Inspection on 17/11/05 for Orchard Manor Nursing Home

This inspection was carried out on 17th November 2005.

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

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

Other inspections for this house

Orchard Manor Nursing Home 19/07/07

Orchard Manor Nursing Home 13/12/06

Orchard Manor Nursing Home 01/08/06

Orchard Manor Nursing Home 11/07/05

Orchard Manor Nursing Home 06/01/05

Orchard Manor Nursing Home 15/07/04

Orchard Manor Nursing Home 12/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Orchard Manor Nursing Home Greenacres Court Acres Lane Upton, Chester Cheshire CH2 1LY Lead Inspector Wendy Smith Unannounced Inspection 17th November 2005 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 Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 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.V261950.R01.S.doc Version 5.0 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.V261950.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. 11th July 2005 3. Date of last inspection Brief Description of the Service: Orchard Manor is a care home providing nursing care and personal care for up to fifty-three older people. It is owned by Fordent Properties Ltd, a family business. The home is a purpose built property set in two acres of grounds in a residential area approximately two miles from Chester city centre. The home is set adjacent to a sheltered housing complex, which is owned by the same company, and they share well-maintained grounds. Orchard Manor has 51 bedrooms on three floors. 46 bedrooms have en-suite facilities. There is a large lounge and a dining room on the ground floor, and on the first and second floors there are smaller sitting areas with some dining space. Two passenger lifts and staircases provide access to all levels. All rooms have nurse call bells and television points. Orchard Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by two inspectors on 17th November 2005 over a period of four hours. 50 residents were living at the home. A tour of the building, including communal areas and some bedrooms, was completed. A sample of care plans was looked at and the arrangements for the ordering, storage and administration of medicines were inspected. One of the inspectors looked at personnel records, staff training records and the arrangements for handling residents’ personal money. Time was spent in conversation with one of the home owners and the home manager. Several members of staff, eight residents and two visitors were also spoken with. All of the residents were positive about the care they received at the home and said that they were happy at Orchard Manor. What the service does well: What has improved since the last inspection? Orchard Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 Page 6 The standard of care plans had improved since the last inspection. The management of medicines had improved to a good standard. Personnel records were in good order and there was evidence that training had been provided for all staff. The home is working towards the Investors in People award. One bathroom has been refurbished and there are plans in place to upgrade two other bathrooms. The home has a new maintenance person who is enthusiastic about his work. The home manager has been in post for ten months and has made a positive difference to the ethos of the home. 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. Orchard Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 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 Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected on this visit. EVIDENCE: Orchard Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 Page 9 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 and 9. Each resident has a care plan that details their needs and how their needs are to be met. Residents health needs are met however some residents may be at risk of entrapment by bed rails. Medicines are well managed. EVIDENCE: Each resident has a care plan and a sample of four care plans was inspected. The main care plan is kept in the resident’s bedroom and is available for the resident and/or their relatives. A summary of each resident’s daily care needs is contained in a separate folder on each floor of the home for care staff. The standard of documentation had improved considerably since the last inspection. Plans of care were in place for all identified needs and were regularly reviewed and updated in consultation with the resident and next of kin. Residents were assessed for their risk of developing pressure sores and appropriate intervention was recorded in the care plan. Orchard Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 Page 10 Nutritional risk assessments were also carried out to identify those residents at risk of malnutrition and appropriate intervention was recorded in the care plan. However, one resident’s weight chart indicated that she had lost over 7kg in the previous three weeks, but the plan of care had not been changed. This was brought to the attention of the home manager who said that she would investigate. Care files contained evidence that residents were referred to appropriate health care professionals as required, for example GP, dentist, optician, chiropodist and tissue viability nurse. During a tour of the building it was noted that there were a number of residents being cared for in bed. Most of these residents had bed-rails in place and whilst some of the bed-rails had protective covers, others did not. The bed-rail risk assessments in the care plans did not clearly demonstrate why bed-rails were considered necessary for all of these residents, or that the risk of entrapment had been given due consideration. This was discussed with the home manager and the responsible individual for the home. They agreed to carry out a full review of which residents need bed-rails and to ensure that they are not at risk of entrapment. See requirement The home has two clinical stores on the ground and first floors. Both are kept locked and medications were stored appropriately in each within locked cabinets. Controlled drugs are stored in a reinforced controlled drugs cabinet. All medicines received at the home had been checked in by the nurse receiving them. Medication administration records were reviewed and stock levels of medicines checked. This was satisfactory. A contract is in place for the disposal of any unused medicines. Orchard Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 Page 11 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): 13 and 14 Visitors are made welcome at the home. Residents are able to exercise choice in daily living. EVIDENCE: Relatives and friends may visit at any reasonable time. There were several visitors to the home during the morning of the inspection. Two visitors were spoken with; one was the close relative of a resident and is very involved in her care, the other was a friend of a resident who visits every week and said that she is always made welcome and is offered a cup of tea. Most residents had chosen to stay in their own rooms during the morning, but two of those spoken with said