Inspection on 09/09/05 for Orchard Mews

This inspection was carried out on 9th September 2005.

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 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 Mews 11/07/07

Orchard Mews 26/07/06

Orchard Mews 28/02/06

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 NE4 6UX Lead Inspector Aileen Beatty Unannounced 09 & 21 September 2005 09:30 th st 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 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 Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Orchard Mews Address Bentinck Road Elswick Newcastle upon Tyne NE4 6UX 0191 273 4297 N/A orchardmews@schealthcare.co.uk Southern Cross Healthcare Services Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Miriam Pearson CRH 39 Category(ies) of DE(E) Dementia - over 65 [24] registration, with number OP Old age [15] of places Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 01/12/04 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 three-storey 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. Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over two days, and was completed on 21/09/05. The inspection involved a tour of the premises, checking records and talking to residents and staff. 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. Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 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 standard(s) 2, 3 and 4. Each service user is provided with a written contract and statement of terms and condition upon arrival in the home. The needs of service users are assessed prior to admission to the home. The home is not always able to demonstrate that they can meet the needs of service users admitted to the home with complex care needs. EVIDENCE: A statement of purpose and service user guide is placed into the room of new service users and copies given to representatives if necessary. One new service user said that she could remember having had this information in her room but didn’t know where it had gone. The Deputy Manager agreed to provide new copies. There is an outstanding requirement to include the views of service users in the Statement of purpose. Prior to admitting anyone to the home, care managers provide comprehensive assessment information. The home also carries out an assessment. Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 Page 8 While reviewing the records of some residents it was noticed that their care needs appeared to be more complex than would normally be catered for by the home, therefore suggesting that the home may be acting outside their agreed registration categories. The Commission for Social care Inspection are currently addressing this issue in cooperation with the home so that they are not continuing to breach regulations and to make sure that they are able to meet the care needs of the people concerned. Where a home can demonstrate that they have the appropriate level of training support and resources to care for someone with specific care needs they are able to continue to do so, with agreement from CSCI. The home provides care for some people with dementia. They are exploring news ways of working with people to enhance their overall sense of well being, and to analyse and respond positively to difficulties. On the second day of the inspection, two staff members were observed intervening inappropriately with one resident with dementia who was angry and upset. They were physically trying to remove the person from a room by the arms. It was also noted that inappropriate language was also used to describe behaviour such as “when they kick off” or “don’t behave” and also referring to people as “ressies”. The home works on the principles of person centred care and these examples demonstrate that some of this good work is sometimes undermined. Upon speaking to staff they were able to describe how they could have handled the situation better, and were able to say how they can use staff supervision to discuss any difficulties they have. It is clear that training and support is provided but is not always put into practice. On the first day of the inspection, the inspector saw some lovely interactions. The home is using “doll therapy” as a therapeutic intervention for people with dementia, with guidance from a specialist nurse. It appears to be successful with some people who appeared very settled, fulfilled and relaxed as a result. Staff visiting from other settings such as hospital have been complimentary to the home as they develop their skills in this area. It was confirmed that where the needs of a resident change significantly they are reassessed and if necessary will be moved into nursing care for example. Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 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 standard(s) 7,8 and 9. Health, personal and social care needs are set out in an individual plan of care. Service users health care needs are predominantly met. Procedures for the administration of medicines are generally satisfactory. EVIDENCE: A review of care records took place during the inspection. Care records are generally good, with detailed descriptions of daily occurrences. New documentation is being introduced by the company so it will take some time for all records to be transferred over to the new format. It was noted that new assessment documentation for the ongoing monitoring of physical needs is good. These include prompts to staff to seek specialist advice under certain circumstances e.g. dietary. There was a concern expressed that there is less space to record social activities under the new system which should be considered. Each resident has an individual plan of care, which is based on the admission assessment and is then added to during the placement. These care plans are comprehensive and show a process of assessment, planning of care, evaluation Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 