Inspection on 14/08/07 for Orchards Residential Care Home (The)

This inspection was carried out on 14th August 2007.

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

Orchards Residential Care Home... 24/11/06

Orchards Residential Care Home... 20/09/05

Orchards Residential Care Home... 04/04/05

Orchards Residential Care Home... 18/10/04

Orchards Residential Care Home... 14/04/04

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Oak Ridge

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Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Orchards Residential Care Home (The) Mill Lane Bradwell Great Yarmouth Norfolk NR31 8HS Lead Inspector Mrs Geraldine Allen Unannounced Inspection 14th August 2007 09:20 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 Orchards Residential Care Home (The) DS0000048307.V348775.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. Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchards Residential Care Home (The) Address Mill Lane Bradwell Great Yarmouth Norfolk NR31 8HS 01493 652921 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) Mr Dev Tirbhowan Mrs Amitah Tirbhowan Mrs Amitah Tirbhowan Care Home 13 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (13) of places Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Thirteen(13) Older People, not falling into any other category, and six (6) Older People with Dementia may be accommodated. The maximum number not to exceed thirteen (13). 24th November 2006 Date of last inspection Brief Description of the Service: The Orchards is a chalet style bungalow to which has been added an extension with 7 single rooms all having en suite facilities. The premises are located in a residential suburb of Great Yarmouth, close to shops and a bus route. It stands in its own grounds with garden to the front and back and has a small private car park. In addition to the extension, service users are accommodated in 2 further single and 2 double rooms upstairs in the main building. The upper floor is accessed with a stair lift. The care home is registered to accommodate 13 Older People, 3 of whom may in addition be suffering from dementia. Mrs Tirbhowan said that the current fees were between £286 & £395. The fee payable is advised verbally and also included in the contract that is provided before admission to the home. All additional charges are also listed in the contract. Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place during the day of 14th August 2007. Two Inspectors undertook this inspection. Mrs Hilda Stephenson who completed a significant period of observation during the morning accompanied the Lead Inspector, Geraldine Allen, for part of the day. Mr & Mrs Tirbhowan completed and returned an Annual Quality Assurance Assessment to the Commission. This detailed document was well completed and reflected what was found during the course of this inspection. In addition to the above, information was obtained during the day by looking at records, speaking with residents, visitors and staff and also by observing practice. Overall, this service provides good outcomes for people who live there are some areas are excellent. What the service does well: What has improved since the last inspection? Staff training for safeguarding adults has been provided for all staff and there are updates arranged to ensure people are safe from abuse. Minor damp problems in the ground floor bathroom have been dealt with and the stair climber replaced. The service has an on-going programme of repair and renewal to ensure the environment is well maintained. Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 6 The quality assurance process includes people who visit the service in a professional capacity. This helps to ensure that a full range of views are obtained. What they could do better: 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. Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 7 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 Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 8 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): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. The assessment is conducted professionally and involves the individual, their family or representative. This home does not provide intermediate care. EVIDENCE: Two care plans were looked at in detail. Both contained evidence of good preadmission assessment and there was also additional information from other agencies such as social workers and the hospital. Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal support is responsive to the varied needs and preferences of the people who use the service. People who use the service have access to healthcare services. The home has a medication procedure in place but this is not followed at all times. Staff respect privacy and dignity. EVIDENCE: Two care plans were looked at in detail. Both were well written. Each care plan provided good evidence of goal setting and there was also evidence that residents were involved in planning their own care. The care plans were kept with the daily progress notes and any relevant risk assessments were also kept with the care plans. This ensured that all information was up to date and available to all care staff. Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 10 The care plans and daily progress notes need to contain more information about the social and emotional needs of people so that strengths can be more easily recognised and supported. Staff also need to ensure that all documents are clearly dated and all care plans need to have photographs attached. There was good evidence seen that staff refer to health professionals appropriately and good records are kept. The chiropodist was at the home throughout the morning. The dispensing of medication was observed at lunchtime. Some of the procedure seen was not in line with best practice. For example, the records kept to demonstrate the person has taken their medicines were signed before ingestion had taken place. Medications were also removed from the blister pack and handled rather than dropped into the pot. Some of the practice could result in medicines being given to the wrong person. For example, the medication for 2 residents was dispensed into unnamed pots at the same time and taken together to the residents. The medication trolley was fixed to the wall and located in the lobby off the dining room. Other medications were stored in a locked cupboard in the lobby. These concerns were brought to the attention of Mrs Tirbhowan, who undertook to deal with them straight away. A recommendation has been made. There was good evidence that staff protect the privacy and dignity of people living at the home. For example, the Chiropodist saw each resident in private although he did on occasion leave the door open. When this happened, staff closed the door to ensure privacy was maintained. Personal care was given behind closed doors. Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have the opportunity to develop and maintain important personal and family relationships. The practice of staff promotes individual rights and choices and supports people to make informed choices. Mealtimes are flexible and relaxed and staff allow people the time they need to finish their meal comfortably. EVIDENCE: Observations were made and residents were also spoken to throughout the day. A visitor to the home was spoken to. Practice was also observed. Residents said the home “couldn’t be better”. They said staff were very friendly and lovely. They also said there were always people about. The food was described as “wonderful” and that there was “plenty of it”. Residents said they enjoyed the entertainments arranged by the service. Residents said their visitors could visit when they wished. Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 12 The visitor said “Staff are excellent, they care a great deal and are very friendly’. She also said, “I can visit at anytime, but usually come during the morning, so I can have a coffee with my relative’. During the afternoon, 2 residents were sleeping in the lounge but others were very chatty and were interacting with staff and each other. A good record of activity was seen that included games, knitting, birthdays and other celebrations. Time was spent observing residents daily life. One resident spent much of the time speaking with other residents and staff, and short periods watching the programme on the television. Staff consistently spent time sitting with residents in the lounge discussing various topics. One resident spent half of the time sleeping and observing other people, although the rest of the time was spent speaking with neighbouring residents. Staff care practice were seen to be patient, friendly and encouraging residents to make their own decisions. Lunch was observed briefly. Most residents ate in the dining room, although 1 resident preferred to eat alone in the lounge and another was laying down over lunchtime. Lunch was prepared by care staff and consisted of pork, sprouts, carrots, peas and potatoes followed by trifle. All residents were talking and laughing together and the event was clearly very sociable. Residents confirmed they had enjoyed their lunch “very much”. Some residents required assistance to eat but this consisted only of their meal being cut up so that they could feed themselves independently. Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that is clearly written and easy to understand. The complaints procedure is displayed and well known to all people who use or visit the service. Training of staff in the area of protection is regularly arranged by the service. EVIDENCE: The service’s complaints book was seen. This records all areas of concern with good details. The record also included an action plan and assessment to ensure that any concerns had been resolved. Evidence was seen that staff receive training about safeguarding adults. They were able to speak knowledgeably about what constitutes abuse and how they should deal with any concerns they may have. Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. People who use the service are encouraged to personalise their bedrooms. The home is clean and tidy, well lit and smells fresh. EVIDENCE: A tour of the premises was undertaken. All areas of the home were very clean and tidy. The bedrooms seen were highly personalised and all were decorated differently and in colours chosen by the resident. Six of the bedrooms have en-suite facilities. Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 15 All areas of the home are light and airy. There was evidence of regular maintenance and renewal. For example, a new stair climber has been installed and a leak in the ground floor bathroom has been repaired. It was noted that some tiles in this bathroom were loose but Mrs Tirbhowan stated that this would be dealt with as the bathroom was due to be completely refurbished shortly. A new carpet has also been fitted in the lounge. Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There are consistently enough staff available to meet the needs of the people using the service. The service has a good recruitment procedure. Management prioritise training and facilitate staff members to undertake external qualification beyond the basic requirements. EVIDENCE: The numbers of staff on duty were looked at and those staff seen were in accordance with the displayed staff rota. There was good skill mix and people living at the home confirmed there were always plenty of staff around to meet their needs. They also said staff were able to spend time sitting and talking with them. Two staff files were looked at in detail. These showed that the service follows robust practice when recruiting new staff. One file needed a photograph of the member of staff to be affixed, however she had only very recently been recruited and this was in hand. Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 17 There was evidence that there is a strong commitment to staff training and development that is commended. Mrs Tirbhowan gave information about some recent staff training that had taken place and included dementia (attended by all staff), medication, Health & Safety, risk assessment, food hygiene, Protection Of Vulnerable Adults and 1st Aid. Training planned includes equality and diversity, infection control, leadership and management. Mrs Tirbhowan is a trainer for manual handling and has completed training regarding nutrition. Two staff were spoken to in private. Both spoke very knowledgeably about their role and how they ensure people are well cared for and supported. They confirmed the training and supervision they receive and how they are supported to give good care. Both had worked at the home for a number of years and taken advantage of all the training and development opportunities given to them. One member of staff wanted to talk about further development of some of the processes and recording that takes place at the home so that best practice is followed. Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and experience and is competent to run the home. The service providers work to continuously improve services and provide an increased quality of life for residents with a strong focus on equality and diversity. The home has a consistent record of meeting relevant health & safety requirements and legislation. Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 19 EVIDENCE: Mrs Tirbhowan manages the home and is qualified and competent. She keeps up to date with her own training and knowledge. The home’s quality assurance was looked at. The last Quality Assurance monitoring was dated 29/6/07. The responses received were very positive. Mrs Tirbhowan confirmed she had also asked the visiting district nurse to complete a questionnaire. Thank you notes and letters were also seen and contained comments such as: “nothing was too much trouble”, “the care was 1st class”, “the staff are always polite”, “I would recommend you to anyone”, “I was made to feel welcome by all the staff”, “his dignity remained because of the thought that went into the care you provided”. The practice about resident’s personal allowances was looked at briefly. No changes had been made to the sound practice seen at the last inspection. Staff confirmed that they receive supervision every 2 months. Staff also said they feel well supported. Accident records were seen. There was evidence that accidents were monitored and the action needed/review section was completed as necessary. The health & safety risk assessments had been completed on 29/1/06 and were seen. The service has achieved 5 star assessments from Environmental Health for food hygiene. Fire records were seen and showed that the last instruction/drill took place on 26/6/07. The last fire safety training was dated 1/8/07. All testing was properly recorded and up to date. Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 4 X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X X Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 21 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations Staff must follow the safe medicine procedures and guidelines used at the home. This will ensure that best practice is always followed and the risk of error reduced. Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Orchards Residential Care Home (The) DS0000048307.V348775.R01.S.doc Version 5.2 Page 23 - 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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