Inspection on 12/03/09 for The Orchard

This inspection was carried out on 12th March 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Orchard 29/07/08

The Orchard 28/09/07

The Orchard 18/08/06

The Orchard 06/12/05

The Orchard 15/11/04

The Orchard 14/06/04

The Orchard 20/08/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Orchard High Street South Stewkley Bucks LU7 0HR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Handscombe     Date: 1 6 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: The Orchard High Street South Stewkley Bucks LU7 0HR 01525240240 01525240464 orchardstewkley@supanet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Pauline Hannelly care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 11 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home The Orchard is registered to provide personal care for up to eleven older people. It is a large detached house set in attractive gardens in the village of Stewkley and is close to local amenities. The home is privately owned and managed and is also the private residence of the owner/manager. All bedrooms are single occupancy and have en-suite facilities. People using the service have their own sitting/dining room and there are attractive accessible gardens. All service users are registered with a local doctors Care Homes for Older People Page 4 of 33 Over 65 11 0 Brief description of the care home practices and have access to National Health Service facilities. Fees for the home, as stated in the pre-inspection self-assessment, are 650 pounds per week. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection, which took place over two days. The visit took place on the 12th and 16th March 2009. The purpose of the visit was to see how the home is meeting the National Minimum Standards. Prior to our visit we sent the registered manager a number of surveys to be distributed to service users, staff members and visiting health and social care professionals in order to ascertain their views upon the service and the care provided. At the time of writing this report we have received completed questionnaires from six service users, six staff and three healthcare professionals. Any further completed surveys we receive will be considered as part of our ongoing regulatory responsibilities for registered services. The Inspecting for Better Lives (IBL) involves us requiring the service to complete an Care Homes for Older People Page 6 of 33 Annual Quality Assurance Assessment (AQAA), which enables them to evaluate the quality of their service and forward to ourselves when asked. This initially helps us to prioritise the order of the inspection and identify areas that require more attention during the inspection process Results of this inspection report are derived from feedback gained from the service users, discussions with staff during the visit and responses to questionnaires sent out prior to this visit, viewing service users records held within the service, viewing policies and procedures, staff personnel files, general observation throughout the visit, along with information provided to us within the AQAA and any other information that we have received about the service in order to gain an understanding of how the service meet the service users needs, and impact upon their lives. We looked at how well the service was meeting the key standards set by the government and have in this report made judgments about the standard of the service. We would like to thank the service users, relatives, staff members and visiting health and social care professionals for their time and assistance during this inspection. What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 33 Ensure that the medication trolley is affixed securely to the wall. Ensure that arrangements are in place and procedures adhered to at all times for the recording of medications, the appropriate coding system is to be used and any errors documented appropriately. All staff personnel files must contain a recent photograph. Ensure that staff receive formal supervision at least six times a year, are provided with an annual appraisal of their work and appropriate documentation to evidence these are held within staff personnel files If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home and the services it can offer are provided to prospective and current users of the service.Prior to being admitted to the home, an assessment of the individuals health, social and personal care needs is undertaken to be sure that their needs can be met appropriately. Evidence: A copy of the service users guide and statement of purpose was requested during the last inspection, which highlighted shortfalls and for which requirements were made to update both documents so that people using the service and those looking for a home be provided with all the information they require and allows prospective users of the service to make an informed choice when choosing a home to meet their needs. During this visit we looked at both documents and found them to have been updated; the complaints section had been amended to reflect the Regulators and the commissions contact details. Likewise qualifications of staff had been added. Whilst information within the documents referred to the home recently caring for a person Care Homes for Older People Page 11 of 33 Evidence: with dementia and the support they received from the relevant health care professionals, it was not clear that the home is not registered to admit people whose primary care needs, at the point of admission, are that of dementia. This omission was pointed out to the manager who duly made changes to the master copies held on the computer so that the information provided to prospective and current users of the service informs them that the service is only registered to provide for older people whose primary care need at the time of admission is that of personal care. The service provides care to a number of people who have since their admission developed dementia and the statement of purpose has been expanded to provide information about how their needs are met in conjunction with other healthcare professionals within the community. The amendments made to the service users guide and statement of purpose, since the last inspection, now collectively fulfil the criteria expected in the National Minimum Standards and accompanying regulations. A sample of care plans and assessments were looked at for people who had been admitted to the home from which there was evidence that prospective users of the service receive an assessment of their health, personal and social care needs