Inspection on 20/06/06 for The Orchards

This inspection was carried out on 20th June 2006.

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

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

Other inspections for this house

The Orchards 10/07/07

The Orchards 07/03/06

The Orchards 29/09/05

The Orchards 31/03/05

The Orchards 17/08/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Orchards Orchard Lane Crewkerne Somerset TA18 7AF Lead Inspector Gail Richardson Unannounced Inspection 20th June 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Orchards Address Orchard Lane Crewkerne Somerset TA18 7AF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01823 270694 01823 323270 Somerset Redstone trust Post Vacant Care Home 66 Category(ies) of Old age, not falling within any other category registration, with number (66) of places The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Older persons, who require general nursing care, up to a maximum of 31 people. Nursing placements are permitted only in the `nursing wing` The `nursing wing` will have a named first level nurse, on part 1 or 12 of the NMC register leading the management of nursing care. Mrs Susan Tresidder is currently fulfilling this role. If this member of the management team leaves or is absent for more than 28 days, the CSCI will be informed of alternative arrangements. The Somerset Redstone Trust will give the CSCI copies of the CV, references and qualifications of the first level nurse leading the management of nursing care. Additionally to the availability of at least one registered nurse 24 hours per day, Mrs Tresidder will have no less than two shifts per week `supernumerary` to this roster, for the purpose of strategically managing the nursing care. A maximum of 33 places are permitted in each of the two units Only rooms 4 & 5 of the Nursing Wing may be used for intermediate care`. Service users in these rooms (up to a maximum of 4) are subject to the following conditions:(a) not less than 50 years of age (b) maximum duration of any single admission - 56 days. 3. 4. 5. 6. Date of last inspection Brief Description of the Service: The Orchards consists of two separate units, one for personal care and one for nursing care. The Orchards is owned by Somerset Redstone Trust, a charity that also manages five other units for older people throughout the counties of Somerset, Devon, Hereford and Worcester. The Orchards is situated in the small town of Crewkerne and is within easy walking distance of the town’s amenities, including shops, banks, pubs, dental surgery and small community hospital. The majority of the home’s bedrooms are for single occupancy. There is a passenger lift in each of the two units. The home has a large lawned garden to one side and there is a patio area off the dining room of the nursing unit. The gardens are well maintained and easily accessible. The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on 19th June 2006 by two inspectors, which lasted 8.5 hours. A tour of both units of the home took place and all the bedrooms and communal areas were seen. There were 57 service users and 1 intermediate care resident currently residing at the home, with one service user in hospital. The inspector’s spoke to 14 service users, 2 visitors and 15 members of staff, the Registered Manager was available throughout the day of the inspection. The unit manager of the Social Care unit Suzanne Butts was available for the morning. As part of this inspection the inspectors surveyed the opinions of a random selection of 30 of service users and their representatives, GP’s, District Nurses and Care Workers. A small amount of responses were received. Records relating to care, staff, finances and health and safety were examined The inspectors noted that service users appeared settled and comfortable and there was a pleasant atmosphere within the nursing unit. The social care unit has been under a period of disruption due to staffing shortages and building work taking place and the report will reflected this. The service users looked well cared for with an attention to detail of personal care was evident. Staff spoken to were complimentary about working in the home and time spent by the inspectors observing staff, evidenced that they were kind and caring towards service users and spoke to them at all time with support and reassurance. Both visitors spoken to were pleased with the care their relatives were receiving and confirmed that they were always made very welcome to the home at any time. The inspectors would like to thank the service users and staff for their time and hospitality through out the inspection. The inspector would like to clarify that the home consists of two separate units and in the writing of this report the judgement of the overall outcomes are reflective of the home as a whole unit. The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 6 The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are; - excellent, good, adequate and poor. What the service does well: What has improved since the last inspection? What they could do better: The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 7 The Service User Guide requires updating to ensure the correct management details are available and all service users are required to have a contract with the home and this needs to include the number of the room to be occupied. Care plan recording has improved since the last inspection but requires further work. Cares planning for service users receiving intermediate care are recommended to have a plan of action to ensure supported rehabilitation takes place. The recording of medication on the Medication Administration Records requires review in the Social Care Wing and the provision of lockable storage for service users wishing to self medicate. Further activity planning and recording is required in the Social Care Wing. Further decoration of the home is required. Staff files required further review to ensure that recruitment practices protect the service users. The practice of destroying identification documents requires review. An overview of staff training is required to ensure that the Managers of both units can unsure that all mandatory staff training has taken place. Inspectors noted that clinical waste bags were being stored on the floor next to full bins in the car park An Immediate Requirement was issued to ensure safe storage of clinical waste. It is recommended that the storage of wheelchairs and equipment in bathrooms is altered and alternative suitable storage is found. Further Health and Safety issues were raised at feedback with the Registered Manager and are outlined in the report and the requirements and recommendations issued. 