Inspection on 05/01/06 for The Orchards

This inspection was carried out on 5th January 2006.

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

The inspector 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 02/08/07

The Orchards 15/08/06

The Orchards 21/09/05

The Orchards 13/10/04

The Orchards 15/06/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE The Orchards 1 Wilmer Drive Heaton Bradford West Yorkshire BD9 4AR Lead Inspector Susan Knox Unannounced Inspection 5th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Orchards Address 1 Wilmer Drive Heaton Bradford West Yorkshire BD9 4AR 01274 547086 01274 548776 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) Baybury Limited Mrs Susan Davies Care Home 24 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (19), of places Physical disability over 65 years of age (2) The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st September 2005 Brief Description of the Service: The Orchards is a detached property set in its own grounds. Accommodation is provided on the ground, first and second floors. The majority of rooms are singles. A passenger lift provides access to the first and second floors. The home is registered predominately for Older People. A small number may have mental health needs and/or physical disabilities. This care home is located adjacent to Lister Park and is close to local shops, churches and city bus route. The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector between 9.30 am and 3.00pm. This inspection continued at a further unannounced inspection 10 January 2006 9.30 am to 11.30 am in order to review medication as there was insufficient time on the first day. The inspection also included the investigation of an anonymous complaint. Time was spent talking to service users, staff and observing practice. Records were reviewed including duty rotas, service user care records; recruitment records; medication and staff training records. This inspection found a number of failures to meet standards. Further additional inspections will be carried out until the concerns are resolved. Requirements and recommendations from this inspection are included at the end of the report. What the service does well: What has improved since the last inspection? What they could do better: Care plans must address the individual needs of service users. Staff training in care planning would help staff to understand this. Staffing levels for day duty need to be increased. The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 6 The procedures for the storage and administration of medication requires a major overhaul with the help of the local pharmacist. An investigation must be carried out about one service user not receiving prescribed medication. Infection control procedures must be improved. Staff providing advice and training to others on the use of equipment must receive appropriate instruction/training themselves. 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 DS0000001167.V274906.R01.S.doc Version 5.1 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 The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 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): 3 and 5. The needs of service users are assessed before admission to make sure the home can meet individual needs. The home encourages prospective service users and relatives to visit. EVIDENCE: Mrs Davies, one of the two registered managers confirmed that service users are assessed before admission to the home to make sure that their needs can be met. Either of the managers will make a domiciliary visit to ensure preadmission assessments were completed about the individual’s needs. Prospective service users and families are encouraged to visit the home. In discussions with one service user it was said that relatives had visited the home to look around before admission was arranged. This was confirmed in discussions with managers. The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 9 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, 11. Care planning does not fully identify individual needs and does not give details of the action that care staff have to take to provide effective care for service users. The current procedures in the administration and storage of medication do not safeguard the health and well being of the service users. With the support of the district nurses, service users who are terminally ill are well cared for. EVIDENCE: Four sets of care documentation were reveiwed. These were evaluated monthly and included the signature of the service user where possible. The formatting of the care plans was simple and could easily be followed but the individual care plans had all the same headings such as socialising, environment, personal hygiene, and elimination. These headings were too broad and did not focus on individual needs. One fairly independent service user had a care plan about socialising but this was not a need and although it was positive to address this in a care plan, care staff evaluation was ‘no action The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 10 required’. Whereas for the same service user a chronic medical need was not identified in a care plan. Another service user had a nutritional need that was identified in a care plan but the plan did not include all necessary information. In addition, a falls risk assessment had been completed and the service user was identified as a high risk. This was not followed through by setting up a care plan to inform staff how to try and reduce the risk. Daily records provided a chronological account of events and health professional’s input for individual service users but this is not setting out each service user’s health, personal and social care needs in an individual care plan as required. Care plans are not working tools that can be used by all staff. Therefore, it is highly recommended that external training relating to care planning is arranged for senior staff and then this can be cascaded to others. From discussions with health professionals and from records it is clear that health needs are being met. When it is felt that the home cannot meet the needs of individuals, reassessment is arranged to move to a home that can provide the right care. The health professionals visiting on the day of inspection confirmed that staff seek advice when necessary and follow instructions. Service users confirmed that they were well looked after. The home administers medication via a Monitored Dosage System (MDS). A Policy and Procedure document was available set up by the local pharmacist. It was said that the pharmacist provides good support and advice to the home. The home was advised to discuss with the pharmacist a number of issues such as the storage and recording of controlled drugs. In addition, the medication cupboard was being used to store staff’s personal possessions and storage was very untidy causing difficulty in locating items. It was noted that staff were removing the label from medication packaging and sticking it in the Medication Administration Record (MAR) This was for medication received other than via the MDS, such as antibiotics. The pharmacist confirmed at the time this was an incorrect procedure and staff should copy onto the MAR the exact detail and instruction as printed on the label. Staff had acted correctly in reporting