CARE HOMES FOR OLDER PEOPLE
The Orchards Nursing & Residential Care Home St Marys Road Huyton with Roby Merseyside L36 5UY Lead Inspector
Joanne Revie Unannounced 4th July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Orchards Nursing & Residential Care Home Address St Marys Road Huyton with Roby Merseyside L36 5UY 0151 449 2899 0151 287 6501 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Flightcare Limited Mrs Margaret Brown Care Home 55 Category(ies) of DE(E) - Dementia registration, with number OP - Old Age of places PD - Physical Disability The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 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) 2. Maximum no registered 55, of which up to a maximum of 29 N (Nursing) and up to a maximum of 26 PC (Personal Care) 3. One named female out of category service user, under pensionable age. Date of last inspection 21st March 2005 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 registered provider 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. The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors visited both units at the same time. For the purpose of this report the findings for each unit have been recorded separately. What the service does well: General It is common practise in the home for all residents for both units to be assessed prior to admission by the manager of the home. This means that staff are able to plan for the needs of a new resident and residents who are being admitted straight from hospital are able to meet the manager prior to admission. This enables both parties to decide whether the home is a suitable place for the resident to live. EMI Residential Unit Relatives commented that they had been provided with” a lot of good information” and that they felt that the unit was able” to understand how they were going to look after my wife”. New residents receive a medical review from a G.P shortly after admittance to the home. This helps to ensure that the resident’s needs are being met correctly. One relative confirmed that she had been involved in the forming and reviewing of her loved ones care plan. This helps to make relatives feel involved in their loved ones care. Relatives commented that staff are “ quick to get the doctor” if needs change and that they felt that their loved ones medical needs were being met. Staff quickly seek advice from other health care professionals also such as District Nurses. Residents receive their medication from staff that have had training to do so, so the risk of mistakes occurring are reduced. A monitored dosage system is in place, which also reduces the risk of a mistake occurring. Relatives said that staff were “kind, caring and always respectful”. Staff showed that they had a clear understanding of the importance of maintaining residents dignity. Staff appeared caring, enthusiastic and keen to care. One
The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 6 resident said that she was always treated with dignity. Relatives explained that they are free to visit the unit whenever they wish. One resident explained that her husband often stays to have a meal with her and that she feels that the staff are” part of the family”. Relatives are aware of how to complain should the need arise. Residents spoken to were confident that any concerns they may have would be dealt with correctly. One relative said, “Callie makes sure that anything we worry about, is taken care of”. Residents who wish and are able are supported to manage their own finances and lockable drawers are provided for this purpose to keep money safe. The unit appeared clean and tidy. Staff are following good practise guidelines by each carrying their own personal supply of alcohol hand rub. They were seen to use this frequently. This greatly reduces the risk of infection being spread on the unit. Nursing Unit All residents receive an assessment of medical needs by the Home Manager prior to admission. On admission residents receive a review of health needs, which includes monitoring of weight, blood pressure, pulse, temperature and urinalysis. One resident remembered the home manager visiting her prior to admission and stated “ it put my mind at rest”. A comprehensive care plan is developed following the assessment. This means that staff are given clear instructions on how to care for the resident. This has been developed further to include what the future expectations of the resident are. Plans were found to be well written and regularly reviewed and updated. Staff were aware of the plans and of the knowledge contained within them therefore they are aware of how to meet the residents needs. A resident stated, “ I am very well cared for”. Another stated” I want for nothing”. A resident confided that she never felt embarrassed or exposed when staff were assisting her and that it was nearly always the same carer who bathed her. She explained she liked this as “its not nice to be undressed in front of a stranger”. Another resident confirmed that she always received her post unopened. Staff were respectful and courteous to the residents. Close relationships in some cases have developed which allow for humour to be shared. Staff were seen to be quick to attend to the residents requests for help. Medications are managed safely on the unit and are administered by Qualified Nurses who are trained in this subject. Residents confirmed that their visitors were always made to feel welcome and that they could visit whenever they wanted. Another stated, “ the staff are marvellous they always make her a cup of tea”. Another resident spoke of the pleasure she gets from attending church. This means that she has to rise early on a Sunday morning and staff support her by ensuring she is ready to leave on time.
The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 7 Staff on the unit are receiving regular one to one time with a senior staff member to discuss any concerns they may have and to identify any training needs. What has improved since the last inspection?
