Inspection on 28/02/06 for Orchard Mews

This inspection was carried out on 28th February 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.

Other inspections for this house

Orchard Mews 11/07/07

Orchard Mews 26/07/06

Orchard Mews 09/09/05

Orchard Mews 01/12/04

Orchard Mews 28/06/04

Orchard Mews 17/11/03

Orchard Mews 15/05/03

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

CARE HOMES FOR OLDER PEOPLE Orchard Mews Bentinck Road Elswick Newcastle Upon Tyne Tyne & Wear NE4 6UX Lead Inspector Aileen Beatty Unannounced Inspection 28th February 2006 10:00 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 DS0000000450.V269272.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. DS0000000450.V269272.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Orchard Mews Address Bentinck Road Elswick Newcastle Upon Tyne Tyne & Wear NE4 6UX 0191 273 4297 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) orchardmews@schealthcare.co.uk Southern Cross Healthcare Services Limited Mrs Miriam Pearson Care Home 39 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (15) of places DS0000000450.V269272.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. To named Service Users are in category MH(E). No further admissions are to take place in this category without the prior agreement of CSCI. if either Service User leave Orchard Mews, CSCI are to be informed 9th September 2005 Date of last inspection Brief Description of the Service: Orchard Mews is a residential care home, which may provide permanent accommodation and personal care for up to thirty-six older people, some of whom may have Dementia.The home is located within a residential area in the west end of Newcastle upon Tyne, at the bottom of a steep bank, close to Newcastle General Hospital. Local amenities and shops are situated nearby on the main thoroughfare of Benwell and the area is well served by public transport.The threestorey property is purpose built. External on street parking is available at the front of the home and there is a small car park at the side. There is a sensory garden situated in the internal courtyard with water feature, chimes and scented plants. DS0000000450.V269272.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 28th February and involved a tour of the premises, discussions with staff and residents, and a review of care records. The inspection found that the overall standard of care is good. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000000450.V269272.R01.S.doc Version 5.0 Page 6 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 DS0000000450.V269272.R01.S.doc Version 5.0 Page 7 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): 4. Standard 3 was assessed and met at the last inspection. Service users and their representatives know that they home will meet their needs. Intermediate care is not provided EVIDENCE: At the last inspection it was found that the home had admitted some residents whose needs appeared to be outside the registration category for the home. Appropriate action was then taken by the home, and a variation to registration category was granted to allow care to continue, on the understanding that the home were able to meet the needs of these people. There have been no further concerns or admissions outside current agreed categories of care. Standard 3 was assessed and met at the last inspection. Standard 6 was not assessed, as intermediate care is not provided. Standard 2 was not fully assessed but it was noted that the views of service users are now contained in the statement of purpose. DS0000000450.V269272.R01.S.doc Version 5.0 Page 8 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, 9, 10 and 11. Service user’s needs are set out in an individual plan of care. Service users are treated with respect and their right to privacy upheld. Arrangements are in place to ensure staff will act appropriately at the time of death of a service user. EVIDENCE: The care plans of 4 residents were examined. Most were detailed and up to date. The physical care plans of a resident with chronic physical care needs had not been formulated, although it was recognised that they had recently been admitted to the home. These areas would have been identified during a pre admission assessment and care plans should have been devised prior to admission. The remaining care plans were detailed and up to date. Plans are based on the Roper Logan and Tierney model of activities of daily living. The plans showed that they are regularly reviewed and updated and that reviews are regularly held with residents and their representatives. Residents have access to a range of health professionals including dentist chiropodist, GP, optician and district nurses. DS0000000450.V269272.R01.S.doc Version 5.0 Page 9 Medication procedures have improved since the last inspection. One resident is supported to self medicate. A concern was raised about the change in chemist used by the company, and one resident is upset by this as they have used the same service for a long time and have confidence in that service. It is an indication of good person centred care that staff are going to try to ensure that this person’s relationship with the community chemist is maintained as it is their preference and shows that the corporate arrangements do not take priority over individual choices. Residents were treated with respect during the inspection visit. Staff were found to be polite and friendly and were observed knocking on doors before entry. Following the last inspection, staff were spoken to regarding inappropriate descriptions such as calling people “ressies” and describing challenging behaviour in an inappropriate way. It was reported that staff did not mean any disrespect to residents and were now more aware of how this may be perceived. Staff are currently receiving training in palliative care (care of the dying). It is a 12-week course and it is the policy of the home for residents to remain there if it is their wish to do so, and the home can meet their care needs. Staff remain with individuals who are seriously ill, providing 1:1 attention. DS0000000450.V269272.R01.S.doc Version 5.0 Page 10 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): 12, 13, 14 and 15. Social cultural recreational and religious needs are met. 