Inspection on 16/10/08 for The Orchards

This inspection was carried out on 16th October 2008.

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

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 10/10/06

The Orchards 04/10/05

The Orchards 23/06/05

The Orchards 09/09/04

The Orchards 05/04/04

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 17/12/2008.

CARE HOMES FOR OLDER PEOPLE Orchards (The) Orchards (The) 1 Perrys Lane Wroughton Swindon Wilts SN4 9AX Lead Inspector Pauline Lintern Unannounced Inspection 09:30 16 October 2008 th 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) DS0000050595.V372962.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) DS0000050595.V372962.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchards (The) Address Orchards (The) 1 Perrys Lane Wroughton Swindon Wilts SN4 9AX 01793 812242 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) orchards45@aol.com Buckland Care Ltd Vacant Care Home 35 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (32) of places Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 17 service users in total with dementia (DE and DE(E)) may be accommodated. This is a temporary arrangement and subject to conditions 2 and 3 below. When the accomodation occupied by the 10 of the 16 current service users with dementia aged 65 years and over iis no longer required, the maximum number of service users in the category DE(E) must be reduced to a maximum of 6. No service users with dementia to be accommodated on the second floor. 10th October 2006 3. Date of last inspection Brief Description of the Service: The Orchards is one of a number of homes owned by Buckland Care Limited. The Orchards provides accommodation and personal care to a total of 35 service users. The home is located in the village of Wroughton and is close to local shops and public amenities. The home is a large three-storey building set in its own well-maintained grounds. Service users’ bedrooms are located on three floors and can be reached by either a passenger lift or a stair lift and each room has an emergency call bell installed. The home has an attractive conservatory that is appropriately furnished and allows service users the benefit of extra communal space. The fees for living at the home range from £420 to £560 per week, depending on needs. Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star. This means the people who use this service experience adequate quality outcomes. The key unannounced inspection took place over seven hours on the 16th October 2008. The manager, Mrs Buckingham and the deputy manager were available throughout the day to assist us. Feedback was given to Mrs Buckingham at the end of the inspection. We had the opportunity to meet with people using the service to obtain their views, both in private and in communal areas. As part of our inspection, surveys were sent out to a random sample of people using the service, their relatives and representatives and health care professionals. Comments received are included in this report. A tour of the premises took place and the majority of people’s bedrooms were viewed. We looked at four care plans in detail. In addition, medication records, staff recruitment files, training records and health and safety documents and risk assessments were sampled. We met with two members of staff in private to obtain their views. Prior to our visit we asked the manager to complete an Annual Quality Assurance Assessment (AQAA). This was completed and returned to us, which provided us with information about the service. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: Within the four returned surveys, people told us that they had received enough information about the home, so that they could decide if it was the right place for them. One comment was: ‘we were desperate to find a pleasant home for mother and the Orchards went out of their way to help us.’ A full assessment of each person’s needs is carried out to ensure that they can be met. Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 6 Meals are of a high standard, with plenty of fresh vegetables and fruit available. The menu offers choices of food and drinks. People using the service are able to make choices about the way they live their life, such as, when to go to bed and when to get up. People are able to stay in their bedrooms if they wish to do so. The home has a nice relaxed and homely atmosphere. People appeared to enjoy interacting with each other in the communal areas. Staff members communicate well with the people living at the home. Generally, staff are inducted, recruited, trained and supervised properly. What has improved since the last inspection? What they could do better: Following the initial assessment, the manager should confirm in writing that the home is able to meet the person’s needs. Care plans could be more focused to ensure that the needs of the people with dementia are fully considered. There is little evidence to demonstrate that staff have explored what may be important to the person, through discussion with families and friends. Although there is a key worker system in place, some people weren’t aware of who their key worker was. Generally, the recording of medication was very good. However, there were a couple of unexplained gaps. When had written entries are made on the medication administration record, they must be signed and dated by two Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 7 people. Consideration should be given to purchasing a medication cupboard for the storage of controlled medication, which meets the new legislation. Some daily records provide the reader with insufficient information, such as what the day has been like for the person using the service. Regular checks of hot water temperatures must be carried out and records kept to ensure the safety of the people using the service. 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) DS0000050595.V372962.