General The home manger has commenced regular meetings with residents and residents for both units. This helps both residents and relatives to feel involved in the running of the home. Staff have recently attended training on the prevention of infection control. An audit has been undertaken identifying which staff require fresher training in certain subjects. A further audit has been carried out on staff files and many of the shortfalls have been addressed. Since the last inspection the home manager has accessed numerous staff training courses through the primary care trust. EMI Residential Unit The Manager of the EMI unit has settled into post and has undertaken audits on care plans and other documentation so that she is aware of any shortfalls. She has achieved Level 4 NVQ in management since the last inspection. An activities organiser is employed to work on the unit. She is enthusiastic about her role and is new to post. The communal areas of the home have been redecorated, these present as a more homely place to live. The small lounge has also been redecorated and is used for residents when they have visitors. A number of bedroom carpets have been identified as needing replacing and this is being undertaken as part of an on-going programme. A number of bathrooms have been redecorated and these are substantially improved. Two families said, that the home was looking much better. They said that there had been a significant improvement in the way that the home felt, looked and smelt. One resident said that she thought, Its a much nicer place to live in. Staffing levels were reviewed following the last inspection and an increase has occurred which relatives and staff believe is a definite improvement. A family member spoken with said that in her opinion there is enough staff available at all times. Staff on both units have started to receive “ one to one “ supervision. This is an opportunity for both the staff member and the supervisor to discuss any concerns and identify any training needs. Nursing Unit Care plans have been greatly developed since the last inspection. All plans were found to be consistently reviewed and updated. This is important, as staff need to be kept informed of changes of the residents needs. Efforts have been made to include relatives in this process. The Home manager has been carrying out
The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 8 monthly audits on the care plans to ensure that they are completed to a good standard. Nutritional risk assessments have been developed to identify if a resident’s appetite changes and what to do if this should occur. A social history has been developed for each resident which gives details of what they have done in their past life. This promotes good practise and enables staff to have a clearer understanding of their social needs. Since the last inspection the Unit manager has settled into her role. Staff spoke positively on her ability to manage the unit. More activities have been offered which include weekly aromatherapy sessions, gentle exercise classes, individual shopping trips, monthly cinema afternoons and visiting singers. A great deal of effort has been made on the fabric of the building. All the bedrooms and most of the communal areas have been redecorated to a good standard. A rolling programme to replace flooring is underway. Over half of the care staff employed on the unit have now achieved NVQ qualifications in care. What they could do better:
General The management of resident’s personal monies should be reviewed throughout the home as the home manager was unaware of whether residents are receiving their full entitlement due to a lack of information. Some relatives were accessing monies for their loved ones without the resident’s permission. The manager was unsure of the relative’s legal status and whether they had the right to do this. These matters should be reviewed to ensure that the resident’s rights are protected. Recruitment procedures are not as safe as they could be. The Home manager is not seeing all CRB checks prior to member of staff commencing employment. This must be rectified. A training programme was shown which was developed for last year. The Home manager has undertaken an audit identifying what staffs training needs are and has developed individual training files for staff, which shows some commitment on her part in this area. The manager stated her intention to develop this into a current training programme. This must be developed and implemented. Staff inductions do not reflect current good practise. The Home manager must ensure that she familiarises herself with these current recommendations and develop new induction programmes to ensure all new staff receive adequate training to carry out their duties. Although many shortfalls have been addressed in ensuring staff files meet the required legislation, some files are still missing photographs. The Home manager stated her intention in carrying this out and this must be followed through. Areas of the home have been identified to be fitted with new carpets. Consideration should also be made to replacing the lino flooring in all dining areas, as this is unattractive and not domestic in appearance. Although works have been carried out on bathrooms they appeared rather clinical. Adding
The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 9 “homely” touches such as pictures, plants etc could rectify this. It was identified that the flooring to bathroom 30 required repair and bathroom 50 had had paint splashed on the floor following the redecoration. This must be rectified. Although staff have a good understanding of what constitutes abuse, senior staff on both units were unaware of how to report abuse to outside agencies such as social services. Senior staff on the units should familiarise themselves with the procedure to ensure the residents are safe. It was also identified that some staff on the nursing unit were unsure of how to” whistle blow” or what the homes policy was. In view of this Abuse awareness training must be revisited and were appropriate include the homes own policies and the local guidelines on protection of vulnerable adults to ensure the safety of the residents. Although the home attempts to ensure the Health and Safety of the residents. Some areas were found to be lacking. An electrical safety certificate was not available stating that the electrical supply is safe. This must be addressed. Not all staff have had recent refresher training on fire safety. Practise fire evacuations and fire drills have not occurred and residents were unsure of what to do if the fire bell rang. Staff were not aware of the need to close fire doors during times when less staff were on duty. These matters must be addressed to ensure that the resident’s safety is maintained. EMI Residential Unit Although the home manager carries out assessments for new residents, this information is not always readily available to the staff on the unit. The unit manager could be given the opportunity to be involved in assessments so that she is also involved in planning the resident’s care. Once this information is obtained staff should ensure that they consult with other health care professionals who have been involved in giving care to the resident prior to admission. This would enable the unit to have a full pen picture of the resident’s needs, wishes, likes and dislikes. Two residents who had recently been admitted to the unit had not had care plans developed. Some plans were detailed however others lacked the necessary information required for staff to deliver care. This must be rectified, as staff require clear instructions to follow. Staff receive a comprehensive verbal report at the beginning of their shift and rely on this information to carry out their duties rather than reading the plans of care. Staff must be encouraged to use the plans and to write all information down rather than storing it to memory. This will help to reduce the risk of making mistakes and to ensure that all information is available to all staff at all times. Management had undertaken audits and had also identified shortfalls in the plans of care however these shortfalls had not been rectified. Although everyone spoken with confirmed that the resident’s health needs were being met there was little documentary evidence to support this. Records must now be developed showing when health care visits such as dentist,
