Inspection on 09/05/07 for Orchard Lodge

This inspection was carried out on 9th May 2007.

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

The inspector 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 Lodge 08/07/08

Orchard Lodge 21/11/06

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 09:00 9th May 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 Lodge DS0000063169.V333288.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.V333288.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.V333288.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 21st November 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.V333288.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 one day and lasted 7.45 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 and external garden areas. Care records and other residential home records were inspected also. Discussion took place with the registered manager, deputy manager and care staff. One to one conversations took place with 3 staff. Several residents were also spoken with. Some of which were interviewed in private and their views were obtained on how the home was run and of the care and support provided. Relatives visiting the home during the inspection were also interviewed. Feedback was sought by the Commission through ‘Have your say about…………....questionnaires’, which were issued to the residents and some of their feedback is included in this report. Four residents care plans were ‘case tracked’ (looking at all information with regard to care for the individual residents) and three staff and training files were examined. What the service does well: The home continues to practice good planned admissions, which ensures residents needs are assessed prior to admission. One resident interviewed stated, “we came to the home two different days and had some meals and met with some of the staff and other residents”. One family interviewed were very complimentary about how the home managed their relative’s care, stating, “mum was unsettled at first but there was constant contact from the home to keep us informed”, “the GP was informed and a change of medication helped mum, she is okay now, mum gets good care”. One relative interviewed stated, “my wife is quite happy, always saying how marvellous it is here and I’m happy with the medical care, the GP’s are lovely, they come to the home”. Medications brought into the home are checked and confirmed by the residents’ GP practice prior to admission to ensure residents are being administered the correct medication. This is good practice. Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 6 The manager has commenced a general audit of medication to ensure that stock is not ordered unnecessarily and this appears to be working well. Orchard Lodge continues to provide a caring and homely environment that suits the individual residents routines and needs. Residents interviewed confirmed that their daily routines are fairly flexible and can get up in the morning and retire to bed when they pleased, stating, “when I wake up I get up, I don’t have to, I usually retire at 10.30pm, I go when I want to they (staff) are very nice. Orchard Lodge provides a comfortable environment for the residents who live there. Residents interviewed stated, “we took this room, couldn’t wish for a better room, we brought our possessions that we wanted, our cabinet and our …….collection” and “my bedroom is lovely, beautiful, plenty of space”. Orchard Lodge provides caring, supportive and friendly staff, which ensures that residents quickly settle into their new environment. Residents were complimentary about the staff that cares for them. Residents interviewed stated, “staff are very kind to us”, “you couldn’t ask for better carers”, “they go out of their way to make you feel welcome” and “I’m very happy here, it’s lovely”. One relative interviewed stated, “staff are very nice, quite chatty and approachable, they know how to handle the residents”. Staff were observed communicating in a friendly and respectful manner with residents. Staff interviewed stated, “there isn’t a day when I don’t look forward to going to work” and “I love it, it’s all very friendly”. What has improved since the last inspection? There has been improvement in how the home is meeting the needs of the residents therefore improving their quality of care provided. Previous requirements with regard to healthcare needs have been addressed. The manager has improved the overall documentation that makes up the care files therefore making it easier to find information and easier to use. There is evidence of residents’ signatures to agree their plan of care. GP and other healthcare records have been reviewed. There is improvement in the administration and management of medication. Screens are provided for residents who share rooms. There has been a marked improvement in how the home deals with any concerns/complaints raised. All concerns/complaints are now recorded in the complaints book and the records show that all are fully investigated and resolved and outcomes for residents are recorded. Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 7 The home is at present being upgraded to include new windows, carpeting, curtains and bedding in most of the newly decorated bedrooms, which enhances the comfort of the residents. The staff training programme has commenced earlier in this year with most mandatory training addressed. The Legionella test has been carried out with no problems apparent. What they could do better: Two of the residents’ case-tracked need to have more detailed care plans with regard to how their management of their mental health needs are addressed and managed in the care plan. Residents’ oral health should be clearly detailed in care plans. Care files need to identify if the resident has their own teeth/dentures or not and information on previous dental care. Risk assessments need to be in place for residents who are at risk of falls with a manual handling assessment in place for residents who need one. Residents interviewed confirmed that activities are arranged, although there was a lack of activities for residents during the week of inspection as the activities person was not available. This needs addressing to ensure residents are accommodated during any staff absence. One relative interviewed stated, “it’s a shame they (residents) can’t get out a bit more” There were no receipts for cigarettes that had been purchased for the residents therefore discussion took place with the manager to ensure these are kept within the individual residents financial documentation. Bedroom doors have locks fitted therefore the manager needs to ensure that residents who wish to can have a key to ensure privacy. If the resident does not hold keys this should be explained in the care plan. There is no lockable facility for residents to secure valuables in their bedrooms although new furniture is under order. The sluice area needs to be redecorated and pipes boxed in to ensure it is easy to keep clean. Residents and staff are placed at risk due to lack of fire training for all night staff. This needs to be addressed as a matter of urgency. Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 8 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.V333288.R01.S.doc Version 5.2 Page 9 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.V333288.R01.S.doc Version 5.2 Page 10 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 continues to practice good planned admissions, which ensures residents needs are assessed prior to admission. . Op 3 was assessed Op6 is not applicable. EVIDENCE: Four of the residents were case tracked (when residents are individually interviewed and all care documentation is examined with regard to their stay in the home). The assessment documentation details for all of these residents were examined. All four residents had assessments prior to admission. Reasons for admission were identified. Copies of the social work assessments are also in place. The assessment documentation evidences that each resident visited the home prior to taking up permanent residency. This was confirmed through interviews with the residents who were case tracked. Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 11 One resident interviewed stated, “we came to the home on two different days and had some meals and met with some of the staff and other residents”. One resident who was not case tracked advised that they had been unable to visit the home prior to admission. The relative of this resident was interviewed during this visit and they confirmed that a visit prior to taking up residency was not practical, as the admission to the home had been arranged as a matter of urgency. The relative (PG) stated, “mum didn’t visit the home at first as we were going somewhere else”. Discussion took place with senior staff with regard to the admission process. Orchard Lodge encourages prospective residents to visit the home prior to admission. Senior staff are keen to ensure that any prospective residents are given the opportunity to see what the home is like and if it is suitable for them. Residents’ needs are identified prior to admission and this information is used to set up the care plan. Assessments carried out are dated and signed for all four residents case tracked. Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 12 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 adequate. This judgement has been made using available evidence including a visit to this service. There has been some improvement in how the home is meeting the needs of the residents therefore improving their quality of care provided although they need to ensure all areas of care needs are identified and addressed in the care plan. OP7,8,9,10 were assessed. EVIDENCE: Four of the residents were case tracked. Care plan documentation has improved and evidence is easily accessed in all the documentation viewed during this visit. All four residents had a care plan in place. Care plan documentation evidences residents’ signatures. A brief summary of care needs is in place for each resident. Care plan documentation evidences that most of the residents’ social, personal and healthcare needs are identified. Some of the healthcare needs have not been addressed. Two of the residents’ care plans were viewed with regard to the management of their mental health needs. Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 13 One of the care plans did not have sufficient detail with regard to how their mental health needs impacted on their daily lives and how they were to be managed. Another resident whose daily evaluation evidences episodes of ‘aggression’ have not been addressed in the care plan. Discussion took place with the manager on how these areas could be improved. Care plans have been reviewed on a monthly basis. Care reviews with social workers, residents and staff representatives are evidenced in all four residents files. These reviews are evidenced as taking place approximately 4 weeks following admission. A twelve-month review is planned and evidenced in care files to ensure the needs of the residents are still being met. Relatives are also invited to these care reviews and attendance is documented. One family interviewed were very complimentary about how the home managed their relative’s care, stating, “mum was unsettled at first but there was constant contact from the home to keep us informed”, “the GP was informed and a change of medication helped mum, she is okay now, mum gets good care”. Dependency levels are recorded and updated monthly. One resident’s dependency level has reduced since admission as their mobility has increased through staff support and reassurance. One resident who was identified as at risk of falls had no individual risk assessment or management of risk in place. Although a general risk record identifies some of the residents mobility needs, there is no manual handling assessment in place, therefore this needs addressing with detailed information regarding transfers, bathing and wheelchair use. Residents are regularly weighed with records kept, which is good practice. One resident has refused to have specialist tests, which have been recommended as necessary for the promotion of their health. The importance of this needs to be discussed with the resident and their relatives where agreed and documented in care files. Chiropody and dental records need to be stored in the individual care files of residents. One resident interviewed confirmed that they had last seen the chiropodist in March this year. There is no record to say if residents have their own teeth or dentures therefore this needs addressing to ensure residents oral care is not compromised. GP and other health care professional visits are recorded. One resident who is at risk of falls due to low blood pressure has recorded evidence of this being monitored on a regular basis. Relatives interviewed stated, “my wife is quite happy, always saying how marvellous it is here and I’m happy with the medical care, the GP’s are lovely, they come to the home”. Accident record documentation is clear and in place. Medications brought into the home are checked and confirmed by the residents’ GP practice prior to admission to ensure residents are being administered the correct medication. This is good practice. The medication storage was viewed during inspection. The medicine trolley is secured to a wall and storage for medication awaiting return to the pharmacy is locked and secure. Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 14 The storage of medication is well organised. There is no old stock in storage and the ‘returns’ book evidences regular returns of unwanted medication to the local pharmacist. The home has a list of staff trained to administer medication with signatures/initials in place. Medication order and receipt of is clearly recorded on medication sheets. One resident is missing a signature for administration of Amisupride 50mg with no reason recorded. One resident is prescribed cream am and pm with staff signing at night but not in the morning therefore this needs addressing. One resident self-administers their inhaler medication. The home is advised to carry out an assessment of this resident’s ability to use their inhalers correctly to ensure they receive the correct dose. This should then be documented. Residents interviewed confirmed that they received their medication on time stating, “staff give me my medicines, eye drops daily and they are given on time”. The manager has commenced a general audit of medication to ensure that stock is not ordered unnecessarily and this appears to be working well. One of the residents prescribed medication dose was changed by the GP and during the visit discussion took place with regard to how to record the change in dose on the medication sheet. The changes already made on the medication record were not easily understood. This was rectified during the visit and records are now quite clear and easy to follow. Staff who administer medication have recently received medication training and this shows, as there has been an improvement in the medication records. Screens are now available in the double bedrooms to ensure resident privacy. Residents confirmed that staff knocks on their bedroom doors prior to entry. Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 15 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 continues to provide a caring and homely environment that suits the individual residents routines and needs. OP12,13,14,15 were assessed. EVIDENCE: Some of the residents interviewed confirmed that they sometimes go out shopping either unaided or with family. The home still receive visits throughout the year from the local sheltered housing residents in particular when entertainment/parties are on. Activities provided include bingo; sing a long, carpet bowls, dancing, pub visits and musical entertainment. Residents interviewed stated, “I won a necklace at the bingo”. One carer is allocated to activities in the afternoon, although the carer was absent the week of inspection. Residents and relatives interviewed confirmed this. Relatives interviewed stated, “I visit every week, my wife joins in the entertainment and I join in”, “it’s a shame they (residents) can’t get out a bit more” and they have beauty therapy, like, their nails”. Residents interviewed stated, “I can’t join in the activities a lot, but we join in with the simple things”. Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 16 Residents interviewed confirmed that their daily routines are fairly flexible and can get up in the morning and retire to bed when they pleased, stating, “when I wake up I get up, I don’t have to, I usually retire at 10.30pm, I go when I want to they (staff) are very nice and “I have a young carer who takes me for a shower and my wife has a bath” The menu offers residents a choice of meals and residents interviewed stated, “the food is very good”, “the food is very nice”, I’m fond of my food, I eat most stuff, I definitely never had anything I didn’t like” and “they (staff) go out of their way to make it really nice, the menu for the day is on the table”. One relative interviewed stated, “my wife is always telling me how good the food is” and “Mum likes the food, they (residents) are given a choice, I’ve noticed if someone doesn’t like what’s available they’ll (staff) get something else”. Another resident interviewed stated, “the food is smashing, I’ve gained 5lbs in weight”. The dining room is pleasantly decorated with tables set out and enough space for residents to sit in comfort. New dining furniture has been bought just recently to enhance the dining room and make it more pleasant for residents use. Staff were observed to be patient with residents when assisting with drinks. Some of the residents have lived at the home for some years and feedback from discussions with them and their relative shows that in their opinion the home has improved. One relative interviewed stated, “we are happier now the new owners have taken over”. Three pupils from the local primary school visit the residents weekly and both residents and pupils get mutual enjoyment from these visits. Relatives interviewed confirmed that they were able to visit the home at any time and there are no visiting restrictions, stating, “you can come anytime and tea is available”. One resident interviewed stated, “my family come when they can, mostly Saturday”. Holy Communion is provided once a fortnight for residents who wish to participate. One resident interviewed stated, “the Anglican come in and Margaret from St Lukes, she often gives me Communion”. Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. The home ensures residents are protected by listening to and recording their concerns with a full investigation and outcomes for residents documented. OP16,18 were assessed. EVIDENCE: Staff have attended POVA (Protection of Vulnerable Adults) and Alerter training and therefore they have improved their understanding of how to protect residents under their care. The inspector viewed some of the letters/cards of praised received from grateful relatives to thank them for their caring and understanding whilst caring for their loved ones at Orchard Lodge. Comments included, “Orchard Lodge is the nicest cleanest home one could wish for and all the carers are wonderful” and staff are friendly and helpful, lovely atmosphere”. The home has now commenced a concerns/complaints register. All concerns/complaints are logged however minor. This is good practice. The complaints log evidences a full investigation into each concern raised with outcomes recorded for all. All are dated and signed by the senior staff that investigated. Residents are satisfied with the outcomes. Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 18 Residents interviewed were aware that the home has a complaints procedure and stated, “staff are very helpful, I’ve never once had to complain” and “I have no complaints or worries”. Relatives comments included, “I have no complaints” and most important, the residents are happy”. Financial records were viewed for some of the residents and found to contain regular entries with regard to income and expenditure. Residents sign where able. There were no receipts for cigarettes that had been purchased for the residents therefore discussion took place with the manager to ensure these are kept within the individual residents financial documentation. Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. Orchard Lodge provides a comfortable environment for the residents who live there. OP19, 26 were assessed. EVIDENCE: Following discussion with some of the residents’ they advised the inspector that they are happy with their bedrooms and surroundings. One resident interviewed stated, “we took this room, couldn’t wish for a better room, we brought our possessions that we wanted, our cabinet and our …….collection”. A tour of the home took place with the manager and all public areas including most residents’ bedrooms were viewed. Public areas and residents bedrooms were clean and odour free. Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 20 One relative interviewed were happy with the overall cleanliness of the home and décor and stated, “Mum’s bedroom is to be decorated soon and she has been asked what colours she likes”. Residents interviewed stated, “my room is lovely”, “the bedroom is very comfortable, they make sure you have enough bedclothes as I don’t like a warm bedroom and just enough bed clothes to keep me warm” and “my bedroom is lovely, beautiful, plenty of space” Bedroom doors have locks fitted therefore the manager needs to ensure that residents who wish to can have a key to ensure privacy. If the resident does not hold keys this should be explained in the care plan. There is no lockable facility for residents to secure valuables in their bedrooms. Orchard Lodge is in the process of refurbishing bedrooms and have on order new furniture with a lockable facility for residents. The home is at present being upgraded to include new windows, carpeting, curtains and bedding in most of the newly decorated