and introductory visits to the home are provided prior to any placement decisions, to ensure that both parties are confident that their needs can be met appropriately. Where care managers from the local authority are involved, they undertake an assessment of the individuals needs and provide the home with detailed assessments prepared by them which gives comprehensive information about peoples individual care requirements. The manager uses a purchased package to record the assessment of peoples needs and any associated risks that may be present when delivering the care. The areas of assessment cover mental health, physical health, risk assessments on behaviour, likelihood of developing pressure damage, nutritional assessment, the history of and any risk of falls Details were contained within their files around their individual preferred routines for getting up in the morning and retiring to bed, whether they wished to have keys to their own bedrooms and a lockable safe in their rooms. There were personal profiles covering individuals family history, their personal circumstances, their likes and dislikes in relation to food and their requirements in the event of end of life care. Also documented was Information including peoples date of birth, address, doctor details, next of kin, carer and family involvement and areas like mobility, speech, hearing, sight, communication, mental condition, memory loss, washing and bathing, physical care needs, physical well-being and previous medical history. Whilst viewing one service users file, who was recently admitted for respite care over a duration of three weeks the assessment was not so full in detail and the purchased format had not been used. It was recommended that the registered manager use the Care Homes for Older People Page 12 of 33 Evidence: same format for all users of the service whether they are admitted for a short period of respite care or long term. Intermediate care is not provided by this service. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the home are being met The care plans are person-centred to include peoples preferences in how they wish the care to be provided and promote their overall well-being. Medication is not stored securely and poor recording procedures were evident. Evidence: The care plans of three service users were looked at in detail and they each contained clear information about each individuals care needs, as well as giving information to staff about what they had to do to provide the care the person required. Daily communication sheets were contained within service users files documenting the care and support given, activities undertaken, meals taken and observation notes. The care plans were seen to be drawn up from an initial assessment of needs, in consulatation with the service user and/or their family members. They focused on areas such as; mobility and dexterity, personal care and physical well being, nutrition and dietary requirements, hearing and communication, continence, oral needs, foot care and history of falls. Appropriate risk assessments were in place detailing any risks Care Homes for Older People Page 14 of 33 Evidence: and how the risk was to be minimised to ensure the service users health, safety and welfare. It was noted that when a service user is admitted to the home for respite care, the initial assessment was not in as much detail as the more permanent service users. The home uses a purchased format with a focus on health care needs and risk assessments but this was not being used for those admitted for respite. It is reccommended that the home considers using the purchased format for all those using the service. All three plans viewed contained nutritional assessments along with evidence of regular monthly weights being undertaken. Pressure area care assessments were also evident within the files. Any accidents or incidents that occur and which may affect the health, safety or welfare of service users are contained within the relevant users files, the appropriate accidents/incidents forms are completed and the relevant authorities are notified as is required. Feedback from healthcare professionals who completed comment cards all indicated satisfaction with the provision of care at the service and the good working relationships they have with the service. One GP added that residents appear well cared for with good standards of personal care and tells us that the practice has been informed promptly of any health concerns. Healthcare records were in good order and included records of contact with various healthcare professionals. The records indicated appropriate regularity of appointments and appropriate one-off consultations where necessary, including opthamology and audiology appointments at the outpatient departments. As part of the inspection process we looked at the medication systems within the home and accompanied a staff member on the medication round. During the last inspection it was found that medication was not being stored in an appropriate medication cabinet but that of a domestic piece of wooden furniture with a lockable section and controlled drugs were stored in a lockable cash tin within the said piece of furniture for which requirements were made. Since the last inspection, the service has obtained a suitable medication trolley in which all medication is stored, although it was not affixed securely to the wall, for which a requirement has been made. The manager informed us that a controlled drugs cabinet has been ordered for future storage of controlled drugs but at the time of this visit no one is prescribed controlled drugs which require such storage. Staff who administer medicines are provided with training to ensure that they have the skills, knowledge and competencies to undertake such tasks. Medication is generally well managed, although there was one instance in which a service users medication administration record contained an entry which had been Care Homes for Older People Page 15 of 33 Evidence: tippexed out. The member of staff who had been responsible for the entry said the reason for this was that the medication had been administered but signed for in the wrong column and therefore tippexed out. The member of staff was aware of this being poor procedure and acknowledged that any future errors would be documented appropriately to explain any errors. Feedback from those using the service was positive, all those who completed surveys and those spoken to during our visit said that they receive the care and support that they need and tell us that they always or usually receive the medical support that they need. A relative said the care and support at The Orchards is excellent....it is a great weight off my mind to know that my mother is being well cared for as she is unable to look after herself All those spoken to tell us that the staff are very caring and that their privacy and dignity is respected at all times. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Contact with family, friends and the local community is encouraged and support is given where required. A varied programme of activities satisfies the recreational interests of the residents and the meals offered to users of the service are very good, offering choice and variety, whilst catering for special dietary needs when required. Evidence: A part time activities co-ordinator is employed at The Orchard and she puts a programme of events together such as making cards, making sweets, poetry readings, historical talks, celebrating events such as Christmas and Halloween which are enjoyed by all those using the service. An outside entertainer visits the home regularly to provide music and sing a longs and a hairdresser visits on a weekly basis to provide a hairdressing service to those who require. The users of the service enjoy the services of a manicurist, who has recently been unavailable due to other commitments, although the manager informs us this is only temporary and she should be returning in the very near future; that in the meantime staff members are filing and painting peoples nails as required. Care Homes for Older People Page 17 of 33 Evidence: The activities coordinators record book showed that she researches and plans the topics she gives talks on and presents the information in a way that is both enjoyable and meaningful to people using the service, enabling discussion and reminiscence. Resident meetings are held every six weeks, which are minuted and made available for those who require. We viewed the second edition of the homes magazine which is produced in house and provided to those using the service and their families. This contained photographs and written accounts of special events held in the home which included the garden party held during the summer, to which users of the service, their family members and members of the public were invited, the Halloween party held in October, an interesting biography of one of the users of the service, birthday celebrations and preparations for Christmas. A lay minister from the Church of England visits the home on a six weekly basis and offers Holy Communion to those who require and a volunteer from the local church visits to offer prayers. The Methodist minister will visit people on an as required basis. People using the service are encouraged and supported to attend the local church coffee morning called Bright Hour. Assistance is given by the staff to ensure that family links and friendships outside the home are maintained and records are kept of any contacts made. Family and friends are encouraged to visit and always made welcome in the home. People who use the service are provided with good quality food, which is freshly cooked on the premises and are offered a choice. Special diets are available to meet service users health and cultural needs and the service endeavours to take individual tastes into account. However, there were mixed views in response to the question Do you like the meals at the home?; two responded with always, two answered usually and a further two answered sometimes. One family member said that their relative frequently purchases food for her/himself as often the food is not to her/his liking and states more notice needs to be taken of his/her dietary requirements. Other comments received included my mother loves the meals she has at The Orchard, the staff know the food she prefers and feed her accordingly, another praised the food and stated never any left!another told us one that the meals are not always hot enough and a healthcare professional said nutrition appears satisfactory. All these comments were fedback during our visit to enable the service to monitor the provision of food to ensure that it meets with their service users preferences. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure, which has been updated since the last inspection and people are confident that any concerns would be dealt with appropriately. Evidence: The complaints procedure contained within the statement of purpose has been updated to provide people with the contact details of the regulatory body since the last inspection, copies of which were sent to all relatives and a copy available within the home, although this will need amending again, along with any other documentation referring to the Commission for Social Care Inspection (CSCI) to reflect the Care Quality Commission who will be taking over the responsibilities of CSCI with effect from 1st April 2009. It is recommended that a copy of the complaints procedure be put on view within the home, making it accessible to all users of the service and those visiting the home. The manager stated in the pre-inspection self-assessment and during the visit, that there had not been any complaints about the service in the past twelve months and no safeguarding or restraint issues. The Commission has not received any information to the contrary. The homes own safeguarding procedure has, since the last inspection, been revised to ensure that it includes the duty to refer any allegations or suspicions of abuse to the Care Homes for Older People Page 19 of 33 Evidence: social services department and to notify the regulatory body within 24 hours of any allegation or suspicion. A sample of staff training records highlighted that staff have been provided with safeguarding training in October 2008, to update their skills and knowledge and to provide training for newer members of staff who had not undertaken such training. People using the service tell us that they know who to speak to if they have any concerns or complaints and are confident that any issues would be acted upon appropriately. The healthcare professionals who responded to our questionnaires tell us that the home has always responded appropriately if they or the person using the service have raised concerns and all the staff who completed questionnaires tell us that they know what to do if a service user/relative/advocate or friend has concerns about the home. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are provided with a comfortable, clean, safe and homely environment in which to live, which suits their needs and lifestyles. Evidence: The Orchard is a large detached property located on the road into Stewkley. It is a three-storey building with the top floor providing staff accommodation. There is a sign clearly identifying the home from the road. The grounds are enclosed behind a high brick wall and parking is available for visitors on the road. The standard of environment within this home is good, providing residents with an attractive and comfortable place to live. Accommodation for people using the service is on the ground and first floors; there are nine single rooms and one double room all with en-suite facilities. There are two communal lounges that people can choose from, one of which contains a dining area and overlooks the well maintained gardens and swimming pool. All parts of the home are accessible to the service users, with the use two stair lifts lift to facilitate mobility. However, there are some small steps around the ground floor, including some into the lounge and therefore people need to have fairly good mobility to manage them. During our visit it was noted that the home was cleaned to a good standard, which residents confirmed was always the case and no unpleasant odours were evident during the two days of our visit. Bathrooms are equipped with hoists and the toilets are fitted with raised toilet seats. The laundry is Care Homes for Older People Page 21 of 33 Evidence: sited on the ground floor and was observed to be clean and tidy and had a washing machine with sluice and hot wash options. The registered manager informs us that the issues with the safety of hot water in peoples bedrooms, found during our last inspection, have been dealt with. We tested the hot water in a number of bedrooms and communal bathrooms, including showers and found the temperatures to be appropriate, likewise the recorded temperatures documented by the home were viewed and found to be within the recommended temperature scale. Discussions with service users informed the inspector that they were happy with their bedrooms and their surroundings and that the home is kept to a good standard of cleanliness. Service users are encouraged to bring personal possessions with them, many of which were seen to be on view in those bedrooms viewed during this visit. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is staffed in accordance with the needs of the service users and staff are provided with the appropriate training to meet their needs appropriately. A thorough recruitment procedure is now in place to ensure, as far as is possible, the health, safety and well being of the residents in their care although this remains to be tested since no new staff members have been employed since the last inspection. Evidence: There is a staff rota, showing which staff members are on duty and there were sufficient people working at the home on both days of the inspection to meet the needs of the individuals. During the last inspection accurate rotas were not being maintained to show who was working in the home to allow for a clear audit trial, however on this visit we were provided with worked rotas which highlighted any changes that had been made. During the inspection process, four staff members personnel files were examined to ascertain the procedures that are undertaken when recruiting and selecting staff, that appropriate training is provided for staff to ensure they have the skills knowledge and competencies to undertake their roles safely and that they receive regular support, supervision and appraisal of their work. Of those viewed all contained the relevant pre employment checks, references and their relevant qualifications. Of the three files seen, two failed to contain a recent photograph of the staff members for which a Care Homes for Older People Page 23 of 33 Evidence: requirement has been made within this report. Recent training over the last twelve months has included updating of mandatory training, dementia awareness, safeguarding, developing and reviewing approaches to personalised care planning and first aid. At the time of this visit no new members of staff had been appointed since the last inspection and we therefore were unable to follow up on a requirement made in respect of ensuring that new staff working at the home on a preliminary POVA first clearnce are being supervised and aware of their limitations until a full Criminal Records Bureau Cclearance is received and therefore the previous requirement remains within this report, with new timescales and will be assessed at the next key inspection. However, the manager assures us that all new members of staff will be undertaking The Skills for Care induction and any staff who start to work at the home with a preliminary POVA first clearance, whilst awaiting the full Criminal Records Bureau clearance will be supervised and a written record signed by the manager and said member of staff will be kept on file to evidence this is being done. All six members of staff who completed surveys prior to our visit tell us that they are being given training that is relevant to their role and keeps them up to date with new ways of working. They also inform us that there are usually enough staff to meet the individual needs of all the people who use the service. They all told us that their employer carried out checks and gained references before they started work and were provided with an induction which covered everything they needed to know to do their job when they started. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Requirements made at previous visits relating to peoples health and safety have now been met to ensure that The Orchards is run in the best interests of those using the service and safeguards are in place to protect their health, safety and welfare. Staff files are not provided with regular formal supervision from their line manager or have their standard of work appraised on an annual basis. Evidence: The homes manager has worked in social care for 49 years and has achieved the Registered Managers Award and is registered with the Commission. Residents and members of staff reported that the manager runs the home in an open, positive, inclusive way and they would have no worries approaching her if they had any concerns and were confident that they would be listened to and dealt with appropriately, as did the feedback from surveys sent out prior to the inspection. The home does not act as agent or manage monies on behalf of residents. The Care Homes for Older People Page 25 of 33 Evidence: manager advised that relatives are invoiced for expenditure such as chiropody treatment and that the hairdresser and newsagent send their own invoices direct. The home has a health and safety policy