Inspection on 18/04/08 for The Orchard Nursing Home

This inspection was carried out on 18th April 2008.

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

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

Other inspections for this house

The Orchard Nursing Home 31/03/09

The Orchard Nursing Home 27/11/08

The Orchard Nursing Home 02/10/08

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 Nursing Home 189 Fairlee Road Newport Isle of Wight PO30 2EP Lead Inspector Anita Tengnah & Janet Ktomi Unannounced Inspection 18th April 2008 10:00 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 Nursing Home DS0000071028.V361346.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 Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Orchard Nursing Home Address 189 Fairlee Road Newport Isle of Wight PO30 2EP Telephone number Fax number Email address Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01983 520022 01983 528788 sue.burton@barchester.com www.barchester.com Barchester Healthcare Homes Ltd Post Vacant Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (0) of places The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category (OP) The maximum number of service users to be accommodated is 40. Date of last inspection New Service Brief Description of the Service: The Orchard Nursing Home is a care home registered with the Commission for Social Care Inspection (CSCI) to provide nursing and personal care for 40 service users in the older person category. The home is situated in a residential area within easy access to local facilities. Accommodation is provided over two floors with a shaft lift that allows access to all parts of the building. All the bedrooms are single and have en suite facilities. There is a well -maintained garden to the side of the home and ample parking at the front of the building. Barchester Healthcare owns the service. There is no registered manager for the service at the time of this visit. The current fee charged is £608-£850 The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit to the service was undertaken as part of the inspection on the 18th April 2008. Two inspectors carried out this visit. The process included a tour of the service where a number of the bedrooms, communal areas, kitchen, and bathrooms were viewed. As part of case tracking 6 staff and 5 service users, visitors including a visiting professional, views were sought and care records were looked at. Information gained from the Annual Quality Assurance Assessment (AQAA) was also used and included in this report, as was information gathered by the commission since the last inspection to contribute in assessing judgements in this report. We also sent out service users surveys to people using the service, their relatives and other professionals who regularly have contacts with the service. We gave feedback to the person representing the organisation at the time of the visit. The home does not currently have a registered manager in post. The provider has written to us and informed us that they are actively looking to appoint a manager. There is an acting manager responsible for the service, who had been in post since the beginning of April 08 We have received two surveys from the staff and none from the residents at the time of writing this report, their comments as received will be reflected in the body of the report before it is made final. What the service does well: Accommodation is provided in a well-maintained, homely environment that generally meets the needs of people living at the service. The furnishing was of a high standard, and appropriate to the needs of the residents. The home has a range of equipment including profiling beds and pressure relieving mattresses to support and maintain people’s health and well-being. The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 6 The residents said that meals were good and offered them variety and choices. What has improved since the last inspection? What they could do better: The assessment and care planning that we looked at did not contain adequate information about how the assessed needs of people would be met. There was a lack of reviews and documentation relating to care planning and records of diet and fluids in order to fully protect the well-being of the residents. Assessments such as moving and handling, dietary needs, falls and skin integrity were not completed in all the records we looked at. This put the people at high risks of their care needs not being met. There was a lack of records pertaining to people receiving acute care to ensure that their dietary needs were fully met. The medication management was inadequate and poorly managed; some people did not receive their medication that they had been prescribed and this was detrimental to their health and welfare. The people living at the home are not fully supported to ensure that they receive the support to meet their needs. Care practices do not always offer people the autonomy and choices to make decision about their activities of daily living. There was no process in place to indicate how complaints would be managed such as a complaint log. Although the home until recently had a registered manager, it was evident that there has been a lack of effective management at the service; that has compromised the care that people receive at the service. The recruitment and induction process for new staff did not protect the people living at the service. As part of auditing of care, an action plan must be put in place to demonstrate how shortfalls in care identified will be addressed. The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 7 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 Nursing Home DS0000071028.V361346.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 Nursing Home DS0000071028.V361346.