Inspection on 04/10/05 for The Orchards

This inspection was carried out on 4th October 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Orchards 16/10/08

The Orchards 10/10/06

The Orchards 23/06/05

The Orchards 09/09/04

The Orchards 05/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Orchards (The) Orchards (The) 1 Perrys Lane Wroughton Swindon Wilts SN4 9AX Lead Inspector Bernard McDonald Unannounced Inspection 4th October 2005 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchards (The) DS0000050595.V256847.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. Orchards (The) DS0000050595.V256847.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Orchards (The) Address Orchards (The) 1 Perrys Lane Wroughton Swindon Wilts SN4 9AX 01793 812242 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Buckland Care Limited Care Home 35 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (16), Old age, not falling within any other of places category (32) Orchards (The) DS0000050595.V256847.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users who may be accommodated in the home at any one time is 35 17 service users in total with dementia (DE and DE(E)) may be accommodated. This is a temporary arrangement and subject to conditions 3 and 4 below When the accomodation occupied by the 10 of the 16 current service users with dementia aged 65 years and over (including those named in the variation application dated 4 October 2004) is no longer required, the maximum number of service users in the category DE(E) must be reduced to a maximum of 6 Only the younger, female service user with dementia named in the variation application dated 4 October 2004, may be aged between 18 65 years. When this accommodation is no longer required by the named service user, occupancy must revert to the category OP No service users with dementia to be accommodated on the second floor 23 June 2005 4. 5. Date of last inspection Brief Description of the Service: The Orchards is one of a number of homes owned by Buckland Care Limited. The Orchards provides accommodation and personal care to a total of 35 service users. The home is located in the village of Wroughton and is close to local shops and public amenities. The home is a large three-storey building set in its own well-maintained grounds. Service users’ bedrooms are located on three floors and can be reached by either a passenger lift or a stair lift and each room has an emergency call bell installed. The home has an attractive conservatory that is appropriately furnished and allows service users the benefit of extra communal space. Orchards (The) DS0000050595.V256847.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was completed over seven and a half hours. The inspector viewed all communal living areas and the majority of service users bedrooms. In addition the inspector had the opportunity to meet with service users in private and in small groups to obtain their views on the care they receive. The inspector looked at the assessments for three service users recently admitted to the home and the care plans of five service users. During the inspection the inspector met with the relatives of four service users. The inspector had opportunity to meet with staff in private and four staff recruitment records were examined. The manager was available throughout the inspection to assist with providing documentation and answering questions. There were two requirements outstanding from the last inspection. What the service does well: The home is ensuring service users have an assessment of need prior to moving to the home. One service user did confirm that someone from the home had visited them in hospital and that they had the chance to “look around” before moving. Discussion with service users found there was an almost unanimous approval of the quality of meals served at the home. Comments included “they are really good” and the food is “very nice”. The home is striving to ensure visitors and people who are important to service users are made welcome. Discussion with service users and visitors met during the inspection confirmed they could visit at any time. The home provides a good standard of accommodation. Service users who could express their opinion were generally satisfied with their accommodation and all areas inspected were clean and free odour. Orchards (The) DS0000050595.V256847.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: The home must concentrate their efforts into ensuring service users care plans fully reflect their needs and that the care plan is reviewed a minimum of every month. This requirement has been outstanding from the last inspection and compliance must be achieved within the revised timescale. While the home has identified service users who may be at risk from falling they need to ensure service users safety by completing risk assessments and identify what action they will be taking to reduce the risk to the service users. The home needs to demonstrate they have consulted with service users about what furnishings and equipment they require for their room. This was prompted by discussion with one service user who was concerned about people going into their room but they were not aware they could have a lock that would offer them privacy and yet could be accessed by staff in an emergency. To make the recruitment process more robust the home must explore any gaps in a prospective employees employment record. Orchards (The) DS0000050595.V256847.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. Orchards (The) DS0000050595.V256847.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 Orchards (The) DS0000050595.V256847.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): 3. All service users admitted to the home have an assessment of need, though the home is failing to ensure the assessment is developed into a care plan that fully reflects their needs and risks associated with their care. EVIDENCE: The inspector examined the needs assessment for three service users recently admitted to the home. The home had obtained a community care assessment for service users referred by the local authority. In addition the home had completed their initial assessment prior to admission to ensure they could safely meet the needs of service users. Discussion with two service users confirmed they had visited the home and met with staff and looked at their room before moving. A four-week trial placement is offered to all service users, which allows them to experience what it is like to live at the home before a decision is made to make the move permanent. Orchards (The) DS0000050595.V256847.R01.S.doc Version 5.0 Page 10 Following the move to the home an interim care plan had been developed which was later reviewed and updated. Though the inspector found some improvements had been made to the preadmission assessment and care plans, further work is required to ensure the care plan fully reflects the needs of service users identified in the pre admission assessment. The inspector found not all care plans covered how the home should meet the personal care needs of service users. This was a requirement at the last inspection and compliance must now be achieved within the revised timescale. One service user whose initial assessment specified they had a history of falls did not have a risk assessment completed by the home. To ensure the safety of the service user it is a requirement a risk assessments is completed and that staff are aware of what action they must take to reduce any risk to service users. Orchards (The) DS0000050595.V256847.