CARE HOMES FOR OLDER PEOPLE
Orchard Nursing & Residential Care Home The St Mary`s Road Huyton With Roby Merseyside L36 5UY Lead Inspector
Mrs Joanne Revie Unannounced Inspection 21st December 2005 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 Orchard Nursing & Residential Care Home The DS0000005465.V273763.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 Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Orchard Nursing & Residential Care Home The Address St Mary`s Road Huyton With Roby Merseyside L36 5UY 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) 0151 449 2899 0151 287 6501 Flightcare Limited Mrs Margaret Josephine Brown Care Home 55 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (25), of places Physical disability (4) Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Service users to include up to 25 OP - N(Nursing) and up to 4 PD N(Nursing) and up to 26 DE(E) - PC(Personal Care) One named female out of category service user, under pensionable age Maximum no registered 55, of which up to a maximum of 29 N (Nursing) and up to a maximum of 26 PC ( Personal Care) 04/07/05 Date of last inspection Brief Description of the Service: The Orchards is registered to provide nursing, personal and residential care for older persons over 65 years. 27 beds are registered to provide residential care for older people with mental health needs who do not require nursing care. 27 beds are registered for nursing care. 4 beds are registered for Adults under the age of 65 years old. The home is a private company which is registered in the name of Flightcare Ltd. The home is situated in a residential area of Huyton close to local amenities. Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The visit was unannounced and focused on compliance with meeting the requirements that were issued following the last inspection and assessment of the remaining core standards which were not reviewed during the last visit. Both units were inspectected simultaneously. Discussions were held with 8 members of staff, both cooks, unit managers, 8 residents, and two district nurses. Their views have been reflected within the summary section of the report. A variety of documentation was also viewed which is referred to in the evidence section of the report. What the service does well:
The home presents as a comfortable place to live. It appeared clean and tidy and the areas viewed were decorated and furnished to a good standard. Regular safety checks are carried out on all equipment that is used by staff and residents. This includes fire fighting and prevention, and gas and electricity supplies. This means that the home is a safe place to live. The home manager is a qualified nurse who is registered with the CSCI as the registered manager for the service. This means that CSCI have completed checks and are satisfied that the manager is “ fit” and has sufficient experience and knowledge to do her duties. Medications are managed safely on the nursing unit. This means that residents receive their medication as it is prescribed and that staff understand the importance of following steps to reduce the risk of a mistake occurring. Residents spoken with stated that “ the girls are good, they work very hard” and “ I’m well looked after”. This shows that these residents believe that their needs are being met. Discussions were held with staff, district nurses, residents and a relative on the EMI Residential unit. They all commented positively on staff ability. A relative commented that “Can’t fault these staff; they’re fantastic, if I have any problems I just let the staff know and its sorted”. Residents stated ” staff cant do enough for you” and “I can do what I want the staff look after me well”. The district nurse commented that staff “ try very hard to get it right” and are always welcoming”. These comments show that the staff try hard to give good care. Discussions with staff showed that they believe that the unit is well managed. One staff member commented, “ (unit manager name) is very good, I don’t
Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 6 know what we’d do without her”. Another member of staff stated that “ I like working here, were a good team” and “ we know our residents well and know what they want”. These comments show that staff are settled in their role and that they enjoy their work. This is important as good staff morale helps to promote a pleasant atmosphere for the residents. The service provides a range of home cooked meals for both units. Residents confirmed that they enjoyed the food on offer by stating” the food is tasty, I like what I get to eat” and “ if I don’t want something the girls will always get me something else, they’re very good”. The service employs care staff who half of which have achieved NVQ qualifications in care. Senior care staff that take charge of shifts on the EMI Residential unit have achieved Level 3 qualifications in care and the unit manager has achieved Level 4. This shows that the service tries to develop staff to ensure that the residents receive good care. What has improved since the last inspection?
