Inspection on 24/11/06 for Orchards Residential Care Home (The)

This inspection was carried out on 24th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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... 20/09/05

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

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

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

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

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 Mr Silas Siliprandi Unannounced Inspection 24th November 2006 09:45 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.V322528.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.V322528.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 (3), Old age, registration, with number not falling within any other category (10) of places Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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 ex ceed thirteen (13). 20th September 2005 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. Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine daytime inspection between 9.45am and 7,30 pm. The visit to the home was made unannounced. Two service users were spoken with, plus three visiting relatives. Survey cards had been sent out to the home well in advance of this visit, six of the people living at the home and eight of their relatives/representatives had filled them in and returned them. These written and spoken views are all taken into full account in this report. Two members of care staff were also interviewed to help gain an understanding of their roles and how they carried out their work. A tour was made of the communal areas of the building and its grounds. Two service users’ bedrooms were seen [with permission] as samples. Samples of the home’s own general records were examined, as were samples of staff files and the personal files of some service users. The daily practice of the home was observed as far as practicable. Discussions took place with the registered persons about where they saw the home as doing well and where they were seeking to make changes. Some of the thoughts about change were of a more long term nature as well as covering issues immediately relevant to this inspection. What the service does well: The Orchards provides an extremely ‘homely’ and ‘domestic’ environment for people who live there. Service users commented on this, but the most positive comment came from service users’ relatives who said that the atmosphere of the home had been a key factor in choosing it. Everybody was very complementary about the food [as has been noted previously]. The meal on the day of the inspection certainly looked appetising and generous in amount. The service users and their representatives also continued to be very positive in their views about the staff and the manager [Mrs Tirbhowan]. They said that people were properly attentive and respectful and ‘kindly’ in their approach and manner. They also said that the home was well managed and that they felt that it was easy to raise any concerns or queries, and that when they did so their remarks were listened to and responded to appropriately. It was obvious from what people said, as well as what was seen on the day, that visitors to the home were treated in a very welcoming and positive way. The comments made last year [about what appears to have been a temporary difficulty with staffing levels] did not re-appear again this year. The home has good records to help ensure that peoples’ physical and medical needs are properly attended to, and records can be traced showing this being carried through in a proper fashion for individual service users. Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 6 Staff training continues to be taken seriously and care workers are encouraged and supported in their personal development. What has improved since the last inspection? What they could do better: To put the following remarks into context it is important to think about the home’s own excellent intentions [Statement of Purpose] in providing the best possible service for people who live there or who might want to move there in future. The home finds itself [as is normal in 2006] in a position where service users’ needs are increasingly to do with their mental frailty coupled with an increase in peoples’ physical needs. This puts a growing emphasis for Mr and Mrs Tirbhowan on the finer details of questions like these:How can we find out what people want from us? How can we find out what they like [or don’t like]? How can we find out and take proper account of how their lives used to be before they moved into The Orchards? How can we best involve people fully in the care responses we think we ought to be making to meet those abilities, wishes and needs? How can we genuinely protect and preserve peoples’ choices in daily living in an essentially ‘communal’ environment? How can we make the best physical provision [such as the building and the facilities in it] to match those abilities and needs? What kind of staffing level and skills mix do we actually need to allow us to give of out best? This inspection tried to look at the underpinning that might be most effective in addressing these kinds of issues. Some areas were easy to see, and were already begun, but not yet complete. Training staff in the protection of vulnerable adults, and in the specific Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 7 approaches and techniques needed for people whose mental powers were not what they used to be are good examples of this. How to ensure that the building itself provides a flexible and useable environment [the stair climber and access to upstairs bedrooms is a further example. What emerged form this detailed consideration took two broad forms. The first and most vital is the present system of assessment, planning for care and review of care. This must not be taken to infer that the present system is no good. This isn’t the case at all. What became abundantly clear however was the amount of work that was going into the present system and how poorly the present system was repaying all that effort. Sadly, it was also evident how variable the quality of information coming into the home from referring or placing agencies was. Sometimes the quality of the information received was disappointingly poor. There may not be much that Mr and Mrs Tirbhowan can do to improve what they are getting from outside, but they can control and alter their own procedures and formats with the certainty of getting a better result for the same amount of work they put in now. Experienced staff could also have their present [informal] input put onto a more supportive framework and their formal additional responsibilities for one or two individuals [“Key” or “Prime” working] extended with benefit to everybody and some of the workload shifted from Mr and Mrs Tirbhowan. The system needs to be altered to give many more ‘prompts’ to ask about ‘social and emotional’ issues and to provide more flexible ways of recording people’s responses. It is essential that the present system is broadened to take a more robust account of the specific needs of people whose mental powers [including their memories and their skills in communicating their preferences] are not what they once were. The second issue was that of individual choice. This must not be taken to infer that the home is riding roughshod over what people want. This just isn’t the case at all. It is how now to make the subtle change from “respecting” peoples’ choices to actually “promoting” the notion that it is expected that people will make choices; that not all of these choices will be convenient for the home to take account of and that it is perfectly alright to make this latter kind of choice. It won’t really be possible to look at this issue in isolation; it is a difficult subject to get to grips with. Making and implementing policies to ensure that the home actually ‘promotes’ choice will probably have to take second place to getting the assessment process re-tuned to take a much more robust account of the ‘social and emotional’ issues that the present process isn’t designed to take full account of. Making this change stick won’t be an overnight process either probably. For example, ‘promoting’ choice of food and ‘promoting’ choices and ranges of activities [which are presently receiving some adverse comment from service users] isn’t going to be easy. Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 8 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.V322528.R01.S.doc Version 5.2 Page 9 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.V322528.R01.S.doc Version 5.2 Page 10 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): Key Standard 3 was inspected, Key Standard 6 doesn’t apply here. Other standards in this section were looked at briefly in to help gain a better overview. Three main interlinked themes kept on cropping up during this inspection; all of these centred on the process of assessment and planning for care. Making the existing process more comprehensive and effective to use were the main issues. The home worked hard and diligently to assess, but the system and record used was far, far from truly supporting those efforts. Re-designing the process to take account of a broader range of issues is now essential, especially in those areas that look at how any prospective service users life goes beyond their immediate health and physical needs. There ought to be a much better methodology available to the home when it comes to assessing the abilities and needs of those who find themselves with reducing mental abilities and increasing needs in that area. This latter point is doubly important in view of the home’s present registration category and the steady changes in the abilities of some people living there and the likelihood of further changes in the future. Without a more robust and reliable initial [and ongoing] assessment and care Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 11 planning process the risks to clear and informed choice and assurances of needs being met are high. The situation is not so nearly grave as to warrant a ‘poor’ rating, but this issue must be addressed in depth before the situation can be re-assessed as ‘good’. A specific recommendation is made. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Service Users and the Service users’ relatives all said that felt that they had been well informed before choosing the Orchards. However, they all explained that their satisfaction with the level of knowledge gained came principally from personal impressions, what they could see for themselves in the home and what had been explained to them personally by Mr and Mrs Tirbhowan. The drawback here being that people described is a good level of understanding provided all goes well, but the underpinning isn’t as robust as it could be should difficulties ever arise. The Service Users’ Guide and the home’s own Statement of Purpose do provide an excellent foundation to what is on offer in the home and how Mr and Mrs Tirbhowan expect care to be delivered. These documents do therefore go a long way to providing a more formal grounding to peoples’ understanding should they choose to seek it. The key documentary material examined was that used by the home when it worked to find out what potential service users wanted and needed to live the fullest possible life at The Orchards. The records chiefly involved were those of assessment and planning for care found in individual service user files. Previous inspection reports have seen a fairly solid picture being presented, and when examined in their entirety a similar total picture emerged on this visit. However, while the records of assessment were found to follow a fairly consistent pattern this was not universally the case. Efforts [and records] were sometimes duplicated and the information required patience to tease out rather than being easily and obviously accessible. There was a strong focus on ‘physical and medical’ information with far less ‘social and emotional’ information being sought or recorded. Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 12 Mr and Mrs Tirbhowan agreed that the formats presently in use often didn’t help them [or any person they might delegate to the task] to ask all of the right questions at the right times to assure that the best information was available and the best care responses worked out. [See more comment in Standards 7 to 11]. A system used previously did represent a better layout and contained better prompts. However, even that system was not yet up to the standard the home really needs to aim for. The format and process of initial and ongoing assessment was not well adapted to the needs of people coping with problems associated with declining mental powers. The input from other professional services was found to be extremely patchy in its content and quality. In the majority of instances this information was not of a sufficient standard to allow Mr and Mrs Tirbhowan to rely on it as a mainstay of the assessment process in the home. Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 were inspected. Standard 11 was not re-visited on this occasion. There were plans for care that could be tracked back to individual assessments and the information they contained. The care staff knew where the plans for care were and described using them ‘when they needed to’. The plans for care were not yet developed to cover all aspects of care, nor were they yet focussed on issues intended [and chosen] to alter individuals’ lives for the better. These plans for care were not yet used as formal daily guidance to staff in what was expected of them .As has already been mentioned the format of the plans for care and the design and scope of the assessments were providing a poor reward for the excellent intentions and the high level of hard work going into them. These good intentions and efforts have however ensured that the outcome for people living in the home cannot even remotely be described as ‘poor’. Raising the rating to ‘good’ or ‘excellent’ is now heavily dependant on revising the systems currently in place. Staff could usefully take a far bigger role and responsibility here. Assessments and care plans now need a specific focus designed to take especial care of specific mental health needs. Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 14 The ‘right’ kind of assessment, care planning and review structure is a good tool in helping to ‘promote’ [rather than simply ‘respecting’] choice. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service users and their representatives were all very positive about how they were treated personally and how well they felt people in the home were cared for. Direct observation on the day supported this view of a home conducted in a broadly respectful way. Individual records represented a lot of hard work finding out what people wanted and what they could do, but within a structure and system that undermined a lot of that hard work by missing some key data, by duplicating other areas and by being difficult to access. For example, the very best picture of any individual emerged in a free text ‘pen-portrait’ that felt very much to the point, and gave an early set of indicators of what appropriate care responses might be. The ‘problem’ being was that they needed to be read carefully and in detail, rather than being easily understood, to easy to access and easy to take appropriate care responses from. The care plans tended to focus on a very limited range of issues and were not yet wholly of a type that would assist the home in its good intentions. Staff said that they did see these care plans from time to time, but their comments and their records in the daily log made it easy to see that these care plans were not used as the kind of central vital guide to support their work in the way that they could [and ought] easily be. Mr and Mrs Tirbhowan agreed with this overall analysis after discussion, and put forward some positive thoughts of their own about how the system could be used in a different manner. The ‘medical’ and ‘physical’ focus of the assessments and plans for care appeared to give a sound outcome of ensuring peoples’ health needs were met. The level of input from other professional services [in respect of drawing up care plans for individuals being formally referred by placing agencies] was almost universally distressingly poor. This deprives Mr and Mrs Tirbhowan of Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 15 support and input that they really ought to be able to expect. Mr and Mrs Tirbhowan therefore need to develop a truly robust system of their own. The level of self-administration of medicine was not inspected in detail because this important feature of self-care needs to be re-considered as part of the larger picture of assessment and planning for care. Direct observation suggests that the present level of self-administration is probably in line with what people could manage. The home has taken appropriate steps to review the stock control procedures for medicines [as recommended in the previous report]. The record of administration of medicine was clear and understandable as well as being up-to-date. The medicines were properly and securely stored. An issue relating to privacy and choice - the subject of a recommendation in the previous inspection report - had been aired by the manager with both staff and service users during meetings. Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 16 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): Standards 12,13,14 & 15 were all inspected, but evidence gathered was intended to illustrate a broad overview rather than provide fine details. It hasn’t proved to be straightforward to make a judgement in respect of these standards. The apparent outcomes are not wholly consistent. What was reported, both directly and indirectly, by service users and their representatives was in line with what was seen in the home by direct observation. The daily care is far removed from poor. There is a lot of genuinely concerned and caring work going on, and that shows in the way the home was functioning on the day of inspection. It was easy to see [once the way in which that efforts were underpinned by the professional systems in the home] where this difficulty in forming a clear judgement lay. The systems of assessment, planning for care/reviews of care need to be revisited and tuned up to give much better support to the manager, to staff and above all to the service users. Once this is done the same levels of effort that go into the home today ought easily to help the home move on to a rating of ‘good’ or excellent. The special needs of people with declining mental faculties and ability to communicate has to be given special and detailed attention For example, it will be easy to see that daily routines and choices are intimately and directly linked to individual abilities, needs, and choices. Research shews how this type of approach rapidly re-enforces service users feelings of personal value and satisfaction. Quality in this outcome area is adequate. Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 17 This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service users who volunteered their views, and also the relatives spoken to all gave a positive account of life in the home and how people could be in charge of their own lives and maintain contacts they had previously. The general level of satisfaction expressed [in the comment cards] still showed a dip when it came to the level and range of activity in the home. Mr and Mrs Tirbhowan said that they were not finding an easy route to raising the amount and variety of what went on in the home - as was recommended in the last inspection report. Again, the main issue returned to the underpinning system for assessment, planning for and reviewing of care. In passing, this more detailed knowledge may well assist in developing ‘small scale’ daily activities for individuals and suggest ways of altering how people choose from a range of food options. Some of the actual processes of daily living did seem fairly uniform [which may just simply reflect personal choice and history]. For example care records and assessments did not allow any clear understanding that would explain why people got up at the times they did. Although the way in which people took an active role in choosing the food they ate was not discussed on this occasion widening the system as described above will help underpin a change to ‘promotion’ of choice. Service users described the food as ‘excellent’ and what was seen on the day certainly looked appetising. However, the reported satisfaction level found in the pre-inspection trawl of opinion was lower than the ideal. Is this more to do with how people perceive they are exercising choice and controlling what they eat rather than the standard of food on offer? The dining room was set with tables allowing small groups to eat together which ought to assist in keeping social interaction going at meal-times. Orchards Residential Care Home (The) DS0000048307.V322528.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): Standards 16 and 18 were inspected, Standard17 was not re-examined on this occasion. While the ‘complaints and concerns’ component of this section is probably well looked after it probably needs to pay some extra attention at this point to the needs of those service users who do not find it so easy to voice their views. It will continue to be hard to identify who these individuals might be until the system of assessment and planning for care is expanded to allow it to take stock of some of these special needs. For example, who might need an independent advocate to ensure that their best interests are consistently protected? Staff training on whistle blowing and adult protection issues needs to be completed and an accessible whistle blowing policy put in place before the home can progress to ‘good’ or ‘excellent’. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service Users and their representatives were very confident that their concerns would be Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 19 listened to, taken seriously and acted upon. When asked where they got this feeling from it soon became clear that it was based on what they saw and felt around them, and a generally wholly positive view of their personal relationship with Mrs Tirbhowan. However, they were quite frank in saying that their knowledge of the formal process [for example as laid out in the Service User’ Guide] was not so well founded. How much this matters for the individuals concerned is open to question, the Service Users’ Guide was freely accessible and did explain the formal process for anybody who needed to use it. The level of staff training in adult protection issues had not moved on as rapidly as had initially been forecast, but all staff should complete the training shortly. The whistle blowing policy had two draft forms which could now easily be drawn together into one plain language document that explains what ‘abuse’ is; that it is the duty of each individual member of staff to report any issue they see as constituting abuse; how they will be protected for raising any concerns they genuinely see as needing attention and the process they should follow in protecting vulnerable service users. The staff interviewed proved to have an insightful and thoughtful grasp of the difficult issues involved, but it was clear that there were some gaps in their knowledge and understanding. This is not a criticism of them as caring individuals, quite the opposite; it simply illustrates the fact that training [and the knowledge and confidence it ought to impart] is useful even to the most thoughtful and diligent of people. General observation prompted the judgement that The Orchards generated an atmosphere and culture where abuse would not be tolerated. Orchards Residential Care Home (The) DS0000048307.V322528.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): Standards 19 and 26 were the key standards inspected during this visit, but some attention was also given to standards 20,21,22,23 24 and 25. On the whole the environment is safe and well maintained. There are areas where maintenance is due, but it would be unusual to find otherwise in any care home. There are varied communal facilities that can be seen to meeting the main needs of the people that live there. The service users’ rooms sampled did appear to be comfortable and truly ‘domestic’ in their appearance. No obvious safety worries were seen. The general building was pleasantly domestic, it was clean and [apart from the slight smell of damp in the ground-floor bathroom] everything seen appeared clean and hygienic. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 21 EVIDENCE: The general maintenance was reasonable, there were some areas where the items were reaching the end of their service life [for example, the stair carpet is now showing noticeable wear on the risers and ought to be replaced]. Mr and Mrs Tirbhowan said that one of the improvements they were presently taking stock of was a complete refurbishment of the kitchen. The two service user’s bedrooms seen were obviously personal and in good decorative order. There are two rooms that have the potential for double occupancy, as everybody now knows; double occupancy [unless specifically requested by a partnership] is generally undesirable. While the home avoids the use of these rooms whenever it can a long-term alternative of all single occupancy is desirable. The home was clean and free from odours, excepting a slight smell of damp in the downstairs bathroom. This probably is simply due to the ventilation needing to be upgraded to take account of its frequent use for bathing? The work on covering all radiators [for safety] is now complete. The home still has a stair-lift to access the upstairs bedrooms. This, of course brings up safety and independence considerations that a shaft lift would avoid. These considerations might, economically, be dealt with within a general ‘risk and safety’ system, and/or within each individual service user’s assessment and plan for care. There is a lounge, a separate dining room and a ‘quiet’ room. There is outside space to the front and the rear of the house. Although it is easy to see that the home works reasonably well for people the present system of assessment and planning for care doesn’t help in getting fine, exact detail to say how well the services and facilities of the home meet peoples’ needs and preferences. The downstairs bathroom is obviously used almost exclusively. Mrs Tirbhowan in fact said that nobody now used the upstairs bathroom at all. Staff said that people [who needed it] had been helped to get used to the hoist and were comfortable with it. One drawback with this is that the downstairs bathroom also houses the only communal ground floor wc. While it is true that many service users’ rooms have en-suite wc this is not always going to solve the need that somebody might have to use that wc, only to find it occupied. This bathroom gets used a lot for bathing. The assessment and care planning system needs to develop to ensure the building’s best use in meeting the needs of everybody living there especially people with mental frailty. For example, how best to ensure that people have the easiest [non-institutional] way possible to identify their own room, or how to find their way to the wc. The building is not yet adapted in this way. A similar process and scope is needed to find the best way to use the outside space Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 22 There was a considerable amount of discussion about Mr and Mrs Tirbhowan’s broad intention to alter their registration amend the ratio of people with mental frailty, and how the building might be extended to allow a more flexible set of responses to peoples’ abilities and needs. Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 were all inspected during this visit. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a sound basis for staffing levels and spread, but it is not clear how preciselyl this provision matches assessed need. The comments by service users, by their representatives and by observation on the day make it absolutely clear that the service is far from ‘poor’. The level of staff training in certain key areas is continuing, and certain key issues remain short of completion as yet. Both of these matters need to be addressed before the home can progress forward to ‘good’ or ‘excellent’. The recruitment and selection process continues to be appropriate, but some extra consideration would benefit and re-enforce the current process of staff supervision and appraisal. Staff already have the foundations of the skills required to allow more experienced members of staff to take a much more central and important role [as key workers] in assessing/ planning for care and reviewing care alongside service users. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 24 Judging the precise amount, spread and skill mix of staff needed in The Orchards was not yet possible due to the type of information presently contained in the assessments. As a rough calculation however the roster certainly appeared to provide a solid core of cover. However, service users and their representatives were all positive about the availability of staff both in the comment cards returned before the inspection and in what they had to say on the day of inspection. The core question about staffing numbers may seem therefore to centre on determining the re-enforcement required [if any] ‘at peak times of activity’ during the day. Maybe this might address the queries over the level of activities. It might mean importing some specialist help not there at present. Looking at the spread and number of night staff available produced a picture just like that found and commented on here for day staff. The ‘skills and training’ of staff is progressing well, there are already 50 of the staff who have NVQ to Level Two, and if things go to plan the home will have 100 of staff trained to that level within 18 months. The specialised training for adult protection and the needs of older people with mental frailty needs to proceed rapidly. Plans are in place to conclude this process, but there is [probably] a priority need to re-enforce the latter area, given observed levels of need and potential future changes. The catering and domestic staffing arrangements provide a foundation cover, but detailed judgement is dependant on revising the assessment process. The recruitment and selection process was not looked at in detail on this visit, it has been seen to be sound in the past, and a brief sampling during this inspection shewed no deterioration. Staff interviewed proved to be able to describe their duties in a lucid and coherent way. Their knowledge of individual service users proved to be good, and some particularly sensitive and thoughtful insights were evident. Staff did describe having access to individual care plans, but were clear that these care plans were not yet used on a daily basis to guide their care responses in detail. They also talked about how they fed back what they learned from the people they were working for [but not as written records]. Key pieces of news or specific information [like somebody’s state of health or a doctor’s appointment for example] were logged in the daily record, but more subtle and personal matters depended on a much more informal process. This carries an unnecessary risk Records in the daily log bore out what the staff described. There were a few entries that could clearly be seen to what the care plan expected, there were items of news and appointments. However, the record was not yet focussing fully on specific individual care issues. This is not a criticism of the staff, it is just a reflection on the way in which that care plans are currently constructed and used. The system of staff appraisal/supervision had not yet fully developed into a system aimed at assisting staff to meet their full potential and in assisting Mr and Mrs Tirbhowan in ensuring that their own expectations [as laid out in the Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 25 Statement of Purpose and staff job descriptions] were carried forward into daily practice. Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,& 38 were inspected during this visit. Standards 32 & 36 were looked at briefly [some comment has already been made about staff supervision and appraisal within the previous section]. Standards 34 and 37 were not re-visited on this occasion. Service users, their representatives and staff were all very firm in their assurances that the home was managed well and that they were listened to and taken seriously when expressing their wishes and views. The Quality Assurance and staff appraisal/supervision systems all needed further development, but were already in place and functioning. Systems and procedures to maintain safety in the home were in place. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 27 EVIDENCE: Mrs Tirbhowan is fully qualified and experienced for her role. In addition, her own personal explanation and description of some complex ‘social and emotional’ issues which needed skilful management did not shy away from the fact that many of these issues contained serious areas of conflict within them. On the contrary, these explanations took full account of these serious difficulties and took equal account of how they needed to be considered when reaching an appropriate care response for the individuals concerned. Service users, their representatives and staff were all positive about what they saw as an open and positive form of management. People were especially keen to point out how easy it was to approach Mrs Tirbhowan and to be listened to. The quality assurance process was still at an early stage of development. The present system does the right thing by canvassing service users’ views and recording them. However, it is as yet less robust as a helpful tool to assist positive change and development reflecting the aims and objectives of the home. There was some brief discussion as to how the present system could be re-shaped and streamlined using the present Statement of Purpose in conjunction with a revised process of assessment/planning and review of care to end up with a more focussed and effective system. Very little money was being handled now on behalf of service users, the records and process seen were simple and straightforward. It was recommended that when service users’ representatives deposited more money to be used on behalf of their relative they be asked to check and sign off the preceding account as correct. The procedure for appraisal/supervision was already in place, but the next layer of development needs to look at a format and records more closely attuned to all aspects of practice, the philosophy of the home and in the career development needs of that particular member of staff. This already appears to be being done in an ‘informal’ sort of way, but underpinning and re-enforcing professional practice by tying the procedure in with by each individual member of staff’s job description, the ‘staff handbook’ and the aims and objectives of the home. Previous inspections have shown policies and records in place to manage key areas of safe practice in the home. Sampling showed no deterioration in the standard set previously. Staff proved capable of giving a clear and lucid description [without warning or rehearsal] of fire safety procedures. The previous anomalies with fluctuating water temperatures [noted in the last inspection] now appear to have been resolved and taps sampled on the tour of the building all gave a satisfactory result. However, as there have been problems in the past it would seem prudent to keep a raised level of vigilance about this issue for the time being. Orchards Residential Care Home (The) DS0000048307.V322528.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 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X 2 X X 2 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X X 3 Orchards Residential Care Home (The) DS0000048307.V322528.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. 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 OP3 Good Practice Recommendations It is recommended that the entire system for assessment of care needs, for the planning of care responses and the review of changing care needs is carefully reviewed. It is also recommended that the entire system is then revised to take a much broader account of the ‘social and emotional’ issues that are essential guides to care responses. The entire system also needs to take full and robust account of the special needs of people whose mental capabilities are reducing as they age. This recommendation covers the whole range and scope of this process, rather than being repeated for each individual standard where it is relevant. Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 30 2. OP12 It is recommended that specific attention is paid to the promotion of activities in the home, and to the promotion of choice of meal-time options. It is understood that this recommendation is probably dependant on recommendation 1. above. It is recommended that staff training in the procedures for the protection of vulnerable adults is completed as speedily as possible. In addition it is recommended that the present drafts of the whistle blowing policy are amalgamated and edited to provide a clear and robust instruction and explanation for all. It is recommended that the slight smell of damp in the ground floor bathroom is investigated and eradicated. It is recommended that an enhanced programme of staff training in respect of the specific needs of older people with increasing mental frailty is designed and embarked on as soon as possible. The changing needs of the home make this important. It is also recommended that the present system of appraisal and supervision of staff is more closely aligned to the statement of purpose of the home, the assessments and plans for care for service users, and staff job descriptions. [Standard 33 can also be underpinned by this process of course]. It is also recommended that staff training is also put into place [probably in initially in respect of “key” workers] to help them learn about, and in part then to take over, some of the processes involved in assessment and planning/review of care. It is recommended that the system of Q.A. is now revised and expanded to give full support to the home and its service users. The system of assessment and planning for care will help a lot here. For example, talking to service users on a regular basis [review of care] can see if the care plans fit what was wanted, and if the care actions agreed on have been implemented [satisfaction or dissatisfaction]. It is recommended [just to complete the process] that the manager asks service users’ representatives to sign off the previous account records before leaving further money to be used on the service user’s behalf. 3. OP18 4. 5. OP26 OP30 6. OP33 7. OP35 Orchards Residential Care Home (The) DS0000048307.V322528.R01.S.doc Version 5.2 Page 31 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.V322528.R01.S.doc Version 5.2 Page 32 - 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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