CARE HOMES FOR OLDER PEOPLE
Orchard Lodge Nursing Home 601-603 Lytham Road Blackpool Lancashire FY4 1RG Lead Inspector
Mr Kevan Royston Unannounced Inspection 5th July 2007 09:30 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 DS0000006068.V338627.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 DS0000006068.V338627.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Orchard Lodge Nursing Home Address 601-603 Lytham Road Blackpool Lancashire FY4 1RG 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) 01253 345623 01253 344033 david@dmarrs.wanadoo.co.uk Dharma limited Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44), Physical disability (6) of places Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 44 service users to include: Up to 44 service users in the category OP (Old Age, not falling within any other category) Up to 6 service users in the category PD (Physical Disability) Date of last inspection Brief Description of the Service: Orchard Lodge Nursing Home is registered as a care home that provides nursing and can accommodate 45 service users. The home is situated in the south of Blackpool, in a residential area within close proximity of local amenities. The accommodation is on two floors and a lift facilitates access to all areas There are garden areas to the front and rear that are attractive and accessible to wheelchair users via a ramp. Communal space is accommodated in three lounges and a dining room and a smoking lounge is provided separately. Twenty-three of the bedrooms are single and six shared ten of which have an en-suite facility. The home provides a passenger lift and aids and adaptations to promote independence. There is a statement of Purpose/Service user Guide, which is given to all prospective residents. This written information explains the care service that is offered, who the owners and staff are and what the resident can expect if he or she decides to live at the home. The ranges of fees are, £294.91 - £459.48 per week. Additional charges are for hairdressing £5.00 and chiropody £7.00. Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 05/07/07, over a period of approximately 7.0 hours. The Inspector spoke to the homeowner, manager, five staff, one relative visiting the home, six residents individually and a group of residents together in the lounge. As part of the inspection process the inspector used case tracking as a means of assessing some of the National Minimum Standards. The process allows the inspector to focus on a small number of people living at the home. All records relating to these persons are examined and the rooms they occupy are looked at. Other residents are invited to pass their opinions to the inspector if they wish. Surveys were sent to residents/ relatives for there views on how the home is run all positive comments were received from fourteen completed surveys of residents and one from a relative. Records of three members of staff were also examined. A tour of the premises was undertaken. Examination of the homes documentation, policies and procedures formed the basis of the inspection process. What the service does well:
The home now has two designated social activities persons who are responsible for arranging daily activities and outings to suit each individual’s interests ensuring the residents are motivated and stimulated. A member of staff responsible spoken to said, “With two of us to help organise social events its much better for the residents”. A resident spoken to said, “They do try and vary daily activities”. Another said, “We try and go out a lot but the weather hasn’t helped, the girls are good though at putting things on in the home”. All surveys returned from residents and relatives for their comments on how the home is run and standard of care provided were positive confirming the support and care of residents is a priority. Comments included, “There are trained nurses available all the time to help”. And, “Very caring and helpful staff”. One survey completed by a relative said, “They look after my mum very well”. Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 6 Examination of training records and discussion with staff confirmed the home provides good training opportunities for all staff to attend courses in relation to their job role. This ensures the development of all staff and provides the skills and competencies required to support and provide good care for the residents. Staff spoken to said, “Excellent training provided. “And, No problem attending courses the manager is always willing to pay for courses”. The home has recently been awarded the “Investors In People Award” which means the home is run and operates to a high standard with priority to the residents to ensure they are well cared for and supported. One of the management team spoken to said, “All the staff have worked hard to achieve the award”. Observation of staff helping and talking to residents was good, with one staff member helping a resident with lunch in a dignified and sensitive way ensuring residents dignity and privacy is respected. One staff member spoken to said, “We are aware of residents need as much as possible to be independent but are always there to support in an intrusive way”. Another member of staff commented, “Our induction covered how to treat the residents with respect”. A resident spoken to said, “I do need a lot of help but the staff are very good and caring with personal help”. What has improved since the last inspection?
