Inspection on 28/09/07 for The Orchard

This inspection was carried out on 28th September 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Orchard 12/03/09

The Orchard 29/07/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Orchard High Street South Stewkley Bucks LU7 0HR Lead Inspector Annette Miller Unannounced Inspection 28th September 2007 12.30 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 The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Orchard Address High Street South Stewkley Bucks LU7 0HR 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) 01525 240240 01525 240464 orchardstewkley@supanet.com Mrs Pauline Hannelly Mrs Pauline Hannelly Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th August 2006 Brief Description of the Service: The Orchard care home is registered to provide personal care for 11 elderly people. It is a large detached house set in extensive gardens with a swimming pool. It is situated in the rural village of Stewkley and is close to local amenities. The home is privately owned and managed and is also the private residence of the proprietor/manager. There are nine single bedrooms and one double room, all with en-suite facilities. Residents have their own sitting/dining room and there are attractive accessible gardens. All service users are registered with a local GP practice and have access to NHS services. Fees for the home are approximately £600.00 per week. The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted from 12.30 to 8 pm. The proprietor/manager was present throughout the inspection. We toured the premises and spoke to 3 residents, 1 relative and 4 members of staff to obtain their views of the home. Care plans, recruitment files and other relevant documents were looked at. The inspection took into account detailed information provided by the manager in the home’s Annual Quality Assurance Assessment (AQAA), which was sent to us before the inspection. We sent out a total of 23 surveys to obtain feedback about the standards at the home. 8 residents, 6 relatives and 2 health and social care professionals responded. Where appropriate, their comments are included in the report. We looked at how well the home was meeting the national minimum standards for older people set by the government and have made judgements about this in the report. What the service does well: What has improved since the last inspection? The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 6 The manager has employed consultants to assist in the development of care plans, which was ongoing at the time of inspection. Policies and procedures have been updated. Adult protection training has been provided. The requirements made at the last inspection have been met. 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 The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 8 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 The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are assessed before admission to ensure the home can meet their individual and diverse care needs. Intermediate care (Standard 6) is not provided. EVIDENCE: Prospective residents are admitted after a thorough pre-admission assessment. As part of this process the manager meets with the families and gathers as much information as possible about the individual’s care needs. We looked at an assessment of a recently admitted resident and found there was sufficient information for the manager to be able to make a decision about admission. The manager welcomes pre-admission visits to help people decide whether the home is somewhere they would like to live. We spoke to a resident and a relative and they confirmed this. Responding to our survey, a resident said: “I went there while my son and daughter in law went on holiday and I liked it.” The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 10 Eight residents confirmed through our survey that they had received enough information about the home before moving in. From our observations and the comments received we believe this home can provide a service to meet the religious, racial and cultural needs of people who live there. The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are involved in making decisions about their lives and play an active role in planning their care. EVIDENCE: Care plans for two people were seen. Plans were being updated using new paperwork recommended by consultants employed by the manager to assist in this work. This indicates the manager’s commitment to improving the service. We advised the manager to archive some of the older care plans and paperwork still in use. This is because having too much information in numerous files could be confusing for staff when trying to find out what they need to do to help residents. The right of every resident to have his/her privacy and dignity respected was covered well in the plans. We spoke to two carers and they each showed a good understanding of the importance of treating people as individuals. The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 12 Dietary needs are recorded and residents’ weight is monitored once a fortnight. There was a good account of the action taken about one resident’s weight loss. A referral was made to a dietician and the resident was assessed at the home with recommendations made. We checked and found the recommendations had been implemented. Healthcare is provided by local GPs and district nurses who visit the home regularly. Private chiropody is available at the home every six weeks. Medication is stored safely in a locked cabinet. All residents have medication administration record (MAR) charts showing when medication is given and by which member of staff. Medication training is provided to ensure staff members have the skills and knowledge they need to administer medication safely. Training certificates giving evidence of this were available for inspection. On the day of inspection hand-written medication charts, copying from a doctor’s prescription, were seen. These charts need to be checked by a second person. This is to avoid the potential for error when charts are regularly rewritten by care staff. Responding to our survey, 6 residents said they “always” received the care and support they needed; 2 said “usually”. Relatives commented: “Nothing is ever too much trouble for the staff.” “My relative is very happy and