Inspection on 13/03/08 for The Orchard Manor

This inspection was carried out on 13th March 2008.

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

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 Manor 21/01/09

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Maple Lodge

Polesworth Group 32 Station Road

Heathlands

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

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

CARE HOMES FOR OLDER PEOPLE The Orchard Manor 42 Slaney Road Pleck Walsall West Midlands WS2 9AF Lead Inspector Keith Salmon Unannounced Inspection 13th March 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Orchard Manor DS0000071718.V361107.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 Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Orchard Manor Address 42 Slaney Road Pleck Walsall West Midlands WS2 9AF 01922 644 855 01922 644 855 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) C & V Orchard Manor Ltd Mrs Susan Vanessa Dawson Care Home 34 Category(ies) of Dementia (10), Learning disability over 65 years registration, with number of age (2), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (2), Old age, not falling within any other category (34) The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code 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) 34 Dementia (DE) over 55 10 Learning Disability over 65 years of age (LD)(E) 2 Mental Disorder over 65 years of age (MD)(E) 2 The maximum number of service users to be accommodated is 34. 2. Date of last inspection 11 September 2007 Brief Description of the Service: Orchard Manor is a large, detached building, extended and adapted for its present use as a care home for older people. The home is located in a residential area within close proximity to shops and other amenities including public transport. There is a park at the end of the road, a small garden at the rear and limited parking to the side of the property. The home is registered to provide care and accommodation for a maximum of 34 older people, including 10 places for people with a dementia illness, 2 places for people with a learning disability and 2 places for people with a mental disorder. There were 21 service users in residence at the time of the inspection. Accommodation is provided on the ground and first floors with a passenger lift to enable service easier access to the facilities on the first floor. The home has two interlinked dining rooms and four sitting areas, one of which is designated for service users who smoke. Bathing and toilet facilities are provided throughout the building. The fees, which are set out in the Service User Guide, range from £333.03 per week to £370.00 per week. The fees do not include the cost of hairdressing, outings, newspapers and magazines, private transport and clothing. The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We, the Commission for Social Care Inspection, undertook this Unannounced ‘Key’ Inspection on Thursday, 13 March 2008. It commenced at 9.45am, concluded at 5.00pm, and was undertaken by Mr Keith Salmon, Regulation Inspector. Present throughout the inspection, on behalf of the Home, was Mrs Sue Dawson (Registered Manager). In addition to an inspection of ‘Key’ Standards, this Inspection also sought to review progress in meeting ‘Requirements’ arising from the most recent Unannounced ‘Key’ Inspection, held in September 2007. This report is based on observations made during a tour of the Home, a review of care related documentation, staff files, training files and duty rotas, plus a range of other documents/records reflecting the general operation of the home. Individual discussions were also held with 4 Residents, 2 Visitors, the Manager, and several other members of staff. The inspection visit was further informed by data supplied by the Home’s Manager through our Annual Quality Assurance Assessment (AQAA) document. The AQAA is a self-assessment, which focuses on how outcomes are being met for people using the service, plus any plans the Home may have for future improvements. What the service does well: The home imparts a warm, friendly atmosphere with visitors being made to feel welcome, with no unreasonable restrictions on visiting. Residents were extremely complimentary regarding the standard of food provision. There is a varied menu offering a daily choice, with options including ‘ethnic’ specialties and preferences, with food being well cooked and plentiful. Residents also spoke positively about the staff and considered they are treated with respect. The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? Since the previous key inspection the home has made progress in fully meeting 12 of 20 Requirements cited at that inspection (some of which had been outstanding from earlier inspections). In achieving this there has been satisfactory outcomes in relation to: • • • • • • • • • • Use of care planning documentation Management of medicines’ administration Staff training in respect of ‘adult protection’ Housekeeping/cleaning regimes Staff recruitment checks Commencement of ‘Management’ training for the Manager and Deputy Manager Regular (and documented) unannounced inspection visits to the Home by the Proprietors Completion of proper Registration of the Home with CSCI Staff training in respect of fire safety, infection control, and first aid Risk assessment in respect of ‘safe working practices’ In addition, the Home has shown commitment by addressing 16 of the 26 Recommendations made at the previous key inspection. Further to this Report 6 of the outstanding Requirements have been converted to Recommendations as