The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 10 optician, G.P. have taken place, and include any action/ advice that was given. Some health care needs for some residents were identified during the visit, which had not been acted on, and these must now be addressed. One resident commented during the inspection that she felt that staff were too busy to take care of her needs. Staff should use the opportunity to review the resident’s needs whilst developing the plans of care. Shortfalls were identified in the management of medications. These included “opening dates” not being recorded and explanations of why medication was not given being omitted form records. These matters must be rectified to ensure that residents receive medication that has not expired and to ensure that alternatives can be explored if medication cannot be given as prescribed or is refused. The carrying case, which is used to transport the monitored dosage system, was found to be cumbersome and awkward. Easier alternatives should be explored to reduce the risk of staff injury. Some tablets were found to be loose from the pack and therefore could not be identified. This must be reviewed and actions must be taken to prevent this reoccurring so that adequate stocks of clearly labelled medication are available for the residents so that they each receive their prescribed medication. Activities are organised on a daily basis according to what the staff think the residents would like to do. An organised activity programme must be established once residents or relatives (were residents cant) have been consulted about how they would like to spend their day. This is important, as residents must be supported to feel as though they are in charge of their own lives. Staff rely heavily on verbal communication between each other regarding the residents needs. This practise must stop and staff must familiarise themselves with recording all actions. If all instructions continue to be given verbally and nothing is written down a mistake could occur which could be detrimental to the residents well being. Although relatives and residents spoken with felt concerns were dealt with promptly a complaints policy must be displayed on the unit so that everyone is aware of the procedure to follow. Staff should ensure that they document all concerns rather than just dealing with them and then making a decision about whether they are important enough to write down. To prevent injuries each staircase on the unit has a stair gate at the bottom of the stairs. It is intended that these gates remained locked at all times. However during inspection these gates were rarely locked. A decision should be reached as to whether these gates are useful. Following redecoration a lounge was made available for residents to enjoy with their visitors. However this is kept locked so is not as accessible as it could be. The service should consider whether this is appropriate. During discussions it became evident that staff were not familiar with the GSCC code of conduct. These are guidelines, which have been issued which promote good practise in care and should be distributed to all staff on the unit. The unit also receives support from a voluntary member of staff. However no records could be found to show that the expected recruitment measures to
The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 11 ensure residents are in “ safe hands” had been taken. This matter must be addressed. Staff on the unit confirmed that they have received training on how to manage episodes of challenging behaviour however an incident occurred on the unit during the visit, which could have been handled better. In view of this, the training should be revisited to ensure all staff are familiar with what to do. Although staff have started to receive supervision this has only occurred once and staff were unsure of its purpose. This should be addressed so that the maximum benefit can be obtained form these sessions. Shortfalls were identified in some aspects of Health and Safety on the unit. These included not using wheelchairs correctly, and propping open of fire doors. Staff were not familiar with shutting fire doors on the unit during night time when reduced staffing numbers means staff are less vigilant. Areas, which could pose a risk to the health and safety of the residents, had not been risk assessed such as the locking of the office door. These matters must be addressed to ensure that the residents are safe. Nursing Unit Although residents receive a full assessment prior to admission there is a strong emphasis on their nursing needs. Efforts have been made to include some of the resident’s likes and dislikes but this information is not always included. This must be addressed and staff should ensure wherever possible that if a resident is unable to express their wishes a representative who knows the resident well is included in the process. Prior to admission from hospital an assessment is carried out by a hospital social worker. This is a vital piece of information in the assessment process. The Home manager stated that this information is not always made available to the home prior to admission. This must be addressed and staff must ensure that a copy is made available before admission takes place. Although care plans on the unit were found to be comprehensive further effort regarding the recording of residents likes and dislikes is required. Some plans were found to be detailed on this aspect but other lacked information. The service must continue to develop this aspect and continue to encourage relatives to be involved in care plan reviews whenever possible. Wound care documentation could be developed further through the introduction of taking photographs and measuring of wound sizes. A policy should be developed to support this. An effort has been made to include the resident’s viewpoint in the care plans by adding a section detailing the future expectations of the resident. Although medications are managed well on the unit it would be advisable for staff to have access to the full medication policy, which was being stored, in the home managers office. Although activities have been developed since the last inspection there is no organised activities programme. This must be addressed so that residents are aware of what is going on in the home and able to make the choice of whether they wish to join in. Staff should ensure that records are kept of which activities are attended for future reference. The unit should consider
The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 12 developing reminiscence therapies for those residents with memory loss and consider training on this subject for the activities coordinator. During the tour of the unit it became evident that the rucked carpet on the top floor had not been addressed. A risk assessment has been developed to assess danger of tripping but no decision has been reached as to when this flooring is to be replaced. Building works are being considered in this area and the service has assured that it will replace this carpet once these are done. The provider must now decide whether these works are going ahead and make a firm decision on when this flooring is to be replaced. 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 Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 13 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 14 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 All residents receive an assessment by the Home manager. However other health care professionals and relatives that may hold vital information are not always included in this process. Relatives and residents believe they are given full information about the home prior to admission taking place. EVIDENCE: EMI Residential Unit Five care plans were viewed which contained assessment information. Discussions were held with four relatives who all recalled assessments taken place prior to admission. One care plan showed that the assessment information was limited, as the full assessment had not been passed to the unit. This plan also showed that staff had consulted with other health care professionals five days after the resident’s admission and not before. Nursing Unit Five care plans were viewed which contained assessments and pre admission information. Discussions were held with one resident, two staff and the home manager. All residents receive an assessment prior to admission from the