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 3,6 The pre admission assessment process was inadequate, as it did not ensure that the needs of people were assessed prior to providing care. Care managers assessments were in place. The service was not providing intermediate care. EVIDENCE: The care plans of five service users were looked at as part of this visit. We found that the home carried out the assessment for four of the residents on the day that they were admitted. This was discussed with the person in charge who was unable to provide any further information about the pre- admission process as she had only been there for the past two weeks. From the records we looked at this suggested that the assessment was undertaken on The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 10 admission. One of the resident was admitted for respite care for six weeks and an assessment was completed once permanent residency was agreed. In three of the records we found that care managers’ assessments were available and provided staff with information about the residents. The assessments gave basic details of care needs such as stand aid with two carers. Two contained details of the medication that they were receiving on admission. There was no evidence how these assessments and information received were completed and whether the residents/ relatives were involved. As discussed the assessments must be completed prior to admission unless in emergency, so that the home can determine whether the identified needs can be met. The home must supply the residents with written confirmation that following assessment the home is suitable to meet their health and personal care needs. The person in charge confirmed that the home was not providing intermediate care at the time of the visit. The Orchard Nursing Home DS0000071028.V361346.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 7,8,9,10 There is a lack of clear guidance in care plans and inadequate assessments to promote and protect people’s welfare and safety. The access to external healthcare provision is satisfactory. However people’s healthcare needs are not satisfactorily met. The medication management is poor and puts people at risk. The privacy and dignity of people using the service is mainly protected. However the display of people’s personal care needs compromised their dignity. EVIDENCE: The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 12 We looked at five records of people receiving care at the home. Care plans were formulated and there was basic information about the needs of people. The records contained risk assessments and charts for moving and handling, however one of the five we looked at, one was partly completed and the others were blank. The information was not clear, as it did not tell the staff how the risks were to be managed in practice. Records had information about the pressure risks assessments such as Waterlow score. However some of these assessments including Waterlow score were not reviewed regularly to ensure that they identify the current and changing needs of people. Two of the records identified people had suffered weight losses, there were no care plans to show what action was being taken in order to protect these people. Another resident had been prescribed fortified drinks as supplement to their diet. The records seen showed that he had not been receiving these as prescribed. There were no dietary needs assessments in place in all the five care records seen. Although there was evidence that an assessment was required. The care plans seen contained basic details about how to meet the residents’ health and personal care needs. These included maintaining good oral health, hair washed as necessary for personal care. Other examples were hygiene, all help, Communication: shouts, needs assurance and support. Mobility: needs wheelchair and two staff. The care records did not say how the care needs/ support was to be provided. There was no evidence that the care plans were reviewed, in order that any changes of needs are identified. We noted that one of the resident’s had an indwelling catheter, their continence assessment was blank and there was no catheter care plan to inform staff practice except for daily record that stated catheter bag at night. Although the care records identified that people were using pads to manage their incontinence this was not supported by assessments to ensure that this was managed appropriately. This included no catheter care plans in two of the residents care records we looked at. Another resident was assessed as having numerous falls and had fractured his femur. There was no fall assessment or care plan in place to manage this risk. Another resident had been assessed as moderate risk of falls in February 08 and there was no further review undertaken. We also found that 5 residents had bed rails in use, all other beds were also fitted with bedrails with no evidence that assessments for the use of bedrails had been completed and consents gained for this form of restraint. Other areas of concerns were related to the management of Percutaneous Endoscopic Gastrostomy (PEG) feeds. We looked at the record of a service user The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 13 receiving PEG feeds on the day of the visit. The care record did not contain adequate information relating to the procedures that staff would follow regarding the volume, time, and amount of feed to be administered. We noted that there were some fluid balance charts and these were also incomplete including feeds given on the day of the visit for one of the resident receiving PEG feeds. Staff reported that the night staff had put up the feed and the day staff had followed on with water but had forgotten to record these on the fluid balance sheets. Another resident regime for his PEG feed was seen stuck to his bedroom wall. Again the fluid balance record was incomplete. One resident had a fluid balance chart that had four entries on one