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, 9. The home is failing to ensure service users health, social and personal care needs are kept under review and that action is taken to identify and reduce any risks associated with their care. EVIDENCE: The inspector examined the care plans of five service users. The inspector found that the care plan of one service user whose needs had become increasingly challenging had not been reviewed since July 2005. The inspector met with the relatives of the service user. The relatives stated they were very happy with the care being provided at the home and were fully informed about the difficulties the home was experiencing. The service users daily notes did reflect the challenges the home was facing and records demonstrate the home had involved the service users GP and social worker. However the lack of any formal review of the service users care puts staff at risk and fails to ensure the holistic needs of the service user are being safely managed. Orchards (The) DS0000050595.V256847.R01.S.doc Version 5.0 Page 12 The remaining care plans examined during the inspection had been reviewed. Discussion with the relative’s of two service users confirmed they had been involved in developing the care plan. One service user stated that “staff were very helpful” another service user stated “good food and good staff”. The inspector received a number of compliments from service users regarding the care and the attitudes of staff at the home. Discussion with staff demonstrated an awareness of the needs of service users and how their needs have to be met. Three care plans did identify that either the service user was at risk from falling or had a mobility problem and required assistance. The home had not developed a risk assessment to ensure service users safety and it is a requirement that these are completed. The inspector examined a sample of medication records. The home has improved the way it records medication at the home. The records demonstrated the home was accurately recording medication received at the home and administered to service users. Orchards (The) DS0000050595.V256847.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, 13, 15. The home is providing service users with a life style that not only reflects their interests but also offers support to maintain contact with people who are important to them. The home is providing a well balanced diet that offers choice and caters for service users likes and dislikes. EVIDENCE: Discussion with service users confirmed there have been some improvements in activities provided at the home. One service user said, “there were always things to do” and that they enjoyed playing bingo. Since the last inspection the home has appointed an activities co-ordinator and it would appear that service users have benefited from this appointment. The service user care plan provided details on service users hobbies and interests and involvement in activities at the home. The inspector met with the relatives of three service users who confirmed they could visit the home whenever they wished. Discussion with service users confirmed they could meet with their visitors in one of the communal living areas or in their bedroom. The manager confirmed there is an open door policy for service users friends or relatives and they are welcome to visit at any time. Service users were very complimentary about the standard and quality of meals provided at the home. Service users confirmed they have a choice about Orchards (The) DS0000050595.V256847.R01.S.doc Version 5.0 Page 14 where they eat their meals one service user stated they always have their meal in their room. Discussion with the cook confirmed choices are offered and service users likes and dislikes are known. Orchards (The) DS0000050595.V256847.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 complaints policy that is accessible to service users, relatives and friends, and have policies and procedures in place that strive to ensure staff are made aware what action they should take to protect service users. EVIDENCE: The homes complaints procedure is clearly displayed at the entrance to the home and a copy is also available in the service user guide. The policy is clear and enables the reader to understand the process to be followed should they wish to complain. Discussion with the relatives of four service users confirmed they were satisfied with the care provided at the home. Since the last inspection the Commission has investigated one complaint. The Commissions investigation found the complaint was partly upheld and three requirements were made. In addition the manager stated the home had received one complaint, which is still being investigated. Discussion with staff confirmed they had received training in abuse awareness and were aware of their responsibility in reporting any incidents that affect the welfare of service users. In addition abuse awareness training is now being provided as part of the induction process. One service user was asked whom they would tell if they were not happy with something the service user replied the manager. Other service users replied by naming a staff member or their relative. Orchards (The) DS0000050595.V256847.R01.S.doc Version 5.0 Page 16 Policies and procedures are in place for the protection of vulnerable adults and staff confirmed they had received copies of Wiltshire and Swindon’s “no secrets” guidance. Orchards (The) DS0000050595.V256847.R01.S.doc Version 5.0 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, 24, 26. Service users live in a safe well-maintained environment that is free from odour, though the home is failing to fully obtain the views of service users about what should be provided in their bedroom. Improvements could be made to the way soiled linen is handled and thereby reduce the risk of infection at the home. EVIDENCE: The inspector viewed all communal living areas and the majority of service users bedrooms. Service users were generally satisfied with the overall standard of accommodation provided. The inspector spoke with one service user who that was not aware they could have a lock put on their bedroom door to respect their privacy. This