to the GP where a service user had repeatedly refused to take prescribed medication. Eight-service user’s medication was randomly checked, of these five had satisfactory records completed of administration and a track could be followed of the number of tablets received and administered. Of the remaining three one had had a course of antibiotics. Fifteen tablets were received but only 13 were recorded as given. One other could not be tracked because no date had been recorded when a second box of medication had been commenced. The most serious error was for medication received in the home from hospital. The staff had signed the MAR as administering this medication but this had not The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 11 been given. It would appear this was because it was in the cabinet and not in the MDS. The two managers were advised firstly to contact the GP and report the error in non-administration. Also, to audit all medication and investigate the reasons for discrepancies. In addition, ask the pharmacist to carry out an urgent audit of the system and provided advice about how to avoid the same errors being made again. The terminal care of one service user was reveiwed and this was found to meet the standard required. Last wishes about death and dying are recorded. Relatives and friends can stay if they wish. Management advised that a care plan is established with the district nurse who provides support. Charts are kept of posture repositioning in order to avoid pressure sores and fluid balance charts are also kept. It was noted during the visit that service users were encouraged to visit ill service users if they wished. In this way positive relationships are encouraged. The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 12 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 The service users are happy in the home and appreciate the efforts that staff undertake in arranging activities. The dining room creates a pleasant atmosphere and service users were pleased with the meals. EVIDENCE: Service users confirmed that they had enjoyed the arrangements for the festive season. Some service users had spent Christmas day with relatives but the meal provided for those staying in the home was enjoyable. In addition a party was arranged for service users and relatives. Some service users attended a dinner at a local hotel. Service users appreciated the efforts in making these arrangements. Two service users leave the home to follow own pursuits whether this is to attend local churches, shops or pubs. On the day of the inspection dominoes were being played with a small group of service users. Staff confirmed that this is a regular event including bingo. In the better weather trips out will be arranged. The main meal of the day was taken with the service users. This was taken in an attractive setting with tables laid appropriately. The service users were not rushed and extras were offered. The meal was tasty and although the The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 13 vegetables were satisfactorily cooked for the inspector’s taste they were considered to be slightly hard for older people. Service users said that the meals provided were good to very good. The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 14 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 and 18 Sufficient information is displayed in the home and in documentation to enable service users and representatives to make a complaint if they wish. Service users are protected from abuse by the procedures in the home and staff’s knowledge of the issues. EVIDENCE: A complaints procedure is available and displayed in the hall. It is also included in the Statement of Purpose/Service User guide. There is a complaint/comment book available in the hall. This home generates very few complaints and none have been made to the CSCI. The purpose of this inspection was also to investigate a complaint made by someone who wished to be anonymous. This related to concerns about service users who it was thought needed nursing care; poor level of care; low staffing levels, lack of training and moving and handling concerns. Records were checked and discussions held with managers and staff. None of the concerns were founded other than low staffing levels. Policies and procedures were available about abuse, dealing with aggression and whistle blowing. The adult protection local procedures ‘No Secrets’ were also available for staff to follow. Discussions with staff showed a there was a good understanding of the above. The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 15 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): 22, 23, 24, 25, 26. The home is equipped with sufficient equipment to meet the needs of service users. The majority of the bedrooms are spacious and provide comfortable personal space for service users. The home is clean and odour control is good. More attention must be made to effective infection control procedures in order to safeguard service users. EVIDENCE: This home provides care for fairly independent and ambulant service users. Suitable aids are provided in order to meet service users needs for example, grab rails, raised toilet seats and bath hoist. In addition there is a mobile hoist stored ready to use in the corridor ground floor. The offices, laundry and the kitchen are located on the lower ground and there are extensive storage areas. The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 16 The nurse call system was observed to be in working condition at the time of inspection. The manager has confirmed previously that points are provided in each bedroom easily available from the bed and by extension from a chair. The call can only be cancelled at source therefore staff have to cancel at the site the call was activated. All the bedrooms have measurements that meet the minimum standards. A significant number exceed these measurements. A random number were checked and although general cleaning had not been carried out cleanliness and odour control were good. Many service users had their own possessions around them. They said they were comfortable living in the home. The laundry is located in the cellar area therefore soiled linen does not have to be taken through the dining or kitchen areas. Laundry equipment meets with the specifications of this standard. The laundry walls and floor are impermeable and easily cleaned. However, on the day of the inspection this area required cleaning and tidying. The pots from commodes were blocking staff access to the WHB. No paper towels or dispenser were available. This was referred to at the last inspection. The washer and surrounding area required a thorough clean and items such as plastic bags were piled to one side and had spread about. None of this meets recommended infection control standards although staff had recently attended infection control training. It would appear that low levels of care staff combined with domestic staff taking annual leave had had a severe knock on effect for standards in this area. In discussions with staff about infection control and wearing protective clothing for different tasks, it was said that different coloured aprons were not available to use in the dining room as apposed to care tasks or dealing with laundry. An Environmental Health officer should be contacted for advice about