Inspection on 29/09/05 for The Orchards

This inspection was carried out on 29th September 2005.

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 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 20/06/06

The Orchards 07/03/06

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 Sue Burn Unannounced Inspection 29th September 2005 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.V271890.R01.S.doc Version 5.0 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.V271890.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Orchards Address Orchard Lane Crewkerne Somerset TA18 7AF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01823 270694 01823 323270 Somerset Redstone trust Mrs Angela Joan Watkins Care Home 66 Category(ies) of Old age, not falling within any other category registration, with number (66) of places The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 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. 30-31 March 2005 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.V271890.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors inspected the home over one day as part of the planned programme. The last inspection was unannounced and took place on 30-31 March 2005. Since the last inspection the head of the nursing has left and Mr John Oluwani appointed. The appointment of Mr Oluwani fulfils the conditions of registration of the home. Mr Oluwani is an experienced nurse and has worked at The Orchards for a number of years. Mrs Angela Watkins, Registered Manager, and Mr John Oluwani, Head of Nursing, were both present throughout the inspection. On the day of inspection the home was calm and relaxed and staff were welcoming and helpful to inspectors. Service users all looked well kempt with a small number of people nursed in bed throughout the day. 64 people were living in the home on the day of the inspection, 31 in the nursing unit and 33 in the social care unit. All service users spoken to, and who were able, told the inspector that they were very satisfied with their care, food and accommodation and one person said the staff were excellent. A tour of the premises was made, care in the home observed and a range of records was inspected, including care records. 40 service users and 7 staff were spoken to. All spoke highly of the home. What the service does well: The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 Page 6 Service users benefit from good quality, homely surroundings. They are treated with respect and given suitable privacy for all care interventions The home has thorough pre-admission arrangements that also provide good opportunities for the service user to make a decision about moving in. The home offers a varied menu of home cooked and nutritional meals. Lunch, seen during the inspection, was appetising and plentiful. The home offers a varied activity programme, including regular trips. Service users benefit from a stable staff team, the majority of whom have completed NVQ training in Care. Service users nursing needs are met supported by visiting health professionals. What has improved since the last inspection? What they could do better: A small number of hygiene and health and safety issues are in need of further attention. • The use of bedrails needs to ensure that current arrangements take account of all potential hazards, that is the mattresses that are smaller that the beds. • Oxygen cylinders need to be stored securely with the correct signage. • The laundry door must be locked to ensure that chemicals are stored securely. • The manager needs to take advice on the adequacy of the staff hand washing facilities in the social care unit. It is recommended that clear behavioural/psychological plans are developed to ensure staff consistency of approach. The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 Page 7 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.V271890.R01.S.doc Version 5.0 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.V271890.R01.S.doc Version 5.0 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): 1, 2, 3, 4, 5. The home’s Statement of Purpose and Service User Guide are excellent providing people with up to date details about the services provided at the home. The home has thorough pre-admission arrangements that also provide good opportunities for the service user to make a decision about moving in. EVIDENCE: The home updates its Statement of Purpose regularly and submits this update to CSCI. A ‘welcome pack’ is provided for all who move in. This pack also includes details of the terms and conditions of residency. Emergency admissions are only accepted into the social care unit and the manager described the system in place to minimise disruption and ensure that relevant assessments are carried out. The manager completes a pre-admission assessment for all prospective service users. Where a person is moving into the nursing unit the head of nursing The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 Page 10 completes this assessment. The head of the social care unit is involved in preadmission assessments for this unit. Service users and their families are invited to visit and view the home before making a decision to move in. A new service user confirmed that he was satisfied with the arrangements made and found any problems were dealt with promptly. A sample of 2 pre-admission assessments was seen and contained sufficient information. The nursing unit is staffed with a qualified nurse on duty 24 hours a day and the social care unit has an experienced head and senior staff. The nursing unit and part of the social care unit have been purpose built and have been suitably adapted to meet the needs of older people. The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 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 