Inspection on 20/09/06 for The Orchards

This inspection was carried out on 20th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 15/05/07

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 20th September 2006 10:30 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 Orchards The DS0000024876.V312631.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.V312631.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 None 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) Mrs Kathleen Kirby 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.V312631.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. 9th March 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. 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 spacious lounges and one dining room on both floors. There is a pleasant enclosed courtyard with a variety of attractive features, which is within easy access for residents. The first floor is serviced by two passenger lifts. The home has a hair salon and the hairdresser visits once a week. The home has hoists and pressure relieving equipment available to meet the assessed needs of the residents at the home. There are assisted toilets and bathrooms available and corridors are wide and spacious and enable residents to move around the home freely with any mobility aids they require. Security is good at the home and CCTV is unobtrusively installed, to monitor the car park and reception area. There is limited parking space available at the front of the home however there is ample space to the rear of the building. In the reception area of the home there is a range of information available including menus, activities and the complaints procedure. The previous inspection report for the home is on display and this ensures that visitors to the home can freely access information. The current scales of charges for the home are £373 - £400 and £609 for selffunding residents. Additional charges for the home include chiropody, hairdressing and toiletries. There is no charge for newspapers for permanent residents of the home. Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced fieldwork was undertaken by two inspectors over eight hours and was assisted by the Registered Manager. There were 65 residents living at the home on the day of the inspection. Information was gathered from speaking with the residents and staff, from observing care staff perform their duties and from examining care and health and safety records. Medication procedures were reviewed. Staff personnel files were sampled and a partial tour of the building was undertaken. Prior to the inspection the manager had completed a pre inspection questionnaire and returned it to CSCI, and this gave some information about the home, staff and residents that was also considered. No immediate requirements were made on the day of the fieldwork visit. What the service does well: The home provides information to residents to enable them to make an informed decision about moving into the home. Comprehensive pre admission assessments are undertaken and this ensures that both the resident and the home know that individual care needs can be met. There are a variety of activities on offer should the residents wish to participate and residents are free to go out with relatives as they choose. 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. Personal allowances can be safely held by the home if requested by the residents. The home is regularly monitored for quality and resident’s views are sought and acted upon. Residents are involved in changes they would like to see in the home. The home provides a good atmosphere where staff were observed to interact well with residents. Comments from residents included: “I like everything about it and I would recommend it to everyone” “Its like home” “I’m very well looked after” “I get all the care I need, very much so” Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 6 “I like the food” “I get good meals” “Its good here, its a good place to have” “I like this room” “The staff are helpful” “The staff are very nice, from the cleaners to the nurses, very good and very friendly” 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. Orchards The DS0000024876.V312631.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.V312631.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 & 5 The quality outcome of this area is good. This judgement has been made using available evidence including a visit to the service. Prospective residents have information they need to make an informed choice about where to live. The home completes thorough assessments and gathers pre admission information and this enables the home to ensure that they can meet the needs of the residents. EVIDENCE: The organisation has produced a comprehensive statement of purpose and service user guide, which contains all the information, required, and ensures that prospective residents are given information about the home, which will enable them to make an informed decision about living at the home. These are available in large print on request and on audiocassette, which assists anyone with visual impairments to access the information. The certificates of registration and liability insurance are on display in the reception area which enables anyone to see them when visiting the home. Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 9 Residents are issued with contracts and this ensures that they are informed of terms and conditions of stay at the home. The home offers a four-week trial period, which gives the resident opportunity to sample life at the home and enable them to make an informed decision as to whether they would like to live there permanently. Pre admission assessments were reviewed and were found to be comprehensive and this ensures that the home can meet the assessed needs of the residents prior to admission. A separate assessment is completed for prospective residents with dementia needs and this was found to be comprehensive. Prospective residents are invited to visit the home and have lunch with other residents, and relatives are welcome to visit the home prior to residents being admitted and this provides opportunities for residents and families to sample life at the home before deciding whether they would like to have a trial period. Letters are sent to residents who had come to the home under transitional care and had chosen to become permanent at the home, to state that the home could meet their needs. The letter also identified who the named nurse would be and this provides the residents with information about their continued stay at the home. One resident stated “I like everything about it and I would recommend it to everyone” and another said “Its like home” Orchards The DS0000024876.V312631.