this matter. The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 17 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 ratio of care staff was too low for the numbers and needs of the service users accommodated. The variety and number of staff training courses does ensure that care staff understand the individual needs of service users. The provision of training in the home must be at all times by qualified trainers. Recruitment procedures need to be improved so that clear evidence is kept of the vetting of new staff in order to protect service users. EVIDENCE: On arrival at the home only the manager and a care assistant were on duty. The second manager arrived later in the morning. The housekeeper was taking annual leave. A copy of the rota was provided for the week of the inspection. This was explained as due to the delay in receiving Criminal Record Bureau clearance before new staff could start work. The manager was advised that where a CRB clearance is delayed CRB should be contacted or consider Povafirst in exceptional cases. The CSCI should also be contacted for advice. NVQ training is on going and in discussions with staff it was confirmed that five staff have attained NVQ level 2 and three are undertaking NVQ level 3. Discussions with the care staff on duty showed there was an understanding of the principles of care. The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 18 Recruitment procedures and records were reveiwed for four staff and all had CRB clearance. Three had been transferred from previous employers although this was before the implementation of the POVA scheme had restricted CRB portability in relation to regulated services for adults. The Care Standards Act requires that new staff are checked against the list prior to being offered employment or on moving from a non-care position to a care position. The manager has set up an account so that POVA first can be checked. There was evidence of identity checks but the manager was reminded to make sure that information about an applicant’s 10-year history of previous employment was listed and any gaps discussed. One application form had a poor work history recorded with no length of time or year recorded. This needs to be rectified. In addition two references were not available in some files although the manager said these had been obtained. Records show that induction and foundation training is provided for new staff. All new staff complete an induction programme, the care staff had not signed one record. The manager was advised to ensure that all staff sign induction and training records in order to indicate their responsibility and understanding of the training undertaken. This was confirmed in discussions with staff and evident in the induction record. Records were also available of regular supervision for care staff. From discussions with staff and also records of training it was confirmed that staff training was ongoing. Moving and handling had just been completed. This was provided by Park Lane College and staff were waiting for certificates. In addition they were just finishing Infection Control. The local PCT nursing service had also provided a number of talks for staff the latest had been about Person Centred Care and Dementia. One of the managers is a moving and handling assessor although her certificate was out of date. The second manager said this was not the correct certificate has she had attended a five day course. Attempts will be made to locate the correct document. In addition, it was noted that the deputy manager was giving guidance to new staff on the use of moving and handling equipment. This should not happen without the trainer being appropriately trained. The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 19 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): 33, 35, 38. The staff do have the best interests of service users at heart. Quality assurance systems need to be on a more formal basis. The service users are safeguarded by fire protection procedures apart from one issue. EVIDENCE: Quality assurance of this small care home is carried out on an informal basis through day-to-day contact with service users and visitors. It was apparent from observations that there is good interaction between service users and staff and both parties are aware of one another’s daily lives. Staff meetings and service user meetings are held regularly. Quality assurance systems need to be improved and more formalised such as in development plans, quality assurance audits and surveys. The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 20 The managers said that no service users monies or valuables are dealt with by the home. They were in the process of agreeing to deal with personal allowances for one but decided to refer this back to relatives. The fire records were reveiwed. Information was available showing that fire equipment had been serviced in April 2005. A weekly test was carried out to the fire alarm as required. There was no record of emergency lighting tests. This should also be carried out weekly. Staff fire drills had been held three times in 2005. The record included the names of staff who had attended the training. The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 X 11 3 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 X X X 3 4 3 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 2 The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 22 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 15 Requirement The registered managers must ensure that care planning addresses individual needs and details the action required of care staff. The registered managers must ensure that the administration and storage of medication is improved. Liaise with the pharmacist and follow advice in the recording and storage of CD. Do not remove labels from medication packages. Investigate the reason for not giving prescribed medication and report to the CSCI the results. The registered managers must ensure that staff can access WHB in the laundry. (Referred to at the last inspection) Provide paper towels and dispensers. Clean and tidy the laundry and store items away that are not needed. Observe the procedures for appropriate protective clothing for carers when carrying out different tasks. The registered managers must provide sufficient levels of care DS0000001167.V274906.R01.S.doc Timescale for action 31/01/06 2. OP9 13 (2) 31/01/06 3. OP26 13 (3) 31/01/06 4. OP27 18 31/01/06 The Orchards Version 5.1 Page 23 5. OP29 19 6. OP30 18 7. 8 OP33 OP38 24 23 staff so that service users needs ca be met. The registered managers must ensure that clear evidence is available when recruiting of references and the checking of work histories. The registered managers must ensure that staff sign training records. An appropriately trained person carries out that training in the use of equipment. The registered managers must introduce quality assurance systems. The registered managers must ensure that emergency lights are tested weekly and this is recorded. 31/01/06 31/01/06 30/03/06 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Care planning training should be provided for all care staff. The Orchards DS0000001167.V274906.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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. 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