day and five entries on another day. This was discussed with two staff including the nurse in charge who were all unaware that this resident’s fluid intake was being monitored. Evidence that the service users/ relatives have been consulted on their plan of care must be maintained. This is particularly important for people who due to their mental frailty may not be fully able to participate in the formulation of their plans. Staff reported that all the residents were registered with the local GP practice. Support form the community health care team was also available as required. A visiting health professional we spoke to indicated that things had got a bit better since all the residents had moved onto one floor. However staff were disorganised and calls to the surgery were not were not structured so that sometimes they have to make two visits in a day. Equipment was available for the relief and prevention of pressure ulcers. Care records of two people with pressure ulcers showed that wound care plans were inadequate. One of them did not contain a care plan only an assessment and the other care plans did not identify action that staff would need to take to manage all the pressure ulcers. There was some evidence of review/evaluation of wounds but again this was not consistent in the two wound care plans seen. As discussed the wound care plans needed further development to include clear wound management plan and evaluation for each individual wound and assessment. We noted for one of the resident the record showed that for the three instances that the pressure ulcer was dressed, the staff had used three types of wound dressing. The last wound assessment record was dated the 30th of March 08 and no further reviews were available in the records seen. There was no wound care plan for this person and no evidence why three different dressings were applied. This was brought to the attention of the person in charge at the time of the visit and must be addressed. The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 14 Another person had sores identified to three different areas and the care plans were inadequate to inform practice, as one of the areas identified was not supported by any care plan. The person in charge and other staff spoken with confirmed that only registered nurses are responsible for the management of medication at the home. It was noted that oral medication was stored safely and this included controlled medication. A sample of Medication Administration Record (MAR) sheets was looked at as part of this visit. The Medication Administration Record (MAR) sheets were poorly maintained with a number of them loose. There was evidence that records of medication administered were inadequate with a number of gaps on the MAR sheets. This included one service user who received medication prescribed as one daily, this was given twice on one day and that person had not received this medication from the 30th march to 17th April 08. Some MAR sheets records were duplicated and staff said that they folded them, so as not to cause confusion but they remained in the folders. Comment from a staff member was that medication management systems were confusing, particularly if you did not know the residents. We found another resident who was a diabetic and staff reported that he was self- medicating on his Insulin. The staff kept a record of his blood sugar monitoring and the amount of Insulin taken as part of his diabetes management. His record showed that his Insulin dosages and blood sugar levels had not been recorded for three evenings and one night- time dose. We noted that creams / ointments, mouth sprays and wound dressings in people’s bedrooms were not labelled with their names as needed. One of the resident record seen indicated that a lotion and a cream had been applied to his pressure ulcers, these were not found on his MAR sheet. The person in charge was made aware of these and action is needed to ensure that creams and ointments are labelled in order to prevent these being used as communal and pose infection control risks. All the people are accommodated in single room and staff were observed to knock prior to entering their rooms. Interaction observed and people spoken with confirmed that their privacy and dignity was respected. Comments included that the “staff are very kind” and they do their best. However the practice of displaying personal details of people’s care needs on their bedroom wall did not promote dignity and privacy. The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 12,13,14,15. There are some activities available, however these did not meet the needs of all the people. Further development is needed to meeting social, emotional and recreational needs through more individualised assessment and planning. The visiting policy supports people to maintain contacts with their relatives. There are some choices available to people, however this was not consistent and must be further developed to meet people’s needs. The meals at the home were satisfactory and some choices were offered. EVIDENCE: The person in charge reported that there is an external entertainer that comes in twice a week to provide activities for people using the service. The sample of care records looked at indicated that the staff maintained detailed life histories The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 16 and their social interests. However these had not been developed any further to show how the home plans to meet them and support the residents in maintaining past interests / hobbies if they chose. The person in charge reported that the service was aware of these shortfalls and much work is needed to ensure that people’s social activity needs are met. Staff stated that six residents took part in the activity programme last week. As discussed records of activities undertaken should be maintained in care records and evaluated