The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 15 home manager. A resident described the assessment process and stated that” it put my mind at ease”. Viewing the assessment documentation showed that a strong emphasis was put on medical needs. Not all information was completed on all sections such as likes /dislikes. However this was completed on some. The Home Manager confirmed that the home struggles to receive assessments undertaken by hospital social workers. Advice was given that this information is vital to the assessment process. All residents receive a full examination on admission, which includes recording of weight, blood pressure pulse temperature and urinalysis. The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 16 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Most residents have a care plan but these vary greatly across the units in consistency and detail. Changes in Health are dealt with promptly however documentation on the EMI residential wing does not reflect this. Residents believe they are well cared for. Staff are caring and enthusiastic about their role. Medications require better management on the EMI residential wing. EVIDENCE: EMI Residential Unit 5 care plans were viewed. Discussions were held with 8 residents, 4 relatives, 6 care staff and the unit manager. One relative confirmed that she had been involved in the forming and reviewing of her loved ones care plan. Two residents who had recently been admitted (Eight and four days prior to the inspection) had not had care plans developed. Information available for one resident on one plan was insufficient and had resulted in staff not dealing appropriately with the residents needs. Staff receive a comprehensive verbal report at the beginning of their shift and rely on this information to carry out their duties rather than reading the plans of care. Care plans were not updated consistently. Two of those viewed had been however three had not been updated for over three months. Management has
The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 17 undertaken audits and shortfalls had been identified in the plans of care however these shortfalls had not been rectified. One relative commented that staff are quick to ensure that medical needs are met and that G.P visits are requested quickly. Discussion proved that Staff contact District Nurses for advice and input when needed. All new residents receive a medical review from G.P.shortly after being admitted to the home. However no evidence could be found that staff are recording these visits or visits from opticians dentists and other health care professionals. One service user was seen to be wearing glasses with scratched and worn lenses. Another service users stated that she wished to see a dentist but this had not been arranged. The administration, storage and disposal of medication on the unit was reviewed. Staff confirmed that they had received training on this subject. Viewing records showed that staff do not record the amounts and type of medication received into the home. A nomad system is in use but this found to be cumbersome. Five tablets had come and were found in the carry case, which is used to transport the nomad system. Eye drops had been prescribed for some service users on the unit. One bottle had been opened but had not been dated to say when this had occurred. A further three unopened sets were found in the fridge with no explanation recorded on the medication administration records to say why. Other gaps were also identified in these records and no explanation was available for these gaps also. Dedicated storage has been made available on the unit bout on the day of the visit this was found to be untidy and disorganised. Items of general storage were also being stored rather than just medication. Some residents have been prescribed medication to be given as when required. No written instructions were available to say when or how this should be given. The manager has undertaken audits on medications and has also identified shortfalls and made plans for development. These had not been actioned. Relatives said that staff were “kind, caring and always respectful”. Staff showed that they had a clear understanding of how to maintain residents dignity and were able to give appropriate examples of how this is done. Staff presented as caring, enthusiastic and keen to care. One resident said that she was always treated with dignity. Observing staff showed that they were courteous, approachable, and spoke appropriately to the residents. Nursing Unit Five care plans were viewed. Discussions were held with six staff members, the unit manager, the home manager and four residents. The plans viewed were comprehensive and gave clear guidance on how to meet the resident’s needs. Each resident has a plan of care, which has been developed around the activities of daily living. This has been expanded further to include foot, mouth and eye care and future expectations of the resident. The plans included risk assessments covering all aspects of the resident’s daily
The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 18 life. Nutritional risk assessments have been developed and implemented. Each resident has a dependency analysis, which is regularly reviewed and could indicate a decline in health and changes in needs. The waterlow score is utilised for those residents who are at risk of developing pressure sores. The plans are reviewed monthly. The home manager audits all care plans monthly to ensure that the plans are updated and completed consistently. Some effort has been made to involve relatives in reviewing of the plans but this requires further developing. Wound care is consistent and staff have successfully promoted healing. However this could be further enhanced by the introduction of photographic evidence and measuring of wounds. Residents are supported by staff to attend hospital appointments. Staff are quick to respond to changes in residents needs and will persistently request advice from medical professionals until changes in health are under control. Advice is sought from specialised health care professionals when appropriate. Multidisciplinary records showed that residents have input from Opticians, Dentists, Chiropodists, Tissue Viability Nurses and Diabetic Nurses. A resident stated, “ I am very well cared for”. Another stated” I want for nothing”. Staff were complimentary about each other’s ability to care and were enthusiastic about their role. Each were able to give examples of how they would maintain the residents dignity in a variety of scenarios. A resident confided that she never felt embarrassed or exposed when staff were assisting her and that it was nearly always her key worker (named carer) who bathed her. She explained she liked this as “its not nice to be undressed in front of a stranger”. Another resident confirmed that she always received her post unopened. Staff were seen throughout the visit to respond to the residents appropriately. It was evident that in some cases trusting relationships had developed. Staff were seen to knock on bedroom doors before entering and were quick to respond to the residents requests for help. A staff member stated that the home manager would give the residents “anything that they wanted”. The management of medications was reviewed. This included viewing medication administration records, medication storage, receipt and disposal procedures and the management of controlled drugs. Medication was appropriately stored. A Nomad monitored dosage system is in use. Each MAR sheet had the details and photograph of the resident for proof of identification. A risk assessment has been developed for each resident, which identifies any potential hazards and reflects good practise. A brief version of the medication policy was available with the full version being kept in the home managers office. MAR sheets were completed to a good standard and were clear and easy to follow. An up to date British National Formulae was available for staff reference if required. One drug was being stored and administered as if it were a controlled drug. This was managed correctly with all stocks and administrations accounted for.
