Inspection on 26/11/07 for Orchard Views

This inspection was carried out on 26th November 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Orchard Views 10/11/08

Orchard Views 17/10/06

Orchard Views 25/10/05

Orchard Views 13/05/05

Orchard Views 17/11/04

Orchard Views 10/08/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Orchard Views 39 Gawber Road Barnsley South Yorkshire S75 2AN Lead Inspector Mrs Jayne White Key Unannounced Inspection 26th and 29th November 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard Views DS0000018270.V349707.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 Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard Views Address 39 Gawber Road Barnsley South Yorkshire S75 2AN 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) 01226 284151 01226 284151 none None Mr Mohammed Sharif Mrs Wendy Sharif Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Three service users may be accommodated at the home age 60 years and above. 17th October 2006 Date of last inspection Brief Description of the Service: Orchard Views is a purpose built care home registered to provide personal care and accommodation to 40 older people. The accommodation and facilities are all ground floor level and there are 38 single and one double bedroom. There is a small car park at the front of the building. The home has a garden area. The home is situated on the outskirts of Barnsley town centre within easy reach of local amenities including a main bus route, post office, shops, pubs, clubs, churches and Barnsley Foundation Trust. Information about the home, including the service user guide is available in the entrance hall. This includes the most current Commission for Social Care Inspection (CSCI) report about the service. The manager said the fees ranged from £308.00 to £341.50. Additional charges are made for hairdressing, private chiropody and individual toiletries. Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. I visited the home on 26 November 2007 between 9:00 and 16:30 without giving them any notice. A further visit was made on 29 November between, 13:15 and 16:30, which I’d told them about. Before the visit I took into consideration other information I had received. This included: • An Annual Quality Assurance Assessment (AQAA). An AQAA is a document completed by providers. It gives them the opportunity to tell the CSCI how well they think they are meeting the needs of people using their service. Information from a concern that had been raised directly with the CSCI about maintaining the privacy and dignity of people and the environment. Information contained in reports from the provider about their visits to the home. Surveys that were sent to a range of people, asking them about the home. Five came back from people that lived there and one from a relative of a person that lived there. The acting manager had recently left and the deputy was acting as manager. When I spoke with the owner they said the deputy had been offered the manager’s post. • • • • During the visit I spoke with people that lived there and their relatives and advocates. I also spoke with staff, the manager, looked round parts of the building and read some records. I would like to thank the people and their representatives, staff and the manager for their time and co-operation throughout the inspection process. CSCI have reviewed their guidance on requirements, therefore, some requirements have been removed if they would have no direct affect on the outcome of the service provided for people. What the service does well: On the whole, people had sufficient information available to assist them in choosing a home. Overall, people were treated with respect and dignity. During the visit I saw people following their preferred routine. People said their representatives could visit “at anytime”. Relatives confirmed this and the fact Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 6 that they were always made to feel welcome and kept up to date about the care their relative was receiving. A good and varied choice of menu was offered. When I spoke to people they were all satisfied with the choice and quality of food offered commenting, ‘it’s good’, ‘it’s substantial’ and ‘there’s a good variety’. One said, “they are lovely, fresh meals. There is a good choice and plenty to eat throughout the day and evening. Cannot be faulted.” People spoke highly of the staff team saying, “staff are excellent”, “I enjoy it here and appreciate everything the staff do”, “staff are kind” and “staff are good”. What has improved since the last inspection? What they could do better: The acting manager needed to learn the full responsibilities of her role to ensure she met the legislative requirements of a registered care service. This should enable her to demonstrate effective management and administration through quality assurance systems. Assess peoples’ needs prior to admission, so the service has sufficient information about what action they need to take to meet peoples’ needs. Make sure that staff follow the information in the plan of care to meet peoples’ needs. Where this has changed, for example, after a monthly review, the plan must be updated. This demonstrates the person’s personal and health care needs are being monitored and met. This is important, otherwise it leads to concerns being raised from relatives, such as “on one occasion my relative hadn’t had a bath for two weeks and their feet were in a mess. I told the staff who dealt with this and it hasn’t happened since. They now realise my relative needs prompting with their personal hygiene, therefore I am