as needed. A St George’s day celebration was planned and advertised at the service. Developments planned we have been advised will include regular visits from the local vicar and introduction of religious service/ communion according to people’s expressed wishes as part of pastoral care. Information we received indicated that the home was planning to employ an activity coordinator. The home has an open visiting policy and two people spoken with said that they could visit at any time. The home maintained a record of visitors to the service and this showed that people visited at varying times. The service has a receptionist on weekdays until 5pm and the person in charge has confirmed that security of the building has been considered and the doors are locked once reception is closed. This was in relation to concerns from staff, as all the staff are on the first floor with one resident on the ground floor. Observations of care practices and staff spoken with did not reflect how choices are offered with regards to activities of daily living. Care records seen did not indicate people’s preferences about the times they wish to get up or go to bed. Two people said that we wait and the girls come and get us up. One resident was observed and made three requests during the space of an hour to get up. Each time the carers reassured her that she would be next. Staff reported to us that due to staff shortages and high care needs of people accommodated, a number of the residents were left until midday to receive personal care. This resulted in them being left in wet beds while waiting to be attended to. This was brought to the attention of the senior person in charge, as urgent action is required. Two of the people we spoke to said that the food was good and they were offered choices regarding meals. A comment included ” someone comes in and ask what I want to eat”. The food is transported in a hot trolley to the first floor. The kitchen staff served the meals on trays as all the meals were taken in their own rooms on the day of the visit. We observed that all the courses including hot puddings were all served at the same time. A relative commented that the hot puddings were cold by the time their relative had it. Meals appeared balanced and well presented except for the pureed diets. We observed that pureed diets were not served individually; all the vegetables and potatoes were mixed together, with a scoop of pureed The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 17 meat on top. This was brought to the attention of the person in charge and must be addressed. One person said that they were not aware why the resident was having pureed diet and was able to “eat normal food as he has teeth”, or alternatively have a soft diet. The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 16,18 The process for ensuring that complaints are investigated and records maintained is poor. Staff have knowledge of what constitutes abuse, however there was inadequate action taken to safeguard people receiving care. EVIDENCE: People we spoke to said that they would go to the nurse in charge or matron if they were unhappy about anything. Staff said that they would go to the person in charge if they had any concerns. The commission had received a recent complaint in April 08 regarding allegation of lack of care and this was referred to social services on Isle of Wight as safeguarding. The outcome of this investigation has not as yet been determined. The home is required to have a complaint log to record any concerns/ complaint received, investigation and any action taken in respect of any such complaint. The person in charge at the time of the visit confirmed that this was not available and would be developed and put in place. Four staff spoken with said that they would report to the person in charge if they suspected or allegations of abuse are made to them. However staff had The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 19 not initiated any action although they were aware that people’s needs were not being met and others were left in wet beds as previously mentioned. People we spoke to said that they would go to the nurse in charge or matron if they were unhappy about anything. Staff said that they would go to the person in charge if they had any concerns. One of the qualified nurses spoken with was unsure about whom to report to externally. This was discussed with the person in charge to ensure that all staff receive information and guidance about making referrals as appropriate. Training in safeguarding was available; it was not possible to assess how many of the staff had completed this training as the person in charge stated that training records had not been updated. As a result of the serious concerns regarding the care and the safety of the residents identified at the time of this visit, a safeguarding referral was made to Social Services Department (IOW) in April 08 the investigation is ongoing at the time of writing this report. The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 19,26 The service generally provides the residents with a homely, well maintained which is furnished to a high standard to meet their needs. The infection control procedures are adequate and further development including labelling of personal items and accessible waste bins would further ensure that the residents are protected. EVIDENCE: We walked round the home and looked at a number of bedrooms, communal areas, bathrooms, and laundry room as part of this visit. It was evident that the home has an ongoing programme of refurbishment. The residents are provided with a warm and welcoming environment. Recent refurbishment included soft furnishing and curtains in both communal lounges. The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 21 The residents’ bedrooms seen were personalised and it was evident that the residents are encouraged to make it as