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 Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 123456 The overall quality rating for this section is assessed as adequate. Social Services contracts are available; contracts with the home were not up to date for all service users. Those contracts seen require the room numbers to be included. The service consults all assessment information to see if they can meet the prospective residents needs before they make the decision to accept the application for admission and offer a placement. The assessments process of placements in the social care wing requires review. Service users and their representatives have the opportunity to visit the home prior to admission to assess its suitability. Service users admitted solely for intermediate care are helped to maximise their independence. EVIDENCE: The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 10 The service users guide is available to all service users prior to admission and contains details of the philosophy of care of the home, details of the home, staff and contractual terms and conditions. Contacts were seen. Social services funded residents had a financial contract from them and most cases a contract with the home. Not all service users had a contract and the contracts did not include the room number. There was evidence of pre-admission assessments and service users confirmed that they had received a visit from a representative of the home prior to admission. It was also confirmed by service users that they had the opportunity to visit the home prior to admission. Service users spoken to in the Social Care Wing had not viewed the home prior to admission. All had assessments carried out by the Head of Care or the Head of Nursing also included an NHS assessments for service users who had been admitted from hospital. The head of unit from The Orchard completes the pre assessment document at the pre admission visit and this then becomes the admission sheet stored in the service users files. The criteria for admission into the social care unit require review to ensure that the service users needs can be met. Intermediate care was being provided for one service user awaiting a bed in the social care unit. Whilst care and support were being given there was no plan of action to promote rehabilitation to maximise independence available in the service users care plan. The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 The overall quality rating for this section is assessed as adequate. There was first hand evidence of good care outcomes for service users, however, the care planning system needs to be reviewed to fully reflect the service users needs, to include all risks, protocols for managing these risks and reviews of all its components to which service users are involved. There was evidence of good links with other health professionals to enable service user health needs to be met and maintained. The systems for the medicines was well organised and efficient in the Nursing Unit. Service users who were able and wished to, were supported to be responsible for their own medication. Personal support was offered in such a way as to maintain privacy and dignity of service users. EVIDENCE: The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 12 Three care plans were seen on the nursing unit. All demonstrated good awareness of service user needs. There was very little evidence of service user/ representatives involvement in the care planning process and review. Evidence was seen in several rooms of food and fluid charts and charts monitoring a change of position. All were completed and signed and supported by the evidence seen. Two Care plans were seen in the Social Care Unit. It was noted that not all issued raised in the Social services assessment had been addressed in the homes care plan. These issues were not being addressed in the service users care and were having a negative effect on the dynamic of the home. Risk assessments were not in place for all service users who may wander or may become aggressive and are required to ensure the safety of all service users. These care plans lacked the detail and holistic approach to care planning that would ensure that all service users needs and preferences were being met. Two service users, who spoke to the inspector was unaware of the care plan written for them or any reviews that taken place. Access to health and social care professionals was well evidenced in the plans of care and contact wit families and representatives was recorded. Service users spoken to were happy to confirm that they feel well cared for and spoke very highly of the staff and the care they are receiving Comments include “Staff are very good here”, “It’s like a home, not an institution” “Staff are very kind and look after me”. All care was provided in private and the use of “do not disturb” signs supported This. Both inspectors’ evidenced staff dealing wit service users in a kind and considerate manner and were seen treating service users with dignity and respect. The administration, storage, documentation and disposal of medications were inspected in both areas and found to be well managed. Some gaps were evident in the Medication Administration Records contained at the Social Care Unit. In the social care unit persons who part medicated