Inspection on 10/07/07 for The Orchards

This inspection was carried out on 10th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Orchards 20/06/06

The Orchards 07/03/06

The Orchards 29/09/05

The Orchards 31/03/05

The Orchards 17/08/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Orchards Orchard Lane Crewkerne Somerset TA18 7AF Lead Inspector Gail Richardson Unannounced Inspection 10th July 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Orchards DS0000060598.V339255.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 Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Orchards Address Orchard Lane Crewkerne Somerset TA18 7AF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01823 270694 01823 323270 Somerset Redstone trust Mrs Christine Roberts Care Home 66 Category(ies) of Old age, not falling within any other category registration, with number (66) of places The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Older persons, who require general nursing care, up to a maximum of 31 people. Nursing placements are permitted only in the `nursing wing` The `nursing wing` will have a named first level nurse, on part 1 or 12 of the NMC register leading the management of nursing care. The named nurse must have available no less than two shifts, supernumary to this rosta, for the purpose of strategically managing the nursing care. If this member of the management team leaves or is absent for more than 28 days, the CSCI will be informed of alternative arrangements. The Somerset Redstone Trust will give the CSCI copies of the CV, references and qualifications of the first level nurse leading the management of nursing care. A maximum of 33 places are permitted in each of the two units Only rooms 4 & 5 of the Nursing Wing may be used for intermediate care`. Service users in these rooms (up to a maximum of 4) are subject to the following conditions:(a) not less than 50 years of age (b) maximum duration of any single admission - 56 days. 3. 4. 5. Date of last inspection Brief Description of the Service: The Orchards consists of two separate units, one for personal care and one for nursing care. The Orchards is owned by Somerset Redstone Trust, a charity that also manages five other units for older people throughout the counties of Somerset, Devon, Hereford and Worcester. The Orchards is situated in the small town of Crewkerne and is within easy walking distance of the town’s amenities, including shops, banks, pubs, dental surgery and small community hospital. The majority of the home’s bedrooms are for single occupancy. There is a passenger lift in each of the two units. The home has a large lawned garden to one side and there is a patio area off the dining room of the nursing unit. The gardens are well maintained and easily accessible. The range of fees for residential care is £373.00 to £600.00, the range of fees for nursing care is £504.00 to £700.00 and does not include hairdressing and chiropody. The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over 1 day on the 10th July 2007 by inspectors Gail Richardson and Jane Poole over a period of 6 hours (12 inspection hours). A tour of both units, the nursing unit and the social care unit, took place and a sample of the bedrooms and communal areas were seen. There were 58 service users currently residing at the home, 30 in the nursing wing and 28 in the social care wing. The inspectors spoke to 15 service users, 1visitor and 10 members of staff, the Registered manager was unavailable on the day of inspection and both inspectors would like to thank the deputy managers of each unit for their assistance during the inspection. As part of this inspection the inspectors surveyed the opinions of a random selection of service users and their representatives, GP’s, District Nurses and Care Workers. A good amount of responses were received. Prior to inspection the manager completed an Annual Quality Assurance Audit requested by CSCI, which detailed how the home had improved and plans for future developments. Records relating to care, staff, finances and health and safety were examined at inspection. The inspectors noted that service users appeared settled and comfortable and there was a pleasant, calm atmosphere within both of the units. The service users looked well cared for with an attention to detail of personal care evident. All service users spoken to were complimentary about the staff and the care they are receiving. Staff spoken to were happy to be working in the home and time spent by the inspectors observing staff, evidenced that they were kind and caring towards service users and spoke to them at all time with support and reassurance. One visitor spoken too was happy with the care their relative was receiving and confirmed that they were always made very welcome to the home at any time. The inspectors would like to thank the service users and staff for their time and hospitality through out the inspection. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? During the last twelve months improvements have been made physically to the home in replacement and redecoration. Staff have received and achieved training levels to meet legislation and personal development. The care delivery has moved more fully into becoming person centered, care being flexible to the changing needs of the resident. The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 7 Laundry equipment for the Social wing of the Home has been provided and made it into a lighter enviroment for the staff to work in. Management have recruited more staff. More support put into the shift leaders, with the hours increased to ensure a shift leader is on each shift. The new head of care is responsible for the training programme which is ongoing. Work undertaken has included redecoration,recarpeting,updating the facilities of the main kitchen in the social wing and overall maintanance of the home and gardens. What they could do better: Some care plans in the nursing unit require a more regular review and the time between admission and care planning should be reduced to ensure staff have a clear plan of care for new admissions. Social care planning must be developed and the registered manager must ensure that each service user has a completed social care plan. Oxygen cylinders must be secured in the upright position to ensure they are not able to fall over and therefore reduce the risk of injury or serious damage. The registered manger must ensure that all staff declare any criminal convictions at interview and employment history gaps are explored and documented. The registered manager is further required to ensure that risk assessments are in place following recruitment checks as risks are identified to ensure that service users are not at risk of abuse. The home