the Home has made some in-roads in meeting these objectives. What they could do better: With regard to Requirements not fully met, evidence was seen showing all have been addressed to some level, with progress having been made to varying degrees. In the light of this progress those Requirements have been re-issued in this report as recommendations. Areas of care encompassed are in respect of: • • • • • Storage of medicines requiring refrigeration and sampling/recording of internal refrigerator temperatures Further development of care practices relating to Residents with dementia Further improvements to the rear garden to improve access and safety for Residents Further development of quality assurance systems Further improvements to arrangements regarding the audit of systems controlling Resident’s ‘pocket money’ DS0000071718.V361107.R01.S.doc Version 5.2 Page 7 The Orchard Manor • • Further development of systems relating to formal care staff supervision Continuation of formal supervision of the Manager by the Proprietors Overall, there are indications of progress in addressing Requirements and Recommendations made at the previous (and earlier) inspections - sufficient to raise the rating from ‘poor’ to ‘adequate’. However, the degree of progress, particularly in respect of ’management’ is not, as yet, completed to a level, which would warrant the award in that particular area of a rating above ‘adequate’. For this to be achieved, the current impetus in improvement of the quality of service must be maintained, improvements planned (e.g. to the environment, to staff training) must be implemented, and management systems further developed. 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 summary of this inspection report can be made available in other formats on request. The Orchard Manor DS0000071718.V361107.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 Manor DS0000071718.V361107.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): 1 & 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective Residents, and/or their ‘supporters’, are provided with information, which enables them to make a decision as to the home’s suitability to meet care needs. Processes to ensure appropriate and thorough care needs assessment, prior to admission, are effectively applied. The findings are utilised to ensure appropriate placement and care provision. EVIDENCE: At the previous key inspection it was recommended the Home’s Statement of Purpose and Service Users’ Guide should be amended so as to fully meet the Regulations and relevant Standard. These documents have been revised and are now satisfactory. The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 10 Care plans and documentation relating to four Residents (the two most recently admitted, and two selected at random) were reviewed, in detail, for the period prior to admission through to this Inspection date. This review demonstrated appropriate, and thorough, care needs assessment is undertaken by suitably experienced staff, prior to admission. Evidence of this was observed in the ‘Pre-admission Assessment Form’, which is incorporated as part of a pre-printed ‘Standex’ system of documentation used by the Home. Whilst the basic format is fit for purpose, the Manager does accept some entries could be more detailed, and has agreed to do this for future assessments. The Orchard Manor DS0000071718.V361107.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 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The content, organisation and quality of entries within care plans, indicate Residents’ individual assessed care needs are fully met. The storage, reception, disposal, and record keeping, relating to medicines’ administration are generally in accordance with accepted ‘good practice.’ The care provided is delivered considerately and effectively with Residents’ privacy and dignity being respected. EVIDENCE: At the previous key inspection a number of Requirements were made in respect of the ‘Health and Personal Care’ Outcome Area, which were as follows: 1. Requirements in respect of care planning documentation DS0000071718.V361107.R01.S.doc Version 5.2 Page 12 The Orchard Manor • The care plans must set out in detail the action to be taken by the staff to ensure that all aspects of the service users’ needs are met. Review of care related documentation relating to four ‘case tracked’ Residents’ (1 relating to the most recent admission, 1 to a resident on ‘respite’ placement and 2 selected at random) demonstrated Care Plans were well organised, relevant, easy to understand, and up-todate. Care Plans include sufficient level of detail relating to the Residents’ individual needs, together with clear statements of care to be provided. This detail ensures carers are enabled to fully meet identified needs in an informed and safe manner, regardless of who is providing direct care at any given time, and this was confirmed in conversation with us by ‘case tracked’ Residents. Evidence was also observed, which confirmed regular care needs review is undertaken by the Manager on at least a monthly basis. 