Inspection on 06/12/05 for The Orchard

This inspection was carried out on 6th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

The Orchard 12/03/09

The Orchard 29/07/08

The Orchard 28/09/07

The Orchard 18/08/06

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 Christine Sidwell Announced Inspection 5th and 6th December 2005 09:30 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.V258598.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. The Orchard DS0000023068.V258598.R01.S.doc Version 5.0 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 01908 375075 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.V258598.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd May 2005 Brief Description of the Service: The Orchards is a care home registered to provide personal care for 11 elderly people. It is a large detached house with well-maintained gardens. It is situated in the rural village of Stewkley and is close to local amenities. The home is privately owned and managed and is the private residence of the Proprietor/Manager. There are nine single rooms with en suite facilities and one double en suite room. This is currently occupied by a married couple. 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 local NHS Services. The Orchard DS0000023068.V258598.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of an announced inspection, which took place on the 5th and 6th of December 2005. Policies, procedures and records were examined and care practices were observed. The manager and deputy manager were interviewed. A number of care and ancillary staff members were spoken with. Comment cards were received from a general practitioner, two healthcare professionals, five families and four residents. Seven residents are currently residing in the home and all but one was seen on the day of the inspection. What the service does well: What has improved since the last inspection? What they could do better: The home must continue to monitor resident’s healthcare needs and increase the staffing levels in line with the requirements in this report if residents needs The Orchard DS0000023068.V258598.R01.S.doc Version 5.0 Page 6 increase or the number of residents in the home increases. The weekly staffing rota must be accurate and reflect actual start times and the designation of the staff member. The care plans would benefit from a thorough review and the implementation of systematic proprietary documentation to collate the necessary information. Those residents who have continence difficulties should be assessed by the Primary Healthcare team and be prescribed the appropriate pads which are reserved for them. All staff should have Criminal Records Bureau checks before starting work. An annual audit of the quality of care and the home’s administrative processes should be undertaken. A fire risk assessment and Legionnella assessment should be undertaken. The night carers should have first aid, manual handling, fire and medication administration training as part of their induction. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Orchard DS0000023068.V258598.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 The Orchard DS0000023068.V258598.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 and 4 The pre- assessment process and care management reviews work well ensuring that residents needs can be met when they move to the home. The manager must monitor resident’s ongoing care needs, to ensure that the home can continue to meet resident’s needs if they become frail and need more than one person to care for them at night. EVIDENCE: There were no residents in the home who have moved to the home since the last inspection. It was therefore not possible to fully assess the adequacy of the pre assessment process. However the manager said that potential residents are assessed prior to moving to the home. A number of residents have stayed at the home for respite care during the last year. This is an opportunity for potential residents to assess whether in the future they would like to move to the home. Pre-assessment documentation is available. Those residents who are sponsored by the local health authority have had a care management review with their families during the last year. The staff have the skills to care for the frail elderly but not those with complex needs. There is sufficient staffing during the day although there is only one waking night staff. The Orchard DS0000023068.V258598.R01.S.doc Version 5.0 Page 9 The general practitioner and district nurse visit regularly and a multiprofessional review has been held recently to seek additional help from the local health services in order that one lady may stay at the home rather than move to a home which can offer nursing care. The manager must be careful to review the care of residents on a regular basis to ensure that their care needs, particularly at night, are not in excess of those which can be provided at the home. The Orchard DS0000023068.V258598.R01.S.doc Version 5.0 Page 10 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 and 10 The current care plans remain muddled and do not always reflect the needs of residents. Their care plans would be improved by the use of a systematic care-planning booklet, which if completed carefully and updated regularly would give carers the information that they need to meet resident’s needs. In general resident’s healthcare needs are met with support from the general Practitioner and local District Nursing team. The carers were seen to be speaking to residents politely and ensuring that their privacy and dignity was respected. EVIDENCE: All residents had a care plan although the care plans are not the prime source of information for the care staff. Report books are kept in which the care staff record the care that they give to residents. The care plan documentation is varied and needs rationalization if the information is to be easily accessible. The deputy manager and the assistant manager review the care plans regularly. The manager is considering using a standard care planning book published by a specialist training company. If implemented carefully this would provide a more systematic approach