Inspection on 05/07/07 for The Orchard Nursing & Residential Care Home

This inspection was carried out on 5th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

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

The Orchard Nursing &... 26/10/06

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 Julie Garrity Unannounced Inspection 11:00 5 and 19th July 2007 th 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.V334735.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.V334735.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 admin@flightcare.co.uk Flightcare Limited No registered manager 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.V334735.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. 26th October 2006 Date of last inspection Brief Description of the Service: The Orchards Nursing and Residential Care is divided into two units with a deputy manager taking responsibility for the day-to-day running of the service in each unit. There are 27 bedrooms allocated to provide care for older people with mental health needs who do not require nursing care in one. A further 27 beds are registered for residents needing nursing care in the other unit. Each unit has its own kitchen area, lounges and dining rooms. The unit for residents with mental health needs has two lounges, two dining rooms and a relaxation area. The nursing unit has two lounges and two dining rooms. There is a small garden area available at the back of the home and another garden area at the front of the home. There is also a large car park at the rear or the building The Orchards Nursing and Residential Care Home is located in a residential area of Huyton. It is near to the main shopping centres of Huyton and there is rail and bus access within a 10 minute walk. The home is part of a privately owned company, known as Flightcare Ltd, this organisation has a total of 7 homes located in the North West region. The responsible individual and owner of the service is Mr. Dhanjee, at present there is no registered manager. Fees for the home are in line with those from Knowsley Social Services and start at £399. 61, the maximum fees being paid at present are for a private resident at £491.09. Items such as toiletries, newspapers and hairdressing are not included in the fees. Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over two days and included a pharmacy inspector. 14 residents, 16 staff, 2 relatives, the administrator, two deputy managers, the acting manager and the provider were spoken with. The records available in the home and CSCI offices were reviewed. These included care plans, accident records, medication records, staff rotas, staffing files, maintenance records, menus, activities programme, audits in the home, staff training and information given to residents. Other information sent to CSCI by the home and previous site visits were taken into consideration. A tour of the premises and the grounds was carried out.Observations of staff interactions with the residents took place over the day, over mealtimes and the administration of medications. The inspectors followed an inspection plan written before the start of the inspection to ensure that all areas identified as in need of review were covered. All of the Key standards were covered in this inspection, these are detailed in the report. Feedback was given to the acting manager and the providerduring and at the end of the inspection. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the ways that the home used to determine individual needs, promote independence and support residents to make informed decisions in line with their individual choices. What the service does well: All new residents are assessed before they move into the home. This means that the staff are able to decide whether the home would be a suitable place for them to live and gives prospective residents the opportunity of meeting with the staff. There is a stable staff team on both units, they have an unhurried approach to the residents care and this helps create a relaxed atmosphere. Staff observed during the visit were able to support residents with a genuinely warm and caring attitude. Residents spoken with said, “The staff here are lovely”, “They are lovely girls, kind, fun, some are just like family” and “It’s lovely here I don’t want to live anywhere else. Both units are very welcoming to visitors. The home has open visiting hours and visitors are free to visit as often as they choose. Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 6 One relative explained she “ goes through” her husbands care plan monthly with his key worker and they discus his ’medication, health. This is good practice and includes the relative in the care that her husband receives. Both units are decorated to a good standard and are warm and welcoming. Residents are able to make their bedrooms their own space and they are encouraged to bring in items that make it feel like home. Residents spoken with were positive about their own bedrooms, one resident said, “I have absolutely no issues, this is a lovely place”. What has improved since the last inspection? What they could do better: Medicines that need to be given before food are not always given at the correct time. Administering medicines at the wrong time can affect the way they work which could affect the health and well being of the person taking it. Documentation in the home such as staff training, supervision and staff recruitment is still unclear it will be difficult for the manager to be sure that staff have received the training or have the skills required to provide individual care to residents. This also applies to care planning and monitoring of treatment given to residents, a lack of clear instructions prevents the staff from supplying a service of sufficient quality that meets all the residents individual needs. In some instances the care and support given to the residents does not take into account their personal preferences and choices, there is little consultation with the residents or their families that takes the opportunity to find out their choices and then uses them to determine the service to be given. Please contact the provider for advice of actions taken in response to this Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 7 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.V334735.R01.S.doc Version 5.2 Page 8 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.V334735.R01.S.doc Version 5.2 Page 9 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): Standards 1 and 3 were reviewed in this area. Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All residents are assessed before they move in. This supports the home to determine if they can meet the resident’s needs. Residents are encouraged to visit the home in order that they can decide if the home is for them. EVIDENCE: Six copies of individual assessments on both units were viewed. These showed that assessments of residents needs have been done for each new resident and that the home receives assessments from other health care professionals. The home consults with other professionals and does assessments in order to make sure that they can meet the resident’s needs. A relative spoken with said, “The manager came to the hospital. We talked about what was needed and how they thought that could be sorted”. Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 10 The information in the home says that residents are offered the opportunity to look around the home before they move in. A resident spoken with recalled coming to see the home before they moved in they said, “I came for a look around the home. The manager was really nice and I like the way it looked.” Another resident said, “They showed me a really nice room, my daughter had looked around she thought it looked okay and it’s near the rest of the family”. Although not all residents are able to visit before they move into the home this opportunity and an assessments supports the residents to decide if the home can meet their needs. The home has information about the services that it provides, a copy of this was seen in several of the bedrooms of the residents. This is no longer correct and does not provide potential residents with an accurate account of the services provided by the home. Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 11 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): Standards 7, 8, 9 and 10 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of medicines in the home has improved. However there are essential areas such as clear instructions as to when to give medicines and giving medicines at the correct times that need to be addressed in order that the residents are fully safeguarded. All of the residents have an individual care plan that is reviewed each month. These vary in quality with some of the plans written to a good standard and other plans not containing information vital to that would enable staff as to how to support residents to meet their individual needs and safeguard their dignity, health and welfare. EVIDENCE: The medication administration records seen were up to date and staff were seen correctly signing the records after assisting the residents with their medicines. Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 12 However the instructions for when some medicines were to be given were not always clear, these included medications that are to be given when need, such as painkillers. Staff need to have clear instructions as to when to provide the medicines in order to safeguard residents health and welfare needs and provide appropriate relief from pain. All staff responsible for giving medicines have received training in this area, regular audits are in place to check that staff are meeting the policies and procedures in the home and giving out medicines safely. Part of a medicine round was observed and it was noted that not all medicines are given at the right time. Several prescribed medicines are supposed to be given before food however care staff and residents said that all medicines are given at mealtimes. Records available in the home confirmed this. Giving medicines at the wrong time can affect the way they work and can increase the chances of side effects. All the care plans viewed have been reviewed in some cases changes such as a chest infection have prompted a new short term care plan. In some care plans there was good information that detailed residents personal choices such as “likes two pillows” and ‘ likes to get up early’, others contained good instructions to staff such as “ can get frightened by loud noises … take time to find out what they want”. This is good practice and helps inform staff how to meet resident’s needs. Many of the care plans remain very complex and overly long, with information repeated in several different places. Two of the care plans viewed did not detail what treatment was in place for wound care and in one instance Staff were not undertaking the actions described in the plan. Other information was missing from the some of the care plans this included, pain relief guidance, nutritional management, infection information, behavioural needs and up to date risk management. Staff on the nursing unit said that they did not read the care plans as they are do not understand them. Without clear a care plan that identifies the residents needs and provide staff with clear instructions staff will be unable to provide a service that meets the residents health and welfare needs. Some of the care plans had evidence that the residents or relatives had been consulted. Of the four care plans seen on the nursing unit there was no evidence that the care plan had been discussed with the resident or their relatives. Without consulting the residents and their relatives the home may be delivering care that the resident does not think is appropriate. One resident said, “Most of the staff know what they are doing and are really kind, but not all of them”. During the day staff appeared unhurried and relaxed in caring for the residents. Care was taken when moving residents to explain to them what was happening and to give suitable instructions to assist them. Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 13 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): Standards12, 13, 14 and 15 were reviewed in this area. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some of the information the home is clearly details the residents personal choices and needs however this was not available for all and in the majority of occasions was written in care records that not all care staff read. Without understanding the residents personal preferences and choices staff will not be able to meet their individual choices. EVIDENCE: Observations over the lunch period on the nursing unit showed that the dining room tables had been laid with fresh flowers and table clothes that were clean and fresh. This is good practice and presents a welcoming atmosphere to the residents. Residents were sitting waiting for their meals for a substantial amount of time in one case this had been nearly 40 minutes. One resident said, “Why do we have to wait for everyone to be seated before we can have our meals”. Staff were struggling to seat residents in the rooms, as both were very cramped. The acting manager explained that this is being reviewed and they have plans to change the dining arrangements. Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 14 A copy of the menu is available in both dining rooms. This shows a choice of meals, however is in normal print and not possible to read unless standing very near to it, there is a table in front of one of the boards that prevents someone with visual impairment from being able to read it. One resident said, “I can’t read the menu the writing is to small”. Staff on the residential unit are intending to take photographs of the food available to help support residents to make a choice. Were the residents could express an opinion they were asked what they wanted to eat. Staff giving the meals to the residents did say what was on the plate. Observations of staff supporting residents to eat showed that they did so in a calm, relaxed manner and their support encouraged the residents to eat their meals. Staff spoken with said that they would like to know more about special diets. Residents spoken with said, “Mostly the food is pretty nice”, “It can be very tasty” and “Not always what I want, I tend to ask for a sandwich”. There is activities information on one unit it was clear and structured, however this was not available on the other unit were no activities programme could be located. No activities were observed to take place on the nursing unit. Residents spoken with said, “ I don’t do anything”, “I would like to get out and about more” and “I tend to watch the telly, I would like to get out more, shops would do”. An activities programme was available on the residential unit, observations during the day showed that these activities were being carried out. The activities co-ordinator on this unit is to have training in the future on creating and delivering activities that are individual to the needs of the residents living on the unit. There is a relaxation area on the residential unit that is nicely decorated with different lights, comfortable chairs and music. A visitor advised she sometimes sits in the room with her husband to relax and have some privacy, she described it as ‘lovely’. A visitor described the home as ‘great’ explaining she is always welcomed to visit and feels at home. Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 15 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): Standards 16 and 18 were reviewed in this area. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents feel confident in raising their concerns, however not all complaints are properly investigated with the correct action taken to fully safeguard the residents. EVIDENCE: A copy of how to raise concerns is available in the homes main entrance. Staff spoken with know how to raise concerns but not all are aware of who is responsible for dealing with more serious concerns or how the home would deal with it. All but five staff had received training in protecting vulnerable adults and in recognising signs and symptoms of potential abuse. This was seen in the training records and the staff also discussed the training they had recently had. Residents spoken with were confident that their complaints would be dealt with one resident said, “Things aren’t always perfect but I just talk to the staff. They are pretty good and usually fix it” and another said, “I have absolutely no issues, this is a lovely place I wouldn’t live anywhere else”. A record of all concerns raised is available, there were records available of the two complaints also raised with the Commission, the manager had investigated these at the time and a letter had been sent to the complainant. However the records of these complaints and two others do not show how these concerns Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 16 have been investigated and in one instance a complaint has not been fully addressed. The acting manager detailed that the nature of the complaint had not been given to the home, however the inspectors located information in the homes files that detailed the original concerns raised. There has been three different managers in the home in the last 8 months and the lack of clear recording of complaints has resulted in this complaint not being appropriately addressed. Staff do not always pass on information that is needed for management to review and make sure that concerns can be addressed. One resident complained about the food during the site visit this was addressed by the staff but not passed on the management team. Staff have been given training in recognising and reporting complaints if the acting manager is not informed of all concerns and complaints they will be unable to monitor the concerns, take appropriate action or prevent them from re-occurring. Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 17 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): Standards 19, 20, 21, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Most 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. Equipment that helps maintain the resident’s independence and safety is in place. EVIDENCE: A tour of the environment was undertaken on both units. This included looking at residents bedrooms. All areas viewed were decorated to a good standard and areas used by residents were clean and tidy. Efforts have been made in areas to introduce homely touches such as pictures and new curtains have been put up in the dining rooms. All bedrooms viewed were personal to the resident and it was evidenced that they are supported to make these spaces their own. A relative explained she chose to buy furniture and that the home Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 18 ‘keeps it up to scratch’. Residents spoken with said, “My family brought in all my stuff from home, well some of it, its nice to have my comfy chair and photos around and about” and “Its comfortable here, its clean, tidy, what more can I ask”. A selection of bathrooms, toilets and sluice areas were viewed on each unit. All of these areas viewed contained liquid soap and paper towels with hand washing facilities, which help prevent the spread of infection. Several of the bathrooms were in need or redecoration or refurbishment as they do not meet all the residents needs. The acting manager has also undertaken an audit of these areas and has plans in place to address these areas in the near future. There is no maintenance plan in place that would inform residents, relatives and staff of when the home will be redecorated and refurbished. The kitchens on both units were viewed. Both kitchens had a cleaning schedule to make sure that staff were able to keep it clean at all times. However the kitchen on the nursing unit has been planned to be replaced for sometime as yet there is no date as to when this is to be completed. The kitchen on the residential unit has been refurbished in the last 12 months and is suitable to meeting the needs of the residents. The home has appropriate equipment such as specialised mattresses, handrails, bath hoists and other equipment that supports the residents needs and promotes their independence. Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were reviewed in this area. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are arrangements in place to make sure that there are enough staff to meet the needs of the residents, Although staff training has improved there are still areas that need further development in order for staff to meet the individual needs of the residents. Recruitment processes have improved and all staff are now checked before they start work. EVIDENCE: Staffing in the home is determined weekly taken from the assessed need of the residents. On a weekly basis the provider approves the staffing levels. This is good practice as it supports the residents to have sufficient staff to meet their needs. A review of a few weeks duty rota showed that the right levels of staff were not available all occasions. Although care staff generally work extra hours to cover any staff on holiday or sick this does not always happen. This is unfortunate given the provider has taken the opportunity to make sure that sufficient staff are available at all times. The manager detailed that there are a number of vacancies in the home including kitchen assistant, nursing staff and an activities co-ordinator and that these posts will be filled in the near future. Staff were sure there was enough staff. Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 20 Files within the home are disorganised. Records regarding recruitment were very difficult to review, confirmation that all staff had been given the appropriate checks before starting work in the home was sent to the commission after the site visit. No induction records for new staff could be located. There is a checklist for areas such as fire doors. Exits etc. However this does not include training in meeting the needs of there residents living in the home. The management team need to have good records in order that the staff working in the home have sufficient skills and qualifications to work in the home. The acting manager is aware that the staff files are in need of organisation and had planned to audit them on the day of inspection. A visitor described staff as, ‘very kind’ explaining she is always made welcome and has trust in them to look after her relative. Residents said, “They are lovely girls, kind, fun, some are just like family” and “It’s lovely here I don’t want to live anywhere else. One resident did make a negative comment and this was passed on to the deputy manager. Staff supervision records are available and this has increased from previous inspections. Staff spoken with said that they had received supervision however records in this area were brief. Two members of the nursing staff had requested training in their supervision however arrangements for this had not yet been commenced. Where staff have identified they need to gain skills it is good practice for the home to make sure that this training is supplied. All staff spoken with said that they would like training in dementia care, special diets, alcohol abuse and some would like to receive training in care planning. There is a training matrix that details the training that staff have undertaken. Concerns raised regarding staff not receiving training in fire safety and moving and handling arrangements have been addressed in order to maintain the safety of the residents. Staff explained that they had received training in moving and handling, but were observed on four occasions to be using moving and handling equipment inappropriately and placing the residents at risk. The deputy manager detailed that this would be addressed with the staff. The provider advised and the acting manager confirmed that there are over 20 training videos available within the organisation and a list of these has been circulated. This includes further training on dementia care. As this is one of the training areas that staff have identified that they need further skills in, supporting the staff to use these videos will support them to develop their skills in meeting residents individual needs. Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 21 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): Standards 31, 32, 33, 35, 36 and 38 were reviewed in this area. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has made progress in increasing the quality of the service that it provides. However there are still areas that need significant improvement in order that the service can better meet the individual needs of the residents. EVIDENCE: In the last 8 months the home has had three managers the acting manager is temporarily in post until a permanent manager can be recruited. The acting manager is a registered manager with another home within the organisation she has 5 yrs management experience and has qualifications suitable to manage the home. Following the last key inspection there were serious concerns raised regarding the quality of the service provided. Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 22 This particularly related to staff skills, management of medications and meeting resident’s health and welfare needs. Progress has been seen in all off these areas but further development needs to be made in order to safeguard the residents health and welfare. Staff said that it has been an unsettled time, morale has been very low on occasions. One resident said, “there has been a lot of changes lately A review of the maintenance records showed these were all up to date and that the home had consulted with environmental health and the fire officers. The homes own risk assessments for the environment and fire safety were not available. Risk assessments for individual residents were seen on their care plans, these had all been reviewed each month. However the details in these needs to be further expanded, as they do not always provide staff with sufficient information to maintain residents safety. One resident who smokes was noticed to have burns in their clothing, there was no risk assessment available to support this individual to smoke safely. Four bedroom doors were propped open. The residents were in bed and could be seen by visitors walking down the main corridor. None had equipment on the doors designed to close in the event of a fire. The deputy manager detailed that the bedroom doors were open as that was what the residents wished, however this had not been risk assessed and the appropriate equipment provided to maintain the residents safety. There is no formal quality assurance however questionnaires were sent out last year to residents and staff. These were looked at and issues raised written down. No action plan that would support management to improve the service was put into place. The acting manager has started to audit the home