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 The quality outcome of this area is adequate. This judgement has been made using available evidence including a visit to the service. Residents’ health and personal care needs are well met by the nursing and care staff. Residents are cared for in a respectful manner by staff and this ensures that their dignity and self-esteem are maintained. Some care plans require more specific details to ensure that staff have sufficient details to follow. The management of medication requires enhancing to 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. Some care plans had good details recorded such as “wears hearing aid in left ear” and “staff to watch/look at her face while helping as she will change her expression” but other care plans required amending to include more specific details of the care to be afforded to the residents. Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 11 Residents who come to the home under the transitional care criteria have a short stay care file, where the staff can monitor and assess the needs of the residents to ensure that a suitable further placement is found, and this should prevent the resident being inappropriately placed, therefore causing minimal disruption to their care needs. Falls risk assessments, nutritional risk assessments and sore skin risk assessments were completed and evaluated monthly. A recent admission into the home had a falls risk assessment completed which stated “safety rails to be in use with bumpers” however no rails or bumpers were available in the residents bedroom and staff must ensure that records reflect the actual care being delivered. Pressure relieving equipment was seen in use. Assessments for the use of hoists and slings were undertaken, however the care plans did not detail the specific equipment that individual residents had been assessed as requiring and this does not ensure that staff use the correct equipment. One resident appeared to be exhibiting challenging behaviour and while a care plan was in place, it is required that a behaviour chart was implemented to try and establish any pattern or triggers to the behaviour so that these could be minimised to prevent further occurrence of the behaviour. One resident in the home did not have English as a first language. A care plan had been written to assist staff to communicate with this resident however needed more detail to ensure that staff knew who could communicate with the resident and what signs could be used in order to enable them to communicate effectively. One resident had Diabetes and was using oxygen therapy however no care plans were in place for these and therefore does not give staff any instructions to follow if the residents condition should change. There was good evidence of care plan reviews taking place and details were changed on the care plans to reflect changes. There was evidence that families had been involved in the reviews and one relative had written “Happy with care” and signed the relative’s communication record. There was good detail recorded pertaining to skin sores including size and position of sore, photographs of the wound and details of the dressing to be used. The tissue viability nurse had reviewed a resident and had made specific requests for a resident to be repositioned and gave time limits before the next change of position. This information had not been transferred into the care plan and this does not ensure that this information is passed onto the care staff. Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 12 There was evidence of residents receiving visits from external healthcare professionals including General Practitioners, Tissue Viability Nurses, Continuing Healthcare Nurses and Opticians. Daily records were very detailed and included information about how the resident had spent their day, any visitors received and any changes to condition. 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. Comments from residents included: “I’m very well looked after” “I get all the care I need, very much so” The management of medication was reviewed on both floors, staff signature lists were available to identify who had administered the medication and warning notices for oxygen storage were in place. Generally medications were administered as prescribed with the exception of boxed medications for pain relief, where some audits completed were incorrect and this indicated that some of these tablets had not been given. Some gaps were seen on Medication Administration Records (MAR) and staff must ensure that they sign or give a reason for not administrating prescribed medication. Eye drops were dated upon opening and this ensures that they are discarded when out of date to prevent any infection. A recent admission into the home had a hand written MAR chart but there were no staff signatures recorded and the drugs were not signed in so no audit trail was available. Copies of prescriptions were available for staff to check and two nurses check warfarin, which minimises the risk of an incorrect dose being administered. Daily checks were recorded for fridge and room temperatures and this ensures that medication is stored within its product licence. Controlled drugs were appropriately stored and audits were correct. A payphone is available in a small lounge and this provides a private space for residents to make personal calls. Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 13 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 quality outcome of this area is excellent. This judgement has been made using available evidence including a visit to the service. Residents are able to exercise choice over their daily lives and the activities that they choose to participate in which promotes their individuality and independence. Residents receive a wholesome and varied diet, which meets any special dietary, cultural needs or preferences. EVIDENCE: A new activities coordinator had been employed at the home since the last fieldwork visit to the home; she had been a carer at the home and therefore had good knowledge of the residents needs. Activities on offer included concerts, nail painting, massages, crochet, knitting, skittles, fruit tasting and outside entertainers. An autumn fair was planned and the hairdresser visits weekly. 