had lockable drawers in bedrooms to keep medication safe. In the nursing unit anybody who wished to and was able to part self medicate was risk assessed and supported to do so. However , not all service users had a lockable cupboard in their rooms to store medication. The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 13 The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 The overall quality rating for this section is assessed as good. Service users are supported to lead the lifestyle they wish and have opportunities to participate in leisure activities. Service users maintain contact with family and friends and are supported in being part of the community. Service users rooms are decorated to reflect their own choices and lifestyles. The meals in the home are plentiful and nourishing providing good variety and taking into account personal choice. EVIDENCE: Service users spoken to were able to confirm that they were able to get up and go to bed when they wanted to. They also confirmed that were able to remain in their rooms if they wished too. The home employs and activities organisers for the nursing unit and the Social Care wing. The inspectors evidenced a range of activities through the morning which included the activities organiser helping with the mail , she than sat for a The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 15 while reading to a service user. The organiser then went around the rooms with a small mobile shop. Later activities in the lounge included a flexercise class, which 9 service users participated and enjoyed. This involved gentle exercising the upper body and hands. This was followed by an enjoyable game of inflatable darts, which promoted memory and coordination. The notice board evidenced further activities including a church service. One service user explained that she likes to go out into the town with the activities coordinator to look around the shops. No actives were seen in the social care wing, the notice board did not contain any planned activities and care plans reviewed did not all contain a social care assessment record. One service user commented, “There are no trips out and not much going on “ Visitors to the nursing unit confirmed that they were always made welcome at any time. Service users rooms were decorated in a manner, which reflected their tastes and lifestyles. Evidence was seen of people’s own furniture in their bedrooms. Lunch observed was appetising and plentiful. Care staff spoken to had a good understanding of service users dietary needs. The menu offers a choice and service users were satisfied with the meals provided. Special diets were seen for diabetic and vegetarian service users and pureed diets were served separately. On the day of inspection lunch consisted of Chicken cobbler, mashed potato, peas, carrots ,corn and Gravy Or Corned beef salad with potato if requested. Desert was a choice of rhubarb crumble and custard, Crème Caramel, Tapioca or tinned fruit. Service users spoke positively about the standard of the food.One service user commented that, “The food is very good, lots of choices” The dining room was pleasantly decorated and suitable equipment was used. Staff assisted service users with eating and drinking in a discreet manner. The sample menu available in the Social Care wing contained the previous name of the home and requires updating. The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 The overall quality rating for this section is assessed as adequate. The home has a satisfactory complaints procedure that enables action to be taken. The homes recruitment procedures protect service users from the potential risk of harm or abuse EVIDENCE: There are no complaints registered at the Nursing Unit since 2003. One complaint had been received and investigated in the Social Care Unit. No record of any response or outcome was recorded. Service users spoken to by inspectors, who were able, were confident that the managers of each unit would deal with any issues they may have promptly. One service user discussed a complaint they had which was being dealt with at the time by the Nurse in Charge. The complaints procedure is available and contains the correct information. Staff were able to confirm that they had read the Whistle blowing policy. Recruitment files were examined for staff members recruited since the previous inspection. POVA First and Enhanced CRB checks were seen. The practice of destroying POVA First documents received once CRB checks have arrived requires review. Some record of the receipt of the POVA check is required to remain on the staff file. The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 17 The current practice prevents inspectors evidencing that staff members had received POVA checks before commencing employment. The home is also required to ensure that some means of identification are stored on staff files and not all destroyed when the CRB checks are completed. One staff members file showed that the reference names provided were not the ones contained within the file. The most recent employer did not provide these references. The Registered Manager will investigate this issue. A clear audit trail is required to ensure that any reasons for a change in reference request is recorded and the reasons given. Further issues regarding staff risk assessment and supervision had not been maintained to ensure suitability of staff and the levels of training needed to support these staff. The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 The overall quality rating for this section is assessed as excellent. Service users benefit from comfortable, homely and generally well maintained environment. Communal areas both indoor and outdoor provide safe and comfortable areas. There are adequate lavatories and washing facilities available in the nursing unit. There is specialist equipment available for service users to maximise their independence. Bedrooms are personalised according to service user preference. All the areas of the home are kept clean