homely as possible. Equipment for the promotion of independence was in place such as grab rails and all parts of the service was accessible to the people using the service. There is a passenger lift that allows access to the first floor and wide corridors. Two of the bedrooms were found to be full of equipments, untidy and disorganised, cluttered and included boxes of feeds on the floor and oxygen equipment. This did not provide the residents, who staff stated spent all their times in their bedrooms with a comfortable, homely and safe environment. The sluice room was also cluttered with bedpans and empty boxes that restricted access to the clinical waste bins. We noted that there were four sharp boxes on the floor and two of them contained used needles. The provider must ensure that procedures for clinical waste are adhered to and these sharp boxes are kept locked to safeguard people using the service. We looked at the laundry room that was small and staff reported that one of the bedrooms was in use as an ironing room at present. The laundry undertook the residents’ laundry of personal clothing. While the residents beddings and towels were contracted out. The linen seen appeared in very good condition and fresh. As part of infection control process, staff were observed to use gloves and aprons. One staff reported that only latex gloves were available, as they had run out of non- latex gloves. The provider must ensure that staff are provided with appropriate equipment for their safety. The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 22 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 poor. This judgement has been made using available evidence including a visit to this service. The staffing was inadequate to meet the present needs of people accommodated. The recruitment process was inadequate and did not include all necessary checks. There was a lack of training record to demonstrate that staff had the skills to deliver care safely. EVIDENCE: The home has a duty roster for the nurses and carers and a separate roster for the ancillary staff. There were 2 trained nurses and 4 carers on the day shifts at the time of the visit. The home was undergoing a transitory period where a number of staff had left and had been made redundant, as they had moved temporarily into the service when the other part of the hospital closed. Their staff appeared to be unsettled and reported that they did not feel that there was adequate staff to meet the needs of people. On the day of the visit staff stated that at midday each section still had x5 residents each that had not received any personal care. We observed that some people were not receiving their drinks, as they needed support. As The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 23 previously stated staff said that people’s needs were not being met due to heavy workload and inadequate staffing. Comments included: “Listen to the staff when they say they cannot cope, this in turn will ensure that clients’ needs are met”. “I feel the home needs to assess individuals’ needs to decide on staff ratio”. “I feel the clients are at risk if staff ratio is not increased”. Other comments were that there was a great team but not enough staff. Other concerns that staff discussed were that the staff were “getting people ready for bed at 2-3 in the afternoon”. This was so that they could get their work done. These concerns were brought to the attention of the senior person in charge. Information from the AQAA indicated that of the 36 permanent carers 8 had achieved National Vocational Qualification (NVQ) 2 or above and 11 were working towards the qualification. Of the 15 bank staff 2 had achieved NVQ 2 and 1 was working towards this. We looked at two newly staff records and neither had completed an induction when they started work. We also looked at the recruitment files of these two new staff. Both had completed an application form, an interview record was kept and they were supplied with contracts and terms and conditions of employment. One of the staff had two references and both had all checks including CRB and POVA first prior to commencing work. However one of the staff record showed that the manager failed to secure appropriate and relevant references from the last and previous employers prior to employment. There is a training programme in place and one staff record showed recent training included safe administration of medicine, safeguarding, person centred care. We were unable to assess what training staff had completed as the person in charge reported that the training record was not up to date. The Orchard Nursing Home DS0000071028.V361346.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): 31,33,35,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home lacks consistency and would benefit from a structured process that identifies individual role and responsibilities for the service. Although an internal audit had identified concerns with the lack of assessments, care plans and reviews; the manager had taken no action to resolve these. There is a lack of supervision of staff practices. There is some auditing in place but this requires further development to include action required to resolve issues identified. People are put at risk through inadequate training and poor practices. The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 25 EVIDENCE: The home does not have a registered manager since the departure of the manager in March 08. The company has appointed a general manager from another service to oversee the management of the home. Discussion with staff indicated that the home had been experiencing staffing problem with people’s needs not being met and the manager had not been effective in resolving this. Other staff said that the home needed a good manager to sort things out. Staff were positive that the general manager would effect some changes that will benefit