Page 10 and re-assessment. The model is an eclectic format, which covers the activities of daily living. Those examined (5) were completed effectively and were in sufficient detail to allow the care to be planned according to the assessment. There is use of validated assessment tools and there was evidence that relevant risk assessments are available for moving and assisting, and continence promotion. The plans showed that they are regularly reviewed and updated and that reviews are regularly held with residents and their representatives. Some care plan evaluations were found to be out of date but most records inspected were generally up to date. Residents have access to a range of health professionals including dentist chiropodist, GP, optician and district nurses. The home must demonstrate what extra training and support is being provided to satisfy the Commission for Social Care Inspection that the health needs (including mental health) of all residents are being met. Medication procedures are generally satisfactory. There were no unexplained gaps in medication records and a random count of controlled drugs was correct. All staff have level 1 medication training and are now doing level 2. The label on a medication bottle in the fridge was illegible due to having been spilled on. It was agreed that it was unsafe to administer from this bottle and that a new one should be ordered. Some homely remedies were found in the room of one service user including vitamins and Antacid. This was brought to the immediate attention of the deputy manager. Fridge temperatures were not checked daily. Staff must also remember to record the date of opening on short shelf life medication. A record of all accidents is maintained. Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 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 standard(s) 12, and 15. Social and recreational needs are met. A wholesome appealing balanced diet is not always provided. EVIDENCE: An activities coordinator remains in post. Records of activities were available for inspection. On the second day of the inspection the residents were enjoying a concert by a very talented duo who now entertain the home on a regular basis. If activities require that people must be moved around the home, then this must be planned to ensure that this causes minimal disruption to people who do not wish to join in, and to also ensure that adequate supervision is provided in the home. One resident was observed to be angry and upset and this was thought to be due to having been moved from their own floor to enable staff to be involved in the concert downstairs. There was also a short period of time where there were some residents left unsupervised on the top floor. While it was acknowledged that this was probably a one off incident all staff must be reminded to check that there is adequate cover before leaving the floor. Information about past hobbies and interests is gathered to help with activity planning. Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 Page 12 The standard of meals provided in the home is not always satisfactory. The menus were examined and cross referenced with records of meals actually offered to residents. There have been a large number of days where the meals advertised on the menu were not those provided, including on the day of the inspection. On the first inspection day the evening meal being prepared was sandwiches or chips tomato and egg. The menu said that it should have been bacon and lentil soup or fish cakes. On one day cheese on toast was provided instead of savoury spaghetti as a main evening meal. Some residents spoken to expressed dissatisfaction with the standard of meals provided. One person specifically remarked that the food is good. The home were immediately required to ensure that menus are followed and that a nutritious, appealing and balanced diet is provided. At the second inspection, kitchen staff had been spoken to regarding menus and this area will be monitored carefully. Menus must not be changed without the express permission of the home manager. There was no list of special diets available in the kitchen. This was in place on the second day of the inspection. Three residents complained that they get sandwiches too often. Where sandwiches are provided fillings must be listed and contents of cold buffets recorded to allow ongoing quality monitoring and nutritional assessment. Residents should be made aware of what will be offered at each meal time. The environmental health inspection on 4th August 2005 revealed a number of concerns and these must be addressed by the home. A separate environmental health report is provided. The kitchen was found to be generally clean and tidy and on the second day of the inspection kitchen records were appropriately recorded. On examining the week’s options it was noted that the choices for the main meal included similar type of meats and although there were other choices for the days it was of concern that the variety was not always evident. There was an ample supply of frozen, tinned, dried and fresh food available all of which was appropriately stored. The kitchen staff were aware of residents specialist needs including how to fortify foods for those who have poor appetites or those who have lost weight. The menu contains fruit and the residents confirmed that fresh fruit is offered, usually on the afternoon tea trolley as an alternative to biscuits. The trolleys used for the resident’s morning and afternoon beverages are clean but very stained and this should be addressed. Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16 and 18. There is a satisfactory complaints procedure in place. Service users are protected from abuse. EVIDENCE: There is a satisfactory complaints procedure in place. There have been no complaints since the last inspection. Staff have completed adult protection training and the deputy manager said that staff have enjoyed this and appear to be using skills learned on the course. Satisfactory recruitment procedures are in place to ensure staff are properly vetted before they are able to work with residents. Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19, 24, and 26. The home is generally well maintained, and the majority of bedrooms are comfortable and furnished with service users own possessions. The home is mainly clean, pleasant and hygienic. EVIDENCE: A number of rooms have been decorated since the last inspection. There is a rolling programme of ongoing decoration. Communal areas, bedrooms and bathrooms were inspected. Bathrooms are nicely decorated and are made to appear homely and non clinical. A damaged cushion was stored in one bathroom and should be discarded. A damaged bath rug must also be replaced. A personal cleansing and dressing policy was displayed on the bathroom wall and it is recommended that this is removed to a more discreet area such as staff notice board, as it detracts from the homely feel. Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 Page 15 A small number of bedroom carpets were malodorous. Most bedrooms are nicely furnished and residents are encouraged to bring their own possessions into the home. Some are notably more bare than others and it is recommended that staff assist people with no family or friends to make their rooms as homely as possible. Chairs in some bedrooms were damaged and must be replaced. Paper towels are provided in en suite bathrooms but many do not have a bin for these when used. The home is generally clean and tidy and nicely decorated. Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30. Staff are trained and competent to do their jobs. EVIDENCE: Regular training is provided to care staff including adult protection, dementia care, administration of medication, fire safety, food hygiene, and moving and handling. More specialist training is provided as necessary. The home source training and advice regarding challenging behaviour on a regular basis. Doll therapy is a technique used by the home where dolls are available for people with dementia, who may pick them up and gain pleasure and comfort from them. It is not directed by staff and is a low key but very therapeutic tool. It is carried out with supervision and guidance from a specialist nurse who works closely with the home. Some very positive feedback has been received about the home regarding the therapy. Due to some complex needs of some residents some additional training is necessary. Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36. Staff are appropriately supervised. EVIDENCE: The manager was not present for the majority of the inspection. Standards 33,35 and 38 will be inspected in full at the next inspection. Staff are appropriately supervised. They receive formal supervision on a regular basis. Staff also referred to supervision during discussions about practice. There are also regular staff meetings. Standard 38 was not fully assessed during this inspection. It was observed however, that a resident opened the sluice door on the top floor so an alternative method for securing the room must be considered. Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 x x x x 3 x 3 STAFFING Standard No Score 27 x 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 3 x x Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 Page 19 no Are there any outstanding requirements from the last inspection? 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. 2. Standard OP1 OP4 Regulation 4 12 (1) Requirement Timescale for action 21/12/05 21/10/05 3. OP4 12 (1) 4. OP9 13 (2) 5. 6. OP27 OP21 12 (1) 16 (2) Include the views of service users in the Statement of Purpose. Outstanding. (a) The home must demonstrate it is able to meet specialist needs of service users. Targeted training to meet the specific needs of service users identified during the inspection must be provided. (a) Appropriate language must be used at all times to describe behaviour and people. Physical restraint must not be used to remove service users deemed not at risk to themselves or others. Homely medication must be stored and administered in line with the homes medication policy. Short shelf life medication must be dated when opened. Fridge temperatures must be checked daily. (a) Staff must be deployed effectively to ensure service users are supervised at all times. (c ) Where paper towels are provided in en suites, a suitable waste bin must be provided. 21/11/05 Immediate Immediate 21/10/05 Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 Page 20 7. 8. OP38 OP19 12 (1) (a) 23 9. OP15 16 (2) (i) Sluice facilities must be inaccessible to service users. The stained tea trolley must be cleaned or replaced. Chairs with damaged cushions must be repaired or replaced. Damaged bath mat must be removed. (Immediate) Malodorous carpets in identified rooms must be replaced. Menus must be followed and a record maintained of occasions when changes were unavoidable. Choices of sandwich fillings must be provided and records of fillings used maintained for quality monitoring purposes. 21/10/05 21/01/06 Immediate 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. 3. Refer to Standard 10 15 19 Good Practice Recommendations Information to staff regarding personal care tasks should be displayed discreetly. More variety of meats should be considered. Residents without relatives could be assisted to brighten up bedrooms, some of which are very bare in comparison to others in the home. Orchard Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Northumbria House Manor Walks, Cramlington Northumberland Northumberland 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 Mews B53-B03 S450 Orchard Mews V226713 090905 Stage 4.doc Version 1.30 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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