would not want to move.” “Staff have a good relationship with the residents. They get to know their likes and dislikes and encourage them to chat about their lives.” The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff team have a good understanding of the residents’ support needs. This is evident from the positive relationships that members of staff have formed with the residents and their families. However, a review of some matters relating to meals should be carried out to ensure residents’ dietary needs and wishes are met. EVIDENCE: Information in the AQAA indicates that activities are available, such as musical entertainment twice a month, a talk every Friday afternoon based on a specific theme and occasional trips to places of interest. The home has an activity organiser who works Monday to Friday 12 midday to 5.30 pm, but was on a day off on the day of inspection. The manager explained this was why there were no activities taking place. One resident was out shopping accompanied by a volunteer, which we understand is a regular occurrence. Our survey to residents asked: “Are there activities arranged by the home that you can take part in”. One resident said “always”, three said “usually”, three said “sometimes”. One person indicated a preference to stay in her room. The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 14 One relative was visiting and she told us she always found the staff to be very friendly, and appreciated being offered refreshments during her visits. She gave good feedback about the home. Feedback about the standard of food was generally good, although one relative thought it was “poor”. A resident said: “The meals are wholesome but I would prefer the vegetables not to be overcooked”; another resident made a similar comment. We arrived when lunches were being served. The food was being taken on individual trays to residents and included soup and the main course. This resulted in the main course cooling before a resident was able to eat it. One resident told us that meals and drinks were never very hot. The manager should ensure that the main course is kept back until residents have finished their first course. The last main meal of the day is served at 4 pm. This means that the gap between ‘high tea’ and breakfast the following day is lengthy. The manager needs to review this with residents to ensure the timing of ‘high tea’ suits residents’ needs and wishes. We were assured that carers regularly check with residents through the evening to find out whether they would like a further snack and/or milky drink. However, one resident told us they were not offered a drink and would like one. Hot drinks should be routinely offered, as some residents might not want to ask. The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaints procedure is in place to listen to the views of residents and their representatives. EVIDENCE: The manager said she had not received any complaints since the last inspection. The majority of residents and relatives responding to our survey said they knew of the procedures to follow if they wished to make a complaint. The complaints procedure needs to be updated to take account of our change of address. This should be done as soon as possible to provide people with up to date information about where to contact us. We have received one anonymous complaint since the last inspection about alleged low levels of staffing and the physical fitness of a staff member. This was discussed with the manager at the end of the inspection and is being dealt with separately. The home has protection of vulnerable adults and whistle blowing policies. These have been updated since the last inspection to meet a previous requirement. Adult protection training was last provided in September 2006 and new members of staff are introduced to protection issues during their induction training following employment. We understand that the manager is currently The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 16 arranging for more training through an external trainer to ensure new staff members are fully informed of their role and responsibility with regard to adult protection. We are not aware of any adult protection concerns regarding this home. The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is good providing residents with an attractive and homely place to live. However, water was excessively hot in some areas and this placed residents at risk of being scalded. EVIDENCE: The building is well maintained and is pleasantly decorated. Before new residents move into the home bedrooms are redecorated. A person is employed to carry out odd jobs around the home and also to maintain the garden. The garden is large, well kept and provides good outdoor facilities. Hot water to the bath on the first floor in the old wing recorded 59ºC. We also attempted to test the hot water to two showers in the old wing, but the poor flow of water made this impossible. A shower in the new wing recorded 47ºC. The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 18 Pre-set valves of a type unaffected by changes in water pressure and which have fail safe devices must be fitted to provide water close to 43ºC (baths) 41ºC (showers). This is a requirement for all baths and showers in the home. Hot water to basins in two bedrooms in the old wing recorded 60ºC and 58ºC. It is not a requirement that pre-set valves are fitted to basins, as there is no risk of total body immersion. However, it is the manager’s responsibility to safeguard residents and if pre-set valves are not fitted, the manager must decide how water temperature is to be controlled close to 43ºC. The manager has confirmed that immediate action was taken after the inspection to reduce water temperature. However, it is not clear if pre-set valves are fitted and therefore a requirement is made regarding this. We were also informed that 3 of the showers on the first floor in the old wing were not used because the residents preferred a bath. If showers are provided, whether or not they are used, they must be fitted with a pre-set valve, or taken out of use. We found the home to be clean and tidy and consider the standard of cleanliness is good. Responding to our survey, 7 residents said the home was “always” clean and tidy; 1 said “usually”. The local fire service and environmental health department routinely inspect the building. The inspection reports were not provided for inspection and therefore we cannot confirm the most recent findings. The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The deployment and number of staff available is sufficient to meet the needs of residents. EVIDENCE: The home has a permanent staff team consisting of the registered manager, deputy manager, 7 carers, 1 activity organiser, 1 domestic worker and 1 handyman. The deputy manager deals with administrative matters and also administers medication, but does not provide personal care. He last attended medication training in October 2004. 