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 daily lives. A wholesome and appealing and balanced diet is now provided. EVIDENCE: A new activities co-ordinator is in place and was observed by the inspector to be highly skilled in their interactions with residents. A good range of group and individual activities are offered and a new newsletter has now been developed. On the day of the inspection, the inspector was impressed by the way in which the activities worker ran a group activity (film show with popcorn in lounge) but had also started some individuals doing activities in their rooms, such as knitting and periodically checked how they were managing and popped in for a brief chat. The residents involved clearly enjoyed the contact and it was a very effective use of time, meaning the needs of a number of people were being met simultaneously. Outings have also been arranged and more are planned. Some people have been to see “Guys and Dolls” for example. The role of the activity co-ordinator will also assist people to maintain links with the local community. Friends and relatives may visit the home at any reasonable time, and may meet in private. DS0000000450.V269272.R01.S.doc Version 5.0 Page 11 Service users are encouraged to exercise choice and control over their lives in most instances. Again, staff are looking at how people with dementia may be assisted to make their views known such as providing picture menus for people with speech and language problems. It is hoped that this can be developed further in other areas of home life. It was noticed during the inspection, that one resident appeared a little bored and began to rearrange some items in the lounge. She was prevented from doing so and was sat back down in her chair. This was probably because the items she was rearranging did not belong to her. However, it did at this point strike the inspector that there was actually very little around the room for people to explore or use to occupy them. This was also a good opportunity for staff to find something meaningful for this person to do although it is recognised that staff do not always react, as naturally as they might when an inspector is present. Repeated actions such as these may ultimately prevent a person from displaying this kind of spontaneity. It is recommended that along with other good practice currently being developed in the home, the availability and opportunity for spontaneous activity is monitored and enhanced. This may include items such as vases and imitation flowers, dusters, and items of various shapes and texture being made readily available. Standard 15 was not fully assessed but at a follow up visit in December, it was found that menus were still not being adhered to, and a further requirement was set in respect of this. At this inspection it was found that the meals being made were the same as those advertised with the exception that a dessert had been changed for Pancakes, as it was Shrove Tuesday, which is fine. DS0000000450.V269272.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): 16 and 18 Service users and their representatives know that their complaints will be listened to and acted upon. Service users are protected from abuse although procedures are not always fully followed. EVIDENCE: A satisfactory complaints procedure is available. Information about how to complain is publicly displayed. There have been 2 internal complaints since the last inspection and none to CSCI. These have been satisfactorily resolved but the progress from initial complaint to resolution is not clearly documented in terms of action taken and by whom. An adult protection issue has been investigated since the last inspection and the findings concluded that no further involvement of adult protection services was necessary. There was, however no record of this concern in the care records of the resident concerned, which is contrary to adult protection procedures. The Regional manager has agreed to review the way in which this issue was managed and identify any further staff training needs. A satisfactory adult protection procedure is in place and staff have all received adult protection training. Despite this it is a concern that this issue has not been documented at all, and no follow up care plan put in place. Immediately following the inspection care records were brought up to date with the relevant information. DS0000000450.V269272.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 Service users live in a safe well - maintained environment. EVIDENCE: The home is clean and well maintained, and a number of areas have been redecorated since the last inspection. There is some mild malodour in some areas of the home, which must be monitored closely. Some lounges appeared a little bare (see standard 14) and chairs are arranged around walls. It is recommended that this layout be reviewed. It is noted that a smaller lounge is often empty and if both were used it may be easier for the layout to be altered. It is encouraging to note that the specific needs of people with dementia are being taken into account during the redecoration process and demonstrates that staff have an awareness of these special needs. An example of this is that the doors on one floor are going to be painted, where possible, to resemble the front door of the person with dementia (with false letter box etc). It is also DS0000000450.V269272.R01.S.doc Version 5.0 Page 14 planned that a box display case will positioned next to the door and something relevant to the person’s past will be displayed to help people to recognise their own room without relying on the written word. This has proved effective in some settings. Maintenance records were examined and include checks push call equipment, window restrictors and wheelchairs. Shower - heads are routinely disinfected. The garden was not inspected during this visit. DS0000000450.V269272.