and tidy. EVIDENCE: The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 19 A tour of the home was made and the inspector visited all public, some private and some staff areas. All areas of the home were clean, tidy and free from unpleasant odours. The Registered Manager confirmed that a plan of maintenance and decoration is underway. On the day of inspection the upstairs lounge was being re decorated. Some bedrooms were in need of re decoration and it is planned that service users will be involved in choosing the colours etc. of their rooms. Corridor areas of the nursing unit are in need of redecoration. The communal areas in the nursing unit are light and airy and the outdoor space was wheelchair accessed. The gardens appeared well tended. The social care wing has an attractive back garden and a enclosed patio accessible from the living areas. Suitably equipped toilets were seen. On the nursing unit shower rooms on both floors were being used as storerooms and the upper shower room had a malodour. This was discussed with the Registered Manager and will be addressed. The bathroom within the Social Care Unit, which had previously required repair, is now in full working order. The Nursing Unit kitchen area also has been decorated. A tour of the Nursing unit evidenced that service users requiring specialist pressure relieving equipment and hoists had access to them. Bed rails were suitably fitted. Wheelchairs seen appeared in good condition and had footplates fitted. A tour of the Social Care Wing was undertaken and the inspector noted works taking place to enable a new treatment room and office space to be developed Most rooms are for single occupancy, where rooms are shared this is with the agreement of the service users. Service user bedrooms seen were comfortable and personalised with their own belongings. The Nursing unit was clean, tidy and free from offensive odours. The domestic and laundry staff felt the hours worked were adequate to maintain this level of hygiene. It was noted in the Social Care Wing that clinical waste disposal bins were not identified. This is required to be undertaken, to ensure correct disposal of all clinical waste. The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 20 Controls of infection measures were satisfactory and minimised any risk of cross infection. The laundry systems for disposal of soiled linen and clothing were very hygienic The sluice doors were all kept locked. The staff were wearing suitable clothing and aprons, gloves and hand wash were evident in all areas of both units. The inspector observed staff washing hands between care of service users. Inspectors observed that in the car park clinical waste bags were piled on the floor at the side of two full clinical waste bins. An immediate requirement was made that the home must make satisfactory arrangements for the disposal of clinical waste. In Line with Regulation 16(2)(k) of the Care Homes regulations 2001 An action plan was subsequently received by the inspector from the Registered Manager confirming that the clinical waste bags have been removed and further systems are now in place to prevent a further occurrence of this situation. The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 The overall quality rating for this section is assessed as adequate. The Nursing Care unit is adequately staffed by suitably experienced staff. The Social Care unit requires further recruitment of staff to ensure service users needs are met. The homes recruitment practices are not thorough. EVIDENCE: The head of the Nursing Unit is John Olawuni and the head of the Social Care unit is Suzanne Butts. The Nursing Unit is suitably staffed at all times. Agency staff are used to ensure suitable staffing levels to meet service users needs. On the day of inspection on duty was ; The Registered Manager and Administrator One Qualified Nurse and six care staff On the morning of inspection there was one cleaner and one Laundry staff. There is normally two domestic staff but due to sickness one cleaning staff had moved to the laundry. Previous inspection had evidenced a shortage in kitchen staff; this position has now been filled. Staff confirmed that the level of staff was adequate to meet service users needs. The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 22 Service users confirmed that they were happy with the level of care received. Comments included: “Anything you want hey will get you”, “Staff are very nice “, “Staff are all very good-they do what they can “. The Social Care unit had undergone a period of poor staffing and had lacked the support of a Registered Manager, Recruitment is currently underway. The Manager of the Social Care Wing explained that training and supervision were not up to date, as the unit had undergone a period of poor staffing. Staff training is ongoing. Both heads of unit are currently undertaking the Registered Managers Award. In house training is provided and covers Manual Handling, Fire Training, Health and Safety, Food Hygiene, First Aid and staff have the opportunity to undertake NVQ training. Staff confirmed that training is provided and they are encouraged to undertake updates. Staff training had been provided by the District Nurse within the Social Care Wing. Further training is required for staff to identify the difference between involuntary aggression and Dementia to ensure the correct care is given to service users. The Registered Manager confirmed that whilst a staff-training matrix is not available to see an overview of all staff training, this would be implemented. Five staff files were examined, recruitment records were much improved since the previous inspection but continued to be incomplete. See standard 18. One contract was not signed and photographs were missing. The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 34 36 37 38 The overall quality rating for this section is assessed as adequate. The position of Registered Manager has recently been filled; the heads of care adequately manages each unit. Financial