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. The coordinator was keeping a diary and was talking to residents and their families to find out more about their life histories and has asked relatives to bring in old photographs, which can be used to discuss the past. The documentation provided by the organisation for recording of activities is limited and only allows for a record of the activity participated in. Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 14 Following discussion with the coordinator it was evident that she wanted to record more detail and document any change or progress and it was recommended that she devise a document, which would enable this recording to take place. Residents who remain in their rooms for medical reasons or own choice have one to one time spent where staff read to them or play games and this ensures that they continue to be stimulated. One resident said, “there is concerts and bingo here, I don’t join in yet, maybe when I feel better” This shows that residents know what activities are available in the home and have the choice to attend or not. Staff had devised a picture board for a resident who was unable to communicate verbally and this enables the resident to express needs. The home has organised trips out to the Botanical Gardens, seaside, Cadbury World and Wolverhampton and takes groups of residents out for meals. This ensures that residents are able to maintain links with the local community and take interest in local attractions as they choose. The home has an open visiting policy and this enables residents to receive visitors as they choose and at anytime. One resident had spent the weekend with his niece and this enables residents to maintain close contact with their families. The home has a four-week rolling menu and these identified a range of nutritious meals and the residents had been involved in the reviewing of the menus. Two choices are offered at both mealtimes and a cooked breakfast is available if chosen. Alternatives are available if a resident does not want either of the main options available. Fresh fruit and snacks are available throughout the day. Milky drinks and biscuits are available before bed. Pureed meals were available for residents with swallowing difficulties and these were appropriately served. Food was cooked for residents who required special diets for medical reasons. One resident required a special diet for cultural reasons and this was provided by the home. Separate storage space and utensils were kept for the preparation of the food. Lunchtime was observed and staff were seen to assist resident’s with their meals appropriately to promote dignity. The choice of meal on the day of the visit was steak and kidney pie or lasagne. Meals were attractively served and good size portions were given. Tables were attractively laid with tablecloths, cutlery, vases of flowers and the menu. Comments from residents included: “Food is good, we get plenty” “I like the food” “I get good meals” Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 15 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 quality outcome of this area is good. This judgement has been made using available evidence including a visit to the service. The complaints procedure is comprehensive and accessible to residents and their representatives should they need to make a complaint. The home has systems in place to protect residents from abuse. EVIDENCE: The complaints procedure was on display in the main reception area of the home and included contact details for CSCI, this ensures that residents and representatives have access to the procedure as required and are aware who they can contact if they wish to raise any concerns. CSCI had received one complaint pertaining to the home since the last fieldwork visit to the home and this had been referred to the provider to investigate using the homes own complaints procedure. The home had received two other complaints since the last inspection and the Registered Manager had dealt with the complaints in a timely manner. Response letters and correspondence was available with the complaint and the outcome was clear. A holding letter had been sent to a complainant to inform them of a delay in completing an investigation and this is good practice to ensure that the complainant is aware at what stage their complaint is at. There were a number of thank you cards on display on a notice board in the corridor, which indicate satisfaction with the service the home provides. Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 16 Leaflets for an advocacy service were available throughout the home and this is commendable as such services assist residents and their families to exercise personal autonomy and choice over their lives. The organisation has a comprehensive adult protection policy for staff to follow, and this includes contact details for Adults and Communities and CSCI. This policy had been updated since the last visit to the home. The Registered Manager was unable to locate the Birmingham or Solihull Multi agency guidelines, however has informed CSCI since the visit that the home has received new copies of these documents and this will ensure that staff have guidelines to follow in the event of an allegation of abuse. The majority of staff had recently had training in the protection of vulnerable adults and this ensures that they have the knowledge and skills to act appropriately to protect residents in the event of an allegation of abuse. Staff spoken to during the visit gave good answers on the procedure to follow should they suspect any form of abuse. The home has a Whistle blowing policy to ensure that staff have the knowledge to protect clients/service users without fear of any reprisals. The home follow the correct procedures for reporting any incidents or concerns that may be of an adult protection nature and this ensures that residents are safeguarded from harm. Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 17 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 quality outcome of this area is good. This judgement has been made using available evidence including a visit to the service. Residents are provided with a homely, clean, comfortable and safe environment in which to live where their privacy is maintained. Aids and adaptations provided meet the needs of residents and promote their independence. EVIDENCE: Access to the home is via a doorbell and CCTV covers the reception area, which ensures that staff know who is in the building, and this assists in safeguarding residents from harm. 