to care planning and ensure that the residents care needs were better described and systematic records were kept. The Orchard DS0000023068.V258598.R01.S.doc Version 5.0 Page 11 All residents were well groomed on the day of the inspection. There was evidence in the care plans that their general practitioner and the district nurse see them regularly. The district nurses have undertaken risk assessments to identify those residents who are at risk of developing pressure damage and appropriate mattresses are in place. Not all residents had had a specialist continence assessment and the manager said that she sometimes bought pads for residents if they needed them. The manager must ensure that residents are assessed professionally and that the Primary Care Trust provides the appropriate pads for individual residents. Nutritional screening is not undertaken on a regular basis although there is evidence in the care plans that residents are weighed regularly and that food intake charts are kept where residents have lost weight. The manager must ensure that she reviews resident’s weight regularly and promptly brings any weight loss to the attention of the district nurse and the general practitioner. There was evidence in the care plans that residents see the chiropodist regularly and have their eyes tested annually. All personal care is undertaken in resident’s own rooms and they were all seen to be wearing their own clothes. The staff spoken to were caring and were observed to be treating residents with respect. The manager said that resident’s post was given to them unopened but that some residents needed help to read and deal with their post. There are no shared rooms. The Orchard DS0000023068.V258598.R01.S.doc Version 5.0 Page 12 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 and 15 Residents are supported to maintain their own interests if they wish and there is a variety of activities, which help bring variety and interest to the day. Families are made to feel welcome at any time, helping residents to stay in touch and to continue to feel part of their family. The meals are of a high standard and meet resident’s nutritional needs. EVIDENCE: The carers said that the daily routines are flexible and the manager confirmed that residents might stay in the lounge in the evenings if they wish. Some residents visit the local church on a weekly basis. The assistant manager holds a twice-weekly activities or reading hour and the local nursery has visited the home to sing Christmas carols. On the morning of the inspection the television was on in the lounge showing children’s programmes, which one lady said that she did not like. There is a need to ensure that appropriate television programmes are sought. Five family members returned the comment cards sent out as part of this inspection and all said that they were made welcome at the home at any time and that they could see their relative in private. The home does not manage any money on behalf of residents. This is either managed by the resident themselves or by their family. The hairdresser, The Orchard DS0000023068.V258598.R01.S.doc Version 5.0 Page 13 chiropodist and local newsagent invoice resident’s families for services, which they provide. The standard of food in the home is good. Three meals a day are offered and drinks are available at any time. The meal on the day of the inspection was well presented and appetising. Five residents returned the comment cards and all said that they enjoyed the food. The Orchard DS0000023068.V258598.R01.S.doc Version 5.0 Page 14 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, 17 and 18 The home’s complaints policies and protection of vulnerable people policies should help protect residents from abuse. EVIDENCE: There is a complaints policy in place. Four out of the five relatives who returned the comments cards said that they were aware of the policy. The manager said that she kept a complaints record book although this was not available at the time of the inspection. The Commission for Social Care Inspection has not received any complaints about the home since the last inspection. There are protection of vulnerable adult policies in place and the care staff spoken to said that they had training in how to recognise abuse. Residents are on the electoral role and there is a notice in the home which gives details of a local advocacy service should residents wish to use one. The Orchard DS0000023068.V258598.R01.S.doc Version 5.0 Page 15 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): 26 The standards of hygiene are high and protect residents from infection. EVIDENCE: The home was clean and tidy on the day of the inspection. There were no offensive odours. There is a separate laundry and the washing machines are capable of sluicing soiled laundry and of washing at the required temperatures. There are soap and hand towels in the toilets and also in the rooms of those residents who are visited by the district nurse. There is a control of infection policy. The Orchard DS0000023068.V258598.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, 28 29 and 30 The staffing levels must be monitored carefully if the staff are to meet the needs of frail elderly residents who have complex needs. The training programme gives staff the skills they need to care for elderly residents. EVIDENCE: At the previous inspection a requirement was made that an accurate weekly rota be kept. This is now kept although this is not completely accurate as one carer told the inspector that she starts at 9.00 am and not 8.00 am as shown on the rota. One member of staff is also shown as a carer although she told the inspector that she was a housekeeper. The rota must be amended to show accurate start and finish times and to show the role that staff are undertaking. Requirements were also made that a night carer was appointed for the weekend, that the manager and her husband were to be supernumerary at all times and that a shift pattern of three carers in the morning, two carers between 2pm and 10pm and one waking night carer with one sleeping night carer be maintained unless agreed otherwise with the omission for Social Care Inspection. These requirements