care planning system is adequately maintained to reflect the assessed needs of service users. The home has good systems and links with other health professionals to enable service user health needs to be met. Personal support is offered in such a way as to maintain the privacy and dignity of service users. The management of medicines is satisfactory; the management of oxygen storage is not consistent with requirements. EVIDENCE: 5 service user plans were examined. The home has an adequate documentation system that provides for comprehensive assessment of service user needs. All contained detail of assessed needs with plans that were clear for staff to follow. The home has a key worker system and service users who were asked knew who their key worker was and felt able to approach them. The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 Page 12 The home uses a number of core care plans, whilst these were adequate they would benefit from review to ensure that individual needs are fully recorded. It is also recommended that a precise plan be drawn up where a specific psychological plan has been implemented to ensure staff consistency. The detail of this was discussed during the inspection. Staff demonstrated a good awareness of service user needs. Plans were regularly reviewed and evidenced the involvement of a range of professionals. The head of nursing is reviewing some health monitoring systems to ensure that they better reflect an individualised approach. All care was provided in private and staff respected service user privacy. Some service users expressed concern that staff are less available immediately after tea and bells are not answered promptly. Inspectors observed this and the manager agreed to monitor the situation. The management of medicines is satisfactory and administration, storage and documentation were inspected. The inspectors found a small number of creams in use that were not being used appropriately; this was raised with the manager at the time of the inspection. A large number of oxygen cylinders were stored in the treatment room in the nursing unit. These were not stored securely and posed a potential risk to staff. These cylinders must be stored appropriately until returned to the pharmacy and the room must be signed correctly. The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 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, 15. Service users are supported to lead the lifestyle they wish and have opportunities to participate in leisure activities. The meals in the home are good offering choice and variety and taking account of personal preference. EVIDENCE: Service users spoken to all confirmed that they could spend the day as they choose and were very happy at The Orchards. Most appreciated the activities available; some would like more activities. During the inspection the hairdresser was visiting the nursing unit. There are 2 part time activities organisers employed but they were not on duty during the inspection. In the social care unit a game of bingo had been organised and some people played cards in one of the lounges. During the summer trips are organised and there is a regular church service. Care plans examined indicated regular social opportunities available to these service users. Some service users in the nursing unit spend time in the upstairs lounge and some are upstairs in bed. It is recommended that a permanent staff presence The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 Page 14 be maintained on this floor to ensure that there is adequate time and observation available to these service users. Lunch was observed and was appetising and plentiful. Kitchen staff spoken to had a good understanding of service user needs. The menu provides for choice and all service users spoken to be satisfied with the meals provided. People were able to eat where they chose with pleasant dining rooms available in both units. Staff were available to provide discreet assistance. The manager was asked to ensure that staff are clear about reporting any refusal of meals to the person in charge of the shift. The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 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 home has a satisfactory complaints procedure that enables action to be taken. The home’s recruitment procedures protect service users from the potential risk of harm or abuse. EVIDENCE: The home has a complaints procedure that is made available and a clear format for the manager to follow in response to any complaints. No complaints have been received since the last inspection. Recruitment records examined confirmed that POVA First or Enhanced CRB checks are received prior to an employee starting work. The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 Page 16 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, 23, 24, 25, 26. Service users benefit from comfortable, homely, well maintained surroundings. Bedrooms are personalised according to service user preferences. All areas of the home are kept clean and tidy. EVIDENCE: A tour of the premises was made and found all areas clean and tidy and free from any unpleasant odours, with the exception of one bedroom, which was brought to the manager’s attention. The manager stated that rooms are redecorated and re-carpeted when a new service user moves in. The home has a lawned garden and a patio area accessible from the nursing unit dining room. The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 Page 17 The home has a range of equipment and adaptations that are suitable for the service users accommodated. The home has adjustable beds suitable for those who require assistance in bed. 