satisfied so far”. Seek assistance from appropriate healthcare professionals, when there is a need to do, for example, because people lose or gain weight. This again Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 7 demonstrates the person’s personal and health care needs are being monitored. That the service maintains the responsibility for assessing risks to people and identifying any action required to reduce the risk to the person. For safety and verification purposes, improve the storage of medication for controlled medication and the medication administration record for people who administer their own medication. Review staffing levels, so there are staff in sufficient numbers to meet the social care needs of people. Establishing a planned programme of activity would also improve the quality of life for people, including trips out of the home. Respond to complaints, so that people have confidence that their complaints will be acted on and action taken to resolve their complaint. React to recommendations from adult safeguarding referrals. This would ensure staff have sufficient knowledge to report the different types of abuse and therefore protect people at the first occurrence of any abuse. Refurbishing parts of the environment and maintaining it well would make it a pleasant, well-maintained place for people to live. It would mean that people and their representatives did not have to express regret that the home’s environment wasn’t satisfactory by saying, “a bit of a spruce up wouldn’t go amiss”, “it’s just the décor and carpets that make it look shabby”, “I can’t fault the management, the care or the meals. The only thing to comment on would be the standard of decoration within the home and also the need for new carpets. I have been told that these are to be dealt with in the next two months” and “I know the environments not up to much, but it’s the care that counts. I always check their clothes; hair, nails and glasses are clean. That’s what’s important. But, new carpets wouldn’t go amiss”. Ensure staff receive sufficient training for their role, including refresher training to make sure they have sufficient knowledge to meet the needs of people. This includes adult safeguarding, infection control, fire safety and first aid. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Orchard Views DS0000018270.V349707.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 Views DS0000018270.V349707.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): The outcome for standard 3 was inspected. The home did not provide an intermediate care service. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People had information available to assist them in choosing a home. People did not always have a full assessment before they moved into the home. EVIDENCE: All but one person, via the survey said they’d received enough information about the home before making a decision to move there. The one who said they hadn’t commented, “my relative had to make the choice whilst I was still in hospital. I originally came in for respite care”. When I spoke to people they said either themselves or their family had looked around the home before making a decision about moving there. Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 10 Surveys returned by people who lived at the home permanently identified they had received a contract outlining the terms and conditions of living there. One commented, “I have signed a contract but don’t have a copy”. Another said they didn’t have a contract because they were “on respite care”. I spoke with the acting manager about the need to provide terms and conditions for all people who stay at the home, so they know what these are and what the cost will be. The AQAA stated: • All people have a pre-admission assessment and a full assessment is carried out prior to admission to ensure the home can meet their needs. • People are invited to come and stay for the day and have lunch. They are given a service user guide and invited to read the inspection report in the foyer to help them with their choice of home. • Family members are shown around the home and their concerns addressed. I looked at two peoples’ files for the assessment that was undertaken. These did contain an assessment, but could contain more detail. One contained an assessment that was completed after the person had moved into the home. This meant the service could not demonstrate they had obtained sufficient information before people moved in, about what action they needed to take to meet their needs. I saw the admission of process of someone. The home did not have any information about the person other than brief information they had received from the family over the telephone. This meant until the person arrived the service did not know how they would meet their needs and that they had sufficient skills to do so. I spoke with the acting manager about the admission process. She acknowledged that not having enough information about people before they moved in, meant they could not be sure the service could meet their needs. Orchard Views DS0000018270.V349707.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): The outcomes for standards 7, 8, 9 and 10 were inspected. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The daily report did not confirm staff were following the plan of care for people, which may mean they are not receiving the health and personal care needs they require. On the whole, people were treated with respect and dignity. EVIDENCE: Five people, via the survey said that they always or usually received the care and medical support that they needed. When I spoke to people they said that they were well cared for and some people could describe the help that they received. One commented, “the nurse visits for my six monthly MOT”. Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 12 The AQAA stated: • People are encouraged to assist in the formulation of their own care plan and risk assessments and are consulted at monthly reviews. • Family members are also invited if the person is unable to take part and they confirm they are happy with the input of their family. • All people have comprehensive care plans to cover activities of daily living, which are formulated on admission. • Each person has a key worker and if possible they will formulate their care plan with the key worker. • Social service referrals have a requisition care plan giving an insight into what care needs may be. • Care plans are reviewed monthly. I looked at four care plans. Generally, the plans included information about the person’s life history. People or their representatives had been involved in their plan of care, where this was possible. This gave them the opportunity to discuss with the staff how their care needs could be met. The plans contained information to tell me what action staff needed to take to meet peoples’ needs. The daily report however, did not confirm that the action detailed in the plan had been taken. For example, the plan identified the person should be offered two baths a week and a chiropody visit should be arranged three monthly. Information in the reports confirmed one bath had taken place each week, with no other information to indicate another had been offered. There was no information to indicate a chiropody appointment had been arranged since admission (more than three months). Risk assessments had been devised which identified the individual risks that were presented to people, for example, mobility and falls. The assessment identified the action required by staff to reduce the potential risks to people, promoting and maintaining their independence. I discussed with the acting manager that obtaining the consent of family members did not constitute a risk assessment. The service must take responsibility for any action they have identified within that assessment to reduce any potential risks to people, for example, providing a liquidised diet because of problems with swallowing. Nutritional screening and pressure sore scores were undertaken for people, which identified the level of risk for the person. This in practice did not always result in any action. For example, where the risk had been identified as high, the action to be taken to reduce the risk was not part of the plan of care. When I looked at care files they did demonstrate that people’s weight was recorded. Again, there was no information to indicate the action that had been taken as a result of peoples’ weight increasing or decreasing. Records of healthcare visits were maintained and demonstrated that generally people did receive visits from their general practitioner, chiropodist and Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 13 optician. However, the outcome of their visits was not always fully recorded and the plan of care reviewed when this was necessary. One relative, via the surveys said the service usually met the needs of their relative. They said, “on one occasion my relative hadn’t had a bath for two weeks and their feet were in a mess. I told the staff who dealt with this and it hasn’t happened since. They now realise my relative needs prompting with their personal hygiene, therefore I am satisfied so far” and “the genuine quality of care is excellent”. When I spoke to people they said that staff treated them with respect and they were able to spend time in their room if they wished. I saw staff approaching people in a respectful manner and respecting individual preferences. I saw staff respecting the privacy and dignity of people, for example, knocking on peoples’ doors before entering. On the whole, people were well dressed. They were clean, as was their hair and nails. This confirmed staff were maintaining respect and dignity for them. When I spoke with a relative on my visit they also commented, “I know the environments not up to much, but it’s the care that counts. I always check their clothes; hair, nails and glasses are clean. That’s what’s important. But, new carpets wouldn’t go amiss”. When I spoke to staff they described in detail how they promoted peoples dignity, for example, calling them by the name they preferred. When they described practices that they carried out when assisting people with their personal care, this also demonstrated how they respected the dignity of the people they cared for. When I looked round the building the locks on some toilet and bathroom areas were broken. This compromised the privacy and dignity of people and was raised as a concern when I was speaking with them. Senior care staff administered medication. People were encouraged to look after their own medication. A basic risk assessment was in place to assess their capacity to do so. Staff signed the medication administration record to confirm they’d received the medication on behalf of the people who looked after their own medication and given it to them. The person who had been given their medication had not signed the record to verify this. I looked at the recording, administration and storage of medication on a sample basis. Medication received was clearly recorded on the person’s medication administration record and medication administered had been Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 14 signed for. Medicines were securely stored, but further secure storage for controlled drugs was not in place, as there wasn’t a key for that storage space. For controlled medication, two staff had signed to confirm that the medication had been appropriately administered. Arrangements were in place for the disposal of medication. I spoke with staff responsible for administering medication who said their training had been received through their NVQ Level 3 in Care and completing a safe handling in medicines course. This ensured that they were conversant with the procedure for the storage and administration of medication. Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 12, 13, 14 and 15 were inspected. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were assisted to make choices and decisions about their daily life, but there was little provision for people to take part in social activities. EVIDENCE: The AQAA stated: • The service tries to encourage people to carry on with any activity they had before admission within their range of capabilities. • Peoples’ religious needs are met wherever possible by arranging transport to and from church or by arranging visits from their preferred church leader. • People are given every opportunity to choose how they wish to spend the day, including getting up and going to bed. They have choices about whether they eat in the dining room or not, a choice of menu and if they require something else all attempts will be made to accommodate this. Meal times are not rushed and a choice of drinks are provided. People can have a drink at any time of the day if they wish. Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 16 • • • • Dietary requirements are met when requested. Liquidised meals are provided, if needed, as are soft diets. Any problems with diets are referred to the dietician and weights are monitored monthly. Having a healthier range of options on the menu has improved in last 12 months. The service could offer a wider range of activities, but this is difficult, as we don’t have an activities co-ordinator, so we are reliant on care staff on duty having time to spend involving people in stimulating activities. The surveys returned by people contained a mixed response. One person said that there were always activities available they could take part in, another said sometimes and three said usually. One commented, “other than my meals I do actually prefer to stay in my room and read and watch television”. When I spoke to people they described how they spent their day and commented, “ I get up and go to bed as I wish” and “ I can do what I want”. Several people I spoke with said they preferred to spend the majority of their day in their bedroom as they enjoyed reading, writing and watching television. The quality of life was discussed with one person and they commented, “they talk about extending life, but it’s what quality of life. There’s some aim if there’s some stimulation and something to look forward to”. They were referring to people in the home who were not as fortunate as themselves in considering what they might do that day. When people told me about what activities they did, this included going to church, colouring, reading and visiting other people in their rooms. It was families and friends who mainly took their relatives on their trips out of the home. There was little opportunity to go out with staff, but when I spoke to people some said if there was they would take the opportunity. One person said they missed the outside being kept tidy because the gardener had left, as it wasn’t as pleasant to look out of their window. One person said they got bored, but couldn’t describe what they would like to do. During the visit, I saw people that were able, spending the day as they wished, following their preferred routines. For people who were not as able I saw no interaction with them by staff other than when they were undertaking caring tasks. They spent their time asleep, watching events and staring at the television. I saw planned events displayed on the notice board, which included a clothes party and a Christmas Concert. People said their family and friends could visit “at any time”. I spoke to some of them on my visit and they said they could visit at any time and that they were made to feel welcome by being offered a drink and staff being friendly. Again, the survey from people about meals contained a mixed response. Three people said they always liked the food provided, one usually and one sometimes. One commented, “lovely fresh meals. There is a good choice and plenty to eat throughout the day and evening. Cannot be faulted.” Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 17 When I spoke to people they were all satisfied with the choice and quality of food offered commenting, ‘it’s good’, ‘it’s substantial’ and ‘there’s a good variety’. A menu written on a board in the dining room gave the menu for the day. At breakfast time there was a variety of cereals and spaghetti on toast. The lunchtime meal was braising steak, chips or potatoes and vegetables. There was an alternative. The sweet was rice pudding, but some people said they’d had ice cream. When I spoke to people they said they enjoyed their meals and had enough to eat. They said their individual preferences were catered for. Meals were served at two sittings. This ensured that there was enough staff available to serve people in a timely fashion and provide one to one support for people who needed assistance to eat. The dining room was welcoming, being bright and clean. People were given sufficient time to eat, but the occasion was not leisurely – people ate their dinner, but then left the table to go back to their preferred sitting place. Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 18 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): The outcomes for standards 16 and 18 were inspected. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The complaints procedure was not sufficiently robust enough for people to have confidence that their complaint will be acted on and action taken to resolve their complaint. People hadn’t been sufficiently protected from abuse, but the acting manager spoke about how she’d learnt from that experience. EVIDENCE: There was a mixed response from the survey for people about whether they knew who to talk to should they be unhappy about any aspect of their care. Two said they knew whom they would speak to, two said they usually would know who to speak to and one said they would only sometimes know who to speak to. Two of the three surveys stated they did not know how to make a complaint. Comments from the surveys included, “I would go to the manager who is very approachable and efficient” and “I would get my family to deal with it if I was unhappy about anything”. I spoke with the acting manager about the responses, as people need to know how to complain and be assured their complaint will be listened to and acted upon. When I spoke to people the majority said that they had “no complaints”. Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 19 The complaints procedure was displayed in the foyer and clearly described the procedure for people should they have any concerns. This included who would deal their concern and how soon they could expect a response. A record was maintained of complaints that had been made. The record identified four complaints had been made. Two recorded the action that had been taken as a result of the complaint, two didn’t. One of those that didn’t was about the same two complaints where action had been taken to resolve this complaint. Clearly, the action taken had not resolved the complaint and the record of the further complaint suggested no further action was being taken. One concern had been made to the CSCI. The content was about staff maintaining the privacy and dignity of people and the environment. This information was considered on this inspection. The AQAA stated: • Staff have undergone adult abuse training with new staff booked on a course as soon as possible. It states staff are aware of the signs to look for and of the procedure to be followed. • The plan for next 12 months includes liaising with adult protection in Barnsley to set up management training so managers can then train inhouse without having to wait for places on training for regular updates. • One referral had been made to adult safeguarding. When I spoke with the acting manager she was not aware of the reviewed adult safeguarding policy and procedure for South Yorkshire. She was advised to contact the local adult protection officer to attend an information day about the new procedure. It was also discussed with her about the need to attend further training on safeguarding adults from a manager’s perspective, so that referrals are made when necessary. When I spoke to staff they had a reasonable understanding of the types of abuse that may occur and generally were clear of the action that they would take to protect people. When I looked at staff training records, not all staff had received training in adult safeguarding and in one case the training had been prior to an allegation, that had not been referred in the first instance. The recommendation from the adult protection referral was for staff to receive training in adult safeguarding and for this to be checked at the next inspection, as the referral was not handled well. Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 20 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): The outcomes for standards 19 and 26 were inspected. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. On the whole, the living environment was clean but improvements were still required to make it a well maintained home for people to live. EVIDENCE: When I spoke to people they were all happy with their living environment, their bedrooms were comfortable and that they had everything they needed. Some were conscious that a ‘bit of a spruce up wouldn’t go amiss’. People, via the survey, said that home was always or usually fresh and clean. One commented, “it’s just the décor and carpets that make it look shabby”. Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 21 A relative confirmed this in their survey when they commented, “I can’t fault the management, the care or the meals. The only thing to comment on would be the standard of decoration within the home and also the need for new carpets. I have been told that these are to be dealt with in the next two months”. The daughter of the owner said the corridor carpets were due to be fitted on 16 December 2007. When I spoke with a relative on my visit they also commented, “I know the environments not up to much, but it’s the care that counts. I always check their clothes; hair, nails and glasses are clean. That’s what’s important. But, new carpets wouldn’t go amiss”. When I looked round the home the main lounges and dining areas presented a pleasant and homely environment for people to live. I looked in several bedrooms, which were tidy, appropriately furnished and had been personalised by the person who lived in that room. Taps at the sinks were able to be used by people, people had sufficient pillows that were of good quality, the lamps provided for people were