have only been partially met. The home only has seven residents at the moment at the manager feel that she does not need the same level of staffing as she would should the home be full. A night carer has been recruited for the weekends. However the manager covers the weekend afternoon shifts and acts as the sleeping-in night carer herself. It has been agreed that the home has graduated staffing levels, which are shown The Orchard DS0000023068.V258598.R01.S.doc Version 5.0 Page 17 below, whilst it is not full. The domestic/housekeeping staff should be in addition to the carers. The staffing levels should be as follows: Number of Residents 1 to 7 8.00am – 2.00pm 2 carers 2.00pm10.00pm 2 carers 10.00pm08.00am 1 waking night carer 1 waking night carer 8 to 11 3 carers 2 carers 1 sleeping night carer who may be the manager 1 sleeping night carer who is not the manager The staffing levels, particularly at night, must be monitored regularly and a sleeping-in night carer, who is not the manager, be appointed if there are residents who require two people to help them at night. Four members of staff hold the National Vocational Qualifications in Care at Level 2 and the assistant manager is a qualified assessor. With the exception of a newly appointed night carer, staff have received training in medication manual handling, protection of vulnerable people and first aid. All recruitment records were seen and found to contain the correct documentation with the exception of a long standing part time member of staff who has not had a Criminal Records Bureau check. This must be undertaken as a matter of urgency. The Orchard DS0000023068.V258598.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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, 33, 35 and 38 A systematic quality assirance programm should be implemented if residents are to be sure that the care practices and administrtive processes are sound. The homes health and safety procedures do not full protect residents from risk. EVIDENCE: The manager has had experience managing care homes. She is responsible for one home but assists her son with the management of a second home, which she jointly owns. The second home has a registered manager. There is a deputy manager. The carers were clear as to the lines of accountability in the home. The manager lives in the home and monitors the care on a daily basis. There is an annual capital expenditure plan. A service user satisfaction survey is undertaken and there was some evidence that concerns raised in the satisfaction questionnaire are addressed. The comment cards sent out as part The Orchard DS0000023068.V258598.R01.S.doc Version 5.0 Page 19 of this inspection were distributed and there was a notice of the inspection in the home. There is no systematic audit of administrative or care processes in the home, which would enhance the quality assurance programme. Action is taken in response to requirements arising from the inspection. The home does not manage any money on behalf of residents. Invoices are raised for all expenditure. The manager does not act as appointee for any residents. There are health and safety policies. Staff are given copies of these policies at their induction. There is a manual handling policy and most staff have had manual handling training. The fire log was inspected. The staff have had fire training and the fire alarms are tested regularly. The staff spoken to understood the fire evacuation procedure. The home does not have a fire risk assessment. With the exception of the newly appointed night carer, staff have had first aid training. The home has not had a basic Legionnaires assessment although is planning to have water samples tested on a six monthly basis. It is recommended that the basic assessment be undertaken first. There were records to show that the electrical wiring had been tested but the PAT testing of appliances had not been undertaken. The emergency call system had been maintained. An accident book is kept. The Orchard DS0000023068.V258598.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 X X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 The Orchard DS0000023068.V258598.R01.S.doc Version 5.0 Page 21 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 OP4 Regulation 12 Requirement Residents care needs must be monitored carefully to ensure that, if their needs increase, they can be met, particularly at night. The care plan documentation review must be completed and agreed with the Commission for Social Care Inspection. This is an unmet requirement of the previous inspection and a new timescale has been set. Residents who have continence problems must be assessedby a member of the Primary Healthcare team and the prescribed pads retained for their use. The weekly rota must be accurate and show correct start and finish times, clearly distinguish between care and domestic staff and show changes that are made on an ad hoc basis. This is an unmet requirement of the previous inspection and a new timescale has been set. The staffing levels described in this report must be adhered to. DS0000023068.V258598.R01.S.doc Timescale for action 31/03/06 2 OP7 15 31/01/06 3 OP8 12 31/01/06 4 OP27 17 31/12/05 5 OP27 18 31/12/05 The Orchard Version 5.0 Page 22 6 7 OP29 OP33 19 24 8 9 10 11 OP38 OP38 OP38 OP38 23 13 13 13 Any alteration must be agreed in writing with The Commission for Social Care inspection. All staff must have a Criminal Records Bureau check. An annual internal audit of the quality of the homes care and administrative procedures should be undertaken. A fire risk assessment should be undertaken. The night staff must have first aid, fire safety, manual handling and medication training. All potable electrical appliances must be listed and PAT tested A Legionnella assessment of the water supplies must be undertaken. 31/01/06 31/03/06 31/03/06 31/01/05 31/01/06 31/03/06 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 The Orchard DS0000023068.V258598.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Orchard DS0000023068.V258598.R01.S.doc Version 5.0 Page 24 - 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. 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