Since the last inspection both units are ensuring that all assessment documentation for a new resident is received before admission takes place. Both unit managers have also become involved in the assessment process. This means that the staff who are directly responsible for managing the two staff teams are able to decide whether their team is able to meet the residents needs. It also means that staff are able to plan how they are going to meet the residents needs, as they will have full written information before admission takes place. This reduces the risk of a resident living in a home that cannot meet their needs and this also helps to reassure new residents that the home knows how to care for them. Staff who work on the EMI Residential unit have developed records to show when a resident has received a visit or treatment from an outside health care professional such as dentists, chiropodists, doctors etc. This means that staff can clearly and quickly identify who has given what advice and when this occurred. This can be useful when a summary of the residents needs is required. Staff on the nursing unit are taking part in a pilot initiative, which is lead by Knowsley Council. The pilot involves monitoring the level of falls on the unit and fully exploring why these have occurred. Consideration is given to details such as what medication the resident is taking when the fall occurred. This is a useful study and is providing staff with necessary skills to monitor and hopefully reduce the risk of a resident falling. It also shows commitment from the home to develop and improve the service offered. Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 7 Both units have developed the range of activities on offer. The activities coordinators have both undertaken training to enable this to happen. Some records viewed were very clear (aromatherapist -nursing unit) and gave a good overview of why the activity is occurring and the resident’s response to this. This shows that both units recognise that the provision of fulfilling activities promotes a better quality lifestyle. The nursing unit has turned a bathroom, which was not used into a walk in shower room. Staff stated that this was very useful and several residents were enjoying having showers rather than baths. This is an improvement as it offers the residents on the nursing unit a choice of either having a shower or a bath. Bathrooms on both units have been redecorated in pastel colours. Staff have used coordinating pictures, plants etc as further decoration. All of this helps to promote a homely atmosphere for the benefit of the residents. What they could do better:
It is a matter of concern that some requirements that were issued following the last inspection had not been addressed. These included those made in relation to the development, reviewing and involvement of residents and families in the plans of care for the EMI residential unit. These outstanding requirements must be addressed to ensure staff have and use clear written up to date information about a residents needs. Residents and if appropriate relatives should be involved in the development of plans to enable residents to feel in charge of their lives and to enable relatives to feel involved. It was identified that a requirement that was made regarding medication for the EMI residential unit had not been fully addressed. Some progress had been made but some practise was identified that could result in mistakes occurring. Therefore a CSCI pharmacy inspector has been asked to visit the unit to review practise and to offer support and guidance to the staff. This should ensure that medications are managed safely in the future and reduce the potential risk of a mistake occurring. However the home manager must ensure that the resident identified in the evidence section of this report receives their medication as prescribed without further delay. Although the provision of activities has been developed further, recording of activities needs attention. Staff were unaware of the planned activities on the EMI unit and no programme was displayed to inform residents and relatives of what was happening when. Record keeping needs further development on both units and staff must ensure that residents are consulted about how they would like to spend their time. These areas are a concern as they were identified during the last inspection and had not been addressed. Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 8 Although the residents spoken with enjoy the food provided, some areas could be improved further. Areas to be addressed include why in some instances staff are making choices of meals for some residents. After exploration if this is acceptable, records must be developed showing how staff have reached these decisions and made these choices e.g. information received from discussions with residents/ relatives regarding food preferences etc. Staff were seen to be very supportive to the residents whilst they were eating however it was noted that one resident on the EMI Residential unit would have benefited from specialised cutlery /aids to further promote their independence and to protect their dignity. Plans must be made to ensure that these items are provided and available to those who need them. Records must be also developed for the EMI residential unit showing that residents are being regularly weighed. It would be advisable to carry out nutritional risk assessments for those residents who are refusing to eat or have a poor appetite. This would enable staff to be more aware of their needs and plan how the resident is to be supported to have sufficient nutrition. Tools should also be developed to monitor the number of falls occurring on the unit. This should include falls risk assessments and falls diaries. Since the last inspection many staff have attended abuse awareness training. This has included some senior staff attending;” alerting the alerter” which is designed to inform staff of what to do when abuse occurs. Two incidents (one on each unit) were identified which should have been reported to Social Services under adult protection procedures. Discussions took place, which showed that senior management lacked understanding of when to report incidents and how restraint practises could be viewed. In order to protect the residents in the home staff must revisit this training. An urgent review of needs must be requested for the nursing resident who was identified and discussed during the inspection. A requirement was made following the last inspection that staff on the EMI Residential unit revisit training on managing challenging behaviour. This had not been addressed. Efforts have been made to address a requirement that was made in relation to the resident’s finances however this needs further development. The home manager does not know the amount of personal allowance that each resident is entitled to receive as recorded on the placement statement. Details are not available of whether residents have a representative/relative who acts as appointee, power of attorney etc. The manager must have access to up to date copies of placement statements and explore if anyone has legal rights over the management of the residents financial affairs. Once this information is available the manager must familiarise herself with the different legal positions that can be held when managing monies on behalf of others. This will enable her to uphold the resident’s rights and ensure that they are protected from financial abuse. Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 9 Although the home manager sends out satisfaction questionnaires, staff views are not included within this. Residents who live on the EMI residential unit are also excluded and do not attend unit meetings. This must be addressed so all parties are included. On receipt of completed questionnaires the home manager must ensure that a conclusion is drawn and all parties involved are informed of outcomes. This will reassure everyone that their views are listened to and acted on and will help to make residents feel as though they have a “ voice” and are in charge of their own lives. Generally the service cats responsibly towards Health and Safety and tries to provide a safe environment to live and work in however shortfalls were identified in the kitchen areas of the home. These shortfalls must be addressed to reduce the risk of infection occurring. 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 Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 10 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 Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home is complying by addressing a requirement, which was made following the last inspection, which requested that all assessment documentation for each new resident is received prior to admission. EVIDENCE: Discussions were held with both unit managers and assessment documentation was viewed. Both unit managers confirmed that they ensure all assessment documentation is received prior to admission and this documentation was viewed in the care plans. Both managers have supported the registered home manager to carry out assessments on potential residents. Evidence was viewed that showed that the staff of the EMI residential unit had contacted social services and requested a further assessment as the residents needs had changed. A discussion with a social worker confirmed this to be true. Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 12 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 Visiting professionals, relatives and residents believe staff on both units offer a good standard of care. Staff on the EMI residential unit are not involving residents or relatives in care plan reviews. Care plans are not reviewed as regularly as they could be. Staff did not have access to written instructions regarding the needs of all the residents on the unit. Staff prefer to communicate verbally rather than reading the care plans or recording information. Medications are not managed safely on the EMI Residential unit. Medications are managed safely on the Nursing Unit. EVIDENCE: Four care plans were viewed in total. It was identified that one resident who was residing on the EMI residential unit did not have a care plan in place. This is matter of concern as a requirement was made following the last inspection, which requested that all residents have care plans in place. This was discussed with the Home manager who confirmed that this had been discussed with staff but had not been formalised as requested by CSCI into a policy. Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 13 A further requirement was made that all care plans must be reviewed regularly and that this involved either the resident or a relative (where appropriate). Two plans were viewed on the EMI Residential unit, which had no input from either party. The unit manager has developed a summary section for each care plan, which gives a good overview of the resident’s needs however staff are still verbalising all instructions rather than reading or recording in the plans of care. No documentary evidence could be found to show that the resident’s choices and preferences about their daily routines had been considered. Health care records have been developed since the last inspection. Clear details of who visited when are now available on the unit. Discussions were held with a relative, four residents, two district nurses and a social worker. All commented positively on staffs ability to care. A discussion took place with the deputy manager and records were viewed which showed that the unit has become involved in a pilot scheme with Knowlsey Council to monitor and reduce falls on the unit. The medicine trolley, cupboards and medication administration records were viewed on the nursing unit. A nurse was observed administering medication to the residents. All records were found to be clear and the documentation completed to the required standard. The trolley was tidy and organised. The staff member administered medications safely. Medications and associated documentation were viewed on the EMI residential unit. A requirement was issued following the last inspection, which required that all medication be given as per the homes policy. There was no policy available on the unit for the management of medications. Since the last inspection the Health Authority has undertaken a review on medication and identified areas of concern that had not been addressed. Although staff have received training in medications there is no review of their competency therefore it is not possible for the Home to say if staff are competent to give out medications. Loose tablets were found in the medicine cupboard. Medicine carry boxes were tidy and clean, which is a big improvement on previous inspection. One resident has metranidazole prescribed. The manager detailed that this was to be given 1 tablet in morning and 1 tablet at night for 2 days, none for two weeks and then repeat. This was not in writing on the script nor recorded in the resident’s records. Three doses were noted for the first two days and then one dose in the morning for 4 days. It was explained that the night staff were not giving the doses at night. The medications were not recorded or administrated appropriately. Not all medication was signed for to show when or if it was administered. Not all medication received was recorded.
Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 14 Stickers had been used on several medications on one occasion that were stuck over a set of different instructions. There were handwritten entries, which did not repeat the label directions. These were not signed by the person writing them or signed by another staff member to show that they were correct. Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 A range of activities is provided on both units but records do not exist to show that the residents have chosen these. Residents are generally offered a choice of food that they enjoy EVIDENCE: Activities records were viewed on the nursing unit. A discussion was held with the deputy manager. Since the last inspection a programme of activities has been developed rather than activities occurring Ad Hoc. A notice board is situated close to the communal areas, which displays information about forthcoming events. Outsiders such as the arometherapist keep clear records however records for all activities need to be developed further. I.e. who took part in what and whether it was a worthwhile experience. Staff commented positively on the range of activities available. Since the last inspection the activities coordinator and the deputy manager have undertaken training around the provision of appropriate activities. The provision of activities was reviewed on the EMI residential unit. A requirement was made following the last inspection that an activities programme was to be displayed on the unit. This had not been addressed. Activties have been developed further to include a movement to music class and records are kept of this however on the day of the visit no activity had been planned.
Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 16 A notice board is available; solely to display forthcoming activities but this had not been fully completed. Since the last inspection the activities co-ordinator has attended training on her role. During discussions Staff were not aware of what activities where scheduled or how they were to assist. No evidence of activities was observed during the inspection. The activities co-ordinators records do not show that the provision of activities is reviewed or discussed with the residents and no evidence could be found to show that their preferences are being recorded. Discussions were held with four residents regarding the provision of meals. All commented positively. Discussions were held with both chefs and copies of menus were viewed. Each unit has two dining rooms. Both had tables that had been set with cloths and condiments. Staff were observed supporting the residents with their lunchtime meal in an appropriate manner. Nursing Unit- staff were seen and heard to offer choice. One resident changed their mind as their meal arrived. Staff were heard supporting the resident to make another choice. Staff wore disposable plastic aprons to reduce the risk of cross infection occurring. A discussion with the deputy manager confirmed that originally cloth tabards had been used but these were no longer available. Copies of food surveys were viewed. These had been formulated by the chef and distributed, to measure satisfaction. The preparation of the lunchtime meal was viewed. This was home cooked with fresh ingredients. The meal lasted forty minutes and residents appeared relaxed and unhurried. EMI Residential- a variety of meals were seen. These included a choice of main meals and of accompanying vegetables. A greater choice appeared available in the dining room next to the kitchen. In the other dining room choice was also given however staff rather than the residents made the choices. It was thought that staff had interpreted that these residents lacked capacity to make choices and staff had chosen food that they thought would be easier for them to eat and therefore more enjoyable. There was lots of support and encouragement to eat and enjoy the food. One resident struggled to eat the meal, as the cutlery and plate were not suitable to meet their needs. The mealtime was calm and relaxed, staff attended to residents in a calm and encouraging manner. Two residents were noted to decline the main meal, one in each dining room. Both were very slight in build. Neither were given an alternative. Records in the unit did not show that staff were monitoring the residents weight. Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Staff have had training to ensure that they know how to protect the residents from abuse however staff require further guidance to ensure that they fully understand what can constitute abuse. EVIDENCE: Discussions were held with staff on both units. Two care plans were viewed. A copy of the training programme was reviewed. Staff have received training on abuse awareness and some senior staff have attended an “ alerting the alerter course”. EMI residential- records were viewed that showed a resident had incurred bruising, which hadn’t been investigated. The unit manager stated that this was because the bruising was old and usually all concerns are reported to Social Services. Nursing Unit- A resident was found to be restrained in a chair at the request of her family by using a wheel chair lap strap. A discussion took place with the unit manager who confirmed that the relatives of this resident had completed documentation but that a review would be organised to assess whether the home would be suitable for this residents needs. During the second day of the inspection the home manager confirmed and showed a copy of the agreement, which had been signed by the family but was unable to confirm whether a review of needs had been requested. Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 18 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 Residents live in safe comfortable home EVIDENCE: A tour of the homes communal areas and bathrooms was undertaken on both units. The stair gates on the EMI residential unit have been removed making the stairways safer. Bathrooms on both units have been redecorated in homely colours and pictures plants etc added which helps promote a more homely atmosphere. All communal areas viewed were decorated and furnished to good standard. The home appeared clean and smelt pleasant. No new Health and Safety risks were identified in the areas viewed. Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 19 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): 28,30 Staff are trained or are receiving training to achieve NVQ s however other staff training needs revisiting to ensure residents are in “ safe hands”. EVIDENCE: Discussions were held with both unit managers and the home manager. Training records and a training plan were viewed. It was evidenced that greater than 50 of care staff have achieved an NVQ qualification and that this remains on going. The unit manager for EMI residential has achieved NVQ level 4. Each senior carer in charge of shifts for this unit has achieved an NVQ level 3. A requirement was made following the last inspection that staff on this unit revisit managing challenging behaviour training. This had not been addressed. Although staff on the unit have received training n the administration of medications no competency test is carried out to make sure staff are safe. Both groups of staff have received abuse awareness training but as identified previously this needs to be revisited. Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 20 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): 31,33,35,38 The home manager is “ fit” to manage the home. All parties who are involved in the home are consulted about their views but this information is not compiled into a conclusion therefore these parties are not aware of outcomes. The manager does not have access to full up to date information about the residents financial affairs so therefore is unable to protect their rights. The home is safe place to live however the kitchen areas are not as safe as they could be. EVIDENCE: Discussions were held with both unit managers and the home manager. A variety of documentation was viewed which showed that the home manager is registered as a nurse and has achieved a level 4 NVQ in management qualification. The unit manager for the EMI residential unit has also achieved this qualification.
Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 21 The home manager is sending out satisfaction surveys to various parties within the home. However following discussions with the unit manager and the home manager it was evidenced that residents who reside on the EMI unit are not included in this process and do not attend regular meetings. Once surveys are returned the home manager confirmed that she acts on any concerns however this information is not correlated into a report therefore she is unable to formally respond to anyone who has taken part. The home manager confirmed that Staff are not included within this process. A discussion took place with the responsible individual for the home. He confirmed that the home manager has up to date information about the resident’s financial affairs. This was viewed and discussed with the home manager on day two of the inspection. The information only shows what money is coming in and going out. It doesn’t detail whether the residents relatives are power of attorney, appointee etc for their affairs. It doesn’t detail what personal allowance the resident is entitled to. Certificates and policies were viewed which relate to Health and Safety. It was evidenced that the home has all expected contracts in place and that safety checks on all equipment are current. Training records showed that staff have undertaken training on manual handling, first aid, health and safety and fire prevention. Shortfalls were identified in the kitchen areas of the home. The grouting to the tiles of both kitchens were found to be stained and discoloured and in need of attention. The EMI residential kitchen also required a waste bin with a lid, and replacement fly screens at the windows as these had been torn. Both chefs are ensuring that fridge/freezer temperatures are regularly checked and that stocks of food are rotated. Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 22 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 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 3 X X X X X X X STAFFING Standard No Score 27 X 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 23 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 EMI RESIDENTIAL-A policy must be developed detailing when care plans for new residents will be developed by. This must be implemented and all staff made aware. Outstanding EMI RESIDENTIAL- Staff must ensure all plans are reviewed with residents/ relative input and all information ( including that stored to Staff memory) is added to the plans.Particular attention must be paid to the wishes of the residents.Outstanding EMI RESIDENTIAL- the resident who is identified in the evidence section of this report must receive their medication as psecribed without delay. EMI RESIDENTIAL Medication Adminstration records must be completed as per the homes policy Outstanding BOTH UNITS- an acivity programme must be developed on a weekly basis and displayed in a prominent position.Outstanding Clear records must be developed
DS0000005465.V273763.R01.S.doc Timescale for action 31/01/06 2 OP7 15.-(1) 28/02/06 3 OP9 13.-(2) 15/01/06 I OP9 13.-(2) 28/02/06 5 OP12 16.-(2)(n) 31/01/06 6 OP12 16.- 31/01/06
Page 24 Orchard Nursing & Residential Care Home The Version 5.0 (2)(n)(m) 7 OP12 16.(2)(n)(m) 8 OP15 12. -(2) 9 OP15 12. (1)(a) 10 OP15OP8 12. (1)(a) 13. -(6) 11 OP18 12 OP18 15(2)(b) (c) 13(7) 13 OP30 18. (1)(a) 12. –(2), 24. –(3) 24. –(3) 14 OP33 15 OP33 showing which residents undertook which activities and how the residents would prefer to spend their time. EMI RESIDENTIAL UNITresidents must be consulted about how they want to spend their time. Staff must support them with this and explore ways of promoting choice to the residents.Outstanding EMI Residential- the manager must explore why choice is not fully offered to all residents on the unit. If choices are to be made by staff then this action must be supported by the resident’s preferences and this must be recorded accordingly. The manager must ensure that there are adequate supplies of specialised cutlery, plates, slip mats etc for those residents who are experiencing difficulties when trying to eat independently Residents weight must be monitored and appropriate action taken if weight loss occurs. The manager must ensure that staff revisit abuse awareness training; familiarise themselves with social service s role and responsibility. The manager must ensure that an urgent review of the nursing residents needs as discussed during the inspection is requested and acted on. EMI RESIDENTIAL- Staff must revisit training on managing challenging behaviourOutstanding Residents who live on the EMI Residential unit must be consulted about their views of the service. The manager must ensure that
DS0000005465.V273763.R01.S.doc 31/01/06 28/02/06 28/02/06 28/02/06 10/03/06 31/01/06 28/02/06 10/03/06 10/03/06
Page 25 Orchard Nursing & Residential Care Home The Version 5.0 16 OP35 13.-(6) 17 OP38 23. – (2)(b) all survey results are complied into a report and that all respondents are informed of outcomes. Staff must be included in this process. The manager must have access to resident’s placement statement to determine what financial benefits they are entitled to. Relatives/ representative’s legal rights over these monies must be explored. The responsible individual must ensure that the shortfalls identified in both kitchen areas (see evidence section of report) are addressed. 31/01/06 31/03/06 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 2 3 Refer to Standard OP15 OP8 OP31 Good Practice Recommendations Staff on the nursing unit should use something other than disposable aprons when serving meals. The manager should consider implementing nutritional risk assessments for all residents within the home. The service should consider supporting the deputy manager for the nursing unit to achieve a level 4 qualification NVQ in management Orchard Nursing & Residential Care Home The DS0000005465.V273763.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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