Inspection on 04/04/05 for Orchards Residential Care Home (The)

This inspection was carried out on 4th April 2005.

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

Other inspections for this house

Orchards Residential Care Home... 14/08/07

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

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

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 Unannounced 4 April 2005 - 11.00am 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 Version 1.10 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 Care Home 13 Category(ies) of OP Old Age (10) DE(E) registration, with number Dementia over 65 (3) of places Orchards Residential Care Home Version 1.10 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 18 October 2004 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 Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a routine unannounced inspection which took place over the lunchtime period between 11am and 2pm. Some time was spent talking to the manager and looking at the records. The requirements of the last inspection were discussed. The inspector also spoke to a group of service users (5) privately in the lounge and to two privately in their rooms. Some of the facilities of the building were checked. What the service does well: What has improved since the last inspection? The manager has carried out a survey of the service users to ensure they are not at risk of burning themselves against hot radiators. This is a good safety precaution especially as some service users are frail. A new WC and basin have been installed in the downstairs bathroom. The WC has handles to help with mobility. This is an improvement in the facilities. Orchards Residential Care Home Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Orchards Residential Care Home Version 1.10 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 Version 1.10 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) None of these standards were inspected EVIDENCE: Orchards Residential Care Home Version 1.10 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 and 10, The service users personal needs including their health needs are fully recorded in a care plan. The evidence showed that health needs are being met with regular contact and advice from community health professionals. Service users are treated with respect and are very definite about how well they are looked after. Their privacy is also honoured. EVIDENCE: Samples of the care records were examined and showed that the Home had done a full assessment of the service users’ needs and what assistance they would need from staff. Details were seen regarding their routines and preferences as well as details regarding mobility, medical problems and personal care. Daily notes written by staff were good enabling the reader to gain a picture of how the service user was progressing. Reviews of care were also seen. A goal setting sheet identified particular areas for monitoring, for example the prevention of falls. Orchards Residential Care Home Version 1.10 Page 10 In terms of health needs, the records also recorded contact with medical personnel. Hospital transfer notes were also on file guiding staff as to a service users condition. There was reference to the district nurse calling. Two district nurses were seen arriving on the day of the inspection. Service users confirmed that they had regular visits from nurses and also saw the doctor when they needed to. They also said the chiropodist called on a regular basis. There was also evidence of liaison with the continence advisor and two staff have been on the continence care training course. Overall the records gave a good account of what care the service users received and convinced the inspector that the care needs and the health care needs of the service users were being met. Service users seen were very enthusiastic about the Home and felt staff really treated them well. “If you want anything there is no hesitation” one said. Another said “staff will do anything for you”, another referring to the manager said “she do look after us well”. One service user said “there was never an angry word with any of them”. Service users also felt they could use their room as they liked, a few staying in their room most of the time. Others like to be more sociable and come into the lounge. Overall service users felt their right to privacy and respect was maintained in the home and staff were very good to them. Orchards Residential Care Home Version 1.10 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) 13 and 15 Service users are able to maintain contact with family and friends. The food is judged to be of a good quality and the service users think it is varied and nutritious and provided at appropriate times in both the dining room and in their own rooms. EVIDENCE: Two service users seen in private confirmed that they went out with relatives on a regular basis and there was no problem in their relatives coming into the Home. The group of service users seen together in the lounge (in private) also said lots of service users had visitors and went out to visit their relatives. The home also has parties occasionally where relatives are invited. The main meal of the day was observed by the inspector and helpings seemed to be plentiful. On the menu was ham, potatoes, cabbage and cauliflower with ice cream and apple pie to follow. Service users thought it was “good food” and “not bad at all” and “lovely food” and one person on a special diet said the home catered for her “very well”. They also confirmed that “tea varies” and gave examples of “salmon salad, beans on toast, pork pies” which they thought was a good selection. Orchards Residential Care Home Version 1.10 Page 12 Service users also liked their breakfast which most had in their rooms. Timings seemed to vary with one person saying they had it “when they wake”, others saying 8am. Grapefruit, cereal and toast were mentioned. Drinks and snacks were also regularly served which the service users were quite happy with. The menus looked varied and nutritious. Orchards Residential Care Home Version 1.10 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) None of these standards were inspected EVIDENCE: Orchards Residential Care Home Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20, 21, 23,24 and 25 In general the Home is quite cosy and comfortable and service users have pleasant rooms which they are able to make personal and private. The