Walking around the building found some parts of the home in particular the hallways and landing areas have been redecorated with new pictures and furnishings to provide pleasant surroundings for the residents to live in. One resident commented “It makes the home much brighter” A staff member spoken to said, “it makes it look a lot more cheerful with the light colours”. Health care plans of residents examined have been improved with new systems in place to check weight, blood pressure, intakes of fluids and foods more regularly to ensure each resident health needs are monitored and any problems are identified and can be dealt with. A nurse spoken to said, “ It’s a better system and we can deal with any health problems early”. There has been more domestic staff employed to ensure the home is kept clean and tidy and provide a pleasant environment for the residents. One member of staff spoken to said, “With a bit more help it makes the home easier to keep clean”. One of the management team said, “We recognised we needed more domestic staff”. A resident commented “The girls work hard to keep the place clean”. The homeowner and management team are always improving forms and systems to make them more detailed or easier to follow, ensuring the care is consistent and continues to improve the home for the residents. Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 7 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 DS0000006068.V338627.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 Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The admission and assessment procedures were very clear and precise to ensure the needs of the residents are met. EVIDENCE: The records of three residents were examined and had full assessment information recorded in detail so that a care plan could be developed. All three residents were funded by social services and been assessed by social workers with information on file for the care staff at the home to develop their own assessment and a care plan to ensure all health, welfare and social needs are identified and recorded. A member of the management team said, “Residents and relatives are welcome to visit the home before making a choice”. A relative visiting the home said, “Yes they were thorough at the beginning to get all the information and I was involved in the process”.
Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 10 Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Promotion of health is taken seriously. Resident’s welfare is closely monitored and health needs are identified and met. EVIDENCE: Records of three resident’s case tracked were accurate and had good information about their health, welfare and social care needs that supported the staff to maintain and promote each individuals daily needs. Care plans were up to date and regular reviews taking place with involvement of the residents and relatives where possible with good information of care provided ensuring the welfare and general wellbeing of residents is continuously monitored. New monitoring systems examined have improved the way healthcare needs are checked ensuring any issues can be identified and addressed. Residents spoken to said, “I am aware what I need from staff and the staff are good at going through them with me”. Another said, “Monthly we go through my health checks”. Records examined confirmed risk assessments
Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 12 have been completed and are reviewed when required and updated reflecting any changes that may have occurred individually and in the environment ensuring the resident’s safety and protection is a priority. Examination of resident’s files confirmed significant events had been recorded and daily entries by staff demonstrating the care given and any information is written down to help staff. The home has recently employed a general manager who checks resident records and care plans monthly to ensure files are kept in good order and information is properly recorded. One member of staff said, “It has helped with a new manager here the information on residents is better”. Medication practices observed at breakfast and lunchtime were safe and good records had been kept ensuring residents health is maintained. The procedures for medication on the three resident’s case tracked were examined and discussed with a nurse on duty and confirmed safe practices ensuring the protection of the residents. A nurse spoken to said, “ We ensure medication is taken at the correct time and only by nursing trained staff”. At the time of the inspection controlled drugs were being administered, discussion with the nurse and examination of records, storage and handling of medicines confirmed good systems are in place with experienced trained nursing staff to ensure good practice and the health of residents is maintained at all times. The community pharmacist visits on a regular basis to provide advice and training so care staff are well informed of any changes in medication practices. A staff member spoken to said, “We have a good relationship with the pharmacist”. Resident’s dignity and privacy was observed during the visit ensuring residents are treated with respect. This was confirmed by observing staff members knocking on doors before entering rooms, helping with meals, medication and the way staff talked to the residents. Resident’s comments included “Very caring people here”. And “ Staff are so respectful”. A member of staff spoken to said, “We discussed with the owner privacy and respecting residents during our induction training”. Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. EVIDENCE: Breakfast and lunchtime meals were seen being prepared, and were wholesome, home baked with fresh produce providing a nutritious meal. Observation at lunchtime showed staff supporting residents with their food with dignity. Menus examined are balanced and interesting. Meal times are set although flexible enough to accommodate preferences. One resident was seen taking meals in the privacy of her own room and supported by staff in a sensitive manner ensuring her dignity was respected. Comments from residents spoken to and surveys returned were positive in relation to the standard of food and included, “Always plenty to eat” And “Can’t complain there is always a choice if you don’t like something”. Discussion with the cooks and staff confirmed diabetic diets; liquidised foods and food from different cultures could be provided ensuring residents from any religious faith can be
Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 14 accommodated. One chef spoken to said, “I do prepare liquidised food and it is important to prepare each food separately to ensure it looks nice to eat”. Discussion with staff and examination of records confirmed activities are centred on each individuals preferences ensuring flexibility and residents can enjoy their own personal interests, which are recorded on their care plan. One resident spoken to said, “ We are going to Fleetwood market this week and look forward to that”. Another said, “We do try and get out for tea now and then”. A member of staff spoken to said, “I now have help with organising activities and social events its much better”. Observations of residents rooms showed personal belongings are allowed into the home to provide a homely atmosphere for each individual. A relative of a resident said, “I like the way the staff encouraged us to bring our own bits and pieces in to make it look like home”. Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for recording and reporting of complaints are good ensuring people feel listened to. The management team and staff have a good knowledge and understanding of adult safeguarding issues, which ensures any protection issues are appropriately dealt with. EVIDENCE: The home has a detailed complaints procedure, which is made available to all residents and their relatives on admission and contained in the Statement of Purpose and Service User Guide to ensure people know how to raise any concerns. Comments from residents in surveys returned confirmed they are aware of the complaints procedure and who to complain to. Resident’s comments included, “I would speak to the owner”. And, “I know what to do”. Information from discussion with the home owner and examination of documentation confirmed staff receive abuse and complaints awareness training. Staff spoken to said, “I am recently doing abuse issues through my NVQ (National Vocational Qualification) training”. Another said, “ All complaints and abuse procedures were covered during my induction training”. There have been four complaints since the previous inspection investigated through the homes complaints procedure. Examination of records found complaints had been dealt with appropriately following the procedures with the
Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 16 investigation, outcomes and where appropriate letters sent to the complainant explaining the process and outcomes of the complaints. Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 17 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is safe and clean maintained to a good standard providing comfortable surroundings for the residents. EVIDENCE: A tour of the building found the home to be clean and tidy and provide pleasant surroundings. There has been more domestic staff employed to make sure the cleanliness of the home is a priority. One member of staff said, “We have enough staff when we are all here”. Areas of the home would look better in particular bedrooms with some painting and general updating to provide comfortable rooms for the residents to live in. However discussion with the management team confirmed ongoing work to update the home is being addressed as part of the development plan. At the time of the visit a maintenance member of staff was painting the outside of the building and was
Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 18 spoken to and said, “The inside of the home is next to do”. Parts of the landings and hallways had recently been redecorated and refurbished to make the areas look better. There are policies and guidance for laundry processes and for the control of infection ensuring the home is kept clean, pleasant and hygienic. ‘ Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The procedures for the recruitment of staff are good ensuring the safety and protection of the residents. Training for staff is good and enables staff to have the skills and competencies for their roles. EVIDENCE: Examination of duty rotas, discussion with the management team and staff confirmed there were sufficient numbers of domestic staff, carers and qualified nurses on duty to ensure the resident’s are supported and their needs are being met. Comments from residents included. “Very helpful people here”. And, “There is plenty of them around”. A member of staff spoken to said, “We now work well as a team”. Another member of staff said, “Its 100 better a pleasure to come to work”. Examination of three staff files confirmed the recruitment procedures of the home are good ensuring the protection of the residents is maintained. Staff records include, application forms, Criminal Records Bureau (CRB), Protection of Vulnerable Adults (POVA) disclosures and references, all in place prior to employment. Examination of induction training for new staff confirms thorough procedures are in place for staff to be aware of the policies and systems of the
Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 20 home before commencement of work. One staff commented, “Induction was extremely informative and took a lot in”. Records confirm training is ongoing for staff through their development programme and the home has over 50 of care staff that has completed NVQ (National Vocational Qualification) level 2 in care with some staff achieving level 3. One member of staff spoken to said, “I am now doing my level 3 NVQ which the manager has put me on”. Training is ongoing and accessible for staff development and they are encouraged to attend courses to ensure they are competent and have the skills to provide the care and support for the residents. Records are kept of staff training and were examined. Comments from staff included “ Good training opportunities here”. And “ I have recently updated my Moving and Handling course”. Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 21 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 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed well and systems and policies in place for the protection and safety of staff and residents are good. EVIDENCE: The home owner is a qualified nurse and has the necessary qualifications, skills and experience required to support the staff and residents and enable the home to meet its stated purpose and objectives. Staff and residents spoken to say they found the homeowner and manager supportive and provided a clear sense of leadership. Comments “A lot better than it used to be” Also, “With the home owner back in charge the home runs
Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 22 better and she is always approachable”. One relative visiting the home said, “The manager is very helpful and keeps me informed of mums progress”. Examination of records for residents confirmed they are comprehensive, well written and up to date ensuring the correct information is available and health and welfare needs are continuously monitored. Records show the management has good systems to gather staff, residents and relative’s views to enable ongoing improvements to the home. Staff and resident meetings are held regularly and recorded ensuring there views are discussed and implemented if agreed it would improve the running of the home. Relative surveys are sent out every six months has a quality assurance system to gather the views of friends and relatives to ensure they feel the home is run smoothly and any suggestions to improve the home are taken seriously. Examination of records confirmed regular tests to emergency lighting, fire procedures and extinguishers had been carried out ensuring the safety of residents and staff is maintained. Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 23 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 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 3 Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 Standard Good Practice Recommendations Orchard Lodge Nursing Home DS0000006068.V338627.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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