by undertaking care planning, staff files, staff training and environmental audits. Medication audits have been in place for some time. There has been one residents meeting in the last 6 months, the minutes of this were very brief and not circulated to other residents and their relatives in order to determine their point of view. Regularly looking at the homes quality and supporting the residents to influence the service is necessary in order to build on the areas that the home does well and to advance areas were the home needs to improve. Policies and procedures are in place these have not been reviewed and there is no date for the last update of these policies and procedures. Some are inaccurate and not all are being followed by the staff. If staff do not follow policies and procedures they will be unable to deliver the quality of service needed by the home to meet residents individual needs. The administrator was auditing the resident’s personal allowances on the day of the site visit. Two records were viewed, the administrator was trying to tally all spending with any receipts and to balance that with the money they had available for each residents. Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 23 They had identified a couple of entries that were unclear. The manager said that any spending on behalf of the residents that could not be accounted for would result in the home giving the money to the resident. Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 24 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 2 X 3 3 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 2 X 2 Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation Reg.15. (1) Requirement Care plans need to be reviewed and updated in order to determine that they meet all the assessed needs of the residents They should provide the staff with sufficient instruction to meet the individual needs of residents. Care plans need to be made accessible to residents and staff. Medicines must be administered at the correct time in relation to food intake to ensure the health and well being of residents is maintained. Outstanding previous date of 22/06/07 not met. 3. OP12 16 (2) (i) (m) (n) All resident’s daily routines, personal preferences and choices need to be determined. This information needs to be readily available to influence the personal support of the residents and promote the routine of the home. . Specialised diets need to be DS0000005465.V334735.R01.S.doc Timescale for action 26/07/07 2 OP9 13(2) 19/07/07 05/08/07 4. OP15 Reg. 16. - 05/07/07 Version 5.2 Page 26 Orchard Nursing & Residential Care Home The (2)(i) determined, information then needs to be given to all staff about how to meet the residents need in this area. Were instructions are needed these need to be clearly written down in order that all staff have the same instructions and this does not get missed. Outstanding previous date of 30/11/06 not met. 5. OP16 22 (3) 5. OP27 18 (1) (a) 6. OP27 18 (1) (c) (i) The complaint raised in September 2006 for which records were located in the home needs to be fully investigated and the staffing situation around this complaint have a structured management in plan to reduce any potential risk. Staffing levels that have been agreed by the provider need to be adhered to as these have been done using the assessed needs of the residents and need to be in place in order that staff can fully support the residents needs. A training plan that determines how the home will provide training to staff that supports them to meet the residents be developed and implemented. Where staff are identified as requiring specific training this will need to be included in the training plan. 05/08/07 05/07/07 05/08/07 Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 27 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 OP1 Good Practice Recommendations The statement of purpose for the home needs to be reviewed, this documented is intended to state clearly what services it provides and how it will deliver those services. Documentation regarding resident’s pressure ulcers needs to follow the best practice guidelines in place from professional organisations such as the NMC and include monitoring arrangement to fully determine if the treatment used is working. Were external expertises such as tissue viability or dieticians have been involved in the care of the residents this needs to be clearly recorded including their instructions. All medicines prescribed as when required or, as a variable dose should have clear written instructions for staff to follow to ensure they are administered correctly. Patient information leaflets should be used for all medicines kept in the home to ensure medicines are administered correctly. All handwritten medicines records should be an exact copy of the pharmacists dispensing label, which should be double-checked and countersigned, this should help prevent mistakes. The manner by which the home provides information to residents needs to be looked at. The use of different formats such as large print, photographs, tape and video needs to be thought about in line with resident’s individual needs. A procedure regarding reporting and investigation complaints needs to develop in order that all complaints can be report, investigated and dealt with in an appropriate manner. A maintenance plan that details all the areas in the home that need maintaining, including timescales and a rolling programme will benefit the residents. It is good practice to keep residents, relatives and staff up to date in developing this and to use their input when redecorating or refurbishing any area in the home. Records in the home in particular staff training, DS0000005465.V334735.R01.S.doc Version 5.2 Page 28 2. OP8 3. OP9 4. OP12 5. OP16 6. OP19 7. OP29 Orchard Nursing & Residential Care Home The 8. OP30 9. OP38 recruitment, induction and supervision need to be better organised in order to determine that staff are skilled and suitable to work in the care home. Staffing files should be organised in order that information about the staff in the home can be easily located and the manager can be satisfied that staff working in the home are suitable to do so. Risk assessments for home and individual activities of the residents need to be reviewed. Best practice guidance readily available from external organisations needs to be determined and used in forming effective risk assessments. Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 29 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. Extracts may not be used or reproduced without the express permission of CSCI Orchard Nursing & Residential Care Home The DS0000005465.V334735.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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