bedrooms, which enhances the comfort of the residents. Additional furnishings have been purchased including sink units and these are soon to be fitted to the residents bedrooms where needed. New furniture has been purchased for the dining room and following discussion with residents they appear to like it. Carpeting in the front hall, staircase and hallways is of good quality and safely fitted and decoration in these areas is domestic in style, which adds to the residents’ quality of life. The home is well lit throughout and additional bedside lighting is in place in residents’ bedrooms. The maintenance person is employed on an ‘as and when needed’ basis. Staff interviewed confirmed they had sufficient equipment to carry out their duties stating, “”we have enough equipment and plastic gloves and aprons”. Residents who smoke are accommodated in the conservatory. The sluice area needs to be redecorated and pipes boxed in to ensure it is easy to keep clean. The garden area to the rear of the home has several small sitting out areas with suitable garden furniture and flowers for residents to enjoy. Orchard Lodge DS0000063169.V333288.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 good. This judgement has been made using available evidence including a visit to this service. Orchard Lodge provides caring, supportive and friendly staff, which ensures that residents quickly settle into their new environment. OP27,28,29,30 were assessed. EVIDENCE: Residents living at Orchard Lodge were complimentary about the staff that cares for them. Residents interviewed stated, “very good staff, very obliging, exceptionally good”, “night staff are very good”, “staff are very kind to us”, “you couldn’t ask for better carers”, “staff are very nice”, “they go out of their way to make you feel welcome” and “I’m very happy here, it’s lovely, staff are so nice”. One relative interviewed stated, “staff are very nice, quite chatty and approachable, they know how to handle the residents”. The staffing rota was viewed and evidences sufficient staff are on duty to provide for the residents care. The manager and deputy at present are covering additional hours at weekend were needed. On the day of inspection one member of staff rang in sick. An additional member of staff was called in. Five staff has NVQ certificates in care. Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 22 Three staff files were examined including training attended. Personal information is included for each staff and all had a completed application form. Information included in the application form included a brief educational history and previous employment. Interview notes are included in all three files. Medical questionnaires are in two files and a copy of the terms and conditions of employment are in two files. Two written references are in all three files but for one staff neither is dated. The POVA (Protection of Vulnerable Adults) and CRB’s (Criminal Record Bureau) of all three are in place. Copies of passport and birth certificates are in place. All three files evidence induction has taken place. Annual appraisal and staff supervision records are in place for two staff. The other staff member has only recently been appointed. Training and development plans identify training taking up and certificates are in place. Training planned includes Medication, Challenging Behaviour and Fire Training. Training attended includes Manual Handling, First Aid, Infection Control, Dementia, POVA, Health and Safety, Alerter’s Course, Basic Food Hygiene and Medication. Fire Training for staff is out of date and the manager was advised to arrange this as a matter of urgency. Staff interviewed stated, “I’ve had enough training to do the job properly”. The home has a book for residents and visitors to the home to record their comments and some of them include, “staff are very friendly and helpful, lovely atmosphere”, “the staff are the best and rooms first class”, “the staff are very friendly, most important the residents are happy” and staff are always good, always a warm reception”. Staff interviewed confirmed that they had attended an induction and the training as listed in their files. Equality and Diversity training is not evidenced in staff files. Staff interviewed stated, “residents get good care, especially now as we are getting more training and we are able to offer a better service”, “there isn’t a day when I don’t look forward to going to work” and “I love it, it’s all very friendly”. Orchard Lodge DS0000063169.V333288.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. Residents and staff are placed at risk because of the lack of fire training for all night staff. OP31,33,35,38 were assessed. EVIDENCE: The registered manager has been in post for approximately 2 years. The manager’s qualifications include the institute of leadership management and the RMA (Registered Managers Award). Training attended this year includes Manual Handling, First Aid, Health and Safety, Medication, Alerter’s Course and Infection Control. Residents and staff respect and like the manager, this was observed through discussion with the residents and staff. Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 24 Residents and relatives find it easy to approach her and have confidence in her. Staff interviewed stated, “I get on really brilliant with Margaret (manager)”, “we have a handover for all shifts, there is a good rapport with all staff and the owner, I feel that our views are listened to” and “if we need anything we only have to ask and if we have a valid explanation we get them”. The manager advised that the provider visits the home monthly but there is no other evidence to support this. Monthly provider visit forms have not been completed since last September. It is important that the provider evidences these visits and the documentation is kept on file so that these can be viewed during the next inspection. The home holds an external Quality Assurance Award, which was awarded last August. Residents interviewed confirmed that they had attended residents meetings. Residents meetings are held two monthly and minutes form the most recent (11/4/07) were viewed. Topics discussed included top up payments, menus, decorating schedule and summer activities. The manager is in the process of setting up questionnaires for residents and a new package is about to be purchased so that the home can carry out their own internal quality assurance checks. A ‘comments book’ has been commenced and there is evidence of input from relatives and visitors to the home, some of which has been included in this report. Staff meetings are held two monthly also and the minutes of the most recent (13/4/07) were viewed and include such items as fire training, new staff welcome, Medication records, complaints book and uniforms. Staff interviewed confirmed that they had attended staff meetings. Policies and procedures have been updated and the three staff files examined evidence that each has read them. Financial records have been addressed earlier in this report. Lockable facilities for residents’ individual use are in the process of being addressed. The manager is in the process of trying to open post office accounts for residents who do not have one. Some effort has been made by the home to try and gain individual support for residents from the local advocacy services. Staff supervision is evidenced in staff files and staff interviewed confirmed this had taken place. Mandatory training has been arranged for many of the staff and attendance has been good. Unfortunately fire training is not up to date for night staff, which places residents and staff at risk. The night staff must have fire training and the home had a recent visit from the Fire service in March this year when they recommended that all staff have fire training. There is evidence in staff files that day staff have had fire training updates this year but none of the night staff has up to date training. The manager was advised to address this as a matter of urgency. Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 25 The home has ensured all equipment and servicing has been carried out for all appliances in the home. They are all up to date. Lift 9/4/07, Gas 2/07, Boilers 2/07, Electricity inspection 6/07, Fire extinguishers 3/07, Fire alarm system and maintenance record 2/07, Emergency lighting 12/06, Fire escapes lighting 4/07, Fire risk assessments 1/07, Fire door releases 4/07, Safety lighting 4/07, Fire alarm tests 4/07 and the fire brigade visited the home in April this year to have a chat with the residents. Portable electrical appliances were last checked in 8/06. Hot water temperatures are checked fortnightly and measure 41-42oc. Bath temperatures are taken and recorded in the bath book each bath time. New gas boilers have been fitted in the basement earlier this year Jan/Feb. New radiators and tumble driers have been fitted also. Legionella testing last 3/07 and Call Bell systems 3/07. Sefton collect clinical waste and sharps are collected by District Nurses. Risk assessments are in place also. Accidents are recorded in the residents’ daily record and accident records documentation. Orchard Lodge DS0000063169.V333288.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 3 9 3 10 3 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 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) Requirement The registered provider must ensure that residents who have mental health problems have their needs identified and how staff are to manage them documented in the residents care plan. The registered provider must ensure that residents who are considered to be at risk of falls have a risk assessment in place. Where needed residents must have a manual handling assessment. The registered provider must ensure that all staff attend mandatory training in particular that night staff attend fire training. This is an outstanding requirement from the last inspection 21st November 2006. Timescale for action 11/06/07 2. OP8 13 (4) (b)(c) (5) 11/06/07 2. OP38 18 (1) c 11/06/07 Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 28 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. Refer to Standard OP8 OP9 OP18 OP18 *RCN Good Practice Recommendations Residents should have their oral health problems clearly identified in care plans. The resident who self medicates their inhaler should be assessed with regard to their competency to use it correctly. This should be documented. Residents’ financial records should evidence receipts for the purchase of cigarettes. Residents’ should have access to an individual lockable space in their bedrooms and have a key for their bedroom door where assessed and agreed. The registered provider should ensure that they prepare a written report on the conduct of the care home and send a copy of this report to the Commission. Orchard Lodge DS0000063169.V333288.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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.V333288.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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