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. There are adequate toilet and bathing facilities for the current service users. The home has adequate laundry facilities with identified staff to maintain this service. Control of infection measures were satisfactory in the nursing unit and minimised any risk of cross infection. Inspectors advised that the manager should review the staff hand washing provision in the social care unit with the Health Protection Unit. It was evidenced during the inspection that dressings and personal care was being provided for some service users in their bedrooms. Hand washing facilities are not available in these rooms, as the manager wants to maintain a domestic feel to these bedrooms. Hand washing facilities are available in communal areas. The adequacy of these arrangements should be confirmed. The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 Page 18 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. The home is adequately staffed by suitably experienced staff. The home is well supported by a high proportion of trained care staff. The home operates through recruitment practices ensuring staff employed are suitable for the work they are to do. EVIDENCE: The manager is supernumerary and the head of nursing has 2 days a week for management tasks. Rotas examined confirmed that a RGN is on duty 24 hours a day in the nursing unit. Both units are adequately staffed with the expected minimum numbers of care staff. The home is also supported with catering, housekeeping and administrative staff. Staff are supported to undertake NVQ training with 87 having achieved at least NVQ2 in Care. All staff have recently been updated in Moving and Handling practices and a detailed training matrix is maintained. Recruitment records examined confirmed that robust procedures are followed. The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 Page 19 The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 Page 20 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, 35, 36, 37, 38. The home is well managed and the manager promotes an accessible and open style of management. Service users personal monies are well managed. Health and safety arrangements ensure that staff and service users are protected in most areas. EVIDENCE: The home’s registered manager, Angela Watkins, fulfils the role of general manager and is experienced in residential care work. The named head of nursing and a team leader in the social care unit supports her. Mrs Watkins has completed the Registered Manager’s Award and Mt Oluwani will commence the award when he has completed his current NVQ assessor training. The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 Page 21 All staff spoken to were positive about the management arrangements, felt able to raise concerns and felt that their ideas are listened to. Service user meetings are held in both units every 3 months. The home has a key worker system that staff understood and one experienced member of staff felt that they were a ‘good team’. Staff turnover is low. Personal monies were inspected. Small amounts are held and managed by the administrator behalf of service users. The records and systems examined indicated that these monies are well managed. Staff supervision takes place 6 times a year and is fully documented. Records required for inspection were held appropriately, well managed and made available. A tour of the premises was made and most areas seen were free from hazards. The manager has been required to address the following shortfalls; • The laundry door must be kept locked to ensure that chemicals are securely stored to comply with COSHH regulations 2000. • The use of bedrails must be reviewed and risk assessments undertaken where the mattresses in use do not fit the bed base. The service users risk assessments currently undertaken should be individualised to take account of potential unique risks. • The emergency lighting should be checked monthly (currently checked 3 monthly). A range of records was examined and were well maintained and ordered and demonstrated satisfactory checks are carried out, these included; • Fire equipment and systems. • Water temperatures, legionella checks. • Hoist servicing. • Bed rails, monthly maintenance checks. • Staff fire training. • Medical equipment. The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 Page 22 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 4 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X 3 3 3 3 2 The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement Oxygen in the home must be stored securely and rooms in which it is used or stored must have the correct signage. The laundry door must be kept locked to ensure that chemicals are securely stored. The use of bedrails must be reviewed and risk assessments undertaken where the mattresses in use do not fit the bed base. Timescale for action 30/11/05 2 3 OP38 OP38 13(4)(c) 13(4)(b) 30/11/05 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Where core care plans are used these should be reviewed to ensure that individual needs are fully recorded. It is also recommended that a precise plan be drawn up where a specific psychological plan has been implemented to ensure staff consistency. The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 Page 24 2 OP12 It is recommended that a permanent staff presence be maintained on this floor to ensure that there is adequate time and observation available to these service users. The advice of the HPU should be sought to ensure that the staff hand washing facilities in the social care unit are adequate for all service users. The emergency lighting should be checked monthly. 3 OP26 4 OP38 The Orchards DS0000060598.V271890.R01.S.doc Version 5.0 Page 25 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.V271890.R01.S.doc Version 5.0 Page 26 - 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!