3 carers from the sister home - The Lindens – provide cover when it is needed. We were told that two of these carers were working in the home on the day of inspection, but had left before we arrived. The duty rota showed that normal staffing levels comprised 3 carers from 8am to 1 pm; 2 carers 1 pm – 9pm; one waking night carer. The owner lives on site and provides on-call cover, as well as working approximately two afternoons and evenings each week as a member of the care team. This number of staff is for 10 residents. Responding to our survey, 5 residents said there were “always” enough members of staff available; 3 said “usually”. 1 resident commented: “I get all the help I need on request”. The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 20 Most of the necessary recruitment information and checks had been obtained, except for a full employment history enabling gaps to be checked and a health declaration confirming an applicant is physically and mentally fit for the purposes of the work he/she is to perform. The manager was advised of these shortfalls at the time of inspection. 2 out of 7 permanent carers have achieved the NVQ in care – one has NVQ 2 and the other NVQ 3. To meet training targets there needs to be 50 of care staff with at least level 2 NVQ in care. We spoke to 2 carers and they said they considered they were provided with good training opportunities. Recent training has included, handling and moving, food hygiene, fire safety and infection control. Information in the AQAA indicates that all carers complete the Skills for Care national induction standards following appointment. The activities organiser is a NVQ assessor and also has a background in education. She mentors staff through induction and signs workbooks to show that the required competency level has been achieved. We were given this information by the manager. A member of staff said she was well supported when she started at the home and had been given opportunities to attend a good range of training to equip her for her role and responsibilities. The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are some issues identified in other parts of this report that show that improvements within the service are needed to safeguard residents, which the manager needs to address. EVIDENCE: The manager is experienced in the management of care homes and has achieved the Registered Manager’s Award. This is a management qualification at NVQ level 4. She does not have the care NVQ 4 and this needs to be achieved for Standard 31 to be assessed as ‘fully-met’. The manager said that she obtains feedback quarterly from residents and their families to assist in the future development of the service. The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 22 Our survey asked relatives what the home does well and a relative said: “It is already very good”. The home does not take responsibility for any personal money belonging to residents. Specialist contractors are employed as and when needed to check equipment. Information provided by the manager showed that safety checks are carried out regularly to ensure people living and working in the home are safeguarded. Training records provided evidence of the mandatory health and safety training that had taken place. Two carers told us they had attended fire training and handling and moving training recently. Fire training was last held in August 2007. We found the temperature of hot water in some areas to be excessively hot exposing residents to risk of scalding (see Standard 25). The manager should ensure that the temperature of hot water is regularly checked to ensure it is close to 43ºC. The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 23 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 1 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP25 Regulation 13 (4) Requirement Pre-set valves of a type unaffected by changes in water pressure and which have fail safe devices must be fitted to baths and showers to provide hot water close to 43ºC. This is to protect residents from risk of scalding. Following the inspection the manager informed the Commission that water temperature had been reduced, but did not confirm that pre-set valves had been fitted. Timescale for action 30/11/07 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 OP9 Good Practice Recommendations Medication administration record charts should be checked by a second person to avoid potential error when charts are regularly re-written by care staff. DS0000023068.V344454.R01.S.doc Version 5.2 Page 25 The Orchard 2 3 OP15 OP15 4 5 OP15 OP16 6 7 OP25 OP25 Food courses should be served individually at mealtimes to ensure the next course stays hot. The timing of ‘high tea’ at 4 pm should be discussed with residents to find out if this meets their needs and wishes, as this is the last main meal before breakfast the following day. Hot drinks should be routinely served during the evening to ensure residents have a choice of tea, coffee and milky drinks as preferred, to include biscuits. The complaints procedure should be updated to take account of the Commission’s change of address. This should be done as soon as possible to provide people with up to date information about where to contact us. Water to basins used by residents should be provided close to 43ºC to prevent residents being exposed to risk of scalding. There needs to be a more rigorous system in place to check the temperature of hot water to baths, showers and basins regularly, as water was found to be excessively hot in some areas. Water should be provided close to 43ºC. The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Orchard DS0000023068.V344454.R01.S.doc Version 5.2 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!