all. Comments included: we are pleased that we have someone who is working very hard to sort out this home.” “At last we have someone who listens”. However form the evidence in this report this does not appear to have impacted on care practices. Information from the AQAA showed that there is an auditing process in place including monthly visits as Regulation 26. We saw an example of care plan audit completed in February 08 for one of the residents that we case tracked. This highlighted concerns such as lack of assessments, care plans, lack of reviews, no falls assessments. We have reported the same problems during this visit and the manager had taken no action to address these failures and people needs have remained unmet. There was no evidence and staff we spoke to confirmed that there was no structured supervision programme in place to monitor staff practices. Staff reported that the home did not manage any of the residents’ personal finances and invoices are raised on a monthly basis for items such as hairdressing, chiropody, and physiotherapy as required. Information we have received indicated that there is a programme in place for servicing of equipment. We noted that the electric circuit cupboard was unlocked and pose health and safety risks to people using the service. We noted that there were four sharp boxes on the floor and two of them contained used needles. The provider must ensure that procedures for clinical waste are adhered to and the sharp boxes are kept securely to safeguard people using the service. We noted some substances that can be detrimental to people’s health were left in the sluice and must be locked at all times to protect people using the service. The electric cupboard must be maintained safely with restricted access as required. This was left open and we accessed this room on the day of the visit. The matter was brought to the attention of the senior person in charge. The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 26 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 3 X X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 1 The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? N/A 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 OP3 Regulation 14(1) (a) (d) Requirement Timescale for action 30/05/08 2 OP7 13(4) 15 3 OP7 15(2)(b) (c) 4 OP8 14(1) (a) Schedule 3 (o) The registered person must ensure that a pre admission is completed prior to people moving in order to ensure that the home can meet their needs. The registered person must confirm in writing, that according to the assessment the home can meet their needs. The registered person must 30/05/08 ensure that as part of care planning, risk assessments and care plans for falls, moving and handling are put in place as appropriate in order to protect people using the service. The registered person must 30/05/08 ensure that a detailed care plan is in place for each service user to reflect how their care needs will be met. These care plans must be reviewed to ensure that any changes in needs are identified and action put in place to meet them. Nutritional screening must be 30/05/08 undertaken on admission and people’s weight monitored and DS0000071028.V361346.R01.S.doc Version 5.2 The Orchard Nursing Home Page 28 5 OP8 17(1) (a) Schedule 3(p) appropriate action taken to meet their nutritional needs. The registered person must ensure that care plans for pressure sores detailing their treatment are in place to inform practice and meet the service users’ needs. The registered person must ensure that the people receive their prescribed medication. Staff must maintain a record of all medication kept in the care home and the date on which they are administered to the service user. 30/05/08 6 OP9 17(1) (a) Schedule 3, 13 (2) 30/05/08 7 OP9 13(2) The registered person must ensure that staff follow procedures for the safe handling, safe administration and disposal of medicines received into the care home. Prescribed medication must only be administered to the named person. The registered person must maintain a complaint log and maintain record of all complaints made by people using the service. The complaint log must show any actions taken by the registered person in respect of any such complaints. Training in adult protection and clear guidance for staff about reporting, recording all allegations of abuse and poor practices to the appropriate authority must be put in place. This is to ensure that people living at the service are safe and protected. The registered person must ensure that al all times there are DS0000071028.V361346.R01.S.doc 30/05/08 8 OP16 17(2) Schedule 4 (11) 30/05/08 9 OP18 13(6) 15/06/08 10 OP27 19 30/05/08 Page 29 The Orchard Nursing Home Version 5.2 11 OP29 18(1) 12 OP30 12(!) 18(1) (a) (c) 13 OP38 13(3) (4) 14 OP31 8 (1) (b) experienced, skilled staff and in appropriate numbers in order to meet the needs of people accommodated. This should include a senior nurse who is able to promote and ensure that practices meet with clinical guidelines to safeguard vulnerable people living at the service. The registered person must ensure that all necessary checks including relevant references are sought for all new employee prior to their employment. The registered person must ensue that all new staff complete an induction programme that meets with Skills for Care guidance and records are maintained. The registered person must ensure that arrangements are in place for the protection and health and safety for people using the service at all times. These must include electric cupboard, sharp boxes and COSHH materials. The registered person must appoint a suitably competent person to manage the service. 30/05/08 30/05/08 30/05/08 30/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Orchard Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Nursing Home DS0000071028.V361346.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!