of good quality and in working order and chairs that were provided were comfortable to sit in. However, there were areas where the environment did not provide a pleasant living environment for people because: • There were gaps in the tiling in toilet, bathroom and shower areas. • The wallpaper in the toilets and bathrooms was hanging down from the ceilings or peeling from the wall areas. In some places this had been stuck back on with selotape. • The flooring in the bathroom and shower room was pitted and there were splashes of paint on it. • Toilet seats in some toilet areas did not look clean because the enamel was wearing. • There was a strong offensive smell in one bedroom. • Corridor carpets were stained, which made them look dirty. • Toilets, bathrooms and shower areas were stark and bare. • The sinks in the hairdressing room were leaking • The gardens needed tidying to make it a pleasant area for people to look on to. When I spoke with the acting manager, she said herself and the previous acting manager had identified areas of the environment that needed improving. She said the improvements were areas she was unable to respond to, as the owner had not given approval. At feedback, the daughter of the owner said the areas had been approved. I also saw that there was no soap in toilet areas and towels were being stored on shelving in bathroom areas. This did not promote systems to control the spread of infection. Likewise, liquid soap and paper towels were not provided in bedroom areas where necessary to control the spread of infection. The AQAA stated the Department of Health guide ‘Essential Steps’ to assess current infection control management had not been used. Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 22 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): The outcomes for standards 27, 28, 29 and 30 were inspected. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There were inconsistencies in the number of staff on duty and this did not make it possible for staff to be in sufficient numbers to meet the social care needs of people. Care needs to be taken that staff receive training, which is updated; to make sure they have sufficient knowledge to meet the needs of people. EVIDENCE: Five people, via the survey, said that there was always or usually staff available when they needed them. They also said that staff listened and acted on what they said. Their comments included, “especially if I have soiled my clothing” and “you may have to wait if they are busy, but someone is always popping in throughout the day”. When I spoke with people they spoke highly of the staff team saying, “staff are excellent”, “I enjoy it here and appreciate everything the staff do”, “staff are kind” and “staff are good”. When I spoke to staff they said there understanding was there should be four staff on the morning and afternoon shift, including a senior care, but 50 of Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 23 the time there is only three. They said it was a struggle to meet the needs of 32 people with only three staff and it meant their duties were task orientated, with little time to spend with people. I looked at staff rotas for 5 weeks. The rotas showed that there were inconsistencies of the number of staff on each shift. There were seven morning shifts and five afternoon shifts when three staff were on duty. The number of staff covering the night shift ranged from two to four. Ancillary staff consisted of a domestic and a laundry person who worked 6 hours a day. A cook worked 7 hours a day with assistant to the cook working from 8:30 – 14:30 and 15:00 – 19:30. I saw staff provide assistance for people when they needed this without having to wait an unreasonable amount of time. The AQAA stated: • • • • • • • • • • • There is a dedicated staff team, with low staff turnover. There are sufficient staff on duty to ensure everyone’s care needs are met. All vacancies are advertised and no-one is employed without two good references, a Criminal Records Bureau (CRB) check and Protection of Vulnerable Adults (POVA) first check. All care staff that are doing or have NVQ are aware of issues of equality and diversity. Three staff members are doing an equality and diversity course. All new staff have basic induction and are booked onto mandatory training programmes as soon as possible. An experienced member of staff supervises all new staff until they feel confident to work alone. The service recognises their shortfall of no male carers, but state advertisements have not included any response from males. All staff are up to date with mandatory training. All staff have completed a course on dementia awareness to give them a better understanding of people with the diagnosis and how to approach them. Fifteen staff are to commence a course on infection control, five staff are trained in infection control. When I spoke with staff they confirmed that new staff did receive support and guidance during their initial weeks of employment. This included fire procedures, reading care plans and working with an experienced member of staff until they were confident to work independently. The staff said that they had received a range of training including moving and handling, adult safeguarding, health and safety, first aid, food hygiene, NVQ Level 2 in Care and infection control. Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 24 A training matrix to detail the training that staff had received and when refresher training was due had been implemented. In practice, this was not helping as staff had not received some training and some of the training they had received, needed updating. Staff’s training records were incorporated in staff files. Certificates were in place to verify some of the training that they had attended, but there were gaps, including fire safety and first aid. Some of the training was some time ago and refresher training in some areas was needed to update their knowledge. I looked at two staff files. They contained an application form, declaration of health and identification, but did not contain the employees’ full employment history. The files contained two references, but these were addressed ‘to whom it may concern’ and therefore did not verify the source of the reference. Staff employed had undertaken Criminal Records Bureau checks and a protection of vulnerable adults first check had been received before they commenced work. This promoted the protection of people. Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 25 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): The outcomes for standards 31, 33, 35 and 38 were inspected. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A new manager had been appointed. She still needed to learn the full responsibilities of her role in meeting the legislative requirements of a registered care home. This was so that she could demonstrate effective management and administration through quality assurance systems. EVIDENCE: The manager had been appointed two weeks ago and she said it was the owner’s intention for her to apply to be registered by the Commission For Social Care Inspection. Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 26 She has worked at the home for a number of years giving her experience in the caring profession. She had recently obtained the Registered Managers Award. She had a good knowledge of the needs of people and was committed to providing a good quality service. When I spoke to people they spoke highly of her, with one person particularly commenting, “they’d have every faith in her. She’s ordinary, down to earth but wonderful”. When I spoke to staff they expressed satisfaction with her appointment and said, “she’s approachable and will listen. She’s firm and I think she’ll do a good job” and “she’s good, approachable, great and requires teamwork”. There were no formal systems in place for auditing the quality of the service. The registered owner or a representative did visit the home on a regular basis to carry out monitoring of the service. However, they had not identified areas of the service where improvements were needed. There were no copies of these reports since 16.06.07. This does not provide CSCI with any information of the owner’s opinion of the quality of the service and action they are taking to improve any areas. Requirements made as a result of this visit demonstrate that increased commitment and action by the owner is necessary. When I spoke to people they either said they looked after their own monies and had somewhere safe to keep it. Others said the home looked after their money, but they could get it at any time. When I spoke to the manager, this was not the case as only she had access to the safe. This meant people could be without money when they wanted it. I asked the manager to review this. Arrangements were in place for people who were unable to look after their own monies. Monies were securely stored. When I checked the records these verified that people were able to access their monies for hair care and personal items. A system was in place for recording and monitoring peoples’ finances. When I checked these, there were receipts that gave the impression they had been amended and one purchase where there was no receipt. When I checked the record against the monies that were held, there were discrepancies in all but one. The system therefore was insufficient to safeguard people. Information provided prior to the visit demonstrated that all major systems and equipment, including the premises electrical circuits, portable electrical equipment, hoists, fire detection and fire fighting systems had been routinely serviced to promote a safe environment. The information did not confirm emergency call systems; soiled waste disposal, gas and heating systems had been routinely serviced to promote a safe environment. When I asked for this on the visit, confirmation of servicing was provided for emergency call systems and gas. Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 27 When I looked round the building fire exits had been kept clear, which should make it easy for people and staff to leave the building should there be a fire. I asked for confirmation that a fire risk assessment, fire safety training and fire drills were being carried out. The fire risk assessment was blank and records of fire safety training and drills could not be provided. This meant systems in place with the action and procedures to follow in the event of a fire could not be verified and that they were sufficient to safeguard people. This information was given to the fire service. I saw people being moved safely. When I spoke to staff they said there were adequate gloves and aprons available to control the spread of infection. Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 1 X X 2 Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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) (c) Requirement Timescale for action 30/11/07 2. OP7 OP8 15 (2) (a) 3. OP7 OP8 17 (1) (a) 4. OP7 OP8 13 (1) (b) Appropriate information regarding the assessment of people must take place before people move in the home. This would ensure the service was capable of meeting the needs of the person and can put systems in place to meet those needs. Staff must follow the plan of care 30/11/07 for people, to demonstrate their documented, identified needs are being met. If this has changed the plan must be updated to reflect this. When a risk assessment is 30/11/07 completed as a result of an identified risk to the person, for example, pressure area care, the service must include as part of the plan of care the action they have taken to reduce any risks to the person. Advice must be sought from 30/11/07 appropriate health care professionals when people gain or lose weight. This demonstrates their health needs are being monitored and appropriate action taken. DS0000018270.V349707.R01.S.doc Version 5.2 Orchard Views Page 30 5. OP10 23 (2) (b) 6. OP16 22 (3) 7. OP18 OP28 OP30 OP26 13 (6) 8. 13 (3) 9. OP28 OP30 OP38 OP31 OP33 13 (4) 10. 24 (1) 11. OP33 26 (4) (a) (b) & (c) 12. OP38 23 (4A) (b) Locks on toilet and bathroom doors must be in working order to maintain the privacy of people. All complaints that are made must be fully investigated and inform the person who made the complaint of the action that is to be taken as a result of their complaint. A record of this must be maintained. This demonstrates to people their complaints are taken seriously and acted on. All staff must undertake adult safeguarding training to make sure people are sufficiently protected from abuse. Liquid soap and paper towels must be provided in bedroom areas where necessary to prevent the spread of infection. A risk assessment must be in place to identify the systems in place for first aid should an accident/incident occur. A system for evaluating the quality of care provided must be implemented. This should provide the manager and owner with areas of improvement that are important and matter to people. On visits to the home the registered provider must establish the quality of the service provided by speaking with people, their representatives, looking at the environment and inspecting records. This would identify areas of improvement. A monthly report must be completed of these visits and submitted to CSCI. A fire risk assessment must be in place to determine the systems that need to be in place to DS0000018270.V349707.R01.S.doc 03/12/07 30/11/07 28/02/08 30/11/07 29/12/07 28/02/08 29/12/07 29/12/07 Orchard Views Version 5.2 Page 31 safeguard people in the event of a fire. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Refer to Standard OP9 OP9 OP12 OP18 OP19 OP19 OP26 OP19 OP19 OP26 OP19 OP19 OP19 OP19 OP19 OP26 OP26 Good Practice Recommendations For safe storage, controlled drugs should be stored in cupboards that meet the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973. For people who administer their own medication to sign the medication administration record to verify the receipt of their medication. Establish a planned programme of activity to improve the quality of life for people, including trips out of the home. For the manager to attend further training on adult safeguarding from a manager’s perspective, so that referrals are made when necessary. The corridor carpets should be replaced to make it a pleasant, well-maintained place for people to live. The missing tiles in the toilet, bathroom and shower areas should be replaced to make it a pleasant environment for people and promote infection control systems. Replace the wallpaper in toilets and bathrooms to improve the living environment for people. Clean the bathroom and shower floors so they look clean and improve the look of the flooring for people. Replace toilet seats where the enamel is wearing so it looks clean for people to use. Replace the carpet in the identified bedroom so the smell is removed and is a pleasant place for people to spend their time. Make the toilet, bathroom and shower areas more domestic to make them pleasant areas for people to use. Tidy the garden areas so they are pleasant areas for people to look on to. The sinks in the hairdressing room should be repaired. The DoH guide ‘Essential Steps’ should be used to assess current infection control management systems. Provide soap in toilet areas and cease storing towels in bathroom and shower areas to promote infection control DS0000018270.V349707.R01.S.doc Version 5.2 Page 32 Orchard Views 16. 17. 18. 19. 20. 21. 22. OP27 OP29 OP29 OP30 OP30 OP38 OP35 OP38 23. OP38 systems. Review and provide consistency in the levels of care staff on duty in a morning and afternoon, so staff have time to spend with people pursuing meaningful social activities. To demonstrate a thorough recruitment process that safeguards people records should include written explanation of any gaps in employment. To verify the source of references, these should be requested by the service. Staff should be trained in infection control, so they are up to date with current systems for controlling the spread of infection. There should be a record of fire training to demonstrate staff received this, so they know the action to be taken in the event of a fire, to keep people safe. The records and monies held for people should be audited to make sure peoples’ finances are being safeguarded. There should be a record of fire drills to demonstrate staff receive practice in putting their fire training into practice, so they know the action to be taken in the event of a fire, to keep people safe. The manager should check a contract for soiled waste disposal and servicing of the heating system is in place to make sure the environment is safe for people to live. Orchard Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Views DS0000018270.V349707.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!