Inspection on 27/11/08 for The Orchard Nursing Home

This inspection was carried out on 27th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Orchard Nursing Home 31/03/09

The Orchard Nursing Home 02/10/08

The Orchard Nursing Home 18/04/08

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 06/02/2009.

Inspecting for better lives Random inspection report Care homes for older people Name: Address: The Orchard Nursing Home 189 Fairlee Road Newport Isle of Wight PO30 2EP The quality rating for this care home is: The rating was made on: zero star poor service 02/10/2008 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. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Anita Tengnah Date: 2 7 1 1 2 0 0 8 Information about the care home Name of care home: Address: The Orchard Nursing Home 189 Fairlee Road Newport Isle of Wight PO30 2EP 01983520022 01983528788 sue.burton@barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Barchester Healthcare Homes Ltd care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category 0 Over 65 40 Conditions of registration: The maximum number of service users to be accommodated is 40. 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: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home 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 0 2 1 0 2 0 0 8 Care Homes for Older People Page 2 of 9 parking at the front of the building. Barchester Healthcare Homes Ltd owns the service. There is no registered manager for the service at the time of this visit. Care Homes for Older People Page 3 of 9 What we found: We carried out an unannounced visit on the 27th November 2008 to follow up the Statutory Requirement Notice that we issued on the 28th October 2008. The registered person was required to make arrangement for the recording, handling, safe administration and disposal of medication received into the care home. We looked at the medication records for two of the service users that the staff were administering their medications for at the time visit. We found that staff were recording medication as administered on the Medication Administration Record (MAR) sheets as required. The staff were also maintaining a record of ointment that were applied as required. The record of a controlled drug was signed as received on the 21st November 08 and the controlled drug register showed that this had been received on the 25th and the date changed as the staff said that this was entered wrongly. We looked at the record for another service user who was receiving their medication via a Percutaneous Endoscopic Gastroscopy (PEG ) tube at the time of the inspection. The MAR sheet record and instruction of route of medication administered did not correspond with staff current practice. The staff reported that the service user was receiving all their medication via their PEG tube, although the MAR record showed these to be given orally. There was a separate instruction sheet available that the registered nurse showed us and agreed that this may cause confusion for someone not familiar with the service. We also observed that some of the medications prescribed for this service user was in the form of tablets and others as capsule. Guidance must be sought from the pharmacist and information made available to staff to ensure that all medications are administered correctly, as some medication may not be suitable for crushing. All records of medication, including their preferred route of administration must be clearly identified in order that the service users are not put at unnecessary risks. We were also informed that the nurse in charge was sorting out a discrepancy relating to the amount of fluid and number of flushes that was administered . Although this person has been receiving their medication via the PEG over a long period of time, their PEG tube was required to be flushed with 50 mls of water after each medication was administered. It was unclear why this was not carried out and the staff had recently noted the discrepancy. The staff was seeking further guidance from the health care professional relating to this matter . The record of the fluid balance for this service user showed that the staff did not always record the amount of fluids given through the PEG tube following medication administration. The staff must ensure that accurate instruction in care plans and records are in place with regard to the route and volume of fluids required for the service users receiving PEG feeds to ensure they are not put at risk of harm. The home has taken action and reviewed the excess wound dressings that did not Care Homes for Older People Page 4 of 9 belong to the current service users and these have been disposed of. Some action has been taken in the management of the service users medication. However this is not sustained and embedded in practice. You were required to ensure a system was in place and all staff are aware of the policy and procedures for reporting and responding to allegations of abuse and that no investigation of the same takes place until agreed with the chair of the safeguarding panel. We have written to you following the draft inspection response and shared with you that information we have received indicated that there was no agreement with the chair in relation to carrying out the safeguarding investigation. We looked at the staff training in safeguarding, this indicated that the staff had received this training. The person in charge confirmed that all current staff working at the home have received training in safeguarding. The home has undertaken an internal investigation regarding another staff member. The person in charge reported that this staff member has started work on a phased back to work plan. The registered person is aware that the safeguarding investigation relating to the issues raised regarding this staff has not as yet been determined and is not likely to be completed for some time. We looked at the updated safeguarding guidance available at the home and found that this was dated 2007. The senior person at the service stated that they had been trying to access the updated safeguarding procedures and had been unsuccessful. An updated version had been found that related to Hampshire safeguarding procedures and a staff member was accessing this on the day of this visit. We discussed with the senior person in charge whether the two staff have been referred for inclusion on the POVA list. The person in charge could not confirm this and we requested that this information is sent to us in writing. We have received correspondence from the service following the visit to confirm that the two staff had been referred for inclusion to the POVA list. Some action has been taken, however this is not yet sustained and embedded in practice. You were required to ensure that the service users care needs were identified and documented in care plans, which contain sufficient detailed information about their care needs and support required to ensure that their needs are fully met. These must include accurate record of foods and fluids taken. We looked at the records of two of the service users as part of this visit. We found that care plans and nutritional assessments were in place for the service user receiving PEG feeds. The records for this person showed that staff had identified that they had lost weight and contacted the dietician who advised to monitor their weight and this was carried out and records were maintained for the month of October and November 08. The records of food and fluids were available for the service user receiving PEG feeds. Care Homes for Older People Page 5 of 9 Records of foods and fluids were maintained, however this was inconsistent and did not reflect all the PEG feeds and flushes administered. The records of flush and amount also varied following administration of medication. The recording of food and fluids were confusing as some of the PEG feeds were recorded on the food charts and others on the fluid balance charts. The record also showed that on the 19th of November the PEG feed did not start until 22:00 hrs instead of 18:00 as usual. The recent fluid record chart showed that the staff had started flushing the PEG tube with 50 mls of water following administration of each medication. We looked at the staff training records and in particular the induction of staff. We found that records of induction as completed by the staff were available during this visit. We have written to advise you that we have amended the key inspection report following receipt of this information. We looked at the management arrangement at the service. The senior staff has changed including the lead clinical nurse. The senior person in charge stated that the home has recruited a manager and information regarding management arrangement would be sent to the Commission as required by Regulation. The registered person is aware that the manager will be required to register with the Commission as part of the fit person process. We have not received confirmation of the managers appointment at the time of writing this report. Action has been taken to address this requirement, however this is not yet sustained and embedded in practice. What the care home does well: 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 2. Care Homes for Older People Page 6 of 9 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 9 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 9 13 The registered person must ensure that arrangement for the recording, safe keeping and safe administration of medication of medicines received into the care home So that people receive their medication safely at all times. 30/01/2009 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 Care Homes for Older People Page 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. 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