2. Requirements in respect of the management of medicines storage and administration • The medicine policy must be reviewed and updated to provide clarity about how medicines (including homely remedies) are to be controlled and handled. This will help to ensure that the service users are protected. (Previous timescale 01/04/07 not met). We observed a copy of the now revised medicines policy. This is in accordance with accepted good practice and staff informed us they found it easy to follow and understand. • With regard to administration of ‘homely remedies’ The Home has a policy in which only medicines prescribed by the GP, specifically for a resident, are administered, i.e. the Home does not administer ‘homely’ remedies (e.g. paracetamol) without a prescription. Medication requiring cold storage, e.g. insulin, must be kept in a separate, dedicated lockable fridge. This will help to protect the service users. (Previous timescales 30/09/06 and 01/04/07 not met). One Resident’s insulin supply was found to be stored in a domestic refrigerator in the Resident’s bedroom. Temperature monitoring, whilst completed daily, was without the benefit of a minimum/ maximum thermometer, i.e. sampling was at one point per day, therefore, not reflecting the temperature range over time. It is recommended all medicines requiring refrigeration be stored in the dedicated medicines refrigerator (currently located in the kitchen), • The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 13 with the internal refrigerator temperature maintained within the range 4o to 8o Celsius. In addition, a minimum/maximum thermometer should be purchased, and internal refrigerator temperatures monitored each day at a set time, with the thermometer being reset after reading/recording. The Manager agreed to ensure purchase of such a thermometer, and the dedicated medicines refrigerator be used for all medicines requiring such storage arrangements. • The record for the administration of medication (MAR charts) must be signed at the time that the medication is administered. This will ensure that an accurate record of administration is maintained and that the service users receive the correct medication at the right time. Staff were observed completing the MAR sheets at the appropriate time and a review of the sheets evidenced no anomalies. Overall, with the exception of storage of medicines requiring refrigeration, inspection of medicine storage provision and administration records demonstrated the Home’s practices now meet the guidelines of the Royal Pharmaceutical Society. No evidence was seen during this Inspection, which suggested the privacy or dignity of residents was being compromised, e.g. staff related to resident’s in a friendly and respectful manner and were observed to knock on resident’s bedroom doors prior to entering. The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 14 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 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents who are able choose their life style, social activity and keep in contact with family and friends. A range of activities is offered, which are consistent with Resident’s capabilities and expectations. Opportunities for contact with family/friends/community are established and encouraged. The Home provides a daily choice of attractive and nutritious meals based on Residents’ preferences. EVIDENCE: The Home has a white board in the entrance hall advertising events for the coming month. Responsibility for conducting social/leisure activities is rotated amongst care staff on a shift basis, i.e. for each shift the Senior Carer nominates a carer to be responsible for overseeing the activities programme The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 15 for the day. The overall planning of the programme remains the responsibility of the Manager. The programme includes visiting entertainers, arts and crafts activities (e.g. painting, making Easter bonnets), skittles, bingo (including an in-house variation based on identifying places contained in song titles – aimed particularly to help resident’s with dementia), day trips to the safari park, Walsall Lights, Weston Super Mare, Wickstead Park. The Manager has an open door policy, in addition to regular meetings with residents, and, where possible, relatives. Minutes of the most recent meeting, held on 31 January 2008, were observed and demonstrated a range of topics had been discussed including – how residents and staff get on (“…very well”), menu changes, and other forthcoming events. The record included signatures of those attending, and who were able to sign (sixteen Residents on this occasion). Residents informed us they are able to plan and conduct their day as they wish, with input and support from staff as required. Contact details for the local Age Concern Advocacy Service is made in the ‘Statement of Complaints Procedure’ located at the end of the Service User Guide. Menus based on a 4 weekly cycle, and offering a hot choice at all three main mealtimes, were observed on each dining room table. Some Residents confirmed staff also enquire as to what their preference might be for the next day. For Residents with memory related problems the menu is read to them at each mealtime to help ensure preferences are met. There are two cooks who cover the week between them. Residents, who were able, told us there is very good variety and the food is well cooked and well presented. Evidence was seen, which showed the needs of Residents requiring ‘ethnic ‘ foods are met, e.g. halal and vegetarian meals. The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 16 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 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system with evidence that Service Users and relatives feel their views are listened to and acted upon. Procedures and practices are in place to ensure that individuals are protected from abuse. Residents and relatives/visitors are provided with up-to-date information about adult protection. EVIDENCE: Two Requirements under this Outcome Area have remained outstanding from previous inspections. The first of these