Inspection on 19/07/07 for Orchard Manor Nursing Home

This inspection was carried out on 19th July 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Orchard Manor Nursing Home 13/12/06

Orchard Manor Nursing Home 01/08/06

Orchard Manor Nursing Home 17/11/05

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 19th July 2007 9:50 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard Manor Nursing Home DS0000018788.V338691.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 Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 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 orchardmanornursing@yahoo.co.uk 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.V338691.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to a maximum of 53 service users in the OP (older persons) category may be accommodated. 13th December 2006 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 £505 to £565 per week. Orchard Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit took place on 19th July 2007 and took four hours. The home had 43 residents. A tour of the building, including all communal areas and some bedrooms, was completed. A sample of records was looked at and time was spent in conversation with the home manager, residents and staff. Some of the information contained in this report is taken from the Annual Quality Assurance Assessment that was completed by the manager. Comments cards were provided for residents, visitors, social workers and GPs to give their views of the home. What the service does well: What has improved since the last inspection? A matron has been appointed to oversee the standards of care provided to residents. She has updated some of the policies and procedures and is also working alongside staff to provide practical training and supervision for less experienced nurses and for care staff. Care plans and wound care records were completed to a better standard to show that residents needs are fully assessed and to record the care that has been given. Orchard Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 6 The refurbishment of the bathrooms has been completed. Some towels and bedding have been replaced. There was evidence that residents’ views are being listened to and changes have been made, for example to menus and activities, to reflect the wishes and preferences of residents. The overall standard of record keeping has improved. 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 Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People interested in coming to live at Orchard Manor have a full assessment to ensure that their care needs can be met. EVIDENCE: A relative who completed a comments card wrote: the matron and staff provided invaluable help and assistance in settling father in a caring, professional, comfortable, organised environment where his needs could be met. A new pre-admission assessment form is in use and showed that the manager or the matron had been out to assess prospective residents prior to admission. Orchard Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 9 A person who had previously lived at the adjoining sheltered housing facility had been admitted to the home following a serious accident. She has now fully recovered from the accident and the manager must consider whether this remains an appropriate placement for her. An application to vary the home’s categories of registration needs to be made if care is to be provided for people whose primary needs are due to dementia. Intermediate care is not provided at Orchard Manor. Orchard Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. The health and personal care needs of residents are fully met and residents’ medicines are well managed. EVIDENCE: A resident spoken with was very happy with her care. She was pleased to be able to have a bath every alternate day and her bed changed two or three times a week. She was aware of a pressure sore on her heel that had been acquired in hospital. The sore was proving difficult to heal and this was recorded in her care plan. She had a pressure relieving mattress on her bed and, at her own request, one rail was fitted to her bed and had a protective cover. She experiences pain in her leg is given prescribed analgesics when she asks for them. During a recent illness, one carer in particular was very kind and attentive to her and this was much appreciated. Orchard Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 11 She was aware that a hoist needed to be used to transfer her and this was detailed in a moving and handling plan. She had been weighed monthly since admission. After losing a lot of weight in hospital she was now gaining weight again. Visits by her GP were recorded in June and July 2007. Another resident was poorly and being looked after in bed. She was positioned comfortably, supported with pillows. She had a pressure mattress and bedrails that were well protected. The care plan in her room provided details of her needs and a tick list recorded the personal care she received each day. The care plan recorded weight loss. This had been referred to her GP and discussed with her family; she had been seen by a speech and language therapist. The care plan included a bedrail risk assessment, pressure area risk assessment and a moving and handling plan. The care plan had been checked in March and June. A relative who completed a Commission for Social Care Inspection comments card was very happy with the care of his father. He wrote that: The daily help he gets ensuring that he takes his medication on time and the help he gets getting up and washing means that his angina attacks have significantly reduced in frequency and severity. Wound care records are kept in a separate folder. The records were well completed and included photographs to record progress. Three of the home’s nurses have attended a wound care study day recently. It was pleasing to find that the good standard of medicines management achieved at the last visit had been maintained. The medicine administration record folders contain a front sheet where nurses can record any missing signatures or other discrepancies that they notice at each medicine round. This can then be followed up without delay. Orchard Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. Residents are able to exercise choices in daily living and social activities are provided regularly in the home. EVIDENCE: A social activities organiser is employed and she facilitates a variety of leisure opportunities and activities for residents. On the day of the visit a number of the residents had gone to the main lounge before lunch to do chair exercises. The activities organiser was called away and one of the residents took over and continued the class! The Annual Quality Assurance Assessment completed by the manager highlights plans to further develop social activities, including links with local schools. One of the residents spoken with goes out at least once a month to meet her sister for a meal out. The home arranges a taxi that she can use in her wheelchair. One resident spoken with is a