arrangements within the home are good. Record keeping and storage are in line with the Data Protection Act. Health and safety arrangements ensure that staff and service users are protected in most areas. EVIDENCE: The two dedicated heads of care manage the units. The Registered Manager is new to the post and is currently undergoing orientation. The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 24 All staff, service users and visitors spoken to were positive about the management and felt able to raise concerns and felt that their ideas are listened to. There is a questionnaire at the entrance inviting visitors to provide feedback about the service. The home has a key worker system that staff understood. The care team has a good representation from established staff and all staff members spoken with regarded their team as supportive and the management as open and inclusive. Staff meetings are being held at the moment, as an opportunity for the new Manager to introduce herself and gain ideas and feedback from the staff. Service users financial arrangements were evidenced and all arrangements were satisfactory. The Social Care Unit had received a donation to the staff fund. Clear records of all monies received for a staff fund must be kept with a policy containing details of all monies received and spent and storage arrangement for this money. Staff supervision is ongoing by the heads of each unit and suitable records are kept. Records required for inspection were stored appropriately in both units. A tour of the premises was made and most areas were free from hazards. A range of maintenance records were examined and satisfactory checks were carried out for Fire Equipment and systems Fire alarm Tests Emergency Lighting The Homes Insurance Certificate Water temperature, Legionella checks Nurse call Alarms Gas service Certificate Hoist servicing Wheelchair Maintenance COSHH Data Sheets Some records were not available at inspection and the Registered manager will forward them to the CSCI offices. These include PAT testing for the nursing unit Lift Certificate for the nursing unit The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 25 Some Health and safety issues were raised with the Registered Manager ; The Fire Risk Assessment is out of date. Dental Tablets were seen in several service users rooms. Staff members who are pregnant had not been risk assessed. The Social Care Wing risk assessments for the environment and equipment had not been reviewed since 2004. Hand wash pump dispensers were being refilled from a larger bottle and therefore the contents were no longer what was advised on the original bottle. The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 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 3 1 3 3 3 2 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 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 1 2 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 3 X 3 3 3 1 The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 27 Are there any outstanding requirements from the last inspection? 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 OP2 Regulation 5(1)(b) Requirement The home is required to ensure that all service users have a contract, the contract is required to have the room number to be occupied, recorded within he contract. The Registered manager is required to ensure that all aspects of care and risk assessment are recorded in the service users care plan and reviewed at regular intervals. The home is required to ensure that the Medication Administration Records in the Social Care Unit are complete and any medication not given is recorded with the suitable indicator. Lockable storage space must be provided for any service user who is self medicating 4. OP20 16(2)(k) Immediate Requirement was made to ensure the safe disposal of clinical waste stored on the floor in the care park Two references are required for DS0000060598.V294567.R01.S.doc Timescale for action 01/08/06 2. OP7 15(1) 01/08/06 3. OP9 13(2) 01/08/06 19/08/06 5. OP29 1994)(c) 01/08/06 Page 28 The Orchards Version 5.1 6. OP38 12(1)(a) all new employees, one reference must be received from the previous employer. The Home is required to review the practice of storing dental Tablets in service users bathrooms without lockable facilities. The decanting of hand wash solution form a main bottle to bottles stored around the home, is required to be reviewed 01/08/06 7. OP38 12(1)(a) The Registered Manager is required to ensure that the Fire Risk Assessment is updated Environmental risk assessments are also required to be updated in the Social care Wing 01/08/06 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 OP7 OP12 Good Practice Recommendations It is recommended that any service users receiving intermediate care have a plan of rehabilitation involving a multidisciplinary team. It is strongly recommended that the manager of the Social Care Wing review the activities programmed for service users and ensures that adequate recreational activity is provided. The Registered Manager is recommended to review the practice of destroying the record of personal identification and POVA check once the staff has received the CRB. Evidence must be retailed of supervision provided during the period of time between the POVA arriving and the CRB arriving. The inspectors recommend that the bathrooms are not to be used as stores for wheelchairs and equipment. DS0000060598.V294567.R01.S.doc Version 5.1 Page 29 3. OP18 4. OP21 The Orchards 5. 6. 7. OP30 OP27 OP38 It is recommended that staff receive further training in all aspects of the care to be provided including dealing with aggression. Inspectors recommend that further recruitment takes place to ensure adequate staffing of the Social Care Wing It is recommended that staff who are currently pregnant be risk assessed each trimester of the pregnancy. The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Orchards DS0000060598.V294567.R01.S.doc Version 5.1 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!