being • The adult protection policy must be reviewed to ensure that it reflects the local authority guidance and the principles of No Secrets. This will help to ensure that the service users are protected from abuse. We can now report the relevant policy has been revised to incorporate local authority guidance, and copies of the No Secrets document made available to care staff. Staff training records contained evidence of staff having read the document. This requirement is met. The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 17 Secondly • All staff must receive refresher training in adult protection to further safeguard service users from the risk of harm. Evidence was seen that arrangements are in hand for staff to attend a relevant course held under the auspices of Walsall Metropolitan Borough Council and Walsall College. This Requirement is considered met. Review of CSCI’s own records, and the Home’s complaints records demonstrated there have been a small number of complaints over the period since the previous inspection. All were well documented, thoroughly investigated, and interested parties made aware of the outcome of investigations. The Home’s Complaints Procedure is displayed within the entrance to the Home, and up-to-date information advising on how to proceed in making a complaint is found in the Service Users’ Guide. Evidence was observed confirming Staff have POVA clearance, and satisfactory CRB checks before commencing employment. The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 18 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, 24 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people using the service live in a reasonably comfortable, generally safe, though rather worn environment, with some areas of the home in need of redecoration/refurbishment. The physical environment does not fully meet all Residents’ assessed care and safety needs. Specialist equipment is available, appropriately serviced and maintained. EVIDENCE: A general comment on the quality of the environment is that it is worn and, in some parts, shabby. The manager informed us that a major refurbishment and redecoration programme is to commence at the end of the April 2008. A notice announcing this is displayed in the entrance hallway. The Manager The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 19 stated all bedrooms, corridors and communal rooms are to be included in the refurbishment scheme, and as part of that work four replacement lounge chairs have been purchased. Bedrooms are routinely redecorated/refurbished as and when they become vacant. However, beyond this information, no details of how the ongoing care needs of Residents’ are to be accommodated during the inevitable disruption accompanying such work, e.g. availability of lounges and dining rooms. It is strongly recommended written plans are drawn up, to set out how available accommodation is to be utilised during the programme, so as to minimise the impact of disruption on Residents’ daily lives. Also, a recommendation from the previous inspection • A programme of routine maintenance and renewal of the fabric and decoration of the premises should be produced and implemented. This will help to improve the internal appearance of the home and ensure that the premises are well maintained. There is no written programme evidence of routine maintenance, and although some renewal of the fabric and decoration of the premises was seen, we recommend a programme be established, with proposed timescales for review, leading to implementation of redecoration and refurbishment. The previous inspection report also made reference to specific aspects of Residents’ environment, with the three following Requirements, i.e. • • The home must be furnished with appropriate visual and memory aides to help those service users with dementia find their way around the home. (Previous timescale 01/04/07 not met). A system must be put in place to ensure that the garden is kept tidy and well maintained at all times and the garden paths are made even and provided with handrails. This will help to ensure the safety and wellbeing of the service users. (Previous timescale 01/04/07 not met). A cleaning programme must be devised to ensure that the home is kept free from offensive odours at all times. This is for the comfort and wellbeing of the service users. • At this inspection it was evident some progress had been made in meeting the above Requirements, though to varying degrees. Two recommendations, which have been successfully addressed, were those in relation to the need for home’s Infection Control policy and procedures to be reviewed and amended, and for the introduction of ‘red alginate’ bags to minimise the handling of contaminated laundry. The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 20 ‘Pictorial’ signing has been introduced throughout the Home, e.g. to indicate resident’s bedrooms (use of personal photographs), large format text and pictures to indicate lounges, dining rooms, bathrooms and toilets. Whilst we consider sufficient progress has been attained to consider the removal of this Requirement, there remains room for continuing development. Therefore, it will be a recommendation that the progress achieved so far be built upon to create an environment more specifically designed to meet the particular care needs of resident’s with dementia related illness. With regard to the garden, at the time of this inspection no progress had been made, with the rear garden remaining inaccessible to most residents, and, indeed, posing a hazard to many, e.g. the concrete forming the patio area is rough and