The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 19 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 The home provides a variety of activities on both units however this is not organised into a daily programme and residents appear to have little input into what activities they would like to do. Group outings are infrequent however Staff do support residents well on an individual basis and are always welcoming to visitors. EVIDENCE: EMI Residential Unit 5 care plans were viewed. Discussions were held with 8 residents, 4 relatives, 6 care staff and the unit manager. An activities organiser is employed to work on the unit. She is enthusiastic about her role and is new to post. Activities are not organised into a programme and are delivered on the assumption of this is what the residents would like. No evidence could be found that residents or relatives are consulted about the activities on offer. Social histories have not been completed for each resident. Staff transfer what knowledge they have on this verbally. Two residents stated that they were bored a lot of the time. No activities were observed to be undertaken during the inspection. Staff agreed that activities could be developed further. Relatives explained that they are supported to visit the residents when they wish. One resident explained that her husband often stays to have a meal with her and that she feels that the staff are” part of the family”.
The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 20 Care staff showed genuine caring and enthusiasm for their job role. Staff invariably make decisions for residents. Staff base the decisions that they make for the residents on what they think they know about them. The opportunity to determine resident’s choices has not been taken. There are no formal records that detail resident’s choices, such as what time they would like to go to bed, what they prefer to eat. Staff rely heavily on verbal information, which is likely to result in inappropriate decisions being taken on behalf of the residents. Three of the residents were able to explain what their choices would be. However due to the nature of many of the residents medical conditions their ability to say what their choices are is severely limited. The opportunity to explore resident’s choices has not been taken with the families as an alternative. Nursing Unit Five care plans were viewed. Discussions were held with three staff and five residents. Each resident has a social history within their care plan, which gives staff a clearer idea of what their social needs are. The unit has an activities coordinator who also works part time as a domestic. Residents and staff spoke warmly of her enthusiasm for her role. Residents appreciate the extra duties she does for them such as buying small amounts of shopping, birthday cards etc. No organised programme was in place for activities. Residents and staff were unable to give details of activities except for events that had been pre booked such as regular aromatherapy sessions and weekly exercise classes. No record was found detailing activities that residents had taken part in. Staff explained that an outing had been organised for the residents but that on the day they changed their mind and the transport, which had been specially arranged, still had to be paid for. Since then residents are taken out on an individual basis to local areas such as shopping, pub lunches etc. Residents are supported to pursue their own hobbies if they so wish e.g. Jigsaws cross word puzzles, painting, playing musical instruments etc. It was identified that a large number of residents have memory problems yet reminicense therapy is not regular activity. One staff member stated when asked that she didn’t think the activities coordinator had had training to do her role. Residents confirmed that their visitors were free to visit whenever they wished. Staff were always friendly and polite to them and they were always offered a cup of tea. Residents are supported to go out on outings with their family such as family occasions etc and are also supported to undertake activities such as attending church. The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 21 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Resident’s know how to complain and believe their concerns are quickly dealt with. Not all Staff are familiar with how to record complaints. Staff have a basic understanding of abuse awareness and prevention but require further training to ensure residents are protected. EVIDENCE: EMI Residential Unit A complaints policy was not available on the unit. Records of complaint investigations were available. In general these were appropriate to the complaint and showed good structure in investigating complaints. Two relatives spoken with were aware of a complaints procedure and how to raise any of their concerns. Residents spoken to were confident that any concerns they may have would be appropriately addressed. One relative said, “Callie makes sure that anything we worry about, is taken care of. Care staff discussed how they address concerns on a daily basis. Minor concerns are dealt with directly by the care staff and are not always documented. An Abuse awareness policy and procedures were available within the home, however a copy of this was not available on this unit. All staff spoken with, demonstrated a clear understanding of recognising any potential abuse and reporting this to management. Discussions with senior staff identified that they lacked a clear understanding of how to deal with any allegations of abuse. The senior carers and the deputy manager were unsure of how to proceed with any investigation or when to suspend a member of staff.