has an ongoing maintenance plan, which is recommended to continue to both areas of the home. Areas of the home requiring to be locked for the safety of service users are required to be checked as locked. Accident audits are required to be followed up with a clear plan to address trends and repeated incidences. The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 8 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 Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 9 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 Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 4 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to be able to provide prospective residents and relatives with sufficient information in the format of brochures, the Service User Guide and Statement of Purpose for them to make an informed decision about the home. All prospective residents receive a pre admission assessment to ensure the home can meet the assessed needs identified. EVIDENCE: The homes Annual Quality Assurance Audit states - No service users moves into the home without a pre-assessment to ensure their needs will be met.For individuals referred through social services a copy of the SAP report is obtained before the Home does there own assessment.For individuals who are self funding a full assessment is done covering all aspects of daily living.This The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 11 was confirmed by relatives and service users recently admitted to the home. Five relatives and 4 service users confirmed by survey that they had received enough information about the home prior to admission.One comment was “I came for a look around with my daughter” and another stated “I knew straight away it was the right place for me “ Contracts were not available at inspection as the home has recently reviewed the contract details and reissued to service users/ relatives. One visitor confirmed that they had received a contract. The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each service user has a care plan, the assessed areas of need were reflected in this plan of care and the detail recorded ensures that staff can provide a good standard of care. The management of medications systems in both units now meets the required standard however oxygen storage requires urgent attention. Staff were observed to treat service users with dignity and respect at all times and residents felt well cared for. EVIDENCE: The Annual Quality Assurance Assessment states -The care plan is generated from the pre-assessment before admission, and reviewed monthly. However at inspection it was noted that a recently admitted service user had received a pre admission assessment but a care plan was not made until a month later, the deputy manager confirmed that this is due to staff shortages. The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 13 Care plans identify personal needs and abilities of residents and evidence of relatives involvement was seen. The care plans on the Social Care wing were noted to be detailed and personal and care plans on the nursing unit showed good detail and information for specific nursing interventions. On the day of inspection a visiting health professional was following up a previous visit made at the request of the home to review wound care and share clinical opinion. Social care plans in both units were not fully completed and lacked documentation of social choices and preferences. Some dependancy levels and screening tools had not been completed and risk assessments for medication allergies were not in place. All residents are registered with a G.P. Regular appointments are upheld for visual, dental, chiropody, speech and specialist care requirements. One visiting health professional commented that the home is “A well run home with very caring staff” however, another commented that “It is not always clear to the staff what problem the patient is experiencing”. When visiting health professionals were asked if there was always a member of staff to confer with, 3-yes and 1 said no. However all 4 stated that they had not received any complaints about the home. Residents requiring regular supervision due to the changes in health condition were being observed every 30 minutes and this was being recorded appropriately.It was noted that appropriate measures were being taken to ensure that the service users were re-assessed as health needs changed for the environment that would suit their specific needs. Service users felt well looked after and comments included ”The doctors and nurses are very kind when needed”. The management of the medication systems were good; there were no gaps in the Medication Administration Records. The storage of oxygen requires urgent attention to ensure that the 3 cylinders, which are not secured to the wall, are suitably secured to prevent the risk of the falling over, causing injury or explosion. The home has written protocols in place for the administration of all medications. The manager of the Social Care Unit is recommended to implement a system to record the administration of all prescribed creams. Residents have the option to self medicate should they want to. Suitable documentation was in place in respect of these residents and medication was safely stored within their rooms. The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 14 A homely remedy policy is in place with signed consent on agreed protocols by the relevant GP’s. All medications were stored safely and securely with systems in place for ordering and disposal. The Orchards DS0000060598.V339255.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): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a wide range of opportunities for social stimulation and residents are supported to join in with organised activities or pursue their own interests. The meals in the home are of a good quality and a wide range of choice is available. EVIDENCE: The activities organisers produce a regular activities programme, this enables individuals to participate and enjoy activities of their choice. The home employs 2 activity organisers for a total of 45 hours per week not inclding weekends. The week starts with the shop being taken around and then activities are planned and posted on the board in each unit for the rest of the week. There are a variety of activities and residents stated that there were no strict routines in the home and that they were free to decide how and where they spent their time. One comment included “There are no rules, you can carry on your own life but with a bit of help”. Activities included bingo, quizzes, arts and crafts and use of the garden. Some The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 16 residents requested more trips out and the activity