uneven, the lawn area is very uneven. Following a formal management review held in December 2007, the Home’s Improvement Plan informs us of plans to reform the garden, work that will include new handrails and pathways. Given indications that the Proprietors and Manager are now responding positively and effectively to Requirements and Recommendations we are prepared, at this juncture, to convert this Requirement to a Recommendation – notwithstanding the Home’s responsibilities in respect of ensuring the health and safety of residents, staff, and visitors, and their obligation to complete the ‘Improvement Plan’ to the satisfaction of CSCI. During the tour of the premises the home appeared clean with no offensive odours. This latter state seems due to the Home obtaining its own carpet shampooer linked to regular use, and effective spot cleaning when continence related accidents occur. Also, two bedrooms have had previous carpeting replaced by non-slip vinyl type flooring. Whilst it is accepted this is a commonsense, pragmatic approach to manage problems where there is a situation of intractable incontinence, the Manager understands that should the bedrooms in question be re-allocated a more homely floor covering must be reintroduced. The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 21 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, & 30. Quality in this outcome area is good. Judgement has been made using available evidence including a visit to this service. Staff numbers on duty and skill-mix were sufficient to meet the assessed care needs of current Residents. There is a committed, effective, and well-supported staff group, with the skills and knowledge to ensure Residents enjoy a quality of life, which meets their individual requirements and aspirations. Recruitment and employment practices are consistent with the safeguarding of Residents. The Home’s approach to providing training for Care Staff enables them to be competent to carry out their role in providing safe care to Residents. EVIDENCE: A review of duty rosters, and discussion with staff, confirmed staffing numbers and skill-mix enable a service provision, which comfortably meets the care needs of Residents. Staff were observed to carry out their duties in an enthusiastic and professional manner. The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 22 There were two Requirements made under this Outcome Area at the previous inspection – • No member of staff must be employed at the home without all the specified recruitment checks being undertaken prior to their appointment and determined as satisfactory. This will help to ensure that the service users are protected from abuse. Appropriate training must be provided for all the staff in the care of people with a dementia illness. This training will help to ensure that a person centred approach to care is provided and that the needs of service users with a dementia illness are met. • A review of the employment files relating to the three most recently recruited staff confirmed they contained all elements required by Care Home Regulations. Staff, in discussion with us, stated they considered they were well supervised and supported during their initial induction and first few weeks of employment. This Requirement is considered met. The changes to the environment aimed at enhancing the lifestyle of resident’s with dementia, as reported in the section above, indicate a willingness to recognise the particular needs of that care group. It is accepted there are now components within the National Vocational Qualification Level 2 training, which address this aspect of care provision, and are considered sufficient to meet what has been an outstanding Requirement. However, it is recommended the Home seek specialist advice from agencies such as the Alzheimer’s Disease Society, to enable care staff to attend more specialised training courses in caring for people with dementia. In addition, it is pleasing to note a number of recommendations, made at the previous inspection, have also been effectively addressed including:• Reviewing the length of shifts occasionally worked by staff – staff interviewed stated they only worked long shifts if they were in full agreement, and were able to take sufficient breaks during the shift. Issue to staff of copies of the code of conduct and practice set down by the General Social Care Council – although individual copies have not been issued to staff copies were observed as readily available, and staff interviewed confirmed they had seen and read the information. Improvements to documentation relating to staff employment were observed. Further to that it was agreed, with the manager, this should be extended to include full documentation of appointment interviews particularly reasons for appointment or non-appointment of staff. • • The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 23 • Improvements to documentation relating to staff training (completed and proposed) be maintained – the manager has established an easy to understand matrix showing which staff have completed training and what is planned for the immediate, middle and longer term. A review of staff personal files, and discussions with staff, provided evidence they receive thorough induction, with mentor support from the Manager, plus foundation training, e.g. moving and handling, first aid, fire safety, food hygiene, infection control, plus ‘on-going’ development training, e.g. NVQ, and the manager undertakes regular ‘supervision’ of each staff member. In discussion with us staff were complimentary regarding the induction, support and supervision