The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 22 Nursing Unit The unit was viewed. Discussions were held with six staff and three residents. Complaints records were also viewed. A complaints policy was available on the unit and the procedure of how to complain was displayed in a prominent place. Records showed that staff have a good understanding of how to manage complaints. Outcomes are included as well as actions taken. All residents spoken with confirmed that although they may not know the exact procedure they knew who to approach. One resident confided that “Josie had dealt with a problem straight away” and had returned later to check that the resident was still satisfied. Staff have access to a policy on the prevention of abuse and also guidelines on Adult Protection from the local authority. Training is given on this subject via video. During staff discussions it was` evident that staff have a good understanding of what abuse is but were unaware of POVA guidelines. Staff also seemed unsure of how to whistle blow. The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 23 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,,23,24,25,26 Residents have benefited from the redecoration in the home. Some areas still require attention but plans have been developed to address these. Residents are encouraged to make their bedrooms” feel like home” EVIDENCE: EMI Residential Unit A tour of the unit was undertaken which covered all communal areas (including the two dining areas, and three lounges.) A sample of five bedrooms and three bathrooms were also viewed. The communal areas of the home have been redecorated, these present a more homely atmosphere. The small lounge has also been redecorated and is kept locked to be used for residents when they have visitors. A number of bedroom carpets have been identified as needing replacing and this is being undertaken as part of an ongoing programme. The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 24 To prevent injuries each staircase has a stair gate at the bottom of the stairs. It is intended that these gates remained locked at all times. However during inspection these gates were rarely locked. A number of areas are due to have the carpet replaced. Consideration should be made to replacing the lino flooring in both dining areas, as this is unattractive and not domestic in appearance. A number of bathrooms have been redecorated and these are substantially improved. However they would benefit from the inclusion of more domestic decoration such as plants and pictures. Two families said, that the home was looking much better. They said that there had been a significant improvement in the way that the home felt, looked and smelt. One resident said that she thought, Its a much nicer place to live in. There is a separate kitchen available on the EMI residential unit, which was clean and tidy on the day of inspection. Of good practice is the usage of alcohol hand wash solutions that staff were observed using continuously throughout the inspection. All bedrooms viewed had soap readily available. The home did not have any offensive smells during the inspection. Staff appropriately transported dirty laundry around the home. Sluicing facilities were available. Water supply was regularly checked for legionella. Nursing Unit A tour of the unit was undertaken. Discussions were held with the Home manager and three residents. Much of the unit has been redecorated since the last inspection. Bedrooms were viewed. All were decorated to a good standard and contained, many personal items. Residents agreed that staff supported them with this. Outstanding works to bathrooms have been addressed however these areas could be further improved with homely touches such as pictures plants etc. It was noted that the flooring to bathroom 30 near the ramp to the shower had come away from the subfloor and paint had been splashed on the floor of Bathroom 52 following redecoration. A scheduled plan to replace carpets and flooring is underway with many areas having already benefited from this. Lounge 9 has been identified as requiring anew carpet and this is to be addressed in the near future. The ceiling to the other T.V lounge appeared tired and in need of redecoration. The two dining rooms on the unit have both been redecorated however the lino flooring gives the rooms an institutionalised feel. All areas viewed were furnished to a good standard. Residents have access to large screen TVs video recorders and music centres. An outstanding issue is the carpet to the top floor of the nursing unit. This has been risk assessed and is awaiting the decision of when building works are to be carried out on two empty rooms before it is replaced. No decision had been reached regarding this on the day of the visit. No unpleasant odours were noted during the visit and all areas appeared clean and tidy. The home is well equipped with sluicing facilities and adequate supplies of plastic gloves, aprons were available.
The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 25 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Recruitment procedures are not safe Staff have received training to do their role but much of this is outdated. Staff are provided in sufficient numbers to meet the residents needs. EVIDENCE: EMI Residential Unit Discussions were held with 8 residents, 4 relatives, six staff and the unit manager. Copies of off duties were also viewed. A family member spoken with said that in her opinion there is enough staff available at all times. Staff spoken with said that previous issues with staffing levels and staff not arriving for duty are now resolved. Two staff members said theres more than enough staff now. Residents spoken with spoke positively of the staff levels of available. However one resident said, staff are very busy and I’m very often left waiting, staff frequently say theyre very busy. The opportunity to review resident’s needs and determine that sufficient staff are available to meet those needs has not been taken. Staff spoken with were unaware of the GSCC code of conduct. A volunteer was noted to be working on the EMI residential unit. The volunteer had not undergone any recruitment checks prior to being able to work in the hand. There were no records of references, CRB, application or induction.
