Inspection on 24/10/05 for Orchid Lawns Nursing Home

This inspection was carried out on 24th October 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Orchid Lawns Nursing Home 12/03/08

Orchid Lawns Nursing Home 06/11/07

Orchid Lawns Nursing Home 22/05/07

Orchid Lawns Nursing Home 25/04/06

Orchid Lawns Nursing Home 30/06/05

Orchid Lawns Nursing Home 08/02/05

Orchid Lawns Nursing Home 21/09/04

Orchid Lawns Nursing Home 10/02/04

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

CARE HOMES FOR OLDER PEOPLE Orchid Lawns Nursing Home Steppingley Hospital Grounds Ampthill Road Steppingley Bedfordshire MK45 1AB Lead Inspector Linda Cappello Unannounced Inspection 24th October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 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. Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Orchid Lawns Nursing Home Address Steppingley Hospital Grounds Ampthill Road Steppingley Bedfordshire MK45 1AB 01525 713630 01525 718624 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) Health & Care Services (NW) Limited Mr James Minshull Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (24) Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Elderly over 65 Date of last inspection 30th June 2005 Brief Description of the Service: Orchid Lawns is a purpose built nursing/care home situated in the grounds of Steppingley Hospital. Steppingley is a small village near to Flitwick town in mid Bedfordshire. Flitwick has good public transport and road access but there is a limited bus service to Steppingley. The home is single storey with accommodation separated into three wings each with their own living area and communal space. The home has a large garden and there is a large parking area at the front. Orchid Lawns provides places for up to twenty-four older adults with mental health care needs. All the places at Orchid Lawns are contracted to the local primary care trusts with admission via referral to a placement panel. Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report should be read in conjunction with the National Minimum Standards for Older People and the inspection report of 30th June 2005. Since this last inspection, four investigations under the Protection of Vulnerable Adults procedures have taken place and additional visits to the home by the lead inspector have also taken place, on 11/07/05, 21/07/05, 01/08/05, 10/08/05, 22/08/05, 07/09/05 and an inspection by the Pharmacy Inspector took place on 23rd August 2005. In response to the concerns, which have arisen, the provider has drawn up a recovery programme for the home and adherence to this is being closely monitored by senior personnel from Craegmoor Healthcare. The elements of the recovery programme mirror the Statutory Requirements which have been issued by the Commission for Social Care Commission since 30/06/05. This unannounced inspection was carried out between 10.00hrs and 16.00 hrs on the 24th October 2005. The home currently has an interim manager Mr David Walpole in place, and he and all of the team on duty at the time of the inspection were both welcoming and helpful throughout. The focus of this inspection was to follow up the many issues and concerns which have arisen over recent months. The inspection was undertaken by Linda Cappello (Lead Inspector), Joy Wilson (Business Relations Manager for the Commission) and Louise Trainor (Regulatory Inspector) and included a full update on the improvement plan for the home, tracking of 3 residents, including looking at their care plans, visiting bedrooms and communal areas. Discussions with one relative and one support worker were also included in this inspection, as was the observation of the morning medication round. The Inspectors are grateful for the help received from staff, residents and relatives during this visit. What the service does well: Staff at the home are treating the residents with dignity and respect and a relative confirmed that she was happy with the care being given to her mother. The home is looking carefully at what each resident likes to eat and the way they can eat it and providing nutritious meals which are nicely presented. Residents are being offered snacks and drinks throughout the day and evening. Residents and their relatives are being offered a choice of colours as their bedrooms are being redecorated. Relatives are always welcomed into the Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 Page 6 home and there are regular meetings at which relatives can discuss any concerns or give their views on plans for improvement. What has improved since the last inspection? 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. Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 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 the following standard(s): 3, 4, 6 An assessment of each individual has been completed so that, overall, the needs of current residents can be met. EVIDENCE: Prior to this inspection, it had been found that some elements of the needs of residents had not been assessed, that staff had not received the training necessary to look after them and that their needs were not reflected in care plans or risk assessments. These factors were having a detrimental affect on the way in which residents were cared for in the home. During this inspection it was found that the three residents who were tracked all had clear assessments of needs, individualised care plans and risk assessments in their files. However, in order to be able to demonstrate that the home can effectively meet all residents’ needs, the home needs to continue to ensure that staff receive the necessary training, for example, to identify the presence of depression. Also, until admissions to the home recommence, it is not possible to fully assess whether the home’s practice has substantially improved. This home does not provide intermediate care and this standard was, therefore, not assessed. Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 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 the following standard(s): 7, 8, 9, 10, Resident care plans and risk assessments were improved since the last visit so that generally health and personal care needs are being met. The procedure for administering medication could leave residents at risk. EVIDENCE: It had been found that support workers in the home were not involved in writing care plans and were not encouraged to routinely refer to them. During this inspection it was found that support workers are now being involved more in the individual care needs of the residents and have a section in the files to make their own entries. The support worker who was interviewed was able to discuss the individual needs of one of the tracked residents, demonstrating an understanding of her needs and how she expressed her feelings. All care staff are now benefiting from care planning training which is provided Craegmoor Healthcare as part of the programme of improvement. As discussed above, it had previously been found that the care plans for residents did not contain all of the elements of care which were necessary and this was adversely affecting the care of residents. During this inspection, the records of three residents were scrutinised and found in general to contain care plans and risk assessments appropriate to their needs. These could, however, be more detailed and proactive in form, for example, one resident had a care plan in Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 Page 10 place because she was at risk of choking but it did not describe the suitable position for feeding. Reviews were being undertaken on a monthly basis with care plans being discontinued and rewritten where needs had changed. The records seen have now got personal care charts in place which makes it easier to identify which care tasks have been carried out and what is outstanding. There was some evidence that the healthcare needs of residents were being met more promptly and appropriately. For example, all residents who were identified as being at risk of pressure sores had now got the appropriate equipment in place and no residents, at the time of this inspection, had any pressure wounds. However, the incontinence needs of one resident were unclear in her care plan and she did not appear to have a personal supply of suitable materials. Staff have not yet benefited from incontinence care training. There was little evidence in the records of residents that foot care was being considered, however, the manager said that the chiropodist called at the home regularly. There have been very serious concerns about the way in which medication was managed within the home and the pharmacy inspector was asked to undertake a specialised inspection to identify the issues. He issued a number of requirements and the home’s compliance with these continues to be monitored. The competence of staff involved in the management of medication has been assessed and extra training and supervision provided where necessary. During this inspection, the latter part of a medication round was observed at 11.15hrs. One resident was given his medication by the qualified nurse, but it quickly became evident that he required more liquid to swallow his tablets. However, this was not acted upon by the member of staff present. It was also noted that one resident’s medication chart was marked as “all medication for 0800hrs ‘refused and destroyed’.” However one of these tablets required a pulse to be taken prior to administration and this information was not recorded on the MAR chart. During observations all residents were noted to being treated in a respectful manner. One resident’s daughter confirmed this by stating how well her Mum was cared for. Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14,15, The provision of meals in the home has improved so that residents are receiving a well balanced diet, offering choice and variety. The home welcomes visitors and families so that residents can receive visitors at any time of day. However there is sparse activity programme presently in place, which leaves the residents lacking in stimulation. EVIDENCE: There had been serious concerns about possible long gaps between the provision of food and drinks for residents and about the appropriate identification of those residents who required liquidised food for those residents who were at risk of choking. The home has taken steps to address these issues and during this inspection, the meal which was served at lunchtime was well presented and smelt very appetising. All residents have now been assessed by a dietician so that those who require liquefied food have been clearly identified and staff are fully aware of their needs. The liquefied diets served at lunchtime were presented in moulds which made them look more appealing. Residents were observed to be offered a choice of food at mealtimes, and mid morning snacks were also being offered. The daily intake of food and drink by residents is now carefully monitored. Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 Page 12 As part of the programme of improvement in the home, the residents and their families have been given the opportunity to choose what colour they would like their rooms decorated. There have been longstanding concerns about the provision of suitable activities for the residents at this home and this is now starting to be addressed. The interim manager has introduced a monthly music session and other activities such as bingo, beetle drive and reminiscence are planned. However the present activity sheet only identifies an activity booked in for two hours on a Tuesday afternoon. The lack of activities was demonstrated by one support worker’s response when asked about activities, she replied ‘I don’t know, I don t work afternoons.’ Several residents had visitors during the inspection, and one daughter stated that her mother was well looked after. Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 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 the following standard(s): 16, 18 There is a robust complaints procedure in place so that residents and relatives will know that their complaints will be acted upon. The provider company has co-operated with investigations into potential abuse and taken subsequent action to protect residents. EVIDENCE: The provider company has a robust complaints procedure and details of how to make complaints are displayed in the entrance hall and included in the information provided to residents and relatives. Relatives are also encouraged to speak to staff or the manager when they visit the home and can also discuss any concerns at the regular relatives’ meetings. Due to serious concerns about incidents in the home, the Social Services Department and Primary Care Trust carried out investigations under the Protection of Vulnerable Adults procedures. The provider company has been open, honest and co-operative throughout these procedures. Appropriate action has been taken in relation to the findings of the investigations which have been concluded. One investigation was still being finalised at the time of this inspection. Staff are receiving training in the identification and prevention of abuse and have also been reminded of the company’s whistle blowing procedure. Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 22, 24, 26, Cleanliness and safety in the environment of the home was much improved since the last visit so that the residents are living in a clean environment however, action to safeguard the residents in the event of a fire is needed. EVIDENCE: There had been serious concerns about the level of cleanliness and hygiene in the home and by the presence of a strong offensive odour throughout. However, action has been taken by the provider company and during this inspection, both the communal areas and the bedrooms were noted to be clean and free from offensive odours. The interim manager confirmed that new chairs had been ordered and a new anti bacterial cleaner was on order for the carpet cleaning. The home was in the process of being re decorated throughout which was making a significant improvement to the environment. Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 Page 15 Staff were observed to be using hoists in a safe and competent manner. Records showed evidence that Fire prevention work is currently in process although not yet complete. A recent visit from the Fire Officer had identified a number of issues which required immediate action. It was found that the fire doors in the corridors and to Windrush lounge were not effectively self-closing, that the door and frame to the laundry and the door frame to the kitchen needed repair. It was also found that an extinguisher in the boiler room was defective and that the PLG cylinders at the rear of the premises needed checking and replacing as necessary. A visit to the room of one resident showed that it was clean with a few personal effects evident. A specialist hospital bed was in place with cot sides. This was supported by a care plan which had been signed and agreed with the resident’s daughter. The pathway from the laundry to the drying area had been resurfaced since the last inspection but was found to have a piece of protruding metal across it, causing some risk to staff using that pathway. Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, 30 There are sufficient staff on duty at peak times, and an ongoing training programme is in place so that overall residents needs are met with competence and understanding. Some elements of the recruitment practices within the home could lead to residents being placed at risk. EVIDENCE: With only 20 residents in the home at present, there were two senior support workers, three support workers and one qualified nurse on duty at the time of the inspection and they were able to meet the residents’ needs. Domestic staff have now been appointed which is having a positive effect upon the cleanliness and hygiene within the home. An additional post for a clinical nurse lead has recently been approved. Some concerns were noted in the recruitment processes for one applicant who had gaps in the work history listed and the references had not been properly verified. No photo identification was available. A training plan was now in place and this showed that staff were attending courses in identifying and preventing abuse of the elderly and dementia awareness, but that training in other mental health issues, such as depression, had not yet taken place. The plan also showed that five members of staff still needed to complete the induction programme. Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 The home presently has an interim manager in place with a clear development plan and vision for the home so that, overall, the residents’ welfare and safety needs are now being met. Procedures relating to residents’ finances are not robust enough so that potentially residents’ interests may not be safeguarded. EVIDENCE: The interim manager, who is a registered manager at another Craegmoor home is overseeing the premises twelve hours a day, five days a week and this also includes night and weekend spot checks. There is a clear improvement plan in place, which is steadily progressing under his lead. The home does not have a full quality assurance process in place, however, the provider company have advanced plans for introducing a rigorous audit process which should be in place next year. The home does hold regular meetings with relatives where concerns, compliments, plans and suggestions Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 Page 18 can be discussed. One such meeting was to be held a few days after this inspection. The procedures for managing the finances of residents were found to be flawed. Monies belonging to a deceased resident were found to still be in the office and receipts for another resident were unclear and did not balance with the cash held for him. The interim manager stated that he had not yet audited this system since coming to the home. The formal supervision of staff was improving although, until the nursing staff had undertaken supervision training, it was not possible for the interim manager to ensure that all staff had sufficiently regular supervision sessions. Working practices in the home were found to be generally safe. The company had policies and procedures in place relating to safe working practice and a system for reporting serious incidents. Portable electrical equipment testing must be kept up to date as two items were found to be beyond their retest date. Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 Page 19 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 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 2 X 2 X 3 X 3 STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 X 1 Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13(2) Requirement Medication must be administered in accordance with the home’s policy and procedures for safe administration. Action required by the Fire Safety Inspecting Officer in the letter dated 24/10/05 must be completed. Staff who are recruited to the home should be able to demonstrate a clear employment history, and the source of references provided must be verified. The home must ensure that accurate records in respect of residents’ money are maintained. Timescale for action 18/11/05 2 OP38OP19 23(4)(a,c) 30/11/05 2 OP29 18(1)(a) 30/11/05 3 OP35 17(2) Schedule 4 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 Page 21 1 OP7 More detail should be incorporated into care plans to maximise the safety of residents while their care is being carried out. Orchid Lawns Nursing Home DS0000017684.V258103.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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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