Inspection on 21/01/09 for The Orchard Manor

This inspection was carried out on 21st January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Orchard Manor 13/03/08

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Orchard Manor 42 Slaney Road Pleck Walsall West Midlands WS2 9AF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Amanda Hennessy     Date: 2 3 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: The Orchard Manor 42 Slaney Road Pleck Walsall West Midlands WS2 9AF 01922644855 01922644855 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): C & V Orchard Manor Ltd Name of registered manager (if applicable) Mrs Susan Vanessa Dawson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 34. 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 categoyr (OP) 34 Dementia (DE) over 55 10 Learning Disability over 65 years of age (LD)(E) 2 Mental Disoirder over 65 years of age (MD)(E) 2 Date of last inspection 10 0 0 0 Over 65 0 2 2 34 care home 34 Care Homes for Older People Page 4 of 27 Brief description of the care home Orchard Manor is a large, detached building which has been extended and adapted for its present use as a care home for older people. The home is situated in a residential area close to shops, a small park and other amenities including public transport. The home has very limited car parking available. The home provides care and accommodation for up to thirty-four older people, including ten places for people with a dementia illness, two places for people with a learning disability and two places for people with a mental disorder. 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 people who smoke. Bathing and toilet facilities are provided throughout the building. As no informtion about fees is included in this report the reader is advised to contact the service direct for this information. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was undertaken by two inspectors and an Expert by Experience over two days. An expert by experience is a person who, because of their shared experience of using services, and or ways of communicating, visits a service with us to help us get a picture of what it is like to live in or use the service. The inspection was unannounced, so the home did not know we were coming. The Manager was present throughout the inspection. The previous full inspection of this service was undertaken on the 13th March 2008, a shorter visit as a result of a complaint was undertaken on the 9th June 2008. During the inspection we followed the experiences of living at the home for four people, including looking at their care records, when possible conversations with them, viewing Care Homes for Older People Page 6 of 27 their rooms and if possible talking to their relatives and discussing their care with staff. This process is known as case tracking. As part of this process we also looked at peoples medicines, how they are ordered and records of their administration. We were able to meet with and talk to other people living at the home and the homes staff, they also told us what it is like to live in the home. We looked around most of the home including peoples rooms, bathrooms, toilets and communal rooms. Records about the safety of equipment and the building were also checked. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 8 of 27 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of sufficient information about peoples needs before they moved into the home has resulted in shortfalls in their care. Evidence: The home has a service user guide that provides people with all required information about the home.The manager told us that the service user guide is available both to people who are looking for a care home and also to people who currently live at the home. The manager told us that people have their needs assessed by a senior member of staff before they come to live at the home. We found that all required information was not always available. We found that one person who had recently come to live at the home had very limited information about them, including insufficient information about the medicines and the care that they need. We asked staff about this person and why Care Homes for Older People Page 11 of 27 Evidence: there was so little information about them including the lack of a plan of care, they told us that the person had come to them from another home, as an emergency. We would normally expect people to have had an assessment of their needs before a decision is made that the home is able to meet their needs. A plan of care that provides staff with information about their care needs is usually available before the person comes to stay, in the case of someone admitted as an emergency a care plan should be available within five working days. We found that this was not the case even though the person had lived at the home for two months. We also found that a lack of information about the person had resulted in shortfalls in care that they received. The manager told us that people are able to come and visit the home before they make the decision to come and move into the home. We did speak to a visitor whose relative has lived at The Orchard Manor for about a year. She told us; It was difficult to find somewhere that would take someone with dementia. My friend found me this place and we came to visit and then asked another friend who is a nurse to come and have a look before he came in. They are very good here and always make me welcome. The home does not provide intermediate care. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Insufficient care instructions may mean that people do not receive the care that they want or need. Medication practices need review to give confidence that people receive the medicines that they are prescribed to promote their health and well being. Evidence: People living at the home usually have a plan of care that identifies their needs and how they should be met. We did find that care plans are not always available when people first come to live at the service and in some cases care plans did not reflect all their needs, meaning that important instructions about their care was not available. When we spoke to staff about the absence of care plans they said: Its because they came in as an emergency. We found that one person had lived at the home for almost two months yet care plans were still not available. We found that one person was diabetic and had blood sugars that were identified as high, yet this person had no care instructions available to manage their diabetes. There was a risk assessment for this person that said : Care Homes for Older People