The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 26 The staff detail that they had received a variety of training. They have been given challenging behaviour training from the manager. There is no program as to the contents of this training. On the day of inspection an incident occurred in which staffs training was not sufficient for them to fully manage the situation. Two staff were unsure as to whether they have completed up to date moving and handling training. Fire training records did not detail any recent Fire training for staff. One staff member was unsure as to when they have completed their Fire training. However following the visit it became apparent that this information is stored in the Home Managers office. The unit manager has achieved Level 4 NVQ in management. Eight of the twenty-eight staff employed have achieved or are undertaking NVQ qualifications. Nursing Unit A training programme and staff files were viewed. A discussion took place with the Home manager. The home manager, and another senior staff member have achieved NVQ level 4.The training plan that was viewed was developed for last year. Discussions took place around making Dementia Care, POVA training and abuse awareness training mandatory as well as manual handling food hygiene and first aid. Staff have recently received training on infection control. An audit of staff training has been undertaken to identify which staff require refresher training. Although outdated in places all files viewed contained information that mandatory training had been given at some point. Recently the service has been given access to a variety of training that is available for care homes from the primary care trust. It is the intention to discuss what is available with staff during supervision. Eleven of the twentytwo staff employed on the unit has achieved NVQ qualifications. Viewing off duty and discussions with staff confirmed that the unit is staffed consistently and that there are enough staff to meet the residents needs. Residents held a similar viewpoint during discussions. Staff files have been audited to ensure compliance with the care home regulations 2001 and are greatly improved since the previous inspection however some files were still missing photographs for identification. However the Home manager admitted that she still doesn’t get to see all CRB checks before a member of staff is employed. These are held at head office. A copy of an induction for a new staff member was viewed. This has been devised by the home and does not meet the good practise recommendations of the National Training Organisation. The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 27 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 36,38 Resident’s rights are not upheld due to a lack of financial information. Staff are supervised but this needs to be developed further on the EMI Residential unit. Attempts are made to protect the resident’s health and safety but these are not adequate. EVIDENCE: General All certificates with the exception of the electrical certificate were available, up to date and relevant. The maintenance man checks water temperatures weekly and emergency lighting monthly. There is also an annual check on the call system and emergency lighting. All hoists and moving and handling equipment have been checked and staff said that they have received instruction on how to use it. There are no risk assessments for the building in general this includes the stair gates, usage of the carry case for medications as examples on the EMI Residential unit.
The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 28 Evidence was found in staff files that some staff from both units had recently attended a fire-training lecture and that four staff had attended Health and Safety refresher training. Several fire doors were propped open (mainly on the nursing unit) with footstools, slippers and assorted other items. Staff were aware that this was not appropriate and although risk assessments were available they discussed the risk of residents falling over the wedges. A discussion was held with the home manager and receipts and details of Residents monies were viewed. There are good individual records available in the home that keeps account of each resident’s money. Receipts are available for all spending. The manager does not have sufficient information on each resident’s personal allowances to be fully sure the residents are receiving the funds that they are entitled to. Residents are unable to access their own money unless either the manager or the deputies are on duty. Relatives have access to resident’s money without the permission of the resident. The manager is not aware of relatives legal rights to take care of their relatives money and is not aware of whom the Home is appointee for. One resident does keep his or her own money and this is maintained securely. EMI Residential Unit Staff have received one formal supervision only. They were unsure as to the purpose but said that they found it a positive experience. Records of the supervision were not kept securely but were in the office where they could be accessed by anyone. The records for fire instructions were not completed and it was not possible to determine that all staff had received instruction in fire safety. Staff have not received a fire drill and there have been no drills overnight. Residents were unaware of what to do in the event of a fire. Wheelchairs were used without footrests and lap straps, staff explained this was due to the resident catching their feet on the foot rests, however there was no risk assessment in place. Staff were unaware of the need to make sure that fire doors were shut between the hours of 11pm and 7 am. The office door on the EMI residential unit has only one key. Staff have accidentally left the key in the office and had to force the door open. This should be risk assessed in order to prevent a resident from being accidentally locked in the office. Nursing Unit Records were viewed that showed staff were receiving supervision. These were stored correctly. Supervision has been delegated between senior staff. Staff commented that they felt it worked well and understood the purpose. The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 29 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 x