they receive. The home continues to support staff to undertake National Vocational Qualifications (NVQ), with records evidencing from a total complement of twenty-one care staff, twelve (57 ) have attained NVQ Level 2, with the nine remaining currently working towards this qualification. The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 24 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): 31,32,33,35,36,37 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An experienced and well-qualified individual, who promotes good standards of personal and a professional ethos amongst staff manages the home. However organisational management matters need to be more effectively addressed. Support to the Manager by the proprietors appears insufficient. The ambience is warm, friendly, and inclusive, with the central purpose being ‘the best interests of Residents’. Service Users are safeguarded by the financial procedures operated within the Home. All Staff are subject to effective support with regular supervision having been improved. The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 25 EVIDENCE: A total of nine requirements were made at the previous inspection under this Outcome Area. • The registered manager must make the necessary arrangements to undertake appropriate training to achieve a qualification at NVQ level 4 in management and care by the end of 2008. This will ensure that the manager has the necessary training to enable her to manage the home to the required standards Evidence was seen confirming the Manager and Deputy Manager have commenced NVQ Level 4 in Management, with both expecting to complete the course in early summer. This Requirement is met. • The home’s quality assurance system must be developed in accordance with the requirements of Regulation 24 and Standard 33. This will help to ensure that the home is run in the best interests of the service users and that a consistent standard of good quality care is provided. At this Inspection it was evident the home’s quality assurance systems remain in need of further development. The current arrangements include an Annual Development Plan for Quality Assurance (which addresses performance in respect of the CSCI outcome groups), and an Annual Questionnaire relating to quality of service and a Monitoring Sheet (this addresses broad areas under headings of ‘Service Users’, ‘Staff’ and ‘Building’. However, the Development Plan lacks detail as to the processes necessary to actually measure and assess performance in respect of the ‘outcome groups’. Furthermore, the questionnaire should be utilised more frequently and the Monitoring Sheet (which records weekly and monthly records) would be more instructive if greater detail of the monitoring process was included. It is recommended the Annual Development Plan for Quality Assurance include greater detail in relation to the processes undertaken to measure and assess performance in respect of the ‘outcome groups’. • The registered manager must take action to reduce the excessive amounts of service users’ money being kept on the premises. This will help to protect the service users’ financial interests. The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 26 Since the previous inspection the Home has made arrangements for those Residents with excessive amounts of money held on the premises to have Post Office Accounts. Arrangements in respect of Residents for whom the home manages small amounts of ‘pocket monies’ were seen to be generally satisfactory, i.e. with regard to storage, accessibility and documentation. However, it is recommended that an audit of the system be carried out at least once per year by an independent agency. • All care staff must receive formal supervision at least 6 times a year, with records kept. This will ensure that staff are appropriately supervised and enabled to carry out their duties and to feel valued and supported in the work they do. Evidence was observed in staff records of regular supervision being carried out – staff confirmed to us they are being supervised by the Manager. This Requirement is met. • The manager must receive regular formal supervision, with records kept. This will enable her to carry out her duties to the required standard and to feel valued and supported in the work she does. From records and conversation with the manager it is confirmed by formal supervision of the manager, by the owners, had commenced following the previous key inspection, i.e. for the months of October, November, and December 2007. However, it is noted there is no evidence of such supervision during 2008. The manager explained discussions do take place when the owners visit the Home, but this is of an informal and unstructured nature. Therefore, it is a ‘Recommendation’ that the practice of documented supervision of the manager, by the owners, recommence with immediate effect. • The registered provider must prepare a written report on the conduct of the home by 31 October 2007 and put in place a system to ensure that such reports are produced at least once a month in future. Copies of these reports must be given to the registered manager. This will help to ensure that the home is managed effectively in the best interests of the service users. As with formal supervision of the manager (above) an initial response to this Requirement was documented in the months following the previous inspection, i.e. unannounced visits (under ‘Regulation 26) were made by the owners, and documented, during the months of November and December 2007, but none during 2008. Given the importance of compliance with this Regulation this Requirement