Page 13 of 27 Evidence: make sure that X has their blood sugars done daily as they are high. Give plenty of clear fluids. Another risk assessment said : do not give X any sugary foods or fluids use sweetener. Blood sugars to be checked daily by the senior if too high 999 as he could go into a coma. Care staff we asked did not all know what a high blood sugar was. We checked the records of the persons blood sugar and found that it was very high yet there was no record to show that staff had contacted the persons doctor of other emergency services as indicated by the risk assessment about their high blood sugar. Care records did not identify what reading was high. Care staff told us that the blood monitoring machine told them when the blood sugar was high and advised that a further test for ketones should be undertaken, there were no record that this had been done either. It was positive that this person now receives care from a diabetic nurse but the homes care record must be be more comprehensive so that staff are sure of what actions they must take. We found another person had recently had a chest infection and had a pressure sore.There was no plan of care for the chest infection and the only instructions for caring for the pressure sore identified: Pressure sores- any carer performing personal care on this client must look for red or broken areas. Care records did not detail what care this person needed now that they had a pressure sore, to assist its healing or prevent it from getting worse. We found no daily records detailing any redness or broken areas , although the doctors visit identified a need for referral to the District Nurse because of the pressure sore. People have some risk assessments in place to identify and minimise the possible risk of pressure sore formation, malnutrition, inappropriate moving and handling or falls. When we looked at these risk assessments it was evident that are not reviewed regularly or updated when there are changes to the persons health, such as difficulties in swallowing or the presence of a pressure sore. The lack review means that the true risk to the person will not be identified. We found bedrails on peoples beds that put people at risk of serious risk of injury from entrapment. Risk assessments for those people who needed bedrails were inadequate and did not identify the risk to the person of possible entrapment that could lead to serious injury and what staff should do to address this risk. People are seen by other Health Professionals such as Doctors, Chiropodists, Dentists and Opticians, and we were able to see that staff seek the advice of other professionals. One person said: We are all having new teeth and new glasses. A visitor we spoke to told us: They always tell me if hes not well and that they have Care Homes for Older People Page 14 of 27 Evidence: sent for the Doctor. The home has appropriate arrangements in place for the ordering and storage of medicines. Staff told us that only staff who have received additional training in the safe storage and administration of medicines are responsible for giving out and ordering medicines. We found that there is a record of all medicines that are received and when medicines are administered. We did check the amounts of medicines and found that the balances remaining were not consistent with the amount of medicines that had been signed as given. This means that people may not have had the medicine that they are prescribed for, although staff do do weekly checks of all medicines of all medicines in the home. We did advise that staff record the amount of medicine is given when a variable dose of medicine is prescribed. It is positive that people are able to administer their own medicines such as inhalers although there is a need for appropriate risk assessment to confirm safeguards are in place to ensure peoples safety when storing and administering their medicines. Care Homes for Older People Page 15 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are able choose their life style, social activity and keep in contact with family and friends. Evidence: The home has a programme of activities. Staff record activities that people are interested in such as watching television and gardening and try to ensure that the activity programme reflects their interests. Activities are undertaken by care staff and we saw staff engaged in a game of skittles and other activities taking place during our visit. People we spoke to said: Activities on offer are OK. Another person told us that he liked doing jigsaws and had one in front of him during our visit. He also told us that there was enough activities and that the home organises trips out, to the seaside, Safari park, Illuminations and theatre which he enjoys and would he would like more of them. We saw that people can spend their day as they wish. Some people like to stay in their room and only coming down for their meals, others prefer to the company of other people in one of the lounges. Care Homes for Older People Page 16 of 27 Evidence: Visitors we spoke to said that staff always make them welcome when they visit and they are kept informed about their relative when they are unable to visit: They are very good here, they always make me a nice cup of tea as soon as I get here. The majority of people have their meals in the dining room. Dining tables were found to be appropriately laid with cutlery and cruets and had that days menu displayed. We saw that, tablecloths and table mats were dirty although tables had been relaid ready for tea. The home does have a menu and we saw that a choice of food is always available. People told us that: the food is alright but Im not fussy when it comes to food anyway. Care Homes for Older People Page 17 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has appropriate procedures and practices in place to ensure that people are listened to and are protected from abuse. Evidence: The home has a complaints procedure which is on display on the main notice board, telling people how to make a complaint and the response the home will make. The home has a record of three complaints made in the previous twelve months. Records seen showed us that the Manager has responded positively to the complaints and has investigated them fully to addresss the concerns. We have one complaint about the home following which we visited the home to look at the prevention and management of pressure sores, we upheld this complaint. There have been no safeguarding referrals since the previous inspection. The manager told us that our recommendation of the previous inspection that all staff receive awareness of safeguarding procedures has been addressed. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is a clean and comfortable place to live and has suitable adaptations for people who live there. Evidence: The home has been refurbished in the last twelve months and has had new carpets and new furniture throughout the majority of the home. There is signage on doors of bedrooms, bathrooms and lounge to guide people especially those with dementia. The Manager told us that there are usually photographs on doors to show people which is their room, these will be put back up now that the decoration has been completed. The home has four separate lounges (including one smoking lounge) enabling people to choose where they spend their day. We spoke to one person who told us that she liked to sit in one particular lounge and watch television there as it was quiet. There are also two dining rooms. The home has all single bedrooms, of which seven have en suite facilities. Bathrooms and toilets are available throughout the home and have adaptations for dependent people. The home has a range of aids and adaptions such as grab rails, staff call system throughout and a passenger lift to assist dependent people. The garden has had a new handrail out to it making access less problematic. Staff told us that people do enjoy going out into the garden in the warmer weather. We found at Care Homes for Older People Page 19 of 27 Evidence: the time of our visit it was suffering from winter neglect and will need tidying before people can go out there safely as rubbish and a toilet had been dumped there. We found that the home is generally clean and free from any offensive odour. There are appropriate arrangements around the home with the provision of gloves, aprons, liquid soap and paper towels to minimise the risk of cross infection. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skill mix of staff on duty is sufficient to meet the assessed care needs of people currently living at the home. Evidence: We found that the home has sufficient and appropriately skilled care staff who are supported by laundry, domestic and kitchen staff to meet the needs of people using the service. Staff we spoke to spoke were generally knowledgeable of peoples needs. We saw positive staff personal interactions. One person said: Oh they are as good as gold. A relative also confirmed that staff are: very good. The home has 53 of its care staff with a care qualification (National Vocational Qualification level 2 or above) and is above the minimum requirement of 50 . The Manager told us that the percentage of qualified care staff will increase once care staff currently in training complete their care qualification. This gives assurance that the home has knowledgeable and well trained staff. Care Homes for Older People Page 21 of 27 Evidence: The recruitment of staff is completed to the required standards. All required checks are undertaken before staff start working at the home such as criminal records check and references. This means that the home undertakes all required actions to reduce the risk of unsuitable people working at the home. We were told that new staff have induction training that meets Skills for Care standards. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements are not always effective which means that people do not always receive the care they need and could be placed at risk. Evidence: The registered manager Ms Susan Dawson has worked in the care field for eleven years and has been the home manager for seven years. She has completed the required management qualifications and has been completing further qualifications in care. We did find that the manager has been making improvements but more improvements in areas such as care planning and risk assessment are required to give confidence that people will be kept safe and receive the care that they need. The home has its own quality assurance system which involves auditing and checking key areas of the home such as care, staffing and environmental arrangements. The homes owners do monthly visits of the home and complete a report of these visits. The manager told us that surveys of relatives and professionals such as Doctors, Care Homes for Older People Page 23 of 27 Evidence: District Nurses and Social Workers is in the process of being undertaken and this will also provide good information about peoples satisfaction with the home. We were told that resident and relatives meetings also take place with posters inviting people to the forthcoming meetings at the time of our visit. We found that the home has satisfactory arrangements in place for the safe keeping of peoples money. There is a record of all transactions with receipts available to confirm the transaction.We did find that seven people were in debt to the home which appeared to be a longstanding arrangement with no transactions since the previous summer. We advised that the manager needed to be more proactive to ensure that people have money available to them to treat themselves as they want to. We found that there are no transactions for hairdressing. The Manager told us that they have had no hairdresser for several months and hairdressing is undertaken at no charge by a member of staff who is also a qualified hairdresser. Maintenance contracts were spot checked and were found to be up to date. Hot water temperature records showed that hot water is regularly checked. Mandatory staff training is not up to date, although the Manager told us that there is a plan in progress to address this with a programme of training planned for all staff over the next few months. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 12(1)(a) Care plans must include all people needs and detail when appropriate actions that staff must take to care for people with a pressure sore. 09/06/2008 Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 13 Bedrails must be safely fitted and there must be a risk assessment in place for the use of bedrails. To ensure that people are protected from serious injury. 20/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 8 Care plans for people who have diabetes should detail what actions should be undertaken for high and low blood sugar and what constitutes a high and low blood sugar. Risk assessments should be undertaken for people who self administer their medicines. The amount of medicine given when a variable dose of medicine is prescribed. 2 3 9 9 Care Homes for Older People Page 26 of 27 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 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. 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