Roman Catholic and said that she has Holy Communion every week in the home. Orchard Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 13 Following the last inspection the arrangements for serving meals in the dining room have been changed to ensure that residents receive their meals hot. The Annual Quality Assurance Assessment reported that the choice of meals has been improved as a result of listening to residents’ comments. Residents spoken with said that the food was good and they enjoy their meals. Orchard Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s complaints procedures and by staff being familiar with the protection of vulnerable adults. EVIDENCE: The home has a complaints procedure and any complaints made to the home are recorded on a complaints form and kept in a folder. Two complaints had been recorded since the last inspection in December 2006. This was a significant reduction from the previous year. All serious complaints are referred to the responsible individual for the home. A resident spoken with said that if she had any complaints she would take them straight to the manager, two other residents echoed this on comments cards. Adult Protection policies and procedures were updated in 2006 and staff training was provided. Orchard Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 15 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): Standards 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 home is spacious, comfortable and accessible for wheelchairs. 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. All bathrooms have been refurbished over recent months. Towels, bedding and wash bowls have been replaced as needed. The manager said that corridors are due to be painted in August. Some of the furniture in the bedrooms is showing signs of wear and tear and will need to be replaced. Funding has been secured to improve the dining room. Orchard Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 16 At the last inspection, two relatives commented that the home was not always kept clean and there were no cleaners sometimes at the weekend. This was due to difficulty in recruiting cleaning staff. The manager said that the home now has enough cleaning staff but there is a problem with sickness. On the day of the visit most areas of the home were clean and there were no unpleasant odours. Orchard Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 17 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): Standards 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 needs of residents are met by a sufficient number of qualified and experienced staff. EVIDENCE: During the morning there are three nurses and seven care assistants on duty; in the afternoon and evening two nurses and six care assistants; and at night two nurses and four care assistants. This is sufficient to meet the needs of the people currently living at the home. A resident spoken with said that she never waits more that seven or eight minutes for her call bell to be answered. Call bells were answered promptly during the inspection. Agency staff are used to cover any shortfalls in staff numbers. Most of the staff are experienced and only one is under 25 years of age. Seventeen care assistants have a national vocational qualification in care and one is currently working towards a qualification. There is a significant number of overseas staff. Most have a good command of the English language but a resident said that she has a little difficulty in understanding some staff. Orchard Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 18 Recruitment records were looked at for the last two staff to be employed. The records showed that all of the required recruitment checks had been carried out before they worked with residents. A chart on the wall in the main office confirms details of staff recruitment and mandatory training. The administrator has caught up with outstanding Criminal Records Bureau disclosures and said that only one was still awaited. The current registration for all of the nurses had been checked. There was evidence that a considerable amount of training has been provided for staff over recent months. A training matrix has been developed and all recent training was recorded on this. There are still some gaps where it was not clear whether staff had attended mandatory training, but further training sessions were planned and good progress had been made in addressing shortfalls. There were also induction and supervision records for new staff. Orchard Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed to ensure that the interests of service users are paramount . EVIDENCE: The home manager is a registered nurse and is registered with the Commission for Social Care Inspection. She has completed NVQ level 4 in management. A matron has been appointed to oversee the standards of care provided to residents. She has updated some of the policies and procedures and is also working alongside staff to provide practical training and supervision for less experienced nurses and for care staff. Orchard Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 20 The atmosphere in the home was more relaxed and staff appeared to be well motivated. Rooms have been allocated as offices for the manager and the nurses. Previously they have shared an office with reception/administration. A comments card received from a resident stated: I have been blessed by finding such a well-managed and run nursing home. A relative commented that: manager and staff are always willing to listen and act appropriately if changes are required. There was evidence of monitoring and auditing of medicines and care plans was taking place. Accidents were monitored to identify causes and trends. Policies need to be developed for bullying, COSHH, dealing with violence and aggression, first aid, and racial harassment. Information provided by the manager indicated that all plant and equipment has been serviced and maintained in good condition. Some bedrails were fitted too far from the head of the bed, presenting a risk of a resident’s head/neck being trapped. A poster displayed in the staff room highlighted this, but staff need to be reminded. Some of the kitchen staff have not yet attended food hygiene training. Fire records were good and evidenced that regular drills had been held. Orchard Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 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 2 Orchard Manor Nursing Home DS0000018788.V338691.R01.S.doc Version 5.2 Page 22 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. 1 Standard OP38 Regulation 13(4)(c) Timescale for action Make sure that bedrails are 30/07/07 always fitted safely, no more than four inches from the head of the bed, so that a resident’s head/neck can not get trapped. Arrange for all catering staff to have food hygiene training. 31/08/07 Requirement 2 OP38 18(1)(c) 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 OP19 Good Practice Recommendations Replace bedroom furniture that has become shabby. 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