Inspection on 26/10/06 for The Orchard Nursing & Residential Care Home

This inspection was carried out on 26th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

The Orchard Nursing &... 06/02/08

The Orchard Nursing &... 05/07/07

The Orchard Nursing &... 13/12/05

The Orchard Nursing &... 04/07/05

The Orchard Nursing &... 21/03/05

The Orchard Nursing &... 22/09/04

The Orchard Nursing &... 31/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Orchard Nursing & Residential Care Home The St Mary`s Road Huyton With Roby Merseyside L36 5UY Lead Inspector Mrs Joanne Revie Unannounced Inspection 26th October 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 Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 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 57 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (27), of places Physical disability (4) Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service users to include up to 27 OP - N(Nursing) and up to 4 PD N(Nursing) and up to 26 DE(E) - PC(Personal Care) Maximum no registered 57, of which up to a maximum of 31 N (Nursing) and up to a maximum of 26 PC ( Personal Care) One named female out of category service user, under pensionable age The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 21st December 2006 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 with physical disabilities over the age of 65 years old. The home is a private company, which is registered in the name of Flightcare Ltd. The responsible individual for the service is Mr. Danje and the registered manager is Mrs. Josie Brown. The home is situated in a residential area of Huyton close to local amenities. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit was unannounced and took place over ten hours. Two inspectors visited the service. The manager was provided with a list of records that the inspectors wished to view and most of this was made available for viewing during the visit. These records are referred to in the evidence section of this report. Discussions were held with residents, relatives and representatives and staff. Their comments are included in the summary section of the report. The service provides care to a large number of elderly people who are frail and at times find it difficult to communicate verbally. For this reason conversations with residents were brief. Ten comments cards were left after the site visit for representatives of residents to complete and return to CSCI if they wished. None have been received. Feedback was given to the manager and the responsible individual during and at the end of the inspection. The arrangements for equality and diversity were discussed throughout the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs and the practices that they put into place into meeting those needs. What the service does well: The manager undertakes assessments on all prospective residents before they move into the home. This means that the manager is able to decide whether the Orchards would be a suitable place for them to live and gives prospective residents the opportunity of meeting with a key member of staff. The service employs a regular staff team on both units and residents and relatives believe that they are supplied in sufficient numbers to meet their needs. Residents commented that “ staff are good”, “ the girls are good, and they look after me well”. A relative whose spouse lives on the EMI unit commented that staff were always respectful to the residents.” they’re always nice and kind to him” Care plan documentation on this unit is reviewed monthly. This means that staff are trying to keep records up to date. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 6 Both units are very welcoming to visitors. The home has open visiting hours and visitors are free to visit as often as they choose. Staff support the residents to visit places outside the home such as church services etc. Both units are decorated to a good standard and are warm clean. Residents are encouraged to make their bedrooms their own by furnishing them with small pieces of furniture and personal items. Residents believe that staff listen to their concerns. Residents enjoy the food offered to them and on the day of this visit this looked appetising. What has improved since the last inspection? The manager has developed a policy since the last inspection, which details when new residents care plans will be developed by. Care plans hold vital information about a residents needs and should provide clear written instructions for staff to follow to enable them to care for the resident. The manager has started to carry out monthly medication audits in response to a requirement that was made by a CSCI pharmacist at a previous visit. The manager is trying to review a selection of care plan documentation on each unit on a monthly basis to ensure staff are recording correct information about the residents care. Although the above has been in place as detailed in the next section these actions have not been successful. The responsible individual (RI) has ensured that the programme of redecoration and refurbishment has been completed (with the exception of new curtains to the communal areas on the nursing unit). Plans have also been developed to change the use of two rooms on the Dementia unit to a relaxing therapy room and a cinema screen lounge for viewing of films. Staff on the Dementia unit have included some of the residents personal preferences within their care plan but this needs to be developed further. Staff on this unit are also keeping records, which showed that the residents are encouraged to choose what they would like to eat and which activities the residents take part in and have made some progress in consulting residents about how they like to spend their time. An activities organiser has been recently employed to work on the nursing unit and a trip out to Blackpool has been arranged for all residents in the near future. Since the last visit, the kitchen on the Dementia unit has been developed so that it is fully operational as a kitchen (rather than its previous use as a satellite kitchen) and has been fitted with new furniture to accommodate this. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 7 This means that the unit is equipped to meet the catering needs of the residents rather than accessing the kitchen in the unit next door. Some staff training has taken place in some areas on both units. The responsible individual has sourced an outside training agency to ensure mandatory training (i.e. first aid, health and safety and manual handling) is available and some staff have undertaken this since the last visit. The home is part of a group of homes belonging to Flight care Ltd. The RI is starting to develop quality assurance systems further and has recently sent a mystery shopper to each home. Their purpose was to assess how helpful, staff are to prospective residents and relatives when they are trying to choose a care home. What they could do better: Serious concerns have been identified during this visit regarding the manager’s understanding of what constitutes abuse and the appropriate action to take should she suspect abuse has occurred. This matter as well as the number of outstanding requirements (16), given at the previous inspection which include inappropriate action taken regarding potentially missing medications, inadequate management of health and safety matters, providing accommodation to residents which the service is not registered for and inadequate management of recording systems are to be discussed as part of a management review of the home by CSCI. This means that CSCI will decide what action should be taken to ensure residents are protected and that the home is managed to ensure it complies with the Care Home Regulations 2001. A copy of the homes statement of purpose was viewed. The information within this did not correspond with the homes registration certificate. The certificate on display was a photocopy and the manager stated that it was the wrong one. The manager and RI believed that the home was registered to provide care to residents under the age of 65 and as a consequence residents under this age were living at the home. One resident had needs that were beyond the scope and skills of general nurses. A service users guide was not available for viewing and none were found in the bedrooms viewed. These documents should be given to residents, and relatives, as they provide important information regarding the facilities and services provided by the home and what residents can expect. Although the manager is undertaking assessments of new residents staff are not acting on the findings of the assessments, nor transferring this information into the careplan. Some assessment information was not available, particularly the recent reviews undertaken by Social Services. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 8 Although staff are updating the plans of care no consideration had been given to whether the residents needs had changed and whether the care being given is still what the residents requires. Risk assessments relating to Health such as development of pressure ulcers and nutritional risk appeared meaningless because in some cases records viewed provided conflicting information to that contained within the plan of care. One resident did not have a careplan. This is matter of serious concern as staff require written instructions to follow so that they are able to deliver the correct care required. Record keeping regarding resident’s care was poor. Staff were not completing documentation as per the homes policy and were not responding to written requests, which had been made by their colleagues regarding residents care. Accidents records could not be located and one accident had occurred which had resulted in a request for an ambulance, which had not been recorded as an accident at all. The manager is attempting to audit care planning but is not fulfilling her own policy of reviewing a selection of plans every month. Several Incidents were observed on the nursing unit during the visit, which showed that staff are not respecting residents privacy and dignity. One incident observed in particular resulted in a residents nakedness being potentially exposed by a staff member to other residents close by. Many of the residents who reside on the Dementia unit are encouraged to wear their nightclothes during the early evening, which can affect their privacy and reduce their dignity. One lady was heard asking to go to bed. Staff replied that it was too early. This situation could potentially cause confusion to a resident who already has mental health needs. Ongoing issues have been identified around the management of medications at the home. This has resulted in specialised inspections taking place by a CSCI pharmacy inspector. During this visit it was evidenced that little progress had been made with management of medication and unsafe practises, which required urgent action, have not been addressed. The manager of the home was not aware of the severity of the concerns and had not taken appropriate action. These matters have been referred to the Social Services department and the Police. Issues have been identified around the provision of and recording of activities on both units at the last inspection and during this visit. Although some progress had been made regarding the requirements made, these are not adequate enough to comply with the regulations. There is insufficient evidence to show that residents are feeling fulfilled and in control of their lives. A resident stated” I’m bored- there’s nothing much going on”, a member of staff stated,” no, we don’t do activities there no point, they don’t want to do anything”. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 9 A day board is displayed on the nursing unit but this advertised the wrong information and informed residents that the date was the 13th(it was the 26th) and that the next meal was lunch when in fact it was the evening meal. This could cause confusion for the residents. Although some progress has been made with consulting residents on the Dementia Unit, an activity was observed which few were joining in. This would suggest that residents are still not undertaking activities, which are suitable to their needs and demonstrates that staff to understand the purpose of offering activities which are suitable to a residents needs and preferences. On the day of the visit the lunch time meal offered was not detailed anywhere on the homes six-week menu on either unit. No records were available on the nursing unit to show how residents who need a special diet are being catered for or what choices are being offered to the residents. The chef explained that staff tell him about these before the meal. Neither unit displayed a menu telling residents what they could expect at the next meal. This meant that a decision could not be reached as to whether residents were being provided with a nutritious variety of food. A requirement was made following the last inspection that specialised cutlery and dishes be made available to promote independence for those residents who struggle to eat by themselves. This had not been addressed. The chef revealed that blended diets are offered as one meal (i.e. all parts of the meal are blended together to make one dish rather than offering separate tastes on the plate.). This is very unappetising and shows that these residents are being treated differently from those who don’t have a blended diet. This could be viewed as discrimination. A requirement was made that the tiles to both kitchens be cleaned following the last inspection. During this visit it was evidenced that attempts have been made to do this but it was unsuccessful. This means that this requirement is outstanding. Concerns were identified regarding the level of cleanliness in the kitchen. The RI explained that the kitchen was to be replaced with new equipment the future but that no fixed date had been made. Environmental Health department at the request of the inspectors have visited the home since the CSCI visit took place. They have confirmed that other than these concerns no other concerns were noted in either kitchen. Although some staff training has taken place it was very difficult to work out who had undertaken what training and when. This could indicate that not all staff have had up to date training to meet the needs of the residents. A requirement was made following the last inspection that staff on the Dementia unit undertake training on managing challenging behaviour. Some staff have undertaken this but not all which means that this requirement is now outstanding. It was also identified that some residents who live on the nursing unit have been diagnosed as having dementia. Staff on both units have not undertaken the specialised training required to meet this need and the nursing unit is not registered to provide accommodation to residents with dementia. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 10 One resident was found to be below the age range on the registration certificate and staff were supporting the resident to maintain a specialised regime, which was important to the residents health and welfare. Staff have not had training to carry this out. Staff files were viewed as part of the inspection process. Gaps were found in the documentation that is required to be kept by Care Home Regulations 2001 on each staff member. This means that the necessary checks to ensure that staff are safe to work with vulnerable elderly residents had not been carried out for all staff and recruitment practises operated by the home are unsafe and place residents at risk. This must be addressed. It was difficult to evidence whether new staff have received a proper induction to their role due to conflicting and disorganised training records. The manager must familiarise herself with the national training organisation induction standards for care staff and ensure that all staff receive this. Two requirements were issued following the last inspection, which relate to the quality assurance. Quality assurance has been developed within the home but the final report has not been produced and shared with those who took part and no evidence could be found that consultation is taking place on any level on the Dementia unit, which makes the requirements outstanding. The manager said at this inspection and the previous inspection that she does not understand the information sent to her about resident’s personal allowances or what resident’s weekly entitlement is. A requirement following the last inspection relating to this was given. Despite this requirement the manager had not gained more insight into this important area that can impact upon residents well being. Although the home supplies a regular staff team and residents believe they are provided in sufficient numbers an incident occurred on the nursing wing during late morning where a call bell was ringing for twelve minutes before it was answered by staff. This must be explored by the manager and appropriate action taken. Concerns were identified during the visit, which relate to health and safety. These included poor management and recording of accidents, fire doors being wedged open, portable electrical appliance testing being overdue and not addressing a requirement, which had been made by the fire department in July 06. The Manager does not take appropriate action when complaints are made to her. However records viewed showed that in some instances she is recognising the severity of concerns but is not undertaking appropriate actions to find an outcome. This includes not referring concerns and incidents to outside agencies such as CSCI Social Services and the Police. A requirement was made following the last inspection that all staff revisit abuse awareness training and familiarise themselves with Social Services role when abuse is suspected. It is a matter of serious concern that this has not been thoroughly addressed. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 11 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 12 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.V308953.R01.S.doc Version 5.2 Page 13 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents don’t have access to correct information about the services provided within the home. This puts residents at risk of living in a home, which cannot meet their needs. Residents have their needs fully assessed by the manager before admission. EVIDENCE: The homes statement of purpose was viewed. An age range had been included within the document, which stated that the service could provide care to residents, who are 40 years of age and over. A photocopy of the homes registration certificate was viewed which stated that the age range (with the exception of specific variations) was 65 years and above. The manager was provided with a list of records that were required for viewing by the inspectors during the visit. This included the service users guide but this was not made available to the inspectors. Six sets of assessment documentation on both units were viewed. These showed that the manager carries out an assessment of need for each new Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 14 resident and that the home receives assessments from other health care professionals. However on the Dementia unit no records were available to show that other health care professionals had been involved. A request was made by the inspector for a copy of a recent review that had been undertaken by social services on the nursing unit. The manager was unable to locate this information and wasn’t able to confirm whether it had been received. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 15 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Medications are not managed safely within the home, placing residents at risk. The poor quality of recording in the care plans means they do not reflect the resident’s needs nor indicate that staff are meeting their needs. Residents health care requirements are not being met which could have a detrimental effect upon the residents Health and Wellbeing. The lack of respect concerning resident’s privacy and dignity is attributed to a lack of leadership from the management, and insufficient training of the staff. EVIDENCE: Seven care plans were viewed. Since the last inspection the manager has introduced the use of Core care plans on both units. These were contained within each of the plans viewed and were not reflective of the individual needs of each resident. NURSING UNIT- Documentation was viewed for a resident who had lived on the unit for 15 days. No care plan documentation was completed for this resident. A blank care plan template was available with no name of the Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 16 resident, no written instructions of the care required and no signature of staff to show who had implemented it. The homes Care plan policy was viewed. This has been developed since the last inspection. This stated that within 24- 48 hours a basic care plan would be in place with a full plan being produced within 7 to 14 days. A care plan was viewed for another resident who had lived on the unit for five days. A Core care plan was in place. The assessments from social services highlighted the need for a pressure-relieving mattress however this had not been transferred on to the homes care plan. The assessments also indicated that full support was required to meet all of her personal hygiene needs. The homes care plan did not detail what support the staff were to provide to meet this. The above two care plans did not contain any information about the resident’s social needs or preferences. Directions were available on a core care plan viewed, which would indicate that the resident had a pressure ulcer. This information was not available anywhere else including on going assessments, dressings, or daily records. The manager was unable to confirm whether this resident had a pressure ulcer or not. No evidence was available in any of the plans viewed that consultation with residents and their representatives had taken place. This was a requirement that was made following the last inspection. Two plans viewed contained an assessment, which had been undertaken to identify whether these residents were at risk of developing pressures sores, or not. Both residents had been given a score, which indicated that they were not at risk. However on reading the remaining plan it became evident that both were frail, immobile, using bedrails and one had an assessment from the hospital, which indicated a need for a pressure-relieving mattress. This resident as detailed above also had a plan, which indicated that they had a pressure ulcer. The information available in the plan suggests that both these assessments are incorrect and actions for staff to prevent any development of a pressure ulcer were not available. Both these residents did not have their health care needs meet correctly. Following the last inspection a pharmacy inspector visited the service and made requirements. A return visit took place in August 06 to monitor progress with the requirements. It was identified during this visit four requirements relating to the management of medications had not been met and a further two new requirements for medication were identified. When this visit was commenced the manager informed the inspectors that several months supply of medication (zopliclone) was unaccounted for. The manager she stated that she identified this on Friday the 13th Of October 2006. CSCI had not been made aware of this through a regulation 37 –significant Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 17 incident form. The date of this visit was the 26th October 2006.The only action taken by the manager prior to the visit was to inform the PCT medicine management team. (See evidence also relating to Protection and Complaints). For this reason medications were not examined closely during this visit however sufficient evidence was viewed to judge that medications are not managed safely. The manager was strongly advised to make an Adult Protection referral and to contact the Police, which she carried out later that day during the visit after further discussion with Social Services. One Medication administration record (MAR) was viewed for one resident as part of case tracking. This showed that the resident had been administrated a dose of Imodium following an episode of diarrhoea on the 22/10/06. Staff had recorded this in the daily records and on the back of the MAR sheet. There was no evidence to show that this medication had been prescribed to the resident and the manager confirmed during feedback that there was no homely remedy policy within the home as she had decided not to allow Homely remedies. Therefore it is not known how the Imodium was obtained. On the same day that the Imodium was administrated to the resident ,staff also administered two sennakot tablets at night to the same resident which was the usual prescription. Following the episode of diarrhoea Staff had recorded that the G.P was to be contacted the following day. However no evidence was available to show that this had been carried out. The MAR also showed five days worth of signatures yet the care plan indicated that the resident had resided in the home for six days. No dates were available on the MAR to show when medication was received by the home or when medications were commenced. It was also noted that the door to the treatment room where medication was stored was unlocked and the door ajar. An Inspector observed medications lose within the room. A requirement was made following the last inspection that the registered person must ensure care staff have the necessary skills and competence to administer medication. This was outstanding at the last inspection. Training records showed that the manager had undertaken competency assessments on some staff who administer medications within the home but not all. The manager demonstrated that she had implemented medication audits