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Inspection on 01/08/06 for Orchard Manor Nursing Home

Also see our care home review for Orchard Manor Nursing Home for more information

This inspection was carried out on 1st August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is in a pleasant and peaceful setting but is only two miles from the centre of Chester. The home was purpose built and most bedrooms are very spacious. All parts of the building are accessible for residents who use a wheelchair. All of the residents spoken with described the staff as kind, caring and hard working. A good variety of meals is provided and residents are satisfied with the quality of the food. The home employs an activities organiser and she provides a range of social and recreational opportunities for residents. A high proportion of staff have either a nursing qualification or a national vocational qualification in care. A satisfaction survey was carried out earlier in 2006 and provided very useful feedback for the development of the service.

What has improved since the last inspection?

There had been no noticeable improvements since the last inspection.

What the care home could do better:

There should be a full assessment of each new resident before they are admitted to the home to ensure that their needs can be met in full and that staff are aware of what their individual needs and preferences are and how they are to be met. The care plans should be completed to a more consistent standard to provide a record of all the care that has been given and to demonstrate that each resident`s needs are regularly monitored. Residents who have a pressure sore, or are at risk of developing a pressure sore, must receive the care and treatment that they require and this should be clearly documented. Bedrails should not be used without protective covers to reduce the risk of entrapment. Bedrails are a form of restraint and consent for their use should be sought from the resident and/or their relatives and this should be recorded. All aspects of medicines management need to be improved. The home`s Adult Protection policies and procedures must be compatible with the Department of Health `No Secrets` guidance. All staff must be made aware of this guidance and any allegation of abuse must be reported to Social Services. New staff must not be employed at the home until the required recruitment checks have been carried out for the protection of residents. Records should be maintained to show that all new staff receive induction training. At all times staff must be provided in sufficient numbers to meet the care needs of the residents. All staff who provide direct care to residents must receive moving and handling training, and training updates, and records should be kept to show that this has taken place. All staff employed at the home must attend regular fire drills and fire safety training to ensure that they are aware of how to act in the event of a fire occurring. Make sure that fire doors are never wedged open.

CARE HOMES FOR OLDER PEOPLE Orchard Manor Nursing Home Greenacres Court Acres Lane Upton, Chester Cheshire CH2 1LY Lead Inspector Wendy Smith Key Unannounced Inspection 1st August 2006 09:00 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 Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Orchard Manor Nursing Home Address Greenacres Court Acres Lane Upton, Chester Cheshire CH2 1LY 01244 376568 01244 399855 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) Fordent Properties Limited Caroline Love Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (53) of places Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Up to a maximum of 53 service users in the OP (older persons) category may be accommodated. The registered provider must, at all times, employ a suitably qualified and experienced manger who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection. 17th November 2005 Date of last inspection Brief Description of the Service: Orchard Manor is a care home providing nursing care and personal care for up to 53 older people. It is owned by Fordent Properties Ltd, a family business. The home is a purpose built property in a residential area approximately two miles from Chester city centre. The extensive grounds are shared with an adjoining sheltered housing complex which is owned by the same company. The home’s fees range from £390 to £600 per week. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection process for Orchard Manor included an unannounced site visit to the home by two inspectors on 1st August 2006, with a further visit on 3rd August 2006 to give feedback. Time was spent talking with the manager, staff, residents and visitors and observing the day to day routines of the home. The building was looked at to assess its suitability to provide a comfortable, homely and safe environment. A sample of care plans, staff records and management records was looked at and a pharmacist inspector looked at the arrangements for medicines on 7th August 2006. Before the visit comments cards were sent to residents, relatives and GPs, and the home manager provided information in a pre-inspection questionnaire. The home had 50 residents and all rooms were singly occupied, although most bedrooms are of a sufficient size to be used as a shared room for two people by choice. What the service does well: The home is in a pleasant and peaceful setting but is only two miles from the centre of Chester. The home was purpose built and most bedrooms are very spacious. All parts of the building are accessible for residents who use a wheelchair. All of the residents spoken with described the staff as kind, caring and hard working. A good variety of meals is provided and residents are satisfied with the quality of the food. The home employs an activities organiser and she provides a range of social and recreational opportunities for residents. A high proportion of staff have either a nursing qualification or a national vocational qualification in care. A satisfaction survey was carried out earlier in 2006 and provided very useful feedback for the development of the service. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: There should be a full assessment of each new resident before they are admitted to the home to ensure that their needs can be met in full and that staff are aware of what their individual needs and preferences are and how they are to be met. The care plans should be completed to a more consistent standard to provide a record of all the care that has been given and to demonstrate that each resident’s needs are regularly monitored. Residents who have a pressure sore, or are at risk of developing a pressure sore, must receive the care and treatment that they require and this should be clearly documented. Bedrails should not be used without protective covers to reduce the risk of entrapment. Bedrails are a form of restraint and consent for their use should be sought from the resident and/or their relatives and this should be recorded. All aspects of medicines management need to be improved. The home’s Adult Protection policies and procedures must be compatible with the Department of Health ‘No Secrets’ guidance. All staff must be made aware of this guidance and any allegation of abuse must be reported to Social Services. New staff must not be employed at the home until the required recruitment checks have been carried out for the protection of residents. Records should be maintained to show that all new staff receive induction training. At all times staff must be provided in sufficient numbers to meet the care needs of the residents. All staff who provide direct care to residents must receive moving and handling training, and training updates, and records should be kept to show that this has taken place. All staff employed at the home must attend regular fire drills and fire safety training to ensure that they are aware of how to act in the event of a fire occurring. Make sure that fire doors are never wedged open. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 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 Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The assessment of new residents should be more thorough to ensure that their needs and preferences can be met. EVIDENCE: The responsible individual for the home said that she is currently updating the statement of purpose and service user guide to ensure that comprehensive information is provided for residents and their relatives in a single document. Information provided by the home manager indicated that 30 new residents had been admitted to the home in the last year. Some residents have a degree of cognitive impairment and/or memory loss associated with old age but there was no evidence to suggest that their needs could not be met in full at Orchard Manor. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 10 One resident has an enduring mental illness. He had been admitted to the home during a period of ill-health and the manager considered that now his physical condition had improved he may no longer be appropriately placed at Orchard Manor to meet his long term needs. Advice was being sought from mental health professionals. A sample of care files was looked at to check the arrangements for the assessment of new residents prior to admission. These showed that some basic information had been gathered either by telephone or from a visit, and for some residents there was transfer information from a hospital, however the information provided did not constitute a ‘full assessment’ and did not meet the guidelines of National Minimum Standard 3.3. Orchard Manor does not provide intermediate care. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The standard of recording in residents’ care plans is poor and does not demonstrate that their nursing needs are being met. Medicines are not well managed. EVIDENCE: Each resident has a care plan which is kept in a drawer in their bedroom and so is accessible for staff and the resident to consult. Six care plans were looked at in detail during the visit. None of the care plans looked at recorded the resident’s wishes in the event of their death or serious illness. The nutritional risk assessment had not been scored in any of the care plans and dental assessment forms were included but had not been filled in. The ‘new resident checklists’ had not been completed. Pressure sore risk assessments were recorded inconsistently with some months being missed. A significant number of entries were difficult to read and were in poor hand-writing. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 12 The care plan for a resident admitted five weeks before the visit had only been partly completed and provided very little information about her needs. This person was being cared for in bed due to a spinal injury but there was no assessment of her pressure areas or skin integrity. Positive comments were received from three GPs who each completed a comments card. All of the residents spoken with were very positive about the staff and described them as very kind and caring. Diet and fluid intake charts were being completed for some residents as needed and repositioning charts were in place for residents cared for in bed. The manager said that three residents had a pressure sore. One of these is of a serious nature. From reading the resident’s care plan it was not possible to trace how this ulcer had developed or whether the appropriate treatment had been provided. There was no record that advice had been sought from the tissue viability nurse. The manager was certain that a referral had been made and that the tissue viability nurse was off sick so could not visit. There were records of visits from the resident’s GP. There was no record to show whether the resident’s relatives have been made aware that she had a pressure sore. Her nutritional risk assessment had not been scored but a weight chart recorded that she had lost weight every month since admission. There was no record that a dietician had been consulted for advice about nutrition, however her GP had prescribed supplementary drinks. Another resident had developed an extensive sore on her heel during a stay in hospital. A wound care plan was not written until five days after she