staff was organising this. Church services are planned for each month and there is a bible class in the Social Care Wing. One service user stated that there activities “Usually 3 or 4 times a week, the activity staff are very competent”. The recording of activites undertaken is good but has not been undertaken for all residents and this is recommended to be commenced. Surveys indicated that activities are available 3-always,1-usually and 1 sometimes. One visitor confirmed that service users are able to receive visitors at any reasonable time and are always made welcome. Relatives and friends are encouraged to take part in the life of the home. Service users rooms were decorated in a manner, which reflected their tastes and lifestyles. Evidence was seen of people’s own furniture in their bedrooms. Lunch observed was appetising and plentiful. Care staff spoken to had a good understanding of service users dietary needs. The menu offers a choice and service users were satisfied with the meals provided. Special diets were seen for diabetic and vegetarian service users and pureed diets were served separately. Meals were served both in the dining room and in service users bedrooms if preferred. The kitchen was seen to serve to the residents in bedrooms first and the process appeared well organised. On the day of inspection lunch consisted of: Turkey and Leek casserole or Egg and chips. Desert was a choice of treacle sponge and custard, rice pudding, fresh fruit, tinned fruit salad and yogurt. Almost all service users spoke positively about the standard of the food and mealtimes appeared to be a pleasant dining experience. Two service users commented to the inspector that the meat was sometimes tough and required a different cooking process, but another comment was that “meals are a good variety, cooked by very competent kitchen staff”. The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 17 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff and residents are confident that the homes management team would appropriately deal with any complaints or concerns. Policies, procedures and training are available to staff to ensure they have the knowledge to prevent service users from the risk of abuse Recruitment procedures do not protect service users from the risk of abuse. EVIDENCE: The complaints records of the home were examined and confirmed that all complaints were investigated and outcomes reached within an agreed timescale. CSCI has not received any complaints regarding The Orchards. Eight relatives surveys and 4 service user surveys, confirmed that they knew how to make a complaint and surveys confirmed that service users knew who to speak to if they were unhappy. The homes Annual Quality Assurance Audit states -Our policy is to be open and to welcome suggestions,and where relevant to complain.Whether formal or a concern it is dealt with promptly and effectively.The complaints policy is in place and taken seriously. Staff,residents and relatives are aware of the The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 18 procedure to voice that complaint or concern. The home has policies and procedures in respect of challenging behaviour, making a complaint and whistle blowing, staff training in abuse awareness also takes place at induction and some staff have recently received POVA training. Eight staff surveys confirmed that they were aware of policies about protecting vulnerable adults and how you report any concerns about poor care practice or allegations of abuse. The homes procedures during recruitment to ensure that service users are protected from the risk of abuse are not robust. The registered manager is required to ensure that employment histories are detailed and all gaps are explored and documented, that 2 references are received for all staff . All staff are required to have a Criminal record bureau Check on commencing employment regardless of other checks undertaken and risk assessments are in place for any identified risks resulting from CRB checks. The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is two large buildings with some parts of the buildings suffering from wear and tear that would be typical of a building of similar age and usage. The gardens are attractively laid out and suitable for service users use. The provision of adequate bathrooms in the Social Care Wing requires review. EVIDENCE: A tour of the home was made and the inspectors visited all public, some private and some staff areas. All areas of the home were clean, tidy and free from unpleasant odours. The Registered Manager confirmed in the Annual Quality Assurance Audit that a plan of maintenance and decoration is underway. Some areas have been The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 20 decorated to a high standard and the lounge of the nursing unit has been redecorated and is now light and airy. Some areas of the Social Care Wing were in need of re decoration and corridor areas of the nursing unit are in need of redecoration. It was noted that the Social care Wing has two bathrooms which are in need of repair. The home is required to repair these baths to ensure that service users do not have to walk a distance to a working bathroom. Bedrooms are attractively decorated and furnished with residents enjoying their own personal possessions within the space available.The home has a programme of regularly maintaining and redecorating bedrooms when they become vacant. The grounds around The Orchards are attractively laid out and are well planted and maintained. Various aids and adaptations have been put in place to assist service users to maintain their independence. Specialist pressure relieving cushions and mattresses were seen where there was an assessed need. All wheelchairs were seen to be clean and maintained. The Home is kept clean and hygienic with policies and procedures in place for control of infection. Surveys received had comments which included “The home is very clean “ and “The cleaners work very hard “. A link nurse is in place who is responsible for control of infection and on the day of inspection the home was clean and only some rooms had a mild malodour. Laundry systems are in place to ensure clean linen is available and clothing is returned cleaned and ironed. The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is adequate . This judgement has been made using available evidence including a visit to this service. Staffing levels at the home are adequate to meet the assessed needs of service users and staff training is promoted to support service users. The induction process for staff has been developed to meet the Skills for Care, Common Induction Standards. The recruitment procedures within the home do not protect the service users from the risk of