Inspection on 15/05/07 for The Orchards

This inspection was carried out on 15th May 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Orchards 20/11/07

The Orchards 20/09/06

The Orchards 09/03/06

The Orchards 09/08/05

The Orchards 07/03/05

The Orchards 17/09/04

The Orchards 15/01/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Orchards The 164 Shard End Crescent Shard End Birmingham West Midlands B34 7BP Lead Inspector Lisa Evitts Unannounced Inspection 15th May 2007 09:45 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 Orchards The DS0000024876.V339758.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. Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchards The Address 164 Shard End Crescent Shard End Birmingham West Midlands B34 7BP 0121 730 2040 0121 730 1655 theorchards@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Limited 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) Vacant post Care Home 72 Category(ies) of Dementia - over 65 years of age (72), Old age, registration, with number not falling within any other category (72) of places Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 66 persons requiring nursing care and 6 persons requiring residential care The home may accommodate 5 named residents between 50 and 65 years of age. 20th September 2006 Date of last inspection Brief Description of the Service: The Orchards is a modern purpose built care home first registered in 1998 and situated in a residential area close to local shops and public transport links. The home provides 24 hour nursing, residential and respite care for a maximum of 72 older people. This includes the provision of transitional care for up to sixteen older people who are in need of short-term care arranged by two Primary Care Trusts. The home can also provide care to residents with Dementia. Accommodation is available over two floors and each bedroom is for single occupancy with an en suite facility. Provision can be made for two companion bedrooms if required, subject to availability. There are two good-sized lounges and one dining room on each floor. The first floor is serviced by two passenger lifts. Corridors are wide and spacious and have handrails to enable residents to move freely around the home with any mobility aids they may require. The home has a hair salon. There are four assisted bathrooms and two assisted shower rooms, which meet the needs of the residents. There is a pleasant enclosed courtyard with a variety of attractive features and with easy access for residents. There are three disabled parking spaces and limited parking spaces available at the front of the home however there is ample space to the rear of the building. CCTV is unobtrusively installed. There are a number of notice boards in the reception area, which provide relevant information about the home and forthcoming events, which may be of interest to residents and visitors. The current scale of charges for the home range from £343 - £609. Additional costs include, hairdressing, toiletries, chiropody and newspapers. Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced visit was undertaken by two inspectors over seven and a half hours and was partly assisted by the Operations Manager. Feedback about the visit was given to the Operations Manager at the end of the day. There were 63 residents living at the home on the day of the visit and two of these were receiving hospital care. Information was gathered from speaking to residents, staff and two relatives and staff were observed performing their duties. Care, Health and Safety and staff records were reviewed. Management of medication was reviewed and a partial tour of the building was undertaken. Information has also been collected from complaints received and Regulation 37 notifications. CSCI had received some concerns pertaining to the management of the home and the administration of medication and these concerns were reviewed during the visit. The outcome of this is written in the main body of the report. There has been a decline in the service provided by the home since the Registered Manager left employment at the home. Staff training was taking place on the day of the visit to include, Abuse, Protection Of Vulnerable Adults and Whistle blowing which provides staff with guidelines to follow in the event of an allegation of abuse. No immediate requirements were made on the day of the visit. What the service does well: Residents receive a wholesome and nutritious diet, which meets any dietary, cultural needs and preferences, and there is always a choice of meals on offer. Residents using the service have access to a range of Health and Social Care Professionals and this ensures that any health care needs are met. Aids and adaptations are provided so that independence, choice and dignity of people using the service are promoted whilst maintaining their safety. Regular maintenance checks of this equipment ensure that it is safe to use. Residents are provided with a homely, clean and comfortable environment in which to live where their privacy is maintained. Comments received included: “I have lived here for a month now, it is very good” “We are very happy with the care that dad is getting” “My brother and my nieces visit me here” “The food here is very good, they give us what we like” Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 6 “I’m not kept waiting” “There are plenty of staff and they are very nice” What has improved since the last inspection? What they could do better: 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. Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 7 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 Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents have some information about the home to enable them to make an informed decision about living there. Pre admission assessments are undertaken to ensure that the home can meet the individual residents identified needs. EVIDENCE: The Service User Guide and Statement of Purpose were taken for review as part of the post fieldwork analysis. Both of these documents were on display in the reception area of the home, which ensures that the information is available for residents and visitors to read if they require. These documents are available on audiocassette and this ensures that people who have sensory impairments have alternative ways of accessing the information. The information in these documents requires updating to ensure that the information available to residents reflects the current service provided. Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 9 Comprehensive pre admission assessments are undertaken prior to residents coming into the home and this should ensure that individual residents needs can be met while living there. It is recommended that the needs of the residents already living at the home are also taken into consideration, when assessing prospective residents as a number of residents at the home currently had Dementia, and one resident spoken to said “I don’t sit with other people because there’s not really anyone here who I can talk to“. Another resident said “I have lived here for a month now, it is very good”. Copies of previous inspection reports were available in the main reception area of the home, but did not include a copy of the most recent inspection report dated September 2006. This does not ensure that residents are provided with up to date information about the home. Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments do not reflect the required care in all cases and this does not ensure that staff have sufficient details to follow to meet individual identified needs. The management of medication does not ensure that residents receive medication prescribed for them. EVIDENCE: Each resident has a care plan written. This is an individualised plan about what the person is able to do independently and states what assistance is required from staff in order for the resident to maintain their needs. Three care files were reviewed in detail and one file was partly reviewed. One file was for a resident who had come to the home on numerous occasions for respite care. Residents who come for respite care have a short stay file, which provides assessments for moving and handling, risk of skin sores and nutritional assessments. The resident had come to the home in March 2007 for Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 11 two weeks, there were no further entries made in the daily records from 27 March 2007 until 16 April 2007, which suggests that the resident had returned home during this time, but documentation was not clear. There was an entry in the daily records that the resident had now become a permanent resident at the home, however the care file had not been reviewed and updated to reflect this. Upon discussion with the Operations Manager she did not think that the resident was permanent at the home. A bed rail safety risk assessment had been undertaken in November 2006 but staff had not reassessed this risk each time the resident had returned to the home and this is required to ensure that the resident is still deemed safe to use this equipment. One entry in the file stated that the resident was bed bound, however the resident was sat watching TV in the lounge and therefore documentation did not reflect the current care needs. A falls risk assessment indicated that the resident should be checked on one to two hourly but this should be more specific to ensure that staff know when to check the resident. A care plan for catheter care indicated to “clean the catheter at bath time” but did not give staff any further instructions. The plan stated to “flush weekly” but did not say what with. A care plan was in place for falls and injury prevention. The initial assessment for the resident stated to use a hoist for all transfers, however the care plan stated “belt to be used with two staff for all transfers” and this does not ensure that staff use the correct moving and handling technique to safeguard the resident and themselves from harm. The plan stated a call bell was to be within reach and functioning, however the resident was sat in the lounge and was unable to reach the call bell that remained on the wall and therefore staff are not following instructions to ensure safety is maintained and risks are minimised. Care plans for personal hygiene were basic and did not identify personal preferences to ensure that individual needs were met. The resident was unable to communicate needs verbally but no care plan was written to address this need. Another resident commented “I would like to have a shower every day like I used to at home but the staff say there is not enough time” and this does not ensure that personal preferences are being maintained. A second file reviewed showed that reviews were taking place with the resident and his family and the family had commented “We are very happy with the care that dad is getting”. A visitor spoken with said “No I’ve never seen a written care plan” A risk assessment had been written for a resident who was nursed in bed and stated to place the buzzer within reach, however when visiting the resident in their room, the buzzer was not within reach. Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 12 A care plan was in place for being incontinent of urine but there was also a care plan for a catheter and it was not clear which of these were the identified need. A diabetes care plan gave no instructions for staff regarding hypo/hyper glycaemia (low/high sugar levels) and no information what they should do if they thought this may be occurring and this does not safeguard the resident from harm. The resident had been identified at being at risk of weight loss and had been prescribed supplement drinks. On evaluation of the care plan the resident appeared to have gained 10kgs in one month. Staff had failed to follow this up and the resident had remained on supplement drinks. It is also possible that the resident had not been correctly weighed but there was no evidence that this had been checked again. The bed rail safety risk assessment had not been reviewed since 2005 and this is required to ensure that the resident is still deemed safe to use this equipment. The resident had a medical condition, which was likely to cause pain, and upon speaking with the resident he commented, “I’ve got pain all over”. There was no care plan in place to address this need, although pain relief was prescribed. A third file sampled had not had the moving and handling or nutritional risk assessment updated since January 2007 and therefore does not ensure that the information is correct. The manual handling assessment did not reflect that the resident required the assistance of a hoist. A continence assessment had not been completed however the resident was using continence aids. There was no risk assessment on file for the safe use of bedrails and this does not ensure the safety of the residents. Some care plans were not evaluated and did not reflect current care needs and examples of this are a care plan written for limited mobility and use of Zimmer frame had not been reviewed since January 2007 and the resident was now in bed for majority of time. An assessment stated, “Likes meals in the dining room”, however was now having meals in her room. There was a good care plan written for swollen legs and actions for staff to follow to minimise this and it was pleasing from the evaluation that this problem was resolving. A care plan written for a sore heel had large gaps where it had not been completed. There was no evidence that a Tissue Viability Nurse had been contacted for advice, however staff confirmed that the resident had been seen. The wound treatment chart had not been completed between the 28 March 2007 and 21 April 2007 and this does not ensure that staff are monitoring the progress of the wound. Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 13 A resident who was displaying difficult behaviour had a behaviour record but no care plan to indicate any known triggers or management techniques. A short-term care plan had not been written in respect of a rash and creams that had been prescribed and therefore there was no evidence that the creams were being applied and that the condition was being monitored. There was evidence of residents receiving visits from external healthcare professionals including General Practitioners, Tissue Viability Nurses, Community Psychiatric Nurses, Dentists and Opticians. Residents appeared to be well supported by staff to choose clothing appropriate for the time of year and apply make up and wear jewellery, which reflected individual cultural, gender and personal preferences. A number of medications, which had just been received at the home, were left unattended by staff at the nurse’s station in the corridor and this does not ensure the safety of residents who may potentially pick up medication, which could be harmful to them. This was resolved at the time of the visit and the medications were safely stored. Fridge temperatures were recorded daily and were within acceptable ranges to ensure that the medication was stored within its product licence. Medications are signed into the home upon receipt and copies of the prescriptions are kept so that medication received can be checked against the prescription. It was not possible to audit all boxed medications as medication left over had not been carried forward to the next month and therefore there was no audit trail. A number of boxed medications reviewed were not correct according to the MAR (Medication Administration Record) chart and this does not ensure that residents are receiving their medication as prescribed. Variable dose medications were not always recorded as to whether one or two tablets were administered. There were a number of gaps on the MAR charts so it was not possible to determine if the medication had been given or not and staff must ensure that charts are signed to say if residents have taken medication or reasons why it has been omitted. Controlled medication was reviewed and it was of serious concern that a controlled medication was unaccounted for. Staff had identified this but had failed to take appropriate action at the time of the incident and the relevant people were not informed. This was discussed with the Operations Manager at the time of the visit and she was not aware of the incident. A referral was made to the resident’s social worker. The home had notified CSCI by Regulation 37 of another drug error, which had occurred and had taken the appropriate action at the time to ensure the safety of the resident. During the morning, inspectors observed that morning medication was still being administered at 10.45. The lunchtime drug round commences at 12.30 and this does not ensure that there is a four hour gap between medication administration and this may affect the safety and well being of the residents. Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 14 Due to the number of concerns found with medication administration, the home must undertake a review of its procedures, practice, staff knowledge and competence and identify how this can be improved. This will be monitored and if improvements are not made then the Commission may consider enforcement action to safeguard residents living at the home. A payphone is available in a small lounge and this provides a private space for residents to make personal calls. Alternatively residents can have their own phone installed at an additional cost. Orchards The DS0000024876.V339758.