Inspection on 22/01/07 for Orchard Lodge Nursing Home

This inspection was carried out on 22nd January 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

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Orchard Lodge Nursing Home Stanbridge Road Tilsworth Bedfordshire LU7 9PN Lead Inspector Katrina Derbyshire Unannounced Inspection 22nd January 2007 11:50 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 Nursing Home DS0000064670.V326834.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 Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard Lodge Nursing Home Address Stanbridge Road Tilsworth Bedfordshire LU7 9PN 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) 01525 211059 01525 210585 orchardlodgenh@aol.com Mr Mukesh Patel Mrs Judith Dennis Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26), Terminally ill (3), Terminally ill over 65 of places years of age (3) Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home can accommodate a maximum of 26 service users of either sex. No one falling into the category of terminal illness (TI) or (TI)(E) maybe admitted to the home where there are 3 persons of these categories already accommodated within the home. No one in the age range of 55-65 can be admitted to the home where there are 3 persons in this age range already accommodated within the home. The home is permitted to accommodate one named service user under the age of 55 years from 27th June 2006 until their discharge from the home. This condition is for the service user named on the application and no other 16th January 2006 3. 4. Date of last inspection Brief Description of the Service: Orchard Lodge is situated in the village of Tilsworth, near to the market town of Leighton Buzzard. The home provides accommodation and general nursing care for 26 people over the age of 65 years, within an extended Victorian country house and former vicarage. The residents rooms are on two floors accessed by either a shaft lift or stairs. The building also has accommodation for administration, services including laundry room and a kitchen, a small staff room and a first floor lounge that can be used as a staff training area. There is a large communal room on the ground floor with lounge and dining facilities. Access to the home is via a driveway with adequate parking for staff and visitors on the forecourt. There are substantial grounds and the gardens were well tended with fish pool, decking and outdoor seating areas. The fees for this home vary from £630.00 per week for residential placements, to £658.00 per week. Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was to undertake a key inspection. This unannounced inspection was carried out on 22nd January 2007. The Registered manager Mrs. Judy Dennis was present throughout the inspection. During the inspection areas of the home were visited and the inspector spent time with residents’ mainly in the ground floor sitting area of the home. The care of three residents’ was examined by looking at their records and interviewing the residents’ and staff who look after them. The views of residents and their feedback have been used alongside information from the home to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. Observations of care practice and communication between the residents’ and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well: Many of the residents and their families feel that the standard of care at this home is very good. Several described themselves as being “very happy” living at the home. Another resident said, “ the main thing is the staff care about us and they really do try hard to help me and the others”. Equipment is in place to help make the residents more comfortable, one example is cushions that they can sit on if they are at risk of developing pressure ulcers. This means that the resident’s continue to benefit from the nurses using equipment that is designed to make them feel more comfortable and personal care being carried out to a very good standard. The staff at the home work together as a team and communicate with each other very well, they have worked this way for many years. They all meet regularly for meetings and make sure that they all know about the support that is needed by the residents. This means that the care received by residents’ is always consistent. There is also a very relaxed atmosphere in the home; many of the residents spoke of feeling “comfortable” living at the home. Residents spoke of the staff’s friendliness and felt that it was this that made them feel at ease. Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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 Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 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 Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems in place to assess the needs of prospective residents are good, ensuring the home has sufficient information to ascertain that they are able to meet the resident’s needs. EVIDENCE: The homes policy regarding the admission of residents showed that a planned approach to admissions to the home should be undertaken where possible. One staff member through discussion confirmed that the management in the home would visit a prospective resident prior to their admission to undertake an assessment of need. Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 Page 9 Residents through discussion confirmed that they had been involved in the decision to move into the home and had been given the opportunity to visit prior to making any decisions. Combined assessments by the home and placing authority are in place for more recent admissions to the home, these are comprehensive and make clear the needs that the home would need to meet. Intermediate care is not offered. Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal support given to residents is of a good standard so residents receive care that respects them as individual people and maintains their dignity. EVIDENCE: Residents spoke of the choices available to them whilst living at the home. One resident said “ l come to my room when l want to l don’t believe that the staff restrict me in anyway” Other choices available to residents were choice of meals, clothing and when they received visitors, written evidence of these were seen in the care records. Several residents also confirmed that staff would knock on their bedroom doors before entering, in addition privacy screens were seen to be in place in rooms that were shared. Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 Page 11 Care plans were seen to be in place and showed that a review of their needs had been undertaken every month. For one resident their care plans were comprehensive and gave clear guidance and instructions to staff on how to meet their needs. However another resident’s plan concerning their oedema to their legs did not make clear the action staff should take to reduce the swelling until two months after the plan was written. Care plans must be clear in the care and support that is given to ensure consistency of care at all times. Within the individual care records of residents it was noted that there were documents from a variety of medical specialists. These documents showed that residents received regular support from speech therapists and Doctors alongside the nursing team. Staff confirmed that they assisted residents to attend hospital appointments if this was needed and the outcome of any medical intervention and subsequent guidance was recorded. The storage, receipt and administration of medication were examined. The medication administration sheets were noted to be correct. The storage of medicines was seen to be in a locked facility. Records were seen to show returns of unused medication. Staff confirmed that they did receive regular updates in the administration of medicines and observations were made of medication and noted to be appropriate and follow safe practice guidelines. Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems and support to residents in maintaining personal relationships is good, and enhances the resident’s standard of life. EVIDENCE: All residents spoken with confirmed how much they enjoyed the food at the home. An observation was made during the lunchtime meal, residents had been offered two choices and these were served with two fresh vegetables and potatoes alongside a pudding. Residents were seen to be offered assistance to eat their meal by staff when needed. On examination of stocks of food in the kitchen it was noted that sufficient amounts were in place and stored in accordance with health and safety requirements. Documents were also viewed to show that staff at the home maintained close links with families to ensure the rights of residents were upheld. When discussion had taken place with a family member who had stated that this were acting on the residents behalf, the staff had acknowledged this and Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 Page 13 carried out their wishes. In addition staff confirmed that postal voting was in place for residents. A range of activities is available in the home and were seen to be displayed in the main ground floor corridor of the home. Times and location of these were given. However care plans in place to outline the individual social emotional or cultural needs of the residents did not make clear all the individual wishes or likes of the residents and an improvement in this area is needed and was discussed with the manager at this visit. Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have a good knowledge and understanding of Adult Protection issues which protects residents from abuse. EVIDENCE: Staff training records show that staff had undertaken training in the protection of vulnerable adults. Staff when interviewed were able to describe the types of abuse and the action that they should take if they suspected any abuse had taken place. The home had a copy of the local protocols for the protection of vulnerable adults and its own policy. It was discussed with the manager that an amendment to their own policy is required as it still states that the home would commence an investigation. The manager and staff were aware that this must not be done. Following this site visit an allegation was made and the manager at the home acted swiftly in her actions in accordance with local guidance and procedures. The home also was seen to have a complaints procedure in place. It was not possible to assess the homes response as the manager advised that they had Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 Page 15 not received any. Residents spoken with confirmed that they were aware of their right to complain and would feel comfortable in doing so. Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements are needed to the décor and carpeting in some areas of this home to ensure the environment is homely for the residents to live in. EVIDENCE: Residents rooms that were seen contained personal items for example photographs and pictures. Assisted bathrooms are in place and grab rails were also in place to assist residents with their mobility. The sitting areas in the home were clean and tidy and no odours were detected throughout the home. However several areas require redecoration for example the walls along the main corridor on the ground floor were very scuffed and chipped. The radiator Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 Page 17 guards had been damaged by water and upstairs there were several areas where the carpet was frayed. A planned approach to maintenance and renewal is needed and a requirement has been made. Cleaning schedules were seen to be in place alongside clinical and domestic type waste contracts. Protective clothing such as gloves and aprons were seen to be used by staff and hand washing facilities were situated throughout the home. Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitments practices in this home are good ensuring all checks are undertaken to protect the residents at the home. EVIDENCE: Examination of some staff records showed staff files contained the information listed in schedule 2 and 4. References, identification and evidence of a criminal records bureau check were seen to have been secured prior to the staff commencing their employment at the home. Training records and staff confirmed that alongside statutory training staff had undertaken further training in relation to their roles. The home had been active in commencing staff on a National Vocational Qualification programme and all staff had development and appraisal plans in place. Certificates of attendance were maintained for all courses undertaken. Staff spoke of the training available to them. Training undertaken by staff included fire safety training, understanding loss and bereavement, and assessment of need and Protection of Vulnerable Adults. Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 Page 19 Information through discussions with residents indicated that they felt well cared for, that staff treated them well, respected their privacy and that they felt safe at the home. The homes staff team had clearly defined roles and the observations on the day of inspection demonstrated staff were clear in their roles and were able to advise and explain their post and associated responsibilities. Examples were when a resident makes a complaint, staff were aware that they would need to seek guidance from senior staff at the home in certain instances, to provide the best outcome for the resident. Staff rotas show that there is a sufficient number of staffing on duty as recommended by the care forum. Staff and residents through discussion confirmed that they felt there to be sufficient staff on duty. Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems in place within the home for managing Health and Safety continue to be good so residents benefit from living in a safe environment. EVIDENCE: As assessed at the previous inspection Quality Assurance within the home was examined. The home had undertaken a self audit of its services using the National Minimum Standards as its template, actions taken following their audits were recorded and this showed the improvements that the home had made. Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 Page 21 In addition the home had sought the views of residents and their relatives through the use of questionnaires. Copies of responses were seen and management were able to give an explanation on how the home had used these views to influence and change practice, for example redecorating the resident’s individual rooms. Documents pertaining to the management of Fire, environmental Health and internal safety checks were seen. All were up-to-date and demonstrated that required safety measures were in place to meet the relevant legislation in this area. Staff and their training records confirmed that they had been trained in a variety of Health and Safety areas including moving and handling, food hygiene and infection control. Monies managed on behalf of residents by staff at the home were examined. The home was seen to be invoiced by for example the visiting hairdresser and in turn they would then invoice the individual resident. The system in place did not provide a clear audit trail and staff were not able to show that they understood it completely. Therefore a requirement has been made that a copy of an individual receipt must be kept with the copy of the invoice sent to each resident to ensure a clear audit trail is in place. Residents reported that they found the manager to be a very good listener and all felt that she was very easy to talk to and that they trusted her. Staff said that they found the manager to be both organised and approachable. Residents said that the manager was nice and their comments suggested that they felt confident in her abilities. The manager is a Registered Nurse. Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 Page 22 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 Page 23 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 2 Standard OP7 OP12 Regulation 15 15 Requirement Care plans must be clear in their guidance to staff so that residents needs are always met. Care plans must be in place that make clear the individual social and emotional needs of the residents so that activities in the home are tailored to meet these needs. Repair and redecoration of areas in the home must take place to ensure residents have a homely environment in which to live in. A copy of an individual receipt for any expenditure must be kept with the copy of the invoice sent to each resident to ensure a clear audit trail is in place. Timescale for action 31/03/07 30/04/07 3 OP19 23 31/05/07 4 OP35 17 & 20 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000064670.V326834.R01.S.doc Version 5.2 Page 24 Orchard Lodge Nursing Home Standard Orchard Lodge Nursing Home DS0000064670.V326834.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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. 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