will remain in force. The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 27 • Action must be taken to ensure that the care home is correctly registered with the CSCI. Communication has been made between the Owners and CSCI’s Regional Registration Team and the matter resolved. The Requirement is met. • Arrangements must be made for all the staff to undertake training in fire safety, infection control, first aid and the protection of vulnerable adults from abuse. This will help to ensure the safety and protection of both the service users and staff. Review of staff records, and discussion with staff, provided evidence that arrangements have been made for all staff to undertake relevant training courses under the auspices of Walsall Metropolitan Borough Council in conjunction with Walsall College. The training is currently arranged to commence in September, although the manager stated discussions are being held with representatives from the College to determine whether commencement might be brought forward. In the light of the evidence it is considered this Requirement is met. • Risk assessments must be carried out and recorded for all the safe working practice topics covered in Standards 38.2 and 38.3. This will help to ensure the safety and protection of both the service users and staff. Review of staff records and discussion with staff evidenced that systems in relation to safe working practices, and specifically ‘risk assessment’ are now satisfactory. This Requirement is met. A certificate of public liability insurance was on display with provision in accordance with the Standard. At the time of this inspection, no potential hazards to Residents were identified. A review of relevant records provided evidence that Health and Safety Policies/ Procedures/Practices are satisfactory, with all COSHH requirements met. Records were observed providing evidence the Home has satisfactorily undertaken appropriate maintenance of equipment, including electrical, lifts, hoists, and gas appliances. The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 28 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 X 18 3 2 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 3 2 3 The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 29 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 OP37 Regulation 26 Requirement The registered provider must visit the Home, and prepare reports, in accordance with the Regulation to help ensure that the home is managed effectively in the best interests of the service users. Timescale for action 30/04/08 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 It is recommended all medicines requiring refrigeration be stored in the dedicated medicines refrigerator located in the kitchen, and in addition, a minimum/maximum thermometer should be purchased to enable accurate monitoring of refrigerator temperature. The handles fitted at a high level to some of the corridor doors should be removed. This will enable the service users to have greater freedom of movement around the home. 2. OP19 The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 30 3. OP19 Automatic door closures or glass panels should be fitted to the fire doors in the home. This will enable service users to have greater freedom of movement around the home. All the communal toilets and bathrooms should be appropriately marked and all of the toilets should have grab rails installed. This will help to ensure the service users’ safety, dignity and independence. It is strongly recommended written plans are drawn up to set out how available accommodation is to be utilised during the programme so as to minimise the impact of that disruption on Residents’ day-to-day lives. It is strongly recommended a system is put in place to ensure that the garden is kept tidy and well maintained at all times and the patio and garden paths are made even and the latter provided with handrails. This will help to ensure the safety and wellbeing of the service users, staff and visitors. (Previous timescale 01/04/07 not met). It is recommended a plan for ongoing redecoration/refurbishment be introduced to ensure a good quality of environment is maintained between major redecoration/refurbishment events. It is recommended that the progress achieved so far in providing appropriate visual and memory aides to assist help service users with dementia be extended. It is recommended the Home seek specialist advice from agencies such as the Alzheimer’s Disease Society. It is recommended care staff attend training courses offering specialist components in respect of caring for people with dementia. It is recommended documentation relating to staff employment be extended to include full documentation of appointment interviews - particularly reasons for appointment or non-appointment of staff. It is recommended the Annual Development Plan for Quality Assurance include greater detail in relation to the processes undertaken to measure and assess performance in respect of the ‘outcome groups’. 4. OP19 5. OP19 6. OP19 7. OP19 8. OP19 9. 10. OP30 OP30 11. OP31 12. OP33 The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 31 13. OP35 It is recommended arrangements in respect the Home’s management of Residents ‘pocket monies’ are audited at least once per year by an independent agency. It is recommended the practice of documented supervision of the Manager, by the Owners, recommence with immediate effect. 14. OP36 The Orchard Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Manor DS0000071718.V361107.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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