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents are able to exercise choice regarding the activities they choose to participate in which promotes their individuality and independence. Residents are offered a choice of meals, which meet any special dietary, cultural needs or preferences. EVIDENCE: Since the last inspection at the home in September 2006, the activity coordinator had left employment. A previous administrator of the home had changed jobs to undertake this role. The current hours allocated to the home for the activities role is 27 and a half and it is recommended that this is increased due to the size of the home and different individual residents needs. It was also recommended that the activities coordinator undertakes training to assist her in this role. On the day of the visit the activities coordinator was covering for holidays and managing the administration of the home and therefore was unable to undertake her new role. Staff were seen to assist residents to read newspapers and watch television. The activity programme was reviewed and consisted of memory lane, skittles, sing a long, board games, ball games, beauty care, arts and crafts and bingo. Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 16 External entertainers visit the home and exercises to music are provided for those residents who wish to join in the activities. The hairdresser visits each week to provide hair care for residents who choose this. Exercises to music had been organised for the afternoon of the day of the visit however one resident spoken to said, “I have no idea what is going on this afternoon”. Staff must ensure that residents are aware of any activities that are available. A church service is held once a month for residents who wish to join in this activity and the home has a daily delivery of newspapers. One residents care file stated that she would like to attend the church service but this request had not been met. There was no evidence during this visit of any planned outings or trips outside of the home, however there were photographs on display of previous trips outside the home. The home has a monthly newsletter, which is available for residents on CD and audiocassette, and this assists residents with visual impairments to receive the information. Each resident has an individual activity record and these showed evidence of sing a longs, games, one to one chats, skittles, musical instruments and visits by family and friends. Activity records were not up to date due to the activity coordinator working in the office. One resident had not had any activities recorded since February 2007 but the coordinator stated that she had taken part in one to one discussions and reminiscence. One resident who spent all of the time in bed has records made of “listening to music” but no other activities were recorded. One resident who often did not wish to take part in activities had no records made that she had chosen not to be involved. It is recommended that any activities are recorded including activities offered to residents and their outcomes. A resident commented, “I don’t sit with other people because there is no one to talk to and tend to spend most of my time watching TV in my room” The home has an open visiting policy and this enables residents to receive visitors as they choose and at anytime. One resident said “My brother and my nieces visit me here” and one relative said “I visit my wife every morning”. The home has a four-week rolling menu and these identified a range of meals. The home was currently trialling the main meal in the evening instead of at lunchtime. The chef attends residents meetings so that resident’s opinions on the menu can be sought and changes made to the menu if required. There are hot and cold options available at lunchtime and alternatives are available if the resident does not want either of the choices available. Fresh fruit is available on request throughout the day and a cooked breakfast is available on Sundays if chosen. The lunchtime was observed and staff were seen to assist residents appropriately to respect their dignity and independence. Dining tables were attractively laid and music was playing in the background. Soft diets were served to residents who had swallowing difficulties and these portions were served separately so that the residents could choose what they were eating Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 17 and experience the taste and texture of the foods. Cold drinks were served with the lunch. The staff at the home can cater for meals for dietary and religious requirements and on the day of the inspection were providing soft and diabetic diets. Comments from residents included: “The food here is very good, they give us what we like” “The cooked breakfasts are cold” “Someone comes to help me to eat” Orchards The DS0000024876.V339758.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): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Complaints are not accurately recorded and this does not ensure that residents or their representatives can be confident that their complaints are listened to and acted upon. Staff do not consistently follow procedures to ensure that residents are safeguarded from harm. EVIDENCE: The home has a complaints procedure, which is available in the service user guide and on the notice boards in reception. There were two complaints procedures on display in the reception area of the home and these had different information included. One gave contact details and stated that CSCI could be informed of any complaints but the other procedure did not state this. Names of senior staff in the organisation were identified on the complaints procedure and in the service user guide and statement of purpose, however these made reference to people who no longer worked for the organisation and this does not ensure that residents or their representatives know who to make a complaint should they need to. It is required that this information is updated to reflect the current procedure to be followed so that residents and their representatives have current information and know who to contact should they need to make a complaint. Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 19 CSCI have received three complaints since the last visit to the home in September 2006, and these were referred back to the provider to investigate using their own complaints procedure. The home had received four complaints. Documentation pertaining to these was poor and it was not clear for all the complaints, what the details of the complaint were or the outcome. There were two complaints, which had outcome letters, but copies of the actual complaints were not available. One complaint had been referred as an adult protection but there was no outcome recorded and another complaint had no outcome recorded. A complaint received by CSCI and referred to the provider to investigate had not been recorded into the complaints record. The Operations Manager also informed inspectors that there was another complaint regarding a member of staff, which was being investiagted, but this was not recorded. This does not ensure that complaints are recorded; investigated and appropriate actions are taken to ensure that satisfactory outcomes are achieved and that any risks are minimised. It is required that any complaint received is recorded along with details of any investigations and the outcome. There were a number of thank you cards on display throughout the home and this suggests satisfaction with the service being provided. The home had leaflets on display, which advertised an advocacy service, and this is seen as good practice as enables residents to make their own choices. The home has an adult protection policy which incorporated the Department of Health’s, ‘No Secrets’ policy and the home had copies of Birmingham, Coventry and Solihull Multi Agency Guidelines and this provides staff with guidelines to follow in the event of an allegation of abuse. There had been two incidents, which had been raised as adult protections, these had been dealt with by the home appropriately and the cases were now closed. It was of concern that two further possible adult protections were identified during the inspection and staff had failed to follow the correct procedures and report the incidents appropriately. These were discussed with the Operations Manager on the day of the visit and appropriate referrals were made to ensure that residents are safeguarded from harm. Staff have received Protection Of Vulnerable Adults training however one member of staff spoken to was unable to clearly state the procedure to follow and was unable to identify the lead agency. This does not ensure that staff have the knowledge in order to report allegations or incidents appropriately to safeguard the residents living at the home. Orchards The DS0000024876.V339758.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): 19, 20, 21, 22, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with a homely, clean and comfortable environment in which to live where their privacy is maintained. An accessible call facility is not always available to ensure that residents can summon help when required. EVIDENCE: Access to the home is via a doorbell and CCTV covers the reception area. On the day of the visit to the home, a member of staff opened the door to the inspectors but did not ask who we were or who we had come to see and this does not ensure that residents are safeguarded from harm. Staff must be aware of who is in the building and who people are visiting to ensure that residents are safe. A partial tour of the building was completed and areas seen were homely in style and clean and odour free with the exception of some corridor carpets Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 21 which were marked or had faded due to the deep cleaning. The Operations Manager confirmed that new carpets were in this year’s budget to be replaced. Furniture, fixtures and fittings were all of a high standard. The reception area is spacious and has seating areas and information about the home available for residents or visitors to read if they require. The home has spacious corridors and handrails and this enables residents to move freely around the home with the use of any mobility aids they may require. There is a passenger lift available to the first floor. The home has hoists available for use on each floor, and a stand aid to assist residents where this equipment is required. The home has a number of pressure relieving mattresses, the Primary Care Trust funds some of these and maintenance checks are completed on these to ensure they are in full working order. These mattresses assist in the prevention of skin sores and were seen in use on the day of the visit. There are two lounges and a dining room on each floor. During the morning the inspector sat in the lounge on the ground floor with three residents. It was of concern that these residents were unable to summon help from staff should it be required as they were unable to reach the call bell facility. The door to the lounge was closed and no staff were available in the lounge for half an hour and therefore residents were left unsupervised. A resident who is nursed in bed was unable to reach the call facility in his room and had to wait for staff to check on him and this is not acceptable as residents must be able to call for help as required. The resident said, “I would like to have a call bell”. The home has assisted bathing and shower facilities, which were all homely in style and met the needs of residents living at the home. Assisted toilets were available and had handrails and raised seats as required assisting residents who may require these facilities. These facilities assist residents to maintain their independence for as long as possible. There is access to an enclosed garden via a French door in the small lounge or from a number of ground floor bedrooms and wheelchair access was good. There was a courtyard area and a canopy for residents to sit under and the choice of wooden benches or chairs and tables to sit at. Bedrooms seen were personalised and reflected individual tastes, gender and cultural preferences. Residents are encouraged to bring in their own possessions in order to have familiar items around them to make their rooms as homely as possible. Bedroom doors have locks, which can be overridden in an emergency but one resident spoken to said, “I have asked for a key but they say I cant because of safety”. This was discussed with the Operations Manager who was to review the risk to the resident and it was confirmed following the inspection that the resident had been given a key to their room. Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 22 The laundry area was not reviewed during this visit. The kitchen area was spacious and clean and cleaning schedules were in place. A previous recommendation for more freezer space had been addressed and another freezer had been purchased and this will ensure that the home has the appropriate storage space for foods. Door closures had been fitted to fire doors to ensure that they would close automatically in the event of a fire. Door guards had been ordered to enable residents to keep their bedroom doors open if they required whilst ensuring that they would close in the event of a fire and this will be reviewed at the next visit to the home. Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 23 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. Residents are supported to meet their needs by an appropriate number of staff who receive training, to provide the knowledge, to ensure that staff are competent in their roles. EVIDENCE: In addition to nursing and care staff the home employs, maintenance, domestic, kitchen and administrative staff and this ensure that all the identified needs of the residents are maintained. There were no staff vacancies at the time of the visit to the home. During the day there is a qualified nurse and six care staff on each floor, and a third qualified nurse works across both floors to provide support where required. During the night time hours there are three care staff and a qualified nurse on each floor to support and assist residents to meet their needs. Comments received included: “All the girls are great” “Just ask and they come and do” “There are plenty of staff and they are very nice” “I’m not kept waiting” “They try and help when they can” Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 24 “Sometimes staff say I’ve only got one pair of hands and they shouldn’t speak abruptly”. This comment was brought to the attention of the Operations Manager on the day of the visit as staff must ensure that they maintain good relationships with the residents at all times. 74 of staff have achieved a National Vocational Qualification (NVQ) and a further six staff are enrolled to commence this training. This should ensure that a skilled and knowledgeable workforce can meet the needs of residents individually and collectively. Three staff files were reviewed and were found to contain most information required with the exception of a risk assessment for a member of staff following a declaration on the Criminal Records Bureau check. One member of staff did not have a reference from the last employer, which is required and one reference for another member of staff was sent via email and therefore was not signed or on headed paper. It is recommended that references are verified to ensure that the person who was requested to do so has written them. There was evidence that qualified nurses Person Identification Numbers were checked with the Nursing and Midwifery Council to ensure that they are currently registered and fit to practice. There was evidence on the staff files that staff receive formal counselling and supervision sessions and good evidence that staff are supported to meet their training and development requirements and this should assist in the provision of a skilled and knowledgeable workforce. There was Abuse, Protection Of Vulnerable Adults and Whistle blowing training taking place on the day of the visit to the home, training had recently taken place for Health and Safety. The home has a six-month in house training plan and each member of staff had an individual training record, copies of certificates were available to confirm attendance. The home has an in house trainer and two moving and handling trainers, which ensures that staff receive the appropriate training. The home has devised a training matrix and this was reviewed as part of the post fieldwork analysis. This indicates that staff have received training in fire safety, food hygiene, moving and handling, COSHH (Control Of Substances Hazardous to Health), Health and Safety, infection control, and medication. On the most recent member of staff file, there was evidence that an induction programme had been commenced to ensure that the staff member was introduced to policies and procedures within the home and to residents, and this will ensure that the staff member has the knowledge to perform competently within their role. Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is in need of a stable management team to ensure that the home is run in the best interests of the residents. There are systems in place to monitor the quality of the service on offer. Maintenance checks of equipment used ensure that the safety of residents is protected. EVIDENCE: Since the last visit to the home in September 2006, the Registered Manager had left employment at the home. The Deputy Manager was acting manager however on the day of the visit, she was on annual leave and therefore there were no managers available. CSCI had received some concerns relating to the management of the home and these were discussed with the Operations Manager. Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 26 The organisation had identified the need for a manager for the home and a new manager has been appointed and is due to commence in June 2007. In the interim a project manager is to over see the home and ensure that it is run in the best interests of the residents. One member of staff spoken to said, “We need a manager”. The Operations Manager stated that a residents meeting had been held in March but there were no minutes available to determine what was discussed at the meeting. Previous meeting minutes were available. No staff meetings had been held since January 2007 and therefore staff did not have the opportunity to discuss ideas and concerns. The Organisation has a quality assurance system to monitor the service provided. This includes internal monthly audits including the building, care plans, skin sores, vacancies, accidents, kitchen and recruitment. The Operations Manager visits the home and writes a Regulation 26 visit report each month and these were available for review. Each year the home sends out satisfaction questionnaires to residents, family and external stakeholders and produces a report about the service provided and how it can be further improved. Comment cards are displayed within the home at all times and can be used by residents or visitors to the home. Since the last visit to the home, the procedure for holding residents personal monies had been changed. Each resident had an individual record of monies received and debited from their finances and receipts were available to confirm purchases made. From the records available it was not possible to determine if the home had the correct amounts of money for each resident. There was no clear audit trail for the money and the total amount of money that the home should have was unaccounted for. Some of this money had been paid into a bank account so that it was secure but records were not clear how much had been paid into the bank. Two days after the visit the Operations Manager confirmed that the organisations administrator had been into the home and they had reverted back to the previous system in which each resident had an individual packet for their money. This will be reviewed again at the next visit to the home. Accident records were reviewed and these are audited each month to highlight any trends that could be minimised. A quarterly summary is also completed. It was of concern that in the accident book, there were two incidents of unexplained bruising that had not been reported to social workers or to CSCI as per Regulation 37. These reports were still in the accident book and had not been reviewed by a senior person to ensure that appropriate action had been taken. This was brought to the attention of the Operations Manager and was referred to the resident’s social worker as a potential adult protection. Health and safety checks were maintained on hoists, wheelchairs, window restrictors, passenger lifts and nurse call systems to ensure that they are safe Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 27 for staff and residents of the home. There was no current gas safety certificate available in the home and it is required that these documents are available for inspection to ensure that appliances are safe to use. Staff had undertaken fire training and a recent fire drill had been completed to ensure that staff have the knowledge to act appropriately and safeguard the residents in the event of a fire. The fire alarm and emergency lighting is serviced to ensure that the equipment is in full working order and a weekly check on the fire alarm is maintained. Water temperature checks were recorded each month and this assists in the prevention of residents accidentally scalding themselves. Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 2 X 3 3 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 3 X 2 X X 3 Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4,5 Requirement The Statement of Purpose and Service User Guide must be updated to provide residents with current information about the home. Each resident must have an individual care plan outlining their care needs and the specific support required by staff to meet these needs. Known triggers or management techniques for difficult behaviours must be recorded so that the behaviours can be minimised where possible. Wound treatment charts must be completed to show that monitoring of the wound is taking place. Bed rail risk assessments must be reviewed to ensure the safety of residents living at the home. Moving and Handling risk assessments must state actual equipment to be used and be updated to ensure that staff know what equipment to use. Residents must have access to a call bell to enable them to call or DS0000024876.V339758.R01.S.doc Timescale for action 10/07/07 2. OP7 12 15 03/07/07 3. OP7 15 03/07/07 4. OP7 12(1)(a) 03/07/07 5. 6. OP7 13(4) 13(4) 22/07/07 22/07/07 OP7 7. OP7 OP22 13(4) 15/06/07 Orchards The Version 5.2 Page 30 8. OP9 13(2) help as required. A carry forward system must be completed to ensure that an audit trail can be followed to ensure residents are receiving their medication. Variable doses must be recorded to ensure that an audit trail can be followed to ensure residents are receiving their medication. The timing of medication rounds must be reviewed to ensure that there is at least a four-hour gap in-between administration. Medication Administration Records must be signed. (Previous timescale of 10/11/06 not met) The complaints procedure must be updated to provide current information to residents and representatives. Any complaint received must be recorded along with details of any investigations and the outcome. Risk assessments must be written following declarations on CRB forms to ensure the safety of residents. One reference must be from the last employer in order to safeguard residents. 29/06/07 9. OP16 22 06/07/07 10. OP29 13(4) 19 Sch 2 13(4) 19 Sch 2 26/06/07 11. OP29 26/06/07 Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 31 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. 2. Refer to Standard OP3 OP12 Good Practice Recommendations It is recommended that the needs of other residents living at the home are taken into consideration when completing pre admission assessments. It is recommended that the number of hours for activities is reviewed. It is recommended that the activity coordinator undertakes training in this role. It is recommended that any activities are recorded including activities offered to residents and their outcomes. It is recommended that laundry staff wear disposable gloves. (Previous recommendation, not assessed on this occasion) It is recommended that email references are verified. 3. 4. OP26 OP29 Orchards The DS0000024876.V339758.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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