was admitted to the home. Her care plan was looked at on 3rd August and there had been no evaluation of the wound since 15th July. This would usually be completed after each change of dressing. A number of frail residents were cared for in bed and most had an alternating pressure mattress to protect them from skin breakdown. One resident who had a sore developing on her sacrum did not have an appropriate pressure relieving mattress. A photograph in her care plan, which was undated, appeared to show a pressure sore with surrounding discoloured area but the manager said that this was a blister that had burst. The description of the sore in the care plan did not correspond to the photograph. Most of the residents who were being cared for in bed had bedrails in place. Most of the bedrails were not fitted with any protective covers although some were. A carer said that all bedrails should be fitted with protective covers and that an adequate number of covers were available in the linen room. She did not know why this was not done. The care plans did not contain any consent forms for the use of bedrails. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 13 In the afternoon there were two carers and a nurse working on the middle floor of the home. Nurse call bells were ringing and it was observed that it was sometimes several minutes before they were responded to. One resident and her relative reported that she sometimes waited for a considerable length of time to be assisted to a commode, the longest being 1 hour 20 mins. Staff working on the middle floor confirmed that they find it difficult to meet the needs of residents during the afternoon and evening. A hot drinks trolley was left in corridor for about ten minutes while the carer who was serving the drinks went to assist in a bathroom. The drinks served after this were barely warm. There were a lot of different notices stuck up in bedrooms and this did not contribute to a homely environment. One of these notices was to advise residents and their relatives that they would incur a £25 fine for any damage to the walls caused by hanging up pictures or other items. The responsible individual said that this was company policy. A Commission for Social Care Inspection pharmacist inspected the medicines separately on 7th August 2006 because the two lead inspectors had such concerns. The registered person was in the home and told the pharmacist that she knew the medicines were “a mess” from the previous week’s visit but nothing had been done about them as other things had taken priority. The forms for recording medicines supplied by the pharmacy were in a poor state. There were a lot of duplicated records and nobody had attempted to sort them out and remove those not wanted. Some medicines had been recorded given twice on two forms. This is a risk as it is not clear whether the medicine has been given again by mistake. It is easier to tell what has been given from the blister packs. These are managed satisfactorily on the whole. The rest are more difficult to interpret as some items are double signed and staff have introduced their own lengthy omit codes rather than using the ones quoted on the form. There were some missed receipt records, unexplained gaps in the records and instances of the dose not stated when a medicine is prescribed in a variable dose. There was a lot of poor practice in medicine handling. There was an open sterile dressing and an open steripod saline. These should have been discarded immediately after use to ensure they are used clean. Someone had used the dressing wrapper for calculations. There were a number of medicines that had date expired, both prescribed and homely remedies. A few residents were out of stock of a medicine. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 14 Medicines were stored in a lockable room in lockable cupboards. The keys to the cupboards, including the controlled drugs, were on a hook on the wall next to the cupboards. The controlled drug cupboard was not strong enough nor big enough for the quantity of drugs requiring secure storage. The medicine refrigerator was full to bursting with overstocked items, old vaccines no longer required. It had urine and blood specimens mixed in with the medicines. Some residents’ insulin and eye drops were massively overstocked and it was not always possible to see which drops were current or if they were fit to use. The thermometer was in the door shelf. The refrigerator was so full there would not be enough air circulation to keep the medicines at the right temperature to be sure they were safe to use. There were a number of blood and urine specimens in plastic bags crammed in between sterile medicines. As medicines are managed at all times by registered nurses the evidence suggests that they are not working to Nursing and Midwifery Council Guidelines and are in need of increased supervision. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities are provided for residents and residents are happy with the quality of their meals. EVIDENCE: Residents spoken with expressed their satisfaction with their meals and confirmed that a choice is always available. A comments card received from a relative also confirmed this. Copies of the menu showed a variety of meals, including a vegetarian option each day. The components of pureed meals were served separately which improves the appearance of the food. Most residents prefer to spend much of their time in their bedrooms but join with others in the dining room for lunch. Residents in their bedrooms were watching TV or reading a newspaper or book. Two residents said that they appreciate borrowing books from the visiting library. The home employs an activities organiser for 20 hours a week and in the afternoon a group of ladies had joined with her in the dining room and were engaged in various activities including sewing, knitting and playing dominoes. Two visitors were also joining in the activities. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 16 An activities programme for the month showed that various group activities are available for residents each week and the activities organiser said that she also spends individual time with residents which includes taking them out for a walk or in a wheelchair. Religious services are provided each month. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The procedures for the protection of vulnerable adults are not always followed. EVIDENCE: The home has a complaints procedure and written records are kept of any complaints received. The records showed that eight complaints had been investigated over the last year. One of these complaints should have been referred to social services under adult protection protocols and the Commission for Social Care Inspection should have been notified. Two members of staff were concerned in this complaint and there was no record to show that their practice had been monitored since. One complaint has been received by the Commission for Social Care Inspection and this was fully investigated by the responsible individual for the home. A new adult protection policy was written in April 2006 but it does not follow the Department of Health ‘No Secrets’ guidance and must be revised in line with this. 31 staff watched a Adult Protection training video in 2005, but staff must be made familiar with the home’s policies and procedures when they have been re-written. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is spacious, comfortable and accessible for wheelchairs, but some areas are showing signs of wear and tear EVIDENCE: The home was purpose-built and provides spacious accommodation for residents that is accessible for wheelchairs. Most bedrooms exceed the national minimum standards for space and most have en-suite facilities. The grounds are well-maintained and there are pleasant outdoor sitting areas for residents. At the time of the visit there contractors were on site improving the exterior pathways. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 19 The building has been well-maintained however due to wear and tear some improvements are now needed. Some of the bedroom furniture has become shabby and there are missing handles. The responsible individual said that some new furniture has been ordered and she was considering having built-in furniture in some rooms. One bathroom was refurbished in 2005 but the others are still awaiting attention and the ground floor bathroom looks shabby. One resident said she is unable to have bath as she is very large, and she said there is another resident who is also unable to have a bath. This was discussed with the responsible individual who said that there were plans for a shower that would be accessible for these residents. A relative commented that there were no cleaners sometimes at the weekend and another relative felt that the standard of cleaning had deteriorated The housekeeper said that there was a shortage of cleaners with one having left recently. They were finding it very difficult to recruit cleaning staff but they were doing their best and ensuring that the most important tasks are carried out. On the day of the visit the home was clean and there were no unpleasant odours. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A high proportion of staff have a relevant qualification but there are not always enough staff to meet the needs of residents in full. Recruitment practices are not sufficiently robust to ensure the protection of residents. EVIDENCE: The manager provided information about staff employed at the home. There are 12 registered nurses and 30 care assistants. Eight of the care staff have a national vocational qualification in care and four are working towards this qualification. Six staff working as carers are overseas nurses who are at various stages of achieving conversion to allow them to practice as nurses in the UK. The inspectors were concerned about the number of staff working on the middle floor of the home, where there are 23 residents, including many with a high level of care needs. In the afternoon there was one nurse and two carers working on the middle floor and the staff said that they found it hard to cope. Recruitment records for new staff were looked at and found to be inconsistent. Not all staff had two written references and not all staff had a Criminal Records Bureau disclosure relating to this employment, or in the case of staff who have recently come from overseas, an up to date police clearance from their country. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 21 The manager has developed a training matrix but this did not record any training since January 2005. The training matrix does not include training in fire safety, moving and handling, and protection of vulnerable adults. Other records showed that 19 members of staff had attended moving and handling training in October 2005, but it was not possible to ascertain whether other nurses and care staff had received moving and handling training. The home has three members of staff who are qualified to train other staff in moving and handling but it appeared that records had not been kept. Fire safety training had been provided in October and November 2005 and in April and May 2006 but the inspector was unable to clarify whether all staff had attended. A fire drill was held on 6th April 2006 but there was no record of which staff attended or whether other staff have participated in any fire drill. 11 staff attended a first aid course on 1st July 2006. Records of induction training for new staff had not been completed to demonstrate their induction but a member of nursing staff recently employed at the home considered that she had received a good induction. A member of care staff has recently been appointed to take responsibility for organising training and for ensuring that training records are kept up to date. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Record keeping needs to be improved and management systems should be more robust. EVIDENCE: A new manager was appointed in 2005 and she has been registered with the Commission for Social Care Inspection as manager of this service. The manager works supernumary to the staff rota. She is working towards the Registered Manager Award and expects to complete this before the end of 2006. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 23 Most residents have a small amount of personal money in safekeeping which is used almost exclusively to pay for hairdressing and chiropody. The home’s administrator keeps a detailed record for each resident and issues a receipt for all money paid in. All of the signatures belong to the administrator and it would be a protection for her if a second signature indicated that the records were checked and the amounts reconciled periodically. A resident satisfaction survey was carried out in February 2006 and provided very useful information for the home’s management team. It highlighted difficulty in accessing dental services for residents, but the manager said that this has now improved. There were some comments from residents about having to wait a long time for attention. The last staff meeting was held in March 2006. There have been no recent relatives or relatives meetings because of poor attendance at previous meetings. Accident records were looked at and did not show any issues of concern, except for one accident resulting in a fracture which should have been notified to the Commission for Social Care Inspection. In general the standard of record keeping in the home is poor. Forms are not completed in full and files are not well organised and this makes it difficult to access information. Maintenance records are maintained and demonstrated that equipment in the home is tested and serviced. Some repairs are needed to the passenger lifts due to wear and tear. The responsible individual said the work is in hand and the lifts are in safe working order. The fire-yearly electrical installation certificate has been renewed in 2006. The staff room door was found wedged open twice on 1st August and again on 3rd August. The fire risk assessment was not available to be looked at. Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 25 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 OP3 Regulation 14 Requirement A full assessment of needs must be carried out before any new resident is admitted to the home. Timescale for action 03/08/06 2 OP8 12 Residents who have a pressure 03/08/06 sore, or are at high risk of developing a pressure sore, must be provided with the treatment they require. Residents must be protected 03/08/06 from the risk of entrapment by bed rails. (Timescale of 11/07/05 and 17/11/05 not met) The registered person must make arrangements to provide suitable and sufficient storage for controlled drugs. The registered person must ensure that the audit trail of records of receipt, administration or otherwise and disposal into the waste box is complete, clear and that there is a process to reconcile medicines supplied and DS0000018788.V290972.R01.S.doc 3 OP38 13 4 OP9 13 07/08/06 5 OP9 13 07/08/06 Orchard Manor Nursing Home Version 5.1 Page 26 administered. (In particular for Schedule 3 Controlled Drugs). 6 OP9 13 The registered person must ensure that all medicines and sundries are checked at least monthly and removed from use when not required, date expired or when the dispensing label cannot be fully interpreted. The registered person must ensure that a robust system is in place to ensure that residents do not run out of prescribed medicines and that medicines are not stocked in excessive quantities. 07/08/06 7 OP9 13 07/08/06 8 OP9 13 The registered person must 07/08/06 ensure that there is sufficient medicine refrigerator capacity to allow sufficient ventilation for the refrigerator to work efficiently. The registered person must ensure that the medicine cupboard keys are held by an authorised designated person at all times. The registered person must ensure that registered nurses practice to Nursing and Midwifery Council Guidelines. 07/08/06 9 OP9 13 10 OP9 13 07/08/06 11 OP9 13 The registered person must 07/08/06 ensure that blood and urine specimens are stored so they are not an infection risk to sterile products in the refrigerator. The registered person must make arrangements for all aspects of medicines management to be audited on a daily basis. DS0000018788.V290972.R01.S.doc 12 OP9 13 07/08/06 Orchard Manor Nursing Home Version 5.1 Page 27 13 OP27 18 Staff must be provided in sufficient numbers to meet the needs of residents. In order to comply with this an additional carer is needed during the afternoon and evening shift. 03/08/06 14 OP18 13 The registered person should 03/08/06 make arrangements to prevent service users being harmed or suffering abuse. The home’s policies and procedures must be consistent with national and local protocols and these must be communicated to all staff. New staff must not be employed to work at the home until the required checks have been carried out. Staff must receive training to ensure that they are able to carry out their work safely and records of this maintained. Ensure that all staff are familiar with fire procedures through regular fire drills. Produce a current fire risk assessment for the home. Ensure that the Commission for Social Care Inspection is notified of any serious injury that results in a consultation with a medical practitioner and if a service user develops a pressure sore of grade 2 or above. 03/08/06 15 OP29 19 16 OP30 18 30/09/06 17 OP38 23 31/08/06 18 19 OP38 OP38 23 37 31/08/06 03/08/06 Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 28 3 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 Refer to Standard OP7 Good Practice Recommendations Complete all of the forms and documents in the care plans so that they can be easily read and followed and provide evidence of the care that has been given to residents. Provide suitable shower/bathing facilities for all residents. Maintain records to demonstrate that new staff have received induction training. Provide a second signature on residents’ personal spending records. Improve the overall standard of record keeping and reporting. 2 3 4 3 OP21 OP29 OP35 OP37 Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Orchard Manor Nursing Home DS0000018788.V290972.R01.S.doc Version 5.1 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. 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