in August 06, which evidenced that this requirement had been met. Medications were not assessed on the Dementia unit A discussion took place in a bedroom with two relatives and a resident who was unable to communicate verbally. During the discussion a member of staff entered the room abruptly without prior warning or knocking. The discussion revealed that although these two relatives felt that their relative was cared for properly this was because they visited the home daily and they were quick to raise concerns with the individual staff involved. They also stated that they liked to spend time in the lounge with their relative so that they could” speak Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 18 up” for those residents who didn’t receive visitors and were unable to voice their own concerns. Four female residents where observed sitting in a small communal lounge. All where wearing dresses or skirts, none were wearing tights or stockings. This visit took place in late October on a cold wet day. One resident in this lounge did not have anything on her feet. This means that the residents were not appropriately dressed for the time of year and that their appearance compromised their dignity. Another incident was observed in which the inspector went to investigate why a residents call bell had been ringing for so long (12 minutes). On arrival at the room it became evident that a care assistant had recently answered the bell. The bedroom door to this room was opposite a communal day room, which was being used by approximately seven residents and a visitor. The bedroom window overlooked the main street and the view into the bedroom was unobstructed as no net curtains were being used, and the main curtains were not closed. On arrival at the room the inspector observed the care assistant supporting a resident in an intimate manner, which meant that the residents left buttock and thigh were clearly on view. This was observed, as the door to the bedroom had been left open. As the inspector moved away from the door the carer approached the door and closed it. The resident who resides in this room is unable to verbally communicate. Dementia Unit- Three plans were viewed on the Dementia unit and these indicated that staff had tried to include some preferences such as time of going to bed and which food they like. In some cases this was brief e.g. one plan stated “likes to read newspaper” but didn’t say which one or how the home is going to provide one. This plan also showed that this resident has a high risk of falls, has anxiety and depression following the death of a spouse and had skin integrity issues due to a medical disorder. The homes assessment documentation showed that the manager had identified these needs prior to admission however staff had not included these needs within the care plan. Therefore no written instructions were available telling staff how to support this resident appropriately. Evidence was available that all care plans viewed on the EMI unit had been reviewed on a monthly basis however as detailed above these plans did not accurately reflect the individual needs of each resident. Two requirements were outstanding following the last inspection for care planning on the Dementia unit. One requirement had been met however the other requirement was still outstanding. Staff on the Dementia Unit were observed to address residents in a friendly and professional manner. A relative spoken with said that staff treated her husband with dignity and respect. Staff were seen to close bathrooms doors and knocked on doors before entering. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 19 During feedback at 7 pm it was noted that the majority of residents were wearing nightclothes. When the inspector questioned the staff on duty as to why this was the member of staff stated that this happened because “ they were incontinent”. On leaving the unit a conversation was overheard between a member of staff and a resident. The member of staff was overheard to reply “ No its too early to go to bed yet”. A requirement was made following the last inspection that all residents (both units) weight must be monitored and appropriate action taken if weight loss occurs. A care plan was viewed which showed that a resident had lived in the home for 15 days on the nursing unit. An assessment had been undertaken which identified that this resident was of high risk of developing malnutrition. However records showed that this residents weight had never been recorded. Therefore staff would be unable to determine whether this resident’s nutritional status was declining or increasing. Records for another resident who lived on the Dementia unit showed that this resident had been weighed in June, July, August and September and that over this period a weight loss had occurred of twelve pounds. No written information was available to show what action staff had taken about this. The manager stated that staff were aware and had contacted his G.P. following Septembers weight recording but was not able to state what the outcome was during the site visit. A further two plans were viewed on the nursing unit which did not contain records to show that these residents had been weighed. These two incidents evidence that the requirement remains outstanding. Evidence was shown that the manager is attempting to undertake monthly audits of six care plans on the nursing unit and five on the Dementia unit. The manager had devised a policy stating that these would be undertaken monthly but was unable to fulfil this obligation, as this had not occurred in April or July 06. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 20 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are not offered daily activities in accordance with their personal preferences and have little control over their lives. Residents are supported to meet with their families and visitors who feel welcome in the home. Some residents are offered food that they enjoy, however, the combining of ingredients in the form of liquidised food as one meal for residents is poor practice. It maybe that residents require a soft diet, however in consideration of their dignity and respect some thought needs to be given to the presentation of separate tastes for these residents. The present approach to soft food presentation is more in keeping with catering for Young Children rather than Adults, which is not acceptable and discriminates against those residents who require a softer diet. The fact that the food continues to be presented this way is a failure of the management to affect practice that they do not agree with. It is not known if the food offered to resident’s forms part a healthy balanced diet. The lack of recording special diets that some residents require to maintain their wellbeing places them at risk. EVIDENCE: 5 Requirements were made following the last inspection, which relate to this section. Two of which were outstanding from the previous report. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 21 A requirement was made that an activities programme must be developed on a weekly basis and displayed in a prominent position. NURSING UNIT- an activities programme was displayed on A4 paper but was hidden beneath cards. This had the days of the week, but no dates and no date of implementation and which could suggest that the same activities where happening on the same day each week. 2 staff spoken with who work on the unit said that no activities where happening, but an activities organiser is employed now. This unit also has a board, which displays the weather, the next mealtime that day, date, and month. The date was inaccurate (13th) the name of the day was not completed and at 5pm it was noted the next mealtime displayed was lunch. Four care plans were viewed on this unit. None contained any information regarding the resident’s preferred social activities or how they wished to spend their time. Staff revealed that no activities were being undertaken but an activities coordinator had recently been employed. During a discussion with a visitor it was stated that a resident had said on a couple of occasions that they were bored and that there wasn’t a lot to do. Discussions were held with two relatives who visit the nursing unit on a daily basis. They stated that staff always made them welcome and that they could visit whenever they chose. A further discussion was held with another relative who is supported to visit the home by a community carer. Staff are aware of this and support the resident to be prepared for this. One resident attends church every Sunday and the church arranges a bus service to collect her and staff support her to ensure she is ready on time. No evidence was available on either unit to show that residents are involved in any meetings, which take place within the home. This information was requested from the manager during the visit. Four care plans were viewed on the nursing unit, which did not detail any personal preferences or choices. None of the care plans viewed during the visit (7) showed that consultation had taken place with the resident or the representative about the care delivered. Dementia Unit- Staff had displayed an activities programme opposite one of the day rooms. This showed dates and the name of the activity. However it had been handwritten and was unclear. The inspectors struggled to read the handwriting. Another notice board displayed a handwritten notice in large letters of a forthcoming trip to Blackpool. The trip had also been made available for the residents of the nursing unit. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 22 A requirement was made following the last inspection that clear records must be developed showing which residents undertook which activities and how the residents would prefer to spend their time. The activities coordinator had put records into place that showed what activities had taken place and who had been involved in them. Care plans also showed that exploration of personal choices was being developed however as detailed previously these records were brief and did not give clear instructions to staff on how to support the residents in meeting these choices. A game of Bingo was observed. Ten residents were present. All had a bingo cards. Three of the residents were actively participating. Seven of the residents were not. One member of staff was seen to be supporting one resident. A relative was present who was also playing. The majority of conversations from staff were directed at the relative and not the residents. This gave the impression that this activity was not suitable to the needs of the majority of the residents who were present. A requirement was made for the Dementia unit following the last inspection that Residents 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. The above evidence shows that this requirement has not been fully met. On the Dementia unit staff have put into place assessments that do determine some choices such as prefences time for bedtime, what kind of food they like to eat and some of the activities that they preferred. Discussions with 3 Residents detailed that there is a routine within the home that covers, things like meal times and assistance to use the bathroom after meals. Residents can make choices around this routine such as the time that you would go to bed or where they would like to eat their meals. It was noted on the Dementia Unit that the majority of residents where in night clothing by 18:50 and that staff had done this as the residents had continence issues and had been assisted with meeting this need after the evening meal. Records on the unit did not determine this as a personal choice. A discussion was overhead between a member of staff and a resident, the member of staff was heard to say “no you can’t go to bed yet- its to early”. There were no menus displayed on either unit. A notice board was available with the headings dinner and tea. This was not completed. The Dementia Unit had documented evidence that residents are consulted before their next meal. This is a form completed by staff before each meal and demonstrated that a variety of choices are offered and selected, however it was not being used on the nursing unit and no evidence could be found to show that residents were being consulted in advance. Two residents spoken with on the nursing unit said that they did not know what the meal was until it arrived; however they were offered a choice at that time. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 23 The manager produced a booklet, which contained a six weekly menu. The meals supplied at that time of the visit were different on both units and did not match any Thursday (the day of the visit) mealtime on the six-week menu. No copies of this were available in either kitchen. Discussions with residents who were able to express their view revealed that in general they enjoyed the food that they were offered. Meals were observed during the visit and those viewed appeared appetising. A requirement was made following the last inspection that 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. Both kitchens were examined for evidence of the above and discussions were held with the kitchen staff. One two handled cup was available for units, five beakers with lids and spouts and three sectioned plates. There was no other specialised equipment. No evidence could be found within the seven care plans viewed detailing what support was required or equipment needed for those residents to eat independently if necessary. The chef stated that ingredients for liquidised meals are blended together and presented in a bowl. During feedback the manager stated that this was not acceptable, as all kitchen staff had received training in this area. No details of special diets required by the residents were available in either kitchen and this information was not available on the menus. The chef stated that the staff informed him on a daily basis who required a special diet. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 24 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Relatives believe that their concerns are listened to, residents have access to information about how to complain, however the manager does not always take appropriate action in dealing with complaints. The manager has not recognised incidents identified as potential abuse and has not taken appropriate action. Therefore residents are not protected from abuse EVIDENCE: Three bedrooms viewed contained a copy of the complaints procedure and a copy was displayed by the front door. A senior carers meeting was held on 6th of October 2006 on the Dementia unit. These minutes detailed concerns raised by staff to the manager, that residents on the EMI unit where being refused puddings if they didn’t eat their dinner and refused dinners if they didn’t have their drinks. The manager had recorded in the minutes that this was not acceptable behaviour. This was discussed during feedback and the inspectors asked the manager what action she had taken following these concerns, she stated initially that this hadn’t occurred and she hadn’t written the minutes clearly. The inspectors explained that two staff spoken with had said that the situation had occurred, had been reported to the manager and the staff member concerned was dealt with by a senior carer. The manager then said that senior care staff where monitoring the situation and that she would “look into it”. The manager was asked had she investigated the matter and she explained that she had not. The manager was advised to contact social services the next day and inform them of a possible abuse situation. The Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 25 inspector received confirmation from social services that this had been carried out on the 31st October 2006 and not on the 27th of October as advised. Discussions with two relatives evidenced that they believed, that any concerns that they had, had been addressed by staff. They stated that they “didn’t usually speak to the manager they would speak to the staff concerned”. A requirement was made following the last inspection that the manager must ensure that staff revisit abuse awareness training and familiarise themselves with Social Services roles and responsibilities. During the visit, following advice from Social Services the manager produced a regulation 37 form for CSCI. Attached was an action plan that the manager had completed detailing that she would undertake training on management of allegations of abuse as suggested by Social Services earlier that day. During a discussion with the manager it was evidenced that the manager had already undertaken some training in this area. (Alerting the alerter course) As detailed in the section relating to medications (Health and Personal Care) the incident regarding possible missing medication was not reported to the Police, Social Services or CSCI until instructed to do so by the inspectors during the visit. 