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are fully assessed to ensure that the home is able to meet their needs. However, they must confirm in writing that they are able to currently meet the needs of the person. Information is available to enable people to decide if the home is the right place for them. EVIDENCE: Case files demonstrate that prospective residents are fully assessed to ensure that the home is able to meet their needs. Assessments cover all aspects of the person’s needs. The records of two recently admitted people were examined. Assessments for both had been completed, which detail care needs, social needs, medical information and likes and dislikes. The risk assessments had not been Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 10 completed at the time of our visit. The manager explained that they like to have time to get to know the person before they complete the risk assessments to ensure that they are correct. Consideration should be given to any potential risks, which may occur during this interim period. Following the initial assessment the home must confirm in writing that they are able to meet the person’s needs. Following a requirement set at the last inspection the manager confirmed that the Statement of Purpose and Service User Guide is currently being updated to include current information. Within surveys, four out of four people confirmed that they have received a contract. It is recommended that the home apply to have the second condition of registration removed as the person referred to no longer resides at the home. Mrs Buckingham has also continued to admit people who have dementia when the conditions say not to. This home does not provide intermediate care. Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each person has a care plan in place, which is kept under review. Care plans for people with dementia could be further improved. People tell us that they have access to health care services when they are needed. The arrangements for managing medication is satisfactory, however greater care must be taken when completing the administration records. People told us that they are treated with respect and their right to privacy is upheld. EVIDENCE: The care plans of five people were examined in detail. Evidence shows that the plans are kept under review and reflect their assessed needs. Care plans are signed and dated by the person receiving the service. Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 12 Risk assessments are carried out, which include nutritional assessments, mobility assessment, and pressure sore and continence assessments. Weights are monitored and recorded monthly. Care plans contain limited information on the person’s personal history. For people with dementia, we would expect the care plan to detail more information on the person’s past and their likes, dislikes, past hobbies and interests. Files would benefit from having pictures or photographs or developing a separate ‘life book’ to enable staff to spend time talking to the person about things that they are interested in and highlight things of importance to the person. When this was suggested to Mrs Buckingham, she reported that they thought this would be a good idea and that she had thought of doing something like this. The home has a key worker system in place, however some people did not know whom their key worker was. It was suggested that a photograph and the name of the key worker be placed in people’s bedrooms so that they could be reminded of this. Mrs Buckingham said that she thought that this would be helpful for people using the service. It did not appear that a great deal of thought had been given, to ensuring current good practice and knowledge of working with people with dementia was taking place. The manager explained that dementia training had been planned for the previous day, however it had to be cancelled due to the trainer becoming ill. She confirmed that another date would be booked as soon as possible. Staff training records indicates that some staff have already attended training in dementia, however it is clear that the service could be improved if there was a better awareness of the needs of people with dementia. We sampled daily notes of four people. Some contained adequate information, however others recorded ‘all personal care given or no problems’. This does not provide the reader with sufficient information on what the outcomes of the day had been like for that person. The manager reported that she would remind the staff of the importance of good recording. One person has stated within their care plan that they wish to continue accessing the community independently. They have signed a declaration stating this and their relatives have endorsed it. A risk assessment is in place to support this decision. On the day of our visit the person was making plans to go out in the afternoon with another person using the service. They confirmed that this decision is important to them. People told us that they have access to various health care professionals as and when they are needed. The manager confirmed that they have a good relationship with the district nurse who makes regular visits to the home. Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 13 The home hold weekly GP surgeries. People are encouraged to use a GP of their choice. The pharmacy carries out six monthly audits on the handling of medication by the home. The manager reported that they have been rated as ‘excellent’. At the time of our visit nobody was self administering their medication. Medication files have a photograph of the recipient on the front and there is a copy of the medication procedure in place. Administration records were generally good, however there were a couple of unexplained gaps. It appeared to be when medication had been refused. Care needs to be taken to ensure that an explanation is recorded. When hand written entries are made on the administration record these must be signed and dated by two staff. When ‘as required’ medication is prescribed, this should be explained fully within the care plan to detail when it should be given, doses and indicators as to why it should be administered. Care plans should also list current prescribed medication. We discussed the need for a new medication cabinet for the storage of controlled medication, which is in line with new legislation. During our visit, it was noted that people were interacting with each other in communal areas. Staff members were observed chatting with the people they support and involving them in conversations. People told us that staff treat them respectfully and maintain their privacy when they are being supported with their personal care. Generally feedback from the people using the service was good. Comments included: ‘I am well fed and watered, couldn’t do better in a 1st class hotel’, ‘I have made a lot of friends here, I’m happy and have a comfortable room, everything I need really’ and ‘I have been here a long time and I am really happy, I’ve everything I need’. Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 14 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): NMS 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an activities programme in place to meet individual needs. Family and friends are welcome at the home. People are enabled to make choices about the way they live their life. People told us that they enjoy the meals at the home. EVIDENCE: Mrs Buckingam reported that they have recently recruited an activities coordinator for the home. Planned activities for the month of October include: armchair activities, 40’s music, arts and crafts, quizzes, cards, floor basketball, dominos, dice game, sing-a-long, film afternoon, dance and movement, music for health and resident’s meetings. One person told us ‘I particularly like the quizzes and sing –a longs’. One relative told us ‘mother does enjoy the activities and the parties the Orchards hold are very good, especially those which include the families, I wish they could do more activities though’. Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 15 The deputy reported that they are planning a Halloween party for October. She added that they involve families in cheese and wine parties, BBQ’s, bingo nights and family quiz nights. One person told us that they keep themselves occupied and prefer to not join in the arranged activities. The manager told us that they have recently had a greenhouse erected in the garden and she is hoping to encourage the people using the service to take part in a gardening project, where they will be able to grow plants etc. People told us that they could make decisions regarding their daily routines, such as when to go to bed and when to rise. One person explained that they ‘feel like I am in a prison, as I cannot go out on my own any more, but I understand that the staff have to make sure that I am safe’. Some people told us that they prefer to stay in their rooms and that this choice is respected. One person commented: ‘they ask me what I want to do’, another person added:’ sometimes the staff will take us out for a walk or we go shopping’. The home has a chef who has worked there for a number of years. Menus sampled showed that meals are varied and well balanced. People are able to make choices of meal options. An example of a main mid-day meal is Beef Provencal, 2 vegetables and parsley potatoes. The desert was pineapple turnover and custard. Tea consists of sandwiches or cheese omelette and chips and baked beans with fruit and yogurt to follow. Supper is a choice of cheese and biscuits, sandwiches, crisps and various drink options. The kitchen has a deep cleaning rota in place, which is completed daily. Fridge and freezer temperatures are checked and recorded daily and hot food is probed and recorded to ensure safe temperatures are met. The chef has attended a basic Food Hygiene course. People spoke well of the meals provided by the home. Comments included: ‘we have very good food’, ‘some food I don’t like, so I just tell them and I don’t have to eat it’, and ‘meals are first class, they get to know what you like, it is excellent and you don’t have to do the washing up’. Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 16 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): NMS 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People told us that they know how to make a complaint if necessary. Policies and procedures are in place to protect people from abuse where possible. EVIDENCE: The home has a complaints log in place. The AQAA states: the home has received three complaints in the last twelve months, and that they were all dealt with within 28 days, in line with company policy. People we spoke to confirmed that they knew how to make a complaint or raise any concerns they may have. Within surveys, two people said that they always know who to speak to if they are not happy and one person said they usually knew. Within the AQAA, it states: the complaints policy and procedure has been recently updated and that staff have received training in this. Over the past twelve months there has been two safeguarding referrals made and one safeguarding investigation. This resulted in an individual being moved to a more appropriate placement where their needs could be better met. Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 17 Copies of Wiltshire and Swindon’s ‘No Secrets’ guidance was on display in the home. Staff members who met with us confirmed that they had received safeguarding training. Staff were able to explain what they would do if they suspected that abuse had taken place. The home has a ‘whistle blowing ‘ policy in place. Staff training records demonstrate that the majority of staff have attended abuse awareness training. Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 18 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): NMS 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service benefit from living in a comfortable and well maintained environment. The home is clean and hygienic. EVIDENCE: On the day of our visit we found the home to be clean and tidy with no unpleasant odours. We spent time touring the building. This included most bedrooms and bathrooms and toilets. Bedrooms were found to be comfortable, clean and tidy. Some people had brought in various pieces of furniture, pictures, photographs and ornaments to make the room more personal. People told us that they were happy with the standard of accommodation. Many rooms have recently been refurbished. Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 19 Within surveys, one person said, the home is always clean and fresh and three people said that it usually was. One person commented: ‘ I am aware of the smell of urine more often these days. When X moved in last year, it never smelt. The bedroom is nice but the loo needs cleaning’. The manager reported that they have recently appointed a new maintenance man, who was making a good job of keeping on top of repairs. He is employed for 13 hours a week. The manager explained that the doors to the downstairs toilets need altering to ensure further privacy. Plans are in place for this work to be started in the near future. Each room has a call system in place to alert staff, if help or assistance is required. It was noted that when the call bell was pulled a staff member attended straight away. People using the service confirmed that staff attend to the bells as quick as they can. There is a large bathroom downstairs, which the hairdresser works from on her weekly visits. The manager explained that they had experienced some flooding problems earlier in the year. This has now been rectified by a new soak away system being fitted. The flood had affected some areas of the home, but these are being repaired. The home has a laundry, which houses two washing machine and two driers. There are currently 3 housekeepers employed at the home. Generally people appeared happy with the laundry service. One person commented: ‘they bring it back all folded up nicely and put it away for you’. One person told us that they were upset, as their jumper had gone missing since they moved to the home. This was discussed with the manager during feedback. Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 20 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): NMS 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are properly recruited and inducted but, to fully meet the needs of the people they support more attention must be given to increasing their underpinning knowledge in dementia care. EVIDENCE: The manager told us that they are currently fully staffed and are not using agency staff to cover shifts. The rota shows that there is usually five staff on duty in the morning, four in the afternoon and two waking night staff. People using the service confirmed that there is enough staff on duty to meet their needs. Within surveys, four out of four people confirmed that staff are available when they are needed and that they listen and act on what people say to them. One staff member reported that ‘sometimes we could do with more staff on duty’, another member of staff, also reported that on some occasions more staff would be beneficial. One staff member commented: ‘I don’t feel we always get enough time for one to one with the people we support’. One person living at the home told us that staff do not have the time to sit and chat with them. When we spoke to their relative they confirmed that the person had not settled particularly well into the care home, and might benefit Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 21 from having someone to chat to regularly. This person was not aware of who their key worker was. This was further discussed in feedback at the end of the inspection. One relative told us in their survey form ‘from what I can see, looking from the outside so to speak, the staff seem fairly responsive except during their own meal breaks’. This was later discussed with Mrs Buckingham. One person living at the home told us ‘the staff treat me nice’. In our survey we asked the question, do the care staff have the right skills and experience to look after people properly?. Two people said always and two said usually. One comment received was: ‘most of the staff hold National Vocational Qualification (NVQ) and appear experienced in the care they provide’. The manager confirmed that the staff team is currently a good mix of ages and experience, which works very well. Recruitment records are well ordered and indicate that recruitment and induction are well managed. One staff member, who had not had previous care experience, reported that they shadowed a more experienced member of staff for a week when they commenced employment at the Orchards. They added that they feel confident with the amount of information provided within the care plans to carry out their duties. Recruitment records of four staff members were sampled and found to be satisfactory. However, one person had an unexplained gap in their employment history. Care needs to be taken to ensure any gaps are explored and recorded. Records show that all necessary safeguarding checks are completed prior to a member of staff working at the home. Two references are sought along with proof of identity. Staff receive mandatory training such as fire awareness, manual handling, first aid, basic food hygiene, health and safety and abuse awareness. Staff are trained in the safe handling of medication before they are deemed competent to administer medication. Staff are trained in Infection Control and as mentioned earlier in this report, some staff have received training dementia awareness. There is a training matrix in place, which details when courses have been completed. Within the AQAA it states: ‘we could improve by offering more training to staff in dementia care and palliative care’. As stated earlier in this report, a recently booked dementia course had to be cancelled due to the trainer becoming ill. Mrs Buckingham reported that all new staff are given a copy of ‘Best Working Practice for Working with People with Dementia. Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 22 Two senior members of staff have NVQ level 3, two staff have level 2 and four staff are due to start their level 2. The deputy is currently completing her Registered Manager’s Award. Generally people using the service spoke well of the staff team. Orchards (The) DS0000050595.V372962.