was brought to the attention of the manager who confirmed they would make sure a lock was fitted. The home should ensure that service users views and wishes about what should be provided in their rooms are recorded and regularly reviewed. Orchards (The) DS0000050595.V256847.R01.S.doc Version 5.0 Page 18 The inspector met with the relatives of one service user who confirmed they had negotiated what items of person furniture they could safely bring to the home. The service users stated they liked having their own things around them. Following a requirement made at the last inspection the home had tiled the wall in the laundry room. This ensures staff can more readily clean the walls and reduce the spread of infection. To further reduce the risk of infection it is recommended that the home purchase red alginate bags for soiled linen. These bags can then be put directly into the washing machine reducing the number of people who have to handle soiled linen. Service users and their relatives had no complaints about the laundry service and one service user said their laundry was always returned the next day. Orchards (The) DS0000050595.V256847.R01.S.doc Version 5.0 Page 19 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): 29, 30. The home has improved their recruitment practices and is striving towards having a full complement of suitably trained staff team. EVIDENCE: The inspector examined four staff recruitment files, which had been significantly improved upon since the last inspection. Deficits in recruitment records had been identified and corrected, where necessary new checks had been obtained. The inspector found that gaps in employment history were not being fully explored either at interview or as part of the application process and it is recommended that this is addressed for all future applicants. Discussion with staff confirmed training is being provided in excess of three days a year. The home has made significant strides in ensuring staff have access to NVQ training and specialist training to ensure they have the skills to meet the needs of service users. The home has an induction programme in place that is ‘Skills for Care’ accredited. In addition staff complete a distance learning induction through the local college. The manager confirmed that as part of the induction process staff are able to shadow senior carers, the length of which is determined by staffs’ training needs. The majority of staff have completed or are about to complete NVQ 2 training. Opportunities are also provided to support staff to gain NVQ 3. Orchards (The) DS0000050595.V256847.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, 33, 35, 38. The manager is aware of her responsibilities to ensure service users health and welfare are safeguarded, however the home is failing to demonstrate how the quality of the service is reviewed and how risks are being safely managed. EVIDENCE: Since the last inspection the manager has successfully applied to the Commission to become the registered manager. The manager has completed the registered managers award and now needs to commence NVQ level 4 in care. The inspector has noted some improvements to the overall management of the home and maintenance of records. This work must continue, paying particular attention to service users care plans to ensure the home is safely meeting their needs. The manager confirmed the home has sent out a quality assurance questionnaire to the relatives of service users. This was completed prior to the Orchards (The) DS0000050595.V256847.R01.S.doc Version 5.0 Page 21 manager taking up her post and it is planned that this will be revisited in the early part of 2006. The outcomes of the questionnaires were not available for inspection and this standard will be fully inspected at the next inspection. Service users who were able to express their views on the care they receive were complimentary about the staff and facilities at the home. The relatives of four service users also expressed satisfaction about the care their relatives receive. The home has improved the way it records service users money by ensuring two members of staff sign for money received and money given. The records examined demonstrated money was being accurately recorded. Discussion with staff demonstrated an awareness of what to do in the event of a fire. Records examined confirmed fire safety drills are taking place every three months and there were weekly tests of the fire alarm. Following a requirement made as a result of a complaint investigation, access to the laundry area is restricted by keypad and a risk assessment completed. The manager stated she is currently completing an audit of risks associated with the building. It is a requirement that where any risk associated with the building are identified then a risk assessment must be completed and action taken to reduce risk of injury. Orchards (The) DS0000050595.V256847.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 X X 1 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X 2 STAFFING Standard No Score 27 X 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Orchards (The) DS0000050595.V256847.R01.S.doc Version 5.0 Page 23 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 & OP3 Regulation 15(1) Requirement The registered person must ensure the service user care plans fully reflect the assessed need of the service users. The registered person must ensure any service user at risk from falling has a risk assessment that identifies how to minimise the risk. The registered person must ensure service users are offered furnishing and fittings specified in Standard 24 of the National Minimum Standards for Care Homes for Older People. A written record must be kept and reviewed as part of the care plan. The registered person must ensure the outcomes of the quality audit are available for inspection. The registered person must ensure risk assessments are completed in relation to the service users environment. Timescale for action 01/08/05 2 OP7 & OP3 13(4)(c) 01/11/05 3 OP24 16(2)(c) 01/12/05 4 OP33 24(1)(a) (b) (2) 13(4)(a) (b)(c) 01/04/06 5 OP38 01/12/05 Orchards (The) DS0000050595.V256847.R01.S.doc Version 5.0 Page 24 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 3 Refer to Standard OP3 & OP7 OP26 OP29 Good Practice Recommendations The registered person should ensure staff have read and understood the contents of any risk assessment held at the home. The registered person should ensure red alginate bags are provided for soiled linen. The registered person should ensure any gaps in employment history are explored and recorded as part of the interview process. Orchards (The) DS0000050595.V256847.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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) DS0000050595.V256847.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. 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