statement and provides training for staff on safety topics such as moving and handling residents and fire safety training. We discussed health and safety issues and saw appropriate maintenance records relating to maintaining a safe environment for residents. We discussed health and safety issues and saw appropriate maintenance records relating to maintaining a safe environment for residents. There was evidence of testing for Legionella species in water, and a legionnaires certificate was seen dated October 2008. A fire risk assessment is in place, dated April 2008. The manager informed us that the existing electrical installation is inspected on a 5 yearly basis and we saw the last report on file dated 2007, however it was noted that the annual portable appliance testing (PAT) had not been undertaken since July 2007, the registered manager acted upon this finding and contacted the electrician who she informed us agreed to visit The Orchard, the week following this visit, to ensure that the PAT testing be undertaken. We were shown an invoice to evidence that the home had acted upon previous requirements and informed that thermostatic mixer valves have now been fitted to ensure that the hot water provided to service users be at a maximum of 43 degrees to ensure they are not at risk of scalding themselves. The invoice seen was undated and therefore reccommend that any invoices detailing any works be dated to allow for a clear audit trial. We checked temperatures of hot water in a number of bedrooms and communal bathrooms and the showers all of which were evidenced to now measure consistently at an appropriate temperature. The homes own documented recordings of water temperatures also highlighted that water temperatures are now being delivered at the appropriate temperature and do not pose a risk of scalding to those using the service. The home engages regularly with users of the service to gain feedback on various aspects of the service it provides; this is undertaken on both an informal and formal basis through feedback and questionnaires on various aspects of the service and the care provided. Whilst viewing a sample of three staff personnel files, it was apparent that there were shortfalls around providing staff with formal supervision, at the required level of six per year. although we were informed that staff are provided with supervision on an informal basis regularly. A requirement has been made to ensure that staff receive formal supervision at least six times a year, are provided with an annual appraisal of their work and appropriate documentation to evidence these are held within staff personnel files. The home deals with a number of diverse care needs and offers a personalised service Care Homes for Older People Page 26 of 33 Evidence: to meet the needs of their clients. The service has worked to address the shortfalls found and for which requirements were made during the last key inspection. Providing that the service can sustain this level of service and where areas for improvement emerge if they continue to manage improvements well we would expect to see the overall rating change from that of adequate. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 13(6) The manager is to ensure 01/09/2008 that any staff who start to work at the home with preliminary POVAfirst clearance are supervised and made aware of the limitations of their role until full Criminal Records Bureau clearance is received, and that a written record is kept, signed by the manager and member of staff, to show that this has been done. Care Homes for Older People Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Ensure that the medication trolley is affixed securely to the wall. Ensure that arrangements are in place and procedures adhered to at all times for the recording of medications, the appropriate coding system be used and any errors documented appropriately. Regulation 13(2) of the Care Homes Regulations 2001 requires you to make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines. 30/05/2009 2 29 19 All staff personnell files must 30/05/2009 contain a recent photograph. Regulation 19 of the Care Homes Regulations 2001 requires that; Care Homes for Older People Page 29 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action the registered person shall not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in Schedule 2. 3 29 13 The registered manager 30/05/2009 must ensure that any staff who start to work at the home with preliminary POVAfirst clearance are supervised and made aware of the limitations of their role until full Criminal Records Bureau clearance is received, and that a written record is kept, signed by the manager and member of staff, to show that this has been done. This is a repeated requirement with a new timescale as we were unable to fully assess whether the requirement has been met. The registered person must make sure that people using the service are protected from potential risk whilst awaiting full Criminal Records Bureau clearance for staff. Regulation 13(6) of the Care Homes Regulations 2001 requires the registered Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action person to make arrangements by staff training or other measures to prevent people using the service being harmed or suffering abuse or being placed at risk of harm or abuse. 4 36 18 Ensure that staff receive formal supervision at least six times a year, are provided with an annual appraisal of their work and appropriate documentation to evidence these are held within staff personnel files Regulation 18(2) of the Care Homes Regulations 2001 requires that: The registered person shall ensure that persons working at the care home are appropriately supervised. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 31/07/2009 1 3 It is recommended that the registered manager use the same assessment and care planning format for all users of the service whether they are admitted for a short period of respite care or long term. It is reccommended that the home considers extending the use of the purchased package of documents which focus on healthcare needs and risk assessments for all those using the service. Page 31 of 33 2 7 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 3 16 It is recommended that a copy of the complaints procedure be put on view within the home, making it accessible to all users of the service and those visiting the home and kept up to date. Any invoices detailing any works undertaken be dated to allow for a clear audit trial 4 37 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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