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): NMS 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Mrs Buckingham has recently attended a ‘fit person’ interview with CSCI. A notice of proposal to refuse this application has been served. The outcome of this process has not yet been determined. The home is run in the best interests of the people living there, however lack of underpinning knowledge in dementia care may result in people not receiving the best outcomes. People have their financial interests safeguarded. The health and safety of staff and the people using the service is promoted by policies and procedures. EVIDENCE: Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 24 Mrs Buckingham has recently attended a ‘fit person’ interview with CSCI. A notice of proposal to refuse this application has been served. The outcome of this process has not yet been determined. The registered provider must nominate a person who has the relevant skills to manage the service. Mrs Buckingham reported that she has completed her Registered Manager’s Award and is now completing additional care units. We would expect Mrs Buckingham to be proactive in obtaining updated current good practice guidelines in meeting the needs of people with dementia. Under regulation 37 the Commission should be informed of any adverse event, which may affect the people living at the home. There have been two events, where we should have been notified. One was when a blockage in the toilet caused a flood in the home and also when the police brought a person back to the home. Both were submitted retrospectively. The manager needs to ensure that all staff are aware of the notification procedure. Monthly management audits are completed. The last audit was in October 2008. Monthly residents meetings are held and a newsletter is published to inform people of events and news. The manager reported that they have just held their first meeting of the ‘Continuous Improvement Committee’. This has been developed as a forum for people living at the home, staff and housekeepers to share their views and ideas. The manager does not attend the meeting, only a senior member of staff. The manager reported that questionnaires have been sent out to all staff but they have not yet been returned. Surveys were also sent out to the people using the service. We asked how the manager would provide feedback from the outcome of the surveys and she said that this would be done in resident’s meetings. Some personal money is held by the home for individuals. We checked the records and the cash held of three people. All records balanced with the cash held. Records demonstrate that regular health and safety checks are carried out. Environmental risk assessments are in place and currently being updated. The home has a fire risk assessment, which is due for reviewing in October 2008. The lift was last serviced 20/06/08. All toxic materials are stored securely and have the accompanying data. Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 25 It was noted that the hot water outlet in one bedroom was in excess of 43c, which could place people at risk. The manager requested that this was addressed at the time of our visit. We require that all hot water outlets are regularly checked and recorded. All radiators are guarded and all windows have restrictors fitted to them. Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 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 X 3 X 3 X X 3 Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14 (1)d Requirement The registered person must confirm in writing that the care home is able to meet the needs of the person, following assessment. The registered person must ensure that care plans fully reflect people’s needs and how they are to be supported. This is particularly important for people with dementia. The registered person must ensure that all hand written entries on the medication administration record (MAR) sheet are signed and dated by two members of staff. The registered person must ensure that they can demonstrate a sound underpinning knowledge of current good practice guidelines for working with people with dementia. The registered person must ensure that CSCI are notified of any event or incident, which may affect the people using the service. DS0000050595.V372962.R01.S.doc Timescale for action 16/12/08 2. OP7 15 16/12/08 3. OP9 13 (2) 16/11/08 4 OP31 9 (1) bi 16/12/08 6. OP31 37 16/11/08 Orchards (The) Version 5.2 Page 28 7. OP37 37 The registered provider must nominate a person who has the relevant skills to manage the service. 16/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP7 Good Practice Recommendations Any conditions to registration, no longer needed, is applied to be removed. Greater consideration should be given to obtaining information relating to people with dementia’s past interests, hobbies, skills, likes and dislikes. This could then form a ‘life book’ and a working tool for the staff team. Staff should be allocated one to one time with their person that they key work. People using the service and relatives should be reminded who the key worker is. The daily records should contain aspects contributing to peoples’ quality of life rather than generic comments such as: ‘all personal care given’ and ‘no problems’. Protocols for the administration of ‘as required’ (PRN) medication should be included within the individual’s care plan. A list of current prescribed medication should be included in each person’s care plan. Consideration should be given to purchasing a medication cabinet for the storage of controlled medication. This should be the current legislation. All hot water outlets should have regular checks of the water temperatures, which should be recorded. 3. 4. 5. OP7 OP7 OP7 6. 7. 8. 9. OP9 OP9 OP9 OP38 Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Orchards (The) DS0000050595.V372962.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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