3 staff spoken with said that Social Services had attended the home to deliver training. Records showed that 24 staff had attended. The manager produced documentation that showed 75 staff are employed within the home. Following the last inspection a requirement was made that the manager must ensure that an urgent review of the nursing residents needs as discussed during the inspection is requested and acted on. The records regarding a particular resident where viewed at the site visit. A risk assessment for this resident was available for the usage of restraints (a lap strap whilst the resident was seated). This was implemented in January 2006, the manager stated that a copy was submitted to Social Services and a review was undertaken from Social Services. Social Services and the family had agreed at this time that the use of the lap strap was appropriate. Although there are no written records in the home to confirm this. The resident was unable to participate as she has a diagnosis of dementia. The risk assessment in place identified that it was in use as the resident was immobile and was unable to recognise this. During the visit the resident was observed mobilising with a staff member on three occasions and the lap strap was in use when seated in an armchair. During discussion the manager agreed that the residents needs had changed. The inspectors reviewed the risk assessment and the use of the restraint and noted that it not been revisited to reflect the change in the residents condition and as such was now potentially an inappropriate restraint. She was advised by the inspectors to review the risk assessment and forward a copy to the Social Work team involved in the Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 26 residents care and to highlight the fact that this residents needs had now changed and that the use of the lapstrap could be viewed as restraint. Social services were made aware of this by the inspector on the 31st October when Social Services confirmed that they had been made aware of the issue detailed in the minutes of the staff meeting only and the updated risk assessment had not been sent to them. A care plan was viewed for one resident who resides on the nursing unit. Staff confirmed that bedrails where in use for the resident. However no documentation was available to show consultation with the resident or their representatives. During feedback the manager agreed that this could be viewed as a form of restraint. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 27 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All areas that are used by residents are decorated to a good standard and are warm and clean. Residents are encouraged to make their bedrooms their own. The Kitchens are not as clean as they could be. The home is not as safe from the risk of fire as it could be. EVIDENCE: A tour of the environment was undertaken on both units. This included sampling bedrooms. All areas viewed were decorated to a good standard and areas used by residents were clean and tidy. Efforts have been made in some areas to introduce homely touches such as pictures. However communal areas on the nursing unit lacked pictures and curtains. During feedback the RI and the manager stated that new curtains had been ordered and they were awaiting delivery. In the interim windows where uncovered and there was no specific delivery date. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 28 All bedrooms viewed were very personal to the occupant and it was evidenced that residents are supported to make these spaces their own. On the Dementia unit work had commenced to change the use of one room from a staff smoking room to a residents relaxation/ therapy room. The inspector evidenced that this was in the early stages when the room was viewed. Staff also explained that plans have been developed to change the use of the green lounge to a cinema room for the residents to enjoy. On the day of the visit this was being used as a quiet place for visitors and was kept locked for this purpose. A selection of bathrooms and toilets and sluice areas were viewed on each unit. These have been improved with homely touches such as pictures, which helps to make them feel more domestic. All of these areas viewed contained liquid soap and paper towels with hand washing facilities and had appropriate clinical waste storage. The kitchens on both units were viewed. Since the last visit, the kitchen on the Dementia Unit has been developed so that it is fully operational as a kitchen and has been fitted with new furniture to accommodate this. Neither kitchen had a cleaning schedule in place and the tiles in both kitchens were stained despite a requirement being made that this be addressed following the last inspection. Attempts have been made on the Dementia Unit to address this but viewing this area showed that this had been unsuccessful. The kitchen staff were asked as to when they thought the tiles would be cleaned. They were unable to supply a date. The hot food trolley and the deep fat fryer on the nursing side was noted to be badly stained and needed cleaning however the chef said these were to be replaced and the RI confirmed this to be true. However no fixed date for this replacement was confirmed. Food in the freezer was undated as to when to be used by. The Safer Food better business manual had been provided by Environmental Health since the last visit however the chef stated that this was kept downstairs in a cupboard. The concerns relating to the Kitchen were raised to Environmental health via phone on 27/10/06 who stated that they would visit the service next week. It has been confirmed by an environmental health officer that the visit did take place and other than the concerns identified by the inspectors the kitchen cleanliness was acceptable. The EH officer confirmed that a report of the visit has been left in the home for future viewing. During the visit a report was viewed that had been completed by a fire officer following a visit in July 06. The report stated that the carpet to the green Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 29 lounge on the Dementia unit needed adjusting as it was preventing the door of the room from closing against the rebate. It was evidenced that this was still causing a problem therefore had not been addressed. This information was passed to the local fire authority for the home on the 27/10/06. The fire officer concerned has since confirmed to the inspector that he has received written confirmation from the home that the matter has been addressed. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 30 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents believe that enough staff are supplied by the home however not all of the staff have undertaken training to enable them to meet the residents needs. Recruitment processes of new staff do not protect the residents and are unsafe. EVIDENCE: The staff training file was viewed. According to the training matrix no staff training had been planned for November and December 06. However further exploration showed that 3 staff are attending team working training in November, 4 staff undertook care plan training in October and two staff did communication in November. 3 staff undertook management of catheter care in June 06. Overall the training matrix for 2006 did not accurately reflect what training had been undertaken and what training was planned. Evidence was viewed that the RI had made compulsory training available around manual handling and, first aid. However it was impossible to determine whether all staff had undertaken this training. The training matrix showed that six staff from the Dementia unit have attended managing challenging behaviour since the last inspection yet certificates were available for eight staff. This was an outstanding requirement that this training was revisited following the last inspection. Documentation provided by the manager revealed that 39 staff are employed on the Dementia Unit. The manager agreed during feedback that the training matrix was not up to date and that she would address this matter. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 31 Records were viewed which showed that six staff had commenced NVQ training in September 06. The manager provided documentation which once studied, evidenced that 62 staff work at the home who provide direct care. Ten (including the manager) are qualified nurses and 15 staff have achieved level 2 NVQ or above. A further two staff are undertaking this qualification. If the staff who are undertaking training achieve these qualifications this means that just above 50 of care staff will be suitably qualified to deliver care. During the inspection it was identified that three residents on the nursing unit have dementia care needs and 27 residents live on the Dementia unit which provides care specifically for individuals with dementia care needs. No records were available to show that any staff had undertaken training in Dementia care. During the inspection it was identified that one resident on the nursing unit has been offered restricted amounts of alcohol due to a diagnosis of alcohol abuse. Viewing incident records showed that at times this resident was exhibiting challenging behaviour. It was not evidenced that staff from this unit have under taken training on managing challenging behaviour, mental health needs, alcohol abuse or training on how to implement a restricted alcohol programme. This resident was under 65 years of age and breaches the home registration both on age and care needs. During discussions kitchen staff showed enthusiasm regarding receiving training on how to cook for residents who had diabetes. During feedback the manager stated that a dietician had already delivered this training and that these staff had attended. No certificates had been issued following the training and this information had not been entered on the training matrix. Ten staff files were viewed. None of these files contained a CRB or POVA first check. During feedback the RI stated that these were held in Head office. However there was no information available within the home to confirm this or to show that the manager had reviewed the person’s fitness to work with vulnerable people. A matrix dated June 2005 was produced from the manager, which detailed a CRB unique number and a date of the arrival of the CRB. This did not demonstrate that any POVA first checks had been undertaken and, was significantly out of date. Four of the ten staff files viewed contained two written references. The other six staff files contained one or no relevant references. Documentation was viewed which showed that the manager is keeping a list of the NMC PIN numbers for qualified nursing staff that confirms their registration. This was current. One file contained one copy of an induction record. The manager produced a list of four staff that she said had undertaken induction training to NTO standard however no certificates were available to evidence this or the training Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 32 programme that was followed. Prior to viewing the staff files a request had been made to the manager to produce the staff files of all new members of staff who had been employed since the last inspection. The files for the staff named on the induction list had not been provided. Three of the staff files viewed were for staff that had commenced employment within the last six months. None of these files contained any evidence that these staff members had received an induction. Copies of off duty rotas were requested and viewed which showed that both units have a regular team of staff. Discussions with staff and relatives throughout the inspection confirmed that they believed that there were enough staff available. However it was noted on the nursing unit during late morning that a resident was ringing a call bell for help and staff did not answer this for twelve minutes. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 33 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager does not have all the necessary skills required to manage this service effectively. Some Residents and relatives are consulted about the service but they do not have access to the final report, which summarise the outcomes from the Quality Assurance survey. The financial interests and health and safety interests of the residents are not safeguarded. EVIDENCE: A review of all the evidence sections of this document shows that out of nineteen requirements issued following the last inspection (including Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 34 pharmacy) five have been met and fourteen have not. Some of these remain outstanding from the previous inspection (six). Allegations of abuse have not been acted on (see complaints and protection) despite the manager stating that she had undertaken training in this area (alerting the alerter). Significant incidents affecting the resident’s health have not been reported to CSCI or Social Services or the Police. Auditing systems developed by the manager have not been carried out as regularly as the policy developed by the manager stated they should be. The manager has not been making sure that staff within the home are ” fit” to care f or vulnerable people. Requirements made by the fire officer (see environment) had not been addressed. A resident living on the nursing unit is out of category by being underage and has needs, which are beyond the skills of the staff (see staff training). Viewing this residents care plan showed that the manager of the home assessed this resident before admission took place. The original registration certificate for the home was not displayed and a photocopy was used. The manager stated that this was the wrong certificate but had not taken action. Further evidence in this section details that the manager had not dealt with health and safety concerns. The information within this report when compared with the last report shows that the service is meeting less of the standards and regulations than the last inspection. A requirement was issued following the last inspection, which requested that a summary be produced following quality audits surveys and distributed to residents who took part. Viewing the quality audit file showed that this had not been actioned. During discussions the RI confirmed that surveys are sent out annually and that the results are acted on. A mystery shopper had recently been employed to determine the experience of what it was like to visit the home unannounced. A notice was displayed which showed that a relatives meeting was being held the following evening and that one had also taken place in May 2006. A requirement was made following the last inspection that the manager must have access to resident’s placement statement to determine what financial benefits they are entitled to. Relative’s representatives and legal rights over access to these monies must be explored. It was evidenced that this requirement had not been met. Personal allowances records were examined. These showed that the organisation was aware of who they acted as appointee for. Records regarding residents spending were clear and contained receipts that corresponded to the debits from their accounts. One resident was in deficit in her accounts to the home to the amount of £53. Records showed that the resident had received £12.94 on the 28/09/06 and had not received any more payments since then despite a weekly entitlement of over £16.00. The manager could not explain a spreadsheet that details the amounts of personal allowances that each resident is entitled to the inspectors. During feedback the RI explained it and it became apparent that one column contained clear Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 35 information as to the amount each resident should receive. The records viewed that the manager was completing did not contain clear information regarding the entitlement of each resident. The manager was not monitoring the amounts that each resident was entitled to or the amounts that had been received by the home. A tour of the environment showed two doors labelled as fire doors with a notice attached stating “keep locked”. One was the toiletries cupboard on the first floor and the second was a store cupboard on the second floor. Both were unlocked and no staff were in the area. Bedroom 29 on the nursing unit was found to have the door wedged open with a small piece of furniture. The nursing unit kitchen door was wedged open with a piece of wood. Training records showed that 19 staff have received fire training this year and there are a total 72 staff employed on both units within the home therefore not all staff have received refresher training on fire prevention. A variety of certificates and contracts where viewed which showed that equipment including fire equipment is serviced tested and maintained. With the exception of Portable appliance testing which has not occurred since May 05. During feedback the manager stated that she thought it was due in August and the RI confirmed that the PAT testing kit had recently been delivered to the handyman and testing was to be undertaken in the very near future. Risk assessments for the safety of bedrails were not completed for one residents as detailed in the section Complaints and Protection. This equipment is detailed in their care plan as in use. Staff members confirmed that the bedrails were in use, as did the manager during feedback. A review of accident records showed that since the 30/06/06 3 accidents have occurred where residents have fallen out of bed whilst bedrails where in use. 1 resident had been found with their legs trapped between the bars. This showed that the equipment was not risk assessed appropriately and used correctly. Further review of the accident records showed that not all the accident records could be located. One book finished on the 20/10/06 and the new one started on the 30/06/06. This was a gap of 8 months. The manager confirmed during feedback that accidents had occurred during the 8-month gap but was unable to supply the records. There were 5 instances that detailed, a specific resident being “found on floor” from 30/06/06. The manager was unable to state what action had been taken to prevent a re-occurrence of these accidents. Case tracking of one resident detailed a fall on 24/10/06 in which he sustained a head injury. An ambulance attended the home, but did not take him to hospital. There was no accident record for this date or resident, however a record for a different resident was completed on the 25th October 2006 and there were no gaps in the book between this entry and the previous one of the 23rd of October 2006. Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 36 Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 37 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 1 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X 3 X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 1 X X 1 Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 38 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 OP1 Regulation Reg. 5. (1) (a)(b)(c) (d) (e) (f) (2) (a)(b) (3) (4) Reg. 14.(1)(2) Requirement The registered person must ensure that each resident has a copy of the service users guide and that a copy is available for future inspections. Timescale for action 31/01/07 2 OP3 3 OP7 Reg.15. (1) The registered person must 31/12/06 ensure that assessment information including information from recent reviews is available within the home and that staff act on this information and produce clear care plan documentation, which reflects this. (1) Unless it is impracticable to 30/11/06 carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. The registered person shall— (a) Make the service DS0000005465.V308953.R01.S.doc Version 5.2 Page 39 Orchard Nursing & Residential Care Home The user’s plan available to the service user; (b) keep the service user’s plan under review; (c) where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan; and (d) Notify the service user of any such revision. This requirement is outstanding and should have been addressed by 15/01/06. 4 OP8 Reg.12. (1) (a) (1) The registered person shall ensure that the care home is conducted so as— (a) To promote and make proper provision for the health and welfare of service users; 30/11/06 5 6 OP9 OP9 Reg. 13. (2) Reg. 13. (2) 7 OP9 Reg. 18. (1)(a) 8 OP9 Reg. 13. (2) The registered person must ensure that all medications are stored securely at all times The registered person must ensure all medication is administered and recorded as prescribed. All nonadministration must be clearly explained. This requirement is Outstanding. The timescale for completion was 11/05/06 The registered person must ensure care staff have the necessary skills and competence to administer medication. - This requirement is Outstanding. The timescale for completion was 11/05/06 The registered person must ensure all medication is accurately recorded on receipt DS0000005465.V308953.R01.S.doc 30/11/06 30/11/06 30/11/06 30/11/06 Orchard Nursing & Residential Care Home The Version 5.2 Page 40 9 OP9 Reg. 13. (2) into the home. This requirement is Outstanding. The timescale for completion was 11/05/06 The registered person must ensure all medicines disposal follows current legislation and accurate records are maintained. This requirement is Outstanding. The timescale for completion was 11/05/06 The registered person must ensure that staff on the nursing unit maintain residents privacy and dignity The registered person must ensure that clear records are kept of specialised diets offered within the home. The registered person must ensure that residents who live on the nursing unit are offered a choice of meals and records are kept of this. The registered person 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. This requirement is Outstanding. The timescale for completion was 28/02/06 The registered person must ensure that residents weight is monitored and appropriate action taken if weight loss occurs. This requirement is Outstanding. The timescale for completion was 28/02/06. The registered person must ensure that risk assessments are carried out for any resident who is using bedrails and appropriate action taken. This must include DS0000005465.V308953.R01.S.doc 30/11/06 10 OP10 Reg. 12.(4)(a) Reg. 16. (2)(i) Reg. 16. (2)(i) 30/11/06 11 OP15 30/11/06 12 OP15 30/11/06 13 OP15 Reg. 16. (2)(g) 30/11/06 14 OP15 OP8 Reg. 12. (1)(a) 30/11/06 15 OP18 Reg. 12. (1)(a) (4)(b)(c) 30/11/06 Orchard Nursing & Residential Care Home The Version 5.2 Page 41 16 OP18 Reg.13.(6) 17 OP29 Reg.19. (1)(a) 18 OP29 Reg. 18. (1) (c) (i) 19 OP30 Reg. 18. (1)(a)(c)(i )(2) 20 OP30 Reg. 18. (1)(a)(c)(i )(2) Reg. 18. (1)(a)(c)(i )(2) Reg. 12. (1)(a) 21 OP30 22 OP31 23 OP33 Reg.12. – (2), Reg.24. – (3) consultation with and permission from the resident/representative where appropriate. The registered person must ensure that all staff revisit abuse awareness training; familiarise themselves with social service s role and responsibility. This requirement is Outstanding. The timescale for completion was 10/03/06 The registered person must ensure that an audit is undertaken of all staff files and any missing documentation put in place. The registered person must familiarise herself with the national training organisation induction standards for care staff and ensure that all staff receive this. The registered person must ensure that staff training files are audited and any gaps in training addressed to ensure staff have the necessary skills to care for the residents. The registered person must ensure that staff on the nursing unit receive training on managing challenging behaviour The registered person must ensure that staff receive training to enable them to support residents with alcohol abuse The registered person must ensure that they display the original and correct certificate of registration for the home and that they familiarise themselves with its meaning. The registered person must ensure that residents who live on the EMI Residential unit are consulted about their views of the service. This requirement is Outstanding. The timescale DS0000005465.V308953.R01.S.doc 30/11/06 31/12/06 31/01/07 31/01/07 31/01/07 31/01/07 30/11/06 31/12/06 Orchard Nursing & Residential Care Home The Version 5.2 Page 42 24 OP35 Reg.13.(6) 25 OP38 Reg.23. (2)(d) 26 OP38 Reg.23.(4)(a) 27 OP38 Reg. 12. (1)(a) (4)(b)(c) Reg. 12. (1)(a) (4)(b)(c) Reg.23. (2)(c) 28 OP38 for completion was 10/03/06 The registered person 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. This requirement is Outstanding. The timescale for completion was 31/01/06 The registered person must ensure that the shortfalls identified in both kitchen areas (cleaning of tiles) are addressed This requirement is Outstanding. The timescale for completion was 31/01/06 The registered person must ensure that the two cupboard doors which have been identified, as fire doors must be kept locked as detailed on the sign on each door. The registered person must ensure that staff complete accident records for any accident that occurs and that these are stored securely within the home. The registered person must ensure that they complete portable appliance testing without further delay. 31/12/06 31/12/06 30/11/06 30/11/06 31/12/06 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 OP9 Good Practice Recommendations All handwritten medication administration records should be double-checked by a designated member of staff. DS0000005465.V308953.R01.S.doc Version 5.2 Page 43 Orchard Nursing & Residential Care Home The 2 3 4 5 6 7 OP9 OP9 OP9 OP9 OP15 OP19 All patient information leaflets should be retained and clearly presented to staff for training and information. A designated member of staff should witness all controlled drugs handling. All non-monitored dosage system medication should be dated upon opening to enable accurate and meaningful audit trails to be carried out. All when required medication should be clearly outlined in the residents care plan. The registered person must ensure that each unit displays a menu, which reflects what is available that day, and is in an appropriate format for the residents to read. Pictures should be obtained for the communal lounges and dining rooms on the nursing unit Orchard Nursing & Residential Care Home The DS0000005465.V308953.R01.S.doc Version 5.2 Page 44 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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