore this needs addressing. Orchard Lodge DS0000063169.V299391.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X 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 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Orchard Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 27 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. 2. Standard OP7 OP7 Regulation 15 (2) a c 15 (1) Requirement The registered provider must ensure that all residents sign and agree their care plan. The registered provider must ensure that all healthcare needs are identified and addressed in the individual residents care plan. The registered provider must ensure that a resident whose hearing loss has been identified has access to the audiologist to ensure maximum advice/treatment is gained. The registered provider must ensure that a nutritional assessment is carried out and documented with weight also recorded on admission to the home and checked on a regular basis. The registered provider must ensure that residents who need chiropody treatment have access on a regular basis to a registered chiropodist. The registered provider must ensure that residents have DS0000063169.V299391.R01.S.doc Timescale for action 01/03/07 29/01/07 3. OP8 13 (1) b 29/01/07 4. OP8 12 (1) a 29/01/07 5. OP8 13 (1) b 29/01/07 6. OP9 13 (2) 01/01/07 Orchard Lodge Version 5.2 Page 28 7. OP9 8. OP10 9. OP16 10. OP18 11. OP19 12 OP29 13. OP30 14. OP38 sufficient stock of medication in the home to ensure they are administered their medication as prescribed. 13 (2) The registered provider must ensure that the manager audits the medication and records on a regular basis to ensure staff sign following administration of medication. 12 (4) a The registered provider must ensure that residents who share rooms have their privacy and dignity promoted by having screens in place. 22 (3) The registered provider must ensure that all concerns/complaints are logged and show the investigation and outcomes. 17 The registered provider must (schedule ensure that all residents monies 4) 9 a and are audited on a regular basis b with records kept and include a clear and detailed account of how residents’ monies are spent. 23 (2) b The registered provider must ensure that all areas identified in this report for repair/replacement are addressed. 17 The registered provider must schedule ensure that staff files are audited 4 (6) to ensure all areas discussed in this report are addressed. 18 (1) c The registered provider must ensure that a staff training and development programme is in place that will ensure all staff files evidence all induction and training attended. 18 (1) c The registered provider must ensure that all staff attends all mandatory training. 29/01/07 29/01/07 01/01/07 29/01/07 30/04/07 01/03/07 01/03/07 01/03/07 Orchard Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 29 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. 7. Refer to Standard OP3 OP8 OP9 OP18 OP22 OP26 OP38 Good Practice Recommendations The inspector recommends all staff should sign and date the pre admission assessments The inspector recommends that the GP and other healthcare records should be reviewed to include the most recent visit as discussed. The inspector strongly recommends that all medicine records should be clear and easy to follow. The inspector strongly recommends that a valuables book should be in place. The inspector strongly recommends that the call bell system should be monitored on a daily basis until it is working effectively. The inspector recommends that care staff working in the kitchen should be kept to a minimum and has a clean uniform prior to re commencing work. The inspector recommends that the water system should be tested for legionella. Orchard Lodge DS0000063169.V299391.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Lodge DS0000063169.V299391.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!