COMPLAINTS AND PROTECTION 2 x x x 3 3 2 3 STAFFING Standard No Score 27 3 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x x x x 2 2 x 2 The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 30 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14.-(1) (a)(b)(c) Timescale for action NURSING UNIT-The manager 31st must ensure social worker September assessments are always obtained 2005 prior to admission to the home and representatives are included in the assessment process when residents are unable to express their likes and dislikes. EMI RESIDENTIAL-The manager must ensure assessments of new residents are immediately made available to the unit and when appropriate other health care professionals are involved in the assessment process prior to admission. EMI RESIDENTIAL-A policy must 31st be developed detailing when October care plans for new residents will 2005 be developed by. This must be implemented and all staff made aware. EMI RESIDENTIAL- Staff must 31st ensure all plans are reviewed October with residents/ relative input and 2005 all information ( including that stored to Staff memory) is added to the plans.Particular attention must be paid to the wishes of the residents. EMI RESIDENTIAL- records must 30th
Version 1.40 Page 31 Requirement 2. OP7 15.-(1) 3. OP7 15.-(2) 4. OP8 13.-(1)(b) The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc 5. OP8 13.-(1)(b) 6. OP9 13.-(2) 7. OP9 13.-(2) 8. OP12 16.-(2)(n) 9. OP14 16.-(2)(n) 10. OP16 22.-(1) 11. OP18 13.-(6) 12. OP19 13.-(4)(b) 13. OP19 16.-(2)(c ) be developed to show residents health needs are being met e.g opticians , dentist, chiropody visits EMI RESIDENTIAL- Advice must be sought for the resident whose glasses were scratched and worn. EMI RESIDENTIAL- Opening dates must be recorded on eyedrops to ensure they are administered within their shelf life. EMI RESIDENTIAL Medication Adminstration records must be completed as per the homes policy BOTH UNITS- an acivity programme must be developed on a weekly basis and displayed in a prominent position. 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. EMI RESIDENTIAL- A copy of the homes complaints policy must be displayed in a prominent position.Staff must record all concerns not just those that they think are important. BOTH UNITS-Abuse awareness training must be revisited and were appropriate include the homes own policies and the local guidelines on protection of vulnerable adults. EMI RESIDENTIAL- the unit should either remove the stair gates or keep them closed as was the original intention NURSING UNIT- A firm decision must be made as to when the carpet on the top floor of the building is to be replaced.The November 2005 15th September 2005 Immediate Immediate 31st September 2005 31st September 2005 31st September 2005 30th November 2005 Immediate 31st September 2005
Page 32 The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 14. OP19 16.-(2)( c) 19.(1)(a)(b)( c) 19.-(1)(b) 15. OP29 16. OP29 17. OP30 18.-(1)(a) 18. OP30 18.-(1)( i) 19. 20. OP30 OP35 18.-(1)(a) 13.-(6) 21. 0P 38 23.(4)(a)(b)( c )(d)(e) CSCI must be informed of when this is to take place. NURSING UNIT- the flooring to bathroom 30 must be repaired. The paint to the flooring of bathroom 50 must be removed. The home manager must ensure volunteer staff are recruited in the way as paid staff and all CRBs are viewed prior to employment commencing. The home manager must ensure that she follows through her intention to add photographs for identifIcation to all staff files. The home manager must ensure she familarises herself with the guidelines made by the National Training Organisation regarding inductions for new staff. A new induction procedure must be developed and implemented following this. The home manager must develop and implement an up to date training programme without further delay.A copy of this must be forwarded to CSCI. EMI RESIDENTIAL-Staff must revist training on challenging behaviour. BOTH UNITS- The Home manager must ensure she recieves full financial information for each Resident who requires support with management of finances so she can ensure the residents rights are being upheld. BOTH UNITS- All staff must recieve refresher training in fire prevention. Risk assessments must be followed in relation to wedging open of doors.Six monthly practise fire evacuations must be undertaken( one of which must be undertaken at night). 31st October 2005 31st September 2005 31st October 2005 30th November 2005 30th November 2005 30th November 2005 30th November 2005 30th November 2005 The Orchards Nursing & Residential Care Home F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 33 22. OP38 23.-(2)(b) 23. OP38 23.-(2)(b) 24. OP38 13.-(4)(b) BOTH UNITS- An up to date electrical safety certificate must be obtained and a copy forwarded to CSCI BOTH UNITS- All areas of the building must be assessed for potential risks and documentation developed to support this. EMI RESIDENTIAL- Staff must familarise themselves with the correct use of wheelchairs. 31st October 2005 31st December 2005 31st October 2005 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. Refer to Standard OP3 OP7 Good Practice Recommendations BOTH UNITS-The unit managers should undertake assessments on all prospective residents alongside the Home manager. NURSING UNIT- Wound Care could be developed further by including the use of photographs and measuring wound sizes.If adopted a policy should be developed to support this. NURSING UNIT-Staff should continue to include representatives in care plan reviews when appropriate EMI RESIDENTIAL- the unit manager should carry through her intention to adress the shortfalls which were identifed following the recent care plan audit. EMI RESIDENTIAL- a risk assessment should be carried out on the carrying case used for medication. Any findings should be acted on. BOTH UNITS- the service should consider adding pictures and plants to the bathrooms to make them feel more homely. EMI RESIDENTIAL- the service should consider wether it is approparite to keep the visitors lounge on the unit locked. BOTH UNITS- the service should consider replacing the lino in the dining rooms with something more domestic in apperance. Copies of the code of conduct issued by the General Social Care Council should be given to all care staff.
F53 F03 S5465 The Orchards V228320 040705 Stage 4.doc Version 1.40 Page 34 3. 4. 5. 6. 7. 8. 9. OP7 OP7 OP9 OP19 OP19 OP19 OP29 The Orchards Nursing & Residential Care Home Commission for Social Care Inspection Burlington House Crosby Road North Waterloo, Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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