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): 27, 28 and 29 Service user’s needs are usually met by the number and skill mix of staff, Service users are in safe hands at all times and service users are supported by the homes recruitment policy and practices. EVIDENCE: Staff rotas examined show that there were sufficient staff on duty at the time of the inspection. A period of short staffing was reported to CSCI in line with regulation 37 notifications. It was pointed out that although the home was aware of the shortfall a number of days beforehand, the notification was sent after the dates had passed. Staff are properly vetted before being employed by the home. Adult protection procedures are in place, although as previously mentioned appropriate records are not always maintained. This leaves staff and residents in a potentially vulnerable situation. An examination of the most recently recruited staff found that the files contained all of the required information. It is recommended that personal staff health questionnaires are held in a sealed envelope. DS0000000450.V269272.R01.S.doc Version 5.0 Page 16 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, 36 and 38 The home is usually run in the best interests of the service user. Service user financial interests are safeguarded. Staff are not appropriately supervised. Health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: Standard 31 was not fully assessed, as the manager was not present due to having had to cover a night shift. As this has happened before the inspector raised this with the regional manager who confirmed that this is not a regular occurrence and advised that it prevents an agency worker, unfamiliar with the home being brought in. It is expected that this will continue to be the exception and that where possible, avoided. The current manager is registered with the CSCI and therefore has been found fit to be in charge. The regional manager will supervise and monitor the management of the home to identify any additional training needs and DS0000000450.V269272.R01.S.doc Version 5.0 Page 17 guidance that may be required to ensure that the manager continues to be able to discharge their responsibilities in full. This includes the review of the recent POVA and lessons learned. The Deputy Manager is doing the Registered Managers Award. 33 see standards 14 and 28. It is considered that the lack of recording of the recent POVA (Protection of vulnerable adults) issue, means that the home is not always run in a way that meets the best interests of residents. The home is, however, striving to continuously improve and develop practices and demonstrates this is being achieved in some areas. The recent improvement in activities is an example of how the home does meet the best interests of residents. Procedures for the safeguarding of money and valuables remain in place. Staff must ensure that valuables logs are completed promptly upon admission. Staff supervision remains out of date and is an outstanding requirement from previous inspections. Ways in which the home may try to bring the outstanding supervisions up to date were discussed, in order to ensure staff are receiving adequate support and guidance in their work. It is suggested that some group supervision sessions take place to discuss the types of issues common to all staff (practice based), in order to get as many up to date in one go. All staff must be offered opportunities to meet with their supervisor in private to discuss any issues they would prefer to discuss in private. It would be an expectation that once these were up to date, individual sessions would recommence and take place at least 6 times per year. Health and safety policies and procedures are in place. There are routine checks on window restrictors, and hot water, and equipment is checked on a regular basis. New systems have been implemented for the recording of these checks. Fire procedures are satisfactory and the maintenance man and senior care have completed a 3 day fire training course and are identified fire wardens. DS0000000450.V269272.R01.S.doc Version 5.0 Page 18 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 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 3 11 3 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 2 3 X X X X X X X STAFFING Standard No Score 27 3 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 1 X 3 DS0000000450.V269272.R01.S.doc Version 5.0 Page 19 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 OP7 Regulation 15 (1) Requirement Care plans must be available on day of admission for routine physical care needs identified at pre admission assessment. Records of complaints must be clearly documented in all stages. Records pertaining to adult protection issues must be maintained and training needs in this area identified and addressed. Valuables must be logged upon admission. Staff supervision must take place at least six times per year. Timescale for action 28/02/06 2 3 OP16 OP18 17 (2) 17 (2) 28/02/06 28/03/06 4 5 OP35 OP36 17 (2) 18 (2) 28/02/06 28/02/06 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 OP12 Good Practice Recommendations It is strongly recommended that service users are given more opportunities for spontaneous activity and exploration of surroundings, and staff monitor occasions DS0000000450.V269272.R01.S.doc Version 5.0 Page 20 2 OP29 where there is a risk of inadvertently restricting spontaneity. It is recommended that staff health questionnaires are held in their file in a sealed envelope. 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