Inspection on 20/09/05 for Orchards Residential Care Home (The)

This inspection was carried out on 20th September 2005.

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 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... 14/08/07

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

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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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 Mill Lane Bradwell Great Yarmouth NR31 8HS Lead Inspector Dot Binns Announced 20 September 2005 9.30am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Orchards Residential Care Home Address Mill Lane Bradwell Great Yarmouth Norfolk NR31 8HS 01493 652921 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Dev Tirbhowan Mrs Amitah Tirbhowan Mrs Amitah Tirbhowan Care Home 13 Category(ies) of Dementia - over 65 (3) registration, with number Old age (10) of places Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Ten (10) Older People, not falling into any other category, and three (3) Older People with Dementia may be accommodated. The maximum number not to exceed thirteen (13). Date of last inspection 4 April 2005 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. Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine announced inspection to the home lasting 7 hours. Discussions took place with the manager about any improvements since the last inspection and records and policies were examined. Five service users were seen in private, one with a relative, and three staff were seen individually and in private. Some of the building was seen. A survey was sent out to the Home by the Commission for service users and their relatives to return with their views about the home. Eleven service users returned them but no relatives. Those views were taken into account when writing this report. What the service does well: What has improved since the last inspection? Improvements have been made to the recruitment procedure with rigorous checks now in place to ensure that service users are protected. The downstairs bathroom has been renovated and looks better. The regular supervision of staff on a one to one basis is now being carried out and this will help staff to keep up the standards. Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 Page 6 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. Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Full assessments are carried out before a person comes to the home to ensure they can be satisfactorily cared for. EVIDENCE: Three files were seen to contain assessment documents detailing the various areas where a service user needed assistance and where they were independent. There was also plenty of information received from the social worker to help the home with catering for the service user. Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 The service users personal and health needs are set out in an individual care plan so staff know how to look after them properly. The service users’ health is monitored and access to the doctor and other health professionals is provided. There are policies in place and staff are trained to deal responsibly with medicine to ensure that service users are protected. A review of stock control is recommended. Service users say the staff are very nice to them and in general feel well respected. However there is an issue with privacy which needs to be addressed. Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 Page 10 EVIDENCE: Three files were examined and all had care plans outlining the assistance needed from staff and their personal routines and choices. A goal setting sheet outlined the main areas to be dealt with. Reviews of care were carried out appropriately. There was evidence of full social worker involvement especially where the Home needed special assistance to look after the service user properly. Relatives also were involved in the process. Staff wrote daily reports commenting on the health and progress of the service user and whether they had had a visit or enjoyed an outing. Overall these records were good and detailed. The one omission was not having information about the service users interests. The care plans also had plenty of references to GP visits and two returned the survey forms to the Commission indicating they were satisfied with the overall care in the home. A community nurse also said the same. There were references to a chiropodist visiting and some one from the blind association. There were requests from the service users to call a doctor and requests not to, both taken note of. Overall staff were taking note of the health of the service users and helping them to use community facilities. Medication systems were inspected. Drugs are kept in a locked cupboard and daily administration is correctly carried out and recorded. Staff confirmed that they had received training for this task. There was quite a high level of stock held and it was recommended that the stock control be reviewed. For one service user who looked after their own medication, a risk assessment was seen to be place in the care plan. Service users confirmed they are assisted with their personal care privately in their rooms and can use their rooms at anytime. They wear their own clothes at all times and generally felt staff were mindful of their privacy and dignity. At the inspection a visitor was seen in a service users room and she confirmed that she always had access to her relative and could talk to her in private. Service users also have locks on their doors but do not seem to use them. This should be encouraged. One area to be reconsidered is the habit of staff being in the room when a service user is seen by a doctor. Two people mentioned this. Privacy should be offered at all times unless there is a sound reason not to do so. Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 Service users were on the whole happy with the home but the routines need to be checked out to see if they are what service users prefer. Service users are able to maintain contact with the friends and family and they are welcome in the home. Service users are able to control their own affairs. Service users generally enjoyed the food which from the menus looked varied and nutritious. Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 Page 12 EVIDENCE: Service users were on the whole pleased about mealtimes and how staff treated them but there were some issues regarding routines. Two people mentioned being woken at 6am, one definitely finding it too early the other saying that she was told to get up but she didn’t mind. Day staff did confirm that everyone was up when they came on duty at 8am except for one service user waiting for the nurse. This might indicate that night staff are being too hasty in helping people to get up. Bedtimes did seem more flexible but bathing again was rigid with only once a week being offered. One service user said she would like an extra bath a week. A review is clearly needed with the service users about their routines and instructions need to be clear to staff about honouring them. In terms of activities, staff do provide bingo and games and recently service users enjoyed a day out to Kessingland. There is a library and in good weather service users go out in the garden. However both staff and service users thought they needed to have more activities and service users in particular would like to be taken out for walks. It is recommended that such activities are provided in consultation with the service users. It should be mentioned that the Home has experienced staff shortages which service users felt affected the service. These have now been filled and should allow for more attention for the service users. Visitors and family do seem to be welcomed and a visitor was seen sitting privately with a service user in her room. Service users are able to control their own affairs and all but three handle their own money. Service users can bring their own possessions to the home and can see and go out with their friends and family. Two weeks menus were provided for the inspection and the meals looked varied and nutritious. Ten of the service users who replied to the survey said the food was good. One would have liked better cakes. On the day of the inspection turkey roll and vegetables were seen being served and it looked appetising and in sufficient quantity. In private staff reported that they thought the food was good and that service users were well looked after. There is a set meal at lunchtime but the manager gave examples of other choices when someone did not like the main dish. Teas are all made to individual choices (a record was seen of this) and breakfast is also individually chosen. Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Complaints procedures are in place and formal complaints are attended to. More freedom to act and speak independently should be encouraged. Abuse procedures are in place though more training is recommended. EVIDENCE: The service users guide contains the complaints procedure and it was seen on the wall in the home. A complaints record is kept and showed that complaints are recorded and attended to by the manager. None has reached the Commission. Whilst it was difficult to pinpoint, there was a feeling that service users and staff were not feeling as free as they could be about speaking up. On three occasions throughout the day people seemed worried about what they were saying to the inspector. The inspector picked up that the survey forms issued by the Commission with a free self addressed envelope, had had to be handed in to the proprietor. The replies were sent to the Commission but all replies contained the same answers except for one service user who had kept her form, to hand directly to the inspector. The manager had a different view of this and does come across as someone who would listen to her service users. It is difficult to see where the problem is but the inspector felt more work needed to be done to ensure that service users have the freedom to communicate their views and to have privacy at all times. Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 Page 14 The home does have a policy on the protection of service users from abuse and information about procedures for reporting the suspicion of abuse. A whistle blowing policy is borrowed from another organisation and should be made to fit the home. The manager has received outside training on abuse and has given instructions on the topic to staff in a staff meeting. However the need to ensure that service users have only the best practice from staff should be endorsed by offering outside training for staff. Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 21 There are some areas of the house that require renovation and ideally another WC should be supplied. Radiator covers should be provided in all rooms. EVIDENCE: The bathrooms were inspected as a recommendation had been made at the last inspection for improvement in the downstairs bathroom. It was looking much better. The downstairs bathroom is adapted with a hoist and is the one most used. Upstairs the bathroom could also be improved. The Home also has only two WCs which is short for the number of service users though seven rooms have en suite facilities. Only one communal WC is on the ground floor in the bathroom which can often be occupied. The other one is upstairs which service users have to access via a stair lift. There have been covered radiators supplied in most rooms though one bedroom did not have one. Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 The number of staff on duty each day is sufficient to meet the needs of the service users. The home is doing well on supporting staff to complete their NVQ2. with 50 per cent of staff trained. This gives the service users more assurance that they are in safe hands. Recruitment procedures are now rigorous giving good protection to the service users. Induction training is in place to ensure new staff are properly trained. EVIDENCE: Rotas for staff cover were provided for the inspection and confirmed that at all times two care staff were on duty through till 10pm. This was confirmed by the staff seen at the inspection. After that time there is one staff on duty and awake and another sleeping in to provide back up in an emergency. The majority of the time the manager is in addition to the care hours. Although staff have to do the catering tasks, the hours were considered satisfactory for the number of service users. Five staff have completed their NVQ2 which makes 50 of the workforce trained in a national care qualification. This meets the expected standard. Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 Page 17 Three staff files were checked to see what process was completed when they were recruited. All three had criminal record checks and references prior to employment and the appropriate documents regarding identity were held. An improvement in this process was required following the last inspection and on the evidence now provided the manager has correctly amended their procedures. Induction training was in evidence with the staff completing a notebook on the topics covered. Other training certificates were held including moving and handling. Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,35, 36and 38 Service users live in a home that is well managed and where the manager wants the best for her service users. The quality assurance system could be improved to show that the home is run in the best interests of the service users. Improvements are needed in the way the Home looks after service users money. The supervision of staff has begun and this will benefit their practice. The health and safety of service users and staff is promoted through policies and staff training and ensuring that equipment is properly serviced. Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 Page 19 EVIDENCE: The manager is a qualified nurse and has also completed her NVQ4. She and her husband own the home. She is able to discharge her responsibilities properly and works well with the Commission. The Home has introduced a quality assurance system comprising questionnaires given out to service users asking for their views about the home. The forms were not anonymous however and ask for peoples’ names. It is recommended that these are allowed to be anonymous so that service users or visitors feel free to express themselves. An analysis of the views expressed can then be carried out to see where improvements can be made. This should be printed and a summary shown in the service users guide. This will demonstrate the openness of the scheme and give assurance to service users and their families that they will be listened to. In general service users look after their own money or have the help of relatives. They confirmed this themselves to the inspector. The Home does not cash benefits for the service users. However it does look after some cash for three service users who are unable to handle it themselves. The records of these were inspected and the cash checked against the record. Unfortunately there were mistakes in the record and the cash did not tally with the total. Fortunately the cash was over but this still indicated some poor record keeping. This must be corrected. Staff confirmed that they had met with their manager for a one to one private session though one was not sure whether the sessions were recorded. The manager confirmed that these sessions had started for all staff and notes of the dates and agenda were kept. The health and safety of the staff and service users is protected by policies and procedures relating to safe practices in the Home. Fire safety is given a high priority with equipment serviced and staff trained. The gas boiler and chairlift are serviced. Water temperatures are checked in the home but recordings show that they are higher than advised. Valves are reported to have been fitted to control temperatures so it was not clear what was going wrong. A review is recommended to see that water temperatures are safe. There was evidence of staff training on moving and handling and on food hygiene and an accident record was in place. Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION x x 2 x x x x x STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 3 x 2 x 2 x x 2 Orchards Residential Care Home I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 10 Regulation 12(4) Requirement The home must be conducted in a way that respects the privacy and dignity of the service users. Timescale for action 31.10.05 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. Refer to Standard 9 2 16 18 21 21 38 Good Practice Recommendations It is recommended that the manager review the stock control procedures relating to medication. It is recommended that more activities and short outings are arranged to suit the service users and that staff understand that they are part of their duties. It is recommended that service users are encouraged to express their views and are supported in an atmosphere of openness. It is recommended that the whistle blowing policy is reviewed and that staff are supported to attend local training on abuse. It is recommended that the remaining radiators are covered. Consideration should be given to the provision of another toilet It is recommended that the hot water temperatures are reviewed to ensure they are safe for the service users. I55 S48307 Orchards V243767 200905 Stage 4.doc Version 1.40 Page 22 Orchards Residential Care Home Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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