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 which were in need of deep cleaning. Furniture, fixtures and fittings were all of a high standard. A range of seating was available to meet different heights and needs. Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 18 The reception area is pleasant and spacious and has some seating areas. There are two lounges and a dining room on each floor and there was a good atmosphere in the home where staff were observed interacting with the residents. 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 three hoists available for use on each floor to assist with residents where this equipment is required. A letter from a physiotherapist, which had recommended that a standing hoist would be a good investment, was seen, and it was pleasing that the home had acted on this recommendation and a stand aid had been purchased five months later. This will ensure that residents can maintain as much independence as possible for as long as assessed as being safe to do this. Stairways to the first floor were in need of redecoration to ensure that they were clean and homely. The home has five assisted bath facilities and four assisted shower facilities, which were all homely in style and met the needs of residents living at the home. Staff are able to assist residents who require help, one resident said “I can’t look after myself without help”. One bathroom door had a broken lock and this does not ensure the resident’s privacy is maintained and this will require remedial action. Assisted toilets were available and had handrails and raised seats as required to assist residents who may require these facilities. 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. Access to the enclosed garden was via a French door 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. One resident was observed outside walking with her wheeled frame and residents can access the garden at anytime during the day. 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. A shared room reviewed had appropriate screening to ensure that privacy was maintained. Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 19 Comments from residents included: “Its like home” “Its good here, its a good place to have” “I like this room” There was an effective and hygienic system in place for the laundry of resident’s personal clothing and bed linen. Staff were observed to be using rubber gloves and it was recommended that disposable gloves are used in order to prevent the spread of infection. There are coded locks on the laundry room door to prevent resident’s access and therefore safeguards them from harm. The Environmental Health Officer had recently completed a visit to the home and the report was positive with only two recommendations for the home to consider improving its current practice. The kitchen area was spacious and clean and cleaning schedules were in place. It is required that more freezer space is sought in order for the staff to store quantities of frozen food, a meat slicer is also required and the manager must ensure that appropriate equipment is available. It was previously recommended that more freezer space was sought and the manager informed the inspectors that this had been actioned however there had been a problem with the delivery of the item. Orchards The DS0000024876.V312631.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 The quality outcome of this area is good. This judgement has been made using available evidence including a visit to the service. The home maintains adequate staffing levels to meet the needs of the residents. Recruitment procedures are robust and ensure that residents are protected. Staff receive training to ensure that they have the knowledge to perform competently within their roles. EVIDENCE: The home currently has no vacancies for staff. In addition to the care staff, the home also employs kitchen, domestic, laundry, maintenance and administrative staff. On review of duty rotas it appears that staffing levels are being maintained satisfactorily and this ensures that staff are available to meet the assessed needs of the residents. Three trained nurses are on duty, in the mornings five care staff and six care staff for the evening shift. On call support is provided for staff out of hours and a member of staff commented that “There is good access to a manger if needed” 70 of care staff have the NVQ level 2 or above in care and this ensures that a skilled and knowledgeable workforce is providing care to the residents. Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 21 Recruitment procedures are robust and ensure that residents are protected from harm. Four files were reviewed and were found to contain all the appropriate checks. Comments from residents included: “The staff are helpful” “The staff are very nice, from the cleaners to the nurses, very good and very friendly” One resident commented, “One or two staff are a bit grumpy”. This was brought to the attention of the manager and it is required that staff receive training in customer care to ensure they are trained and aware of their approaches to residents. Staff have received training in POVA and abuse, pressure ulcer care, infection control, nutrition, administration of medicines, safe use of bed rails, moving and handling, fire safety, food hygiene, COSHH (Control of substances hazardous to health) and health and safety. Induction records were seen for the most recent member of staff to be employed at the home and this training ensures that a knowledgeable and skilled workforce cares for residents. One member of staff is to attend the Yesterday, Today, Tomorrow training which will enable them to train the remaining staff at the home about care of residents with Dementia. One member of staff stated, “There are good training opportunities” The Manager has introduced an “Employee of the month” award. Discussions are held with residents and staff to determine members of staff who have worked particularly well and this ensures that residents are involved and staff morale is boosted. Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 22 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): 31,32,33,35,36 & 38 The quality outcome of this area is excellent. This judgement has been made using available evidence including a visit to the service. The Registered Manager ensures that a good standard of service is provided at the home. There are systems in place to monitor the quality of the service on offer and the systems for resident consultation are good. There are robust procedures in place for the management of resident’s personal monies. Maintenance checks of equipment used ensure that the safety of residents is protected. EVIDENCE: The Registered Manager has been in post for a year and has previous experience as a home manager. She is a Registered Nurse and has a Diploma in Nursing Studies, BSc Hons Degree in community nursing, NVQ Level 5 in Operational Management and is a Moving and Handing trainer. Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 23 The manager had recently updated her moving and handling training certificate and this ensures that she has the current knowledge to train staff at the home. The manager is also undertaking Operations Manager training from the Operations Director of the company and this ensures that she continues to improve her knowledge in order to lead the team at the home. The manager is very keen to ensure that standards are maintained and looks for opportunities to further develop the service provided, the manager was receptive to suggestions made and always responds quickly to requests for information. The majority of requirements made at the last fieldwork visit to the home had been actioned and this ensures that the residents live in a home that meets the Regulations. The Registered Manager aims to hold residents meetings every two months and the minutes from these were available for review. There was evidence that residents views are acted upon and that changes are made following these meetings and this ensures that residents are able to voice their opinions about the home. A staff meeting had been held and a further one was planned in two weeks time and this gives staff the opportunity to raise any concerns or discuss ideas about the home. The Manager completes monthly audits on the home to include skin sores, complaints, care plans, catering, medication, catering, premises and recruitment. An external pharmacy audit is also completed. The Operations Manager completes monitoring visits to the home each month and writes a report as per Regulation 26 and copies of these were available for review. An annual satisfaction survey is sent out to residents and the results of this collated and this ensures that the home continues to monitor the service it provides and continues to identify how further improvements could be made. There is a robust system in place for the management of resident’s personal monies. All residents have an individual record of transactions on a computer system and an individual packet for storing money. Receipts were available for all debits and credits to the accounts. Five residents monies were checked and found to be correct. This ensures that resident’s monies are safely held by the home if the resident chooses this. Supervision records were seen on the staff files reviewed and this ensures that staffs performance is monitored and that any training needs are identified to ensure that the staff perform competently within their job roles. Staff spoken to confirmed supervision sessions were held and one staff member said, “We are well supported” Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 24 Accident records were reviewed and were found to be very detailed. The home manager reviews all accident records and there were clear actions recorded on the forms to identify what had been decided to minimise any further risks. Fire records were reviewed and appropriate checks had been maintained on equipment, including the fire alarm and emergency lighting. Fire doors were checked weekly and there were good records of any discrepancies and corrective action recorded to ensure the safety of the residents. Recent fire drills had been completed and names of staff that attended and comments about how the fire drill was undertaken were recorded and this shows how any poor areas are corrected, to ensure that staff have the knowledge to act appropriately and safeguard the residents in the event of a fire. Water temperature checks were recorded each month and discrepancies were rectified and this assists in the prevention of residents accidentally scalding themselves. Health and safety checks were maintained on gas appliances, hoists, wheelchairs, window restrictors and nurse call systems to ensure that they are safe for safe and residents of the home. Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 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 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 4 3 X 2 Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 12(2)(3)1 5 Requirement Care plans and personal risk assessments must be further developed to include: The actual care to be afforded to residents (Previous timescale of 31/10/05 and 30/04/06 not met) Care plans for specific needs must be written. Residents who are displaying challenging behaviour must have behaviour charts implemented. Care plans for communication must provide specific details of how optimum communication levels are to be achieved. Staff must ensure that boxed pain relief is administered as prescribed. Medication Administration Records must be signed. All medication must be signed in upon receipt into the home. Timescale for action 13/12/06 2. 3. OP7 OP7 15(2)(b) 15 (1) 15/11/06 13/12/06 4. OP9 13(2) 10/11/06 Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 27 5. 6. 7. OP19 OP19 OP19 23(2)(d) 23(2)(c) 16(2)(g) Handwritten MAR charts must be signed by staff members. Some stairways require redecoration. The broken bathroom door lock must be repaired. The manager must ensure that the kitchen has appropriate equipment: Further freezer storage space 31/12/06 13/11/06 08/12/06 8. 9. 10. OP26 OP30 OP38 16(2)(j) 12(5)(b) 13(4)23(4 ) Meat Slicer Corridor carpets must be deep cleaned where required. Staff must receive training in customer care. In the event that bedroom and lounge doors on the first floor are to be kept open, they should be fitted with devices that are linked into the fire alarm system (Previous timescale of 24/04/06 not met) (A quote for the work to be completed has been obtained) 30/11/06 12/01/07 31/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP12 OP26 Good Practice Recommendations It is recommended that a document for detailed recording of activities is devised. It is recommended that laundry staff wear disposable gloves. Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Orchards The DS0000024876.V312631.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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