harm. EVIDENCE: The home have recruited more staff to meet the service users needs, agency staff are used when required and the home uses the same agency staff when possible to ensure continuity. More support has been put into the shift leaders, with the hours increased to ensure a shift leader is on each shift. One comment received from a relative was that the home could “maybe employ more staff” and onother comment when asked if staff are available whenever you need them said “Even at night , no matter what time “ On the day of inspection there were, on the Social Care Wing:1 Shift leader and 4 care staff and on the nursing unit 1 qualified nurse and 6 care staff. Further ancillary, maintenance, activity and administrative staff were also on duty. Service users spoken with confirmed that the staff were kind and looked after them well, one service user commented that “you can talk to them (staff),they The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 22 notice if you are not 100 ”. Three service users commented on the service users surveys that the home does everything well and one commented “I think they do a wonderful job” Ten staff surveys confirm that induction takes place and they feel well supported, however survey results stated that when asked , Do you ever have to deal with situations you feel unprepared for or do not have the right training for? 4 said yes and 7 said no.Staff training is ongoing and records support that manadatory training is being undertaken by all staff in fire training, manual handling, infection control, health and safety and POVA training recently took place within the home. Staff meetings take place regularly and staff confirmed that this is an opportunity to discuss any concerns, they felt listened to and issues acted upon. The recruitment files were examined, it was discussed that the registered manager needed to develop the employment history details to contain dates of commencement and leaving previous employment. This will ensure that at interview, the registered manager can explore any gaps in previous employment and document the reasons for this. This is undertaken to protect the residents from the risk of abuse. Not all staff files contained 2 references and some references were photocopied. These procedures are required to ensure that service users are protected from the risk of abuse. See Standard 18. The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is effectively managed and benefits from the positive and proactive management style of the deputy managers. Systems are in place to ensure the health and safety of service users whilst encouraging and promoting independence. EVIDENCE: At the time of report the home does not have a registered manager in post and therefore standards 32 and 33 cannot be assessed. The home has recently employed an office manager to oversee the administration of the Home.This will help to ensure that the residents financial interests are safeguarded. The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 24 There are established systems in place for dealing with service users finances. The inspector evidenced that each service users personal monies were stored in individual envelopes with a running total of deposits and withdrawals. All service users records are stored confidentially in line with the Data Protection Act. Quality assurrance checks and feed back from questionnaires provide opportunity to address points of constructive critisism or suggestions. This process was last undertaken in June 2007 and the outcomes and resulting actions are pending. Records available at inspection confirm that staff receive supevision.Staff surveys confirmed that 8 staff received regular supervision and 2 had not. A full fire assessment has been undertaken in both units of the home with any points of concern now addressed and resolved. Accident records were viewed and were seen to be audited monthly for trends and regular occurrences. Records of action taken to improve practice and reduce any risks of further accidents taking place are recommended to be undertaken. Maintenance records were well maintained and up to date these included; * * * * * * * * * * * Fire Extinguishers Hoist Servicing Emergency lighting Boiler servicing COSHH Hot water temperatures Wheelchair maintenance Electrical Hard Wiring Fire System Lift servicing Nurse call servicing The Portable appliance Testing records were not available and are to be forwarded on to CSCI. 9 staff surveys received stated that they were provided with protective clothing and necessary equipment to do their work safely and cleaning staff confirmed that they had access to COSHH data sheets and had received training in the safe use of chemicals. The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 1 3 3 3 1 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 3 3 3 The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? no 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 OP9 Regulation 13(2) Requirement The management of the home is required to ensure the secure storage of all oxygen cylinders to ensure the health and well being of service users. It is strongly recommended that the manager ensure that care plans are reviewed regularly and social care plans are completed for all service users, which includes the choices and preferences. Recording of activities in the Social Care Wing is recommended. The management of the home is required to ensure that all staff receives a Criminal Record Bureau Check prior to commencing employment and issues raised are identified and risk assessed. That 2 satisfactory references are received for all staff prior to commencing employment That detailed employment history is obtained for all staff and any gaps are investigated The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 27 Timescale for action 04/08/07 2. OP12 12(2)(m)( n) 04/08/07 3. OP18 Schedule 2 (7) 01/08/07 and documented. 4. OP22 23(2)(j) The management of the home are required to repair the 2 baths on the Social Care Wing and advise CSCI of the date of completed repairs. 30/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations The manager of the Social Care Unit is recommended to implement a system to record the administration of all prescribed creams. The inspectors recommend that the home continues the on going maintenance programme. The management of the home is recommended to use the information from the monthly accident audit to promote improved practice and changes to the home to reduce the risks of further accidents. 2. 3. OP21 OP38 The Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Orchards DS0000060598.V339255.R01.S.doc Version 5.2 Page 29 - 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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