bathroom facilities are improving but still need more renovation to bring them up to standard. The home provides a safe environment but the risk assessments in place need to be improved. EVIDENCE: Communal facilities were seen to be safe and comfortable. There is one large lounge with comfortable chairs and television and another little lounge which is a quiet room and contains the library. In addition there is a dining room where most of the service users eat. This has tables for four. There is a garden outside which needs some work to make it accessible to the service users but at the time of year of this inspection was not quite ready for the summer. Orchards Residential Care Home Version 1.10 Page 15 There is only one bathroom currently in use which is located downstairs. There is a bathroom and WC upstairs but because there is no hoist in the bath, no one can use it so all service users are coming downstairs for a bath. The downstairs bathroom is still in a state of renovation. The provider has installed a new WC and basin and handle round the toilet which is good progress but there is still work to be done with tiles off the wall and an unfinished look. There are no homely touches to make it comfortable and the shower is still used as a cupboard. Only a few of the service users rooms were seen at this inspection but those seen were cosy and homely and the service users had been able to bring their own possessions to make them personal. Currently all rooms are being used as singles giving the service users some privacy. Locks are also fitted on the doors. The bedding and curtains are bright and attractive and the décor seen was a good standard. The Home provides a safe environment with most rooms on an even level though those upstairs have to negotiate the stair lift. Thermostatic valves have been fitted to control the water temperature. Following the last inspection when a requirement was made, risk assessments have been carried out on all service users with regard to the risk of them falling against hot radiators as most are not covered. These were however not specific enough and need to be amended and any action taken as a result. Orchards Residential Care Home Version 1.10 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 and 29, Staffing is satisfactory with an appropriate skills mix of staff. The rota shows that the provider is committed to providing satisfactory care hours. Staff training is being given to ensure service users are safely looked after. Service users thought staff looked after them very well. The recruitment procedure is not rigorous enough and is not protecting the service users. Requirements have been made for change. EVIDENCE: On the day of the inspection two care staff were on duty with the manager and a cook was making the main meal. This was considered to be satisfactory staffing for the number of service users accommodated (11). The rota for the week of the inspection was checked and found to have a similar staffing ratio on a daily basis. This allowed for approximately 24 separate management hours with the manager filling in on care and catering hours the remainder of the time. Separate catering hours were provided on three days. One waking and one sleeping in staff were provided every night. Overall these hours were satisfactory. Good progress is being made on staff NVQ training with seven of the staff group in training. Orchards Residential Care Home Version 1.10 Page 17 Despite there being a requirement at the last inspection, two staff had been employed without enhanced criminal records checks or POVA checks. An immediate requirement was made to remedy this situation. Staff are not working on their own but the need for strict recruitment practices was emphasised by the inspector. References were taken up and staff do complete an application form. However there was no medical declaration form nor photographs on the staff files. The manager was reminded of the requirement to keep the required information as outlined in Schedule 2 of the regulations. Orchards Residential Care Home Version 1.10 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) 31,36 Service users are living in a home which is run and managed by a person fit to be in charge and able to discharge their responsibilities well. In practice staff are receiving supervision and how they work is monitored. However a more formal recording of the process is required. EVIDENCE: The manager is studying for her NVQ4 and is nearly finished the qualification. The service users spoke very highly of her giving the inspector the view that she was discharging her responsibilities well. She is promoting staff training and keeps communication channels open with the staff. Orchards Residential Care Home Version 1.10 Page 19 Supervision files of the staff were scrutinised. One to one supervision was being carried out but not in as organised a way as required. Records were not demonstrating that a private discussion took place about practice on a regular basis and this needs to be more formalised. The manager said that she does observe her staff at work and tackles practice issues but this was not being recorded. Orchards Residential Care Home Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x 3 2 x 3 3 2 x STAFFING Standard No Score 27 3 28 3 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x x x x 2 x x Orchards Residential Care Home Version 1.10 Page 21 Yes 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 25 Regulation 13(4) Requirement The risk assessments must be more deatailed to show that service users are not at risk from being burned by hot radiators. Timescale of 31.12.04 not met/ The registered person must ensure that enhanced criminal record checks are carried out prior to employment. Timescale of 30.11.04 not met. The registered person must ensure that staff are appropriately supervised. Timescale for action 31.5.05 2. 29 19 and schedule 2 18(2) Immediate and ongoing. 30.6.05 3. 36 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 21 Good Practice Recommendations The downstairs bathroom should be brought up to a good standard and made more attractive for the service users. Orchards Residential Care Home Version 1.10 Page 22 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. Extracts may not be used or reproduced without the express permission of CSCI Orchards Residential Care Home Version 1.10 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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