that they would be joining in activities in the afternoon. Another resident said that she goes out with her family. Residents had their own belongings, including items of furniture and pictures, in their bedrooms. Some residents have their own phone. Orchard Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 Page 12 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): 18 Residents are protected from abuse. EVIDENCE: There was a copy of Cheshire Social Services adult protection protocol ‘No Secrets’ available. The home also has its own policy and procedure on abuse and adult protection, but this did not make any reference to the fact that any allegation of abuse must be reported to social services in accordance with the locally agreed protocol. See recommendation All staff had received training in adult protection. This was included in the induction programme and further training had been provided earlier in the year. Orchard Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 Page 13 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 The home is clean and well maintained. EVIDENCE: Orchard Manor is a modern building that is spacious and well appointed. The gardens are well-maintained and are safe and pleasant for residents to sit in. Communal areas are light and bright and appropriately decorated and furnished. Bedroom doors have been fitted with magnetic closers that enable residents to choose to have their bedroom door open without any fire risk. The home’s bathrooms are showing signs of wear and tear and one of the bathrooms has been upgraded and greatly improved. There are plans in place for two other bathrooms to be refurbished. Orchard Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 Page 14 The home has a new maintenance person who is a qualified electrician. He said that he is enjoying his work and he had a very positive attitude towards the residents. The home was found to be clean and free from any offensive odours. Orchard Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 Page 15 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): 29 and 30. Good employment practices are followed, however some staff need to have an enhanced Criminal Records Bureau disclosure. Staff receive training to enable them to do their work competently. EVIDENCE: Five staff files were reviewed. Two written references had been obtained for all new staff and Criminal Records Bureau disclosures had been obtained. Two of the staff, who had worked at the home for several years, only had standard disclosures. Both of these staff had close personal contact with residents. The administrator said that these had been obtained before she realised that enhanced disclosures were required. The responsible individual was informed that enhanced disclosures must be obtained for all nursing and care staff who do not already have one. See requirement Checks had been carried out to make sure that all nurses employed were registered with the Nursing and Midwifery Council. All staff have a written statement of their terms and conditions of employment. Orchard Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 Page 16 Training records were reviewed, including the record of induction for the two most recently employed members of care staff. The induction programme, if followed, provides a comprehensive induction but there was insufficient documentary evidence to demonstrate that the two staff concerned had completed it. One had been ticked in pencil and one just had a date recorded against various sections. Neither had been signed by the inductee or their supervisor and neither contained any evidence of how each competency had been achieved. See recommendation There was evidence of investment in training and staff had received regular updates in relation to safe working practices. This year staff had attended training in health and safety, oral health, tissue viability, fire safety, falls prevention and management, deaf awareness, infection control, care of a resident with Parkinson’s disease, confirmation of death, control of substances hazardous to health, pain management in wound care, adult protection, assessment and care planning and moving and handling. The responsible individual said that she had applied for the home to be accredited by Investors in People. Orchard Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 Page 17 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 and 35. The home has a manager who is registered with the Commission for Social Care Inspection. Quality assurance systems are in place. Residents’ money is handled appropriately. EVIDENCE: The home manager has been in post since January 2005. She is a registered nurse and is working towards a management qualification. She has successfully completed the Commission for Social Care Inspection’s manager registration process and has made a positive difference to the smooth running of the home. Orchard Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 Page 18 The home is working towards the Investors in People award. The responsible individual for the home said that satisfaction survey questionnaires were due to be sent out to relatives and to visiting professionals during January 2006 and the results of these will be published. Residents, staff and relatives are able to express their views in regular meetings. Reports required by regulation 26 of the Care Homes Regulations have not been made recently as the responsible individual has been spending a significant amount of time in the home supporting the new manager, however she intends to spend less time in the home over forthcoming months and is aware that regulation 26 visits will be required. The home only looks after small amounts of spending money for residents. A balance sheet is maintained for each resident with records of all payments in and out. The administrator signs for any monies received and provides a receipt. Receipts were also retained for any monies paid out of the account. In the main, the payments out of the account were for hairdressing, chiropody and toiletries. Orchard Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 Page 19 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X x Orchard Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 Page 20 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 OP29 Regulation 19 Requirement All staff who work closely with residents must have an enhanced Criminal Records Bureau disclosure. Timescale for action 31/01/06 7. OP8OP38 13 Residents must be protected from the risk of entrapment by bed rails. (Timescale of 11/07/05 17/11/05 not met) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP29 OP18 Good Practice Recommendations The home should maintain records to demonstrate that new staff have received induction training. The home’s policies relating to the protection of vulnerable adults should be reviewed and updated. Orchard Manor Nursing Home DS0000018788.V261950.R01.S.doc Version 5.0 Page 21 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.V261950.R01.S.doc Version 5.0 Page 22 - 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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