Inspection on 07/03/06 for The Orchards

This inspection was carried out on 7th March 2006.

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

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

Other inspections for this house

The Orchards 10/07/07

The Orchards 20/06/06

The Orchards 29/09/05

The Orchards 31/03/05

The Orchards 17/08/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Orchards Orchard Lane Crewkerne Somerset TA18 7AF Lead Inspector Gail Richardson Unannounced Inspection 7th March 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Orchards Address Orchard Lane Crewkerne Somerset TA18 7AF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01823 270694 01823 323270 Somerset Redstone trust Post Vacant Care Home 66 Category(ies) of Old age, not falling within any other category registration, with number (66) of places The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Older persons, who require general nursing care, up to a maximum of 31 people. Nursing placements are permitted only in the `nursing wing` The `nursing wing` will have a named first level nurse, on part 1 or 12 of the NMC register leading the management of nursing care. Mrs Susan Tresidder is currently fulfilling this role. If this member of the management team leaves or is absent for more than 28 days, the CSCI will be informed of alternative arrangements. The Somerset Redstone Trust will give the CSCI copies of the CV, references and qualifications of the first level nurse leading the management of nursing care. Additionally to the availability of at least one registered nurse 24 hours per day, Mrs Tresidder will have no less than two shifts per week `supernumerary` to this roster, for the purpose of strategically managing the nursing care. A maximum of 33 places are permitted in each of the two units Only rooms 4 & 5 of the Nursing Wing may be used for intermediate care`. Service users in these rooms (up to a maximum of 4) are subject to the following conditions:(a) not less than 50 years of age (b) maximum duration of any single admission - 56 days. 29th September 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. There is also an attractive patio area in the residential home. The gardens are well maintained and easily accessible. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last inspection was unannounced and took place on 29th September 2005. Two inspectors inspected the home over one day as part of a planned programme of inspections. On the day of inspection the Head of Nursing Mr Oluwani was on annual leave. His replacement for the duration of his leave was RGN Maggie Glazsher, Mrs Glazsher has been employed at The Orchard for 7 years and was present during the inspection. The Head of Care, Suzanne Butts, was in the home and assisted with the inspection of the social care wing The previous Registered Manager had left employment at The Orchard and the post is currently vacant. The home is currently recruiting for a replacement and until this process is complete the Operations Manager will be visiting the home twice each week. On the day of inspection both units of the home were calm and relaxed and there was a pleasant atmosphere. All staff were very welcoming to the inspectors. Service users looked happy and well cared for with a small number of people being nursed in bed throughout the day. 62 people were living in the home on the day of inspection 32 service users in the social care unit and 30 in the nursing unit. This number includes 2 people from the nursing unit who are currently in hospital. The focus of the inspection in both units was to obtain direct feedback from service users about the service, to review action following previous requirements and recommendations and to inspect essential records and areas not inspected at the previous inspection. All service users, visitors and staff spoken to, provided the inspectors with very positive feedback of the service. A tour of the premises was made, care in the home observed and a range of records inspected, including care and maintenance records. The inspectors had contact with the majority of service users, some individuals and others in groups. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 6 It has been confirmed with the Operations Manager, that there are early plans being made, to construct a joining wing to create more service user and office space and physically join the two units together. For the purpose of this report the two units were inspected separately and the report will on occasion identify each unit individually. Two immediate requirements were made at the inspection. *The repair and make safe for use, of a bathroom in the social care unit which had been out of use for one year. *The reassessment of a service users care needs to prevent the use of restraint. What the service does well: What has improved since the last inspection? In the social care wing a number of improvements to the environment have taken place. A new staff room facility has been created and previous problems with the hot water have been resolved. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 7 Windows have been replaced in some bedrooms and the in the kitchen a new fly screen has been installed. There are plans to link the nursing and social care wings together, creating a new kitchen and common reception and office areas and providing indoor access. Plans are being drawn up at present and it is expected that an application will be admitted to register this major alteration to the premises. All staff on the social care unit have now completed the essential food hygiene certificate. The oxygen is now stored securely in both units and appropriate notices were displayed and risk assessed. The laundry doors in the nursing unit are now locked with the key secured near the top of the door frame. Risk assessments were evident for service users using bedrails and all bedrails seen appeared to fit correctly. Staff on the nursing unit now take staggered breaks to ensure a staff presence on each floor at all times. The emergency lighting is now checked monthly. What they could do better: An immediate requirement was issued regarding the use of restraint of a service user. Whilst the home had acted in good faith, the management of the service user was inappropriate and an urgent reassessment of need by the medical practitioner was requested. The home were required to put in place a robust risk assessment and individual supervision, for the service user, until an appropriate management plan has been arranged. A further immediate requirement was made to bring a spacious and well-equipped bathroom to use. The bathroom has been out of use since early 2005. The admission process should be improved in both units so that care documents clearly show that all service users entering the home have had the chance to agree with the admission and have been involved in the initial assessment of their needs. The identified needs, areas of risk and protocols for meeting those needs, should be documented prior to entering the home to guide staff in the care needed. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 8 Plans of care should be improved in both units so that needs are comprehensively documented and complete, risks involved in all areas are identified, include monthly reviews of all areas – including risks – and evidence the involvement of service users. It is required that care plans be completed within an appropriate timescale of admission and reviewed regularly. It is recommended that clear behavioural/psychological plans are developed for those service users who have dementia. It is required that all service users have their nutrition needs assessed on admission and regularly reviewed as part of the plan of care. Service users weight should be monitored every month. An improved method of recording when baths are taken and the water temperature in each bathroom is recommended. Staff files are required to be reorganised to contain all the recruitment information required. It is required that further staff recruitment on the nursing unit and catering department takes place to avoid the use of agency staff, to ensure continuity of care and support of permanent staff. The kitchen on the ground floor nursing side is in need of decoration. Advice should be sought from an occupational therapist with regards to the ergonomic needs of a person with a very tiny frame for living room and dining room chairs. It is required that all service users are reviewed as required by the multi disciplinary team to ensure that all their needs are being met. The inspector reviewed with the head of care the health and safety issues identified during the last inspection. She indicated that bedrails are not in use in this part of the service at present and agreed to ensure that the laundry door was locked at all times when not in use. The emergency lights in the social care unit are only checked by the contractors when the fire prevention equipment is serviced. The head of care indicated that the requirement that staff do monthly checks of emergency lighting have not been met because the old house, where the social care unit is, does not allow for manual testing. The system must be updated to meet health and safety standards. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 9 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.V285670.R01.S.doc Version 5.1 Page 10 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.V285670.R01.S.doc Version 5.1 Page 11 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&5 The remaining standards were not inspected but were met during the last inspection. The home has pre-admission arrangements that also provide opportunities for the service user to make a decision about moving in. However these opportunities may not be extended to all as documentary evidence was lacking. Service users, their families/ representatives have the opportunity to visit the home before admission. EVIDENCE: Three care records were inspected in the social care unit and five in the nursing unit. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 12 All had assessments carried out by the head of care or the head of nursing and five in total also included an NHS assessments as service users had been admitted from hospital. The pre assessment document is filled by the head of unit from The Orchard, at the pre admission visit and this then becomes the admission sheet stored in the service users files. None of these assessments were documented as having been agreed with the service users or their relatives. Several service users in the two units were able to evidence having chosen the home with assistance from a relative and being happy with the choice. Another person expressed satisfaction with the home, stating, “they see to all my needs here”, “They are very good”. The third person in the social care unit with dementia care needs was said to be undergoing a period of four weeks assessment in the home. There was insufficient information in the care records about this persons assessed needs or risk as there should have been prior to admission. One service user in the nursing unit explained that she had been involved in the choice of colour for the decoration of her room when admitted. Documentation in the care plans supports the contact with other health care professionals. The nursing unit is staffed with a qualified nurse on duty 24 hours per day and the social care unit has experienced senior staff. The nursing unit has been purpose build and meets the needs of older people. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 13 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 & 11. There was first hand evidence of good care outcomes for service users, however, the care planning system needs to be reviewed to fully reflect the service users needs, to include all risks, protocols for managing these and reviews of all its components to which service users are involved. The care plans did not meet the standard required to ensure that service users needs would be met. Good systems and links with other health professionals enable service user health needs to be met have been maintained. The systems for the medicines was well organised and efficient. Service users who were able and wished to, were supported to be responsible for their own medication. Personal support was offered in such a way as to maintain privacy and dignity of service users. At the time of death service users and their families are treated with care, sympathy and respect. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 14 EVIDENCE: Staff demonstrated a good awareness of service user needs and service users who were able, indicated that their care needs were well met by staff. Evidence was seen in several rooms of fluids/food charts and change of position charts. All were completed, signed and were supported by evidence seen. 3 Service users care plans were examined in the social care wing. The main care needs had been identified for two of the persons and appropriate guidance for staff entered in individual pages per care or support need. These pages had the service users signature. However one care plan had hardly any entries. As identified in the previous inspection, all plans of care could be improved by a holistic person centred approach. Some areas of risk had been identified by the appropriate number in the assessment sheet, appropriate guidance to minimise these risks were not always included. There were review sheets signed by the service user but it was unclear what areas or elements of the care plan had been reviewed. Access to health and social care professionals was well evidenced in the care plans of care and health monitoring documented. Six care plans were viewed in the nursing unit. Four care plans seen were partially incomplete. Two care plans were complete and identified the service users needs with guidance for staff on individual pages per care and support need. This guidance had an attached sheet for comments, updates and signatures. No evidence of any service users signatures was seen. In 4 care plans seen, each lacked sufficient detail for the care staff to be able to meet the specific care needs of the service user. They were erratic and inconsistent; they did not record changes and reviews. Some areas of risk had been identified and assessed but had not been updated. Service user dependency levels were also assessed within the care plan but not in all care plans seen. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 15 One care plan reviewed had evidence of an assessment prior to admission for a person centred approach to care for a service user with dementia. No further specific plan of care had been made to ensure that these needs were met. Further review of care planning is needed to ensure that clients with specific requirements for physical/psychological management have a plan tailored to their needs. Access to health and social care professionals was well evidenced in the plans of care. No record was found of any baths or bath temperatures being recorded, or of any weights being recorded regularly. Spoken to Mrs Glazsher who agreed to would look into a more suitable method of recording bathing and explained that a new weigh scales are being purchased. A date for demonstration of equipment was booked. All care was provided in private and the use of “do not disturb” signs supported this. The administration, storage, documentation and disposal of medications were inspected in both areas and found to be well managed. In the social care unit persons who part medicated had lockable drawers in bedrooms to keep medication safe. In the nursing unit anybody who wished to and was able to self medicate was risk assessed and supported to do so. The care of the terminally ill was discussed with staff in both areas. In the social care unit, one person had died in hospital since the last inspection and fond memories of the person were expressed. Staff described listening to each persons wishes at such a time and, where possible, engaging local NHS staff to assist in order to enable a service user to be cared for in the home. Relatives were involved, as appropriate and staff given time and support during the process. In the nursing unit there had been 8 deaths since the last inspection. The inspector viewed the care plan and notes of one service user and talked to a staff member about support given at these times. There was clear evidence that care needs had been met, the service user was treated with dignity and respect and the involvement of the GP and relatives was well documented. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 16 The involvement of the family had been ongoing and they had been well supported by the staff team. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 17 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. Service users are supported to lead the lifestyle they wish and have opportunities to participate in leisure activities. Service users maintain contact with family and friends and are supported in being part of the community. Service users rooms are decorated to reflect their own choices and lifestyles. The meals in the home are plentiful and nourishing providing good variety and taking into account personal choice. EVIDENCE: Service users were spoken with and activity was observed in both units, all confirmed that they could spend the day as they chose to, and that their agreement was sought by staff with all activities of each person’s day. All service users spoken with indicated that they were happy at The Orchards. Communications notebooks were seen in three service users’ rooms to assist service users continue family contact. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 18 The inspectors spoke to the hairdresser in each unit who explained that the salons are open two days each week. The hairdresser in the social care unit has attended the home for 20 years. Both she and a relative were able to provide positive feedback about the home. The hairdresser in the nursing unit explained that she also worked part time as a carer and was able to continue hairdressing services for those service users who remained in their rooms. The activities are organised by two activities organisers who work weekdays. There are no planned activities at weekends. There were a variety of activities including shopping trips, bingo, quizzes and gentle exercise classes. Each inspector observed two of the mornings planned activities that included contact with the organisers. The social care unit observed a very enjoyable darts session during which memory and co-ordination were promoted. During the afternoon a well-attended church service took place that included an organist and service users enjoying a number of church songs. On the nursing unit, there was an opportunity to purchase from a small in-house shop each day. The activities organiser spoke to each person individually as this shopping took place. A rapport was evident between the organiser and service users. There was a selection of activities throughout the day in the lounge. On the day of inspection there was a bible class with singing and discussion. The previous day one person explained that they had been taken out shopping and had enjoyed this very much. Both activities organisers work jointly to pool their expertise and run joint events. Further planning for Easter bonnets was due to take place with some service users. Entertainment had continued every two months or so and outings would be planned for the summer. The activities programme for the week and the expertise of the organisers was very good. The recording of these activities further promoted the tailoring of personal tastes to each service users activities. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 19 It would be very desirable if this provision could be extended to cover weekend’s as this is a time when staffing levels are lower. Service users were also observed reading the newspaper, doing the days puzzles and doing crafts. There was no evidence of specific activities designed for those service users with dementia. It is required that any service user with specific psychological/ social needs have a plan of activities which suit their needs. Some service users were being nursed in bed and the inspector saw evidence of staff being available to attend to them and all call bells were answered promptly and appropriately. The call bell system is linked to the staff office for times of report. Service users rooms were decorated in a manner, which reflected their tastes and lifestyles. Evidence was seen of people’s own furniture in their bedrooms. Lunch observed was appetising and plentiful. Kitchen staff spoken to had a good understanding of service users needs. The menu offers a choice and service users were satisfied with the meals provided. One person commented that the food can sometimes be cold when it arrives; this was discussed with the nurse in charge. All food is cooked in the social care unit and transported to the nursing side in food warmers. The home has two catering vacancies but they are managing to provide a good standard in this area. In the social care unit menus are displayed and meals were evidenced as being served according to their preferences and individual need. In the nursing unit a system is in place for service users to be advised of the menu a day in advance and make a choice then. This is then recorded and available for mealtimes. This also included any special dietary requirements. Alternatives were available for anybody who did not like that day’s menu choice. The larder was well stocked and the facility for tea making and snacks was also seen. People were able to eat where they chose with pleasant dining rooms available in both units. Staff were available to provide discreet assistance. A person with a very tiny frame was observed refusing the meal. The head of care agreed that the ergonomic and nutritional needs of this person should be The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 20 assessed by the relevant professionals and appropriate remedial action taken. This action must also take into account the positive effects that eating in a social group has on the service users nutritional intake. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 21 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 homes 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 formant for the manager to follow in response to complaints. No complaints had been received in the social care unit since the last inspection. In the nursing unit that information was not available on the day of inspection, however, one service user and one visitor spoken to were happy with the complaints procedure and would know whom to contact if there was a problem or they wished to make a complaint. The inspectors were asked for a means of identification before entering the building. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 22 Recruitment records were examined in both units. POVA First and Enhanced CRB checks were checked in the nursing unit and confirmed that they were received prior to employees starting work. Two staff files showed a break in service and references had not been re applied for the duration of that break. It is required that all staff who have a break in service for a period of time must renew the recruitment process again. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 23 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. Service users benefit from comfortable, homely and generally well maintained environment. In the Social care unit service users have insufficient bathroom facilities due to one of the best-adapted and spacious bathrooms of the home having been out of order for a long period of time. There are adequate lavatories and washing facilities available in the nursing unit. There is specialist equipment available for service users to maximise their independence. Bedrooms are personalised according to service user preference. All the areas of the home are kept clean and tidy. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 24 EVIDENCE: A tour of the home was made and the inspector visited all public, some private and some staff areas. All areas of the home were clean, tidy and free from unpleasant odours. In the social care unit, there were minor areas where the repair appeared institutional, i.e. a patch of different colour carpet in a landing area where a door had been widened and bits of flooring missing from a corner in a corridor. The social care wing has an attractive back garden and a enclosed patio accessible from the living areas. The home has a range of equipment and adaptations that are suitable for the service users accommodated with the exception of appropriate arm chair for the person mentioned in NMS 15 who sat with little support in what was an oversized chair for the person. The home has adjustable beds suitable for those who require assistance in bed. Where needed, the assistance of community nursing services is engaged and additional equipment borrowed to meet specific needs. 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. In the social care unit, one of the 4 bathrooms has been out of order for about 1 year leaving 3 baths for the 32 service users. This bath is well adapted and the bathroom provides space that is needed for wheelchair and zimmer frame users. An immediate requirement was issued to bring this facility to full working order. The head of care confirmed that staff hand washing provision had not been incorporated (as recommended by the previous inspection) in bedrooms where dressings are performed because of wanting to maintain a domestic feel. This was discussed and the head of care agreed that paper towels could easily be made to look domestic with attractive holders. It could not be confirmed if the HPU had been consulted with regards to infection control measures in the bedrooms where dressings and such clinical care is undertaken, as recommended by the previous inspection The Nursing unit was clean, tidy and free from offensive odours. The domestic staff felt the hours worked were adequate to maintain this level of hygiene. The unit appeared generally well maintained. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 25 The nursing unit has a range of equipment and adaptations that are suitable for the service users accommodated. The home has adjustable beds and a range of hoist, slide/glide sheets and lifting belts available. Handrails are available in all corridors and a range of suitable chairs are available in the public areas. The upstairs corridor wall appears scraped where hoists/trolleys lean against it and is in need of decoration. The downstairs kitchen area has several areas were paint is flaking off. This also requires redecorating, The home has a lawn and patio area accessible from the nursing unit dining room. All rooms seen were currently single occupancy. Rooms seen were clean, comfortable and contained personal items and some personal furniture was seen. An upstairs bathroom is currently being used as storage for wheelchairs and hoists. The Nurse in Charge assured the inspector that there were adequate alternative facilities to cater for all service users. There was one laundry staff on each day and she felt this was adequate to maintain a suitable laundry standard. Control of infection measures were satisfactory and minimised any risk of cross infection. The laundry systems for disposal of soiled linen and clothing were very hygienic. The staff were wearing suitable clothing and aprons, gloves and hand wash were evident in all areas. The inspector observed staff washing hands between care of service users. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 26 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 social care unit is adequately staffed by suitably experienced staff. The nursing unit requires further recruitment of staff to maintain continuity. The homes recruitment practices are not thorough. The home is well supported by a high proportion of trained care staff. EVIDENCE: The social care wing was appropriately staffed with domestic, activities and catering support. There were two vacancies in the catering area and also some week-end care hours vacant that were being covered by existing staff. Agency staff were sometimes used to cover vacant posts and staff annual leave. The manager was mindful to ensure that Agency staff who did not know the service users, or could not fully converse with them, were well supported by permanent staff. Staff indicated that this had been a problem on occasions in the past where just one such staff had been on duty to support the team and the care manager indicated that she is careful to plan so that this does not happen. The inspector spoke with a new staff member who had undertaken induction. The first two weeks she had worked in the nursing wing where her file was still kept. She evidenced having undergone CRB, identity and health checks. To The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 27 have been provided with a contract, terms and conditions, code of conduct and to be working through an induction package. She would be working with a established staff for 6 weeks. After 6 months she would be entered for NVQ. The staff member, who had not worked in care before, indicated that she was well supported by the team and was aware of service users rights and issues of vulnerability and protection duties. Staff continue to be supported to undertake NVQ training with over 50 (16 of 25 care staff in the social care wing) staff having achieved or completed at least NVQ2 in Care. Supervisory staff had NVQ III and shift leaders were also entered for this level of training. In addition some training had also been provided in specialist topics. The staff mandatory training was well documented showing that all members had been provided with all mandatory training and were regularly updated. The Head of Nursing was on leave at the time of inspection and RGN Maggie Glazsher was standing in for him. The nursing unit is appropriately staffed with care staff, domestic, activity and catering staff. Rotas examined confirmed that an RGN is on duty 24 hours a day in the nursing unit. The nursing unit is estimated to be 4 care staff short and recruitment is underway. Agency staff are being used in the interim period. Staff spoken to confirmed that the use of agency staff caused extra burden on permanent members of staff. It was indicted that this is a strain in an already busy environment but was mindful that this situation would be resolved with new staff recruited. Staff confirmed a shortage in catering staff was also causing a problem in the nursing unit particularly around tea time. Kitchen rotas for the nursing unit evidenced that staff are not available every evening. Four staff files were viewed. All staff had completed application forms and signed disclosures; two references, CRB and POVA first checks had all been completed. Not all files viewed contained job descriptions, photographs, induction and health checks. Staff records showed that induction training had taken place for some, but not all, staff and manual handling training had been received by 2 staff members. Two staff spoken to confirmed that they had received some in house training, induction, basic food hygiene and fire safety. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 28 Further training by one staff member had also been undertaken in venapuncture. Staff training records were disorganised and no overview of staff training in the nursing unit was available on the day of inspection. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 29 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, 36, 37 & 38. The home is adequately managed by the heads of care, with the support of the Operations manager until a new registered manager takes up the vacant post. Health and safety arrangements ensure that staff and service users are protected in most areas. EVIDENCE: The previous manager, Mrs Watkins, has left the service and the manager’s post is vacant. Until a new manager is recruited, the home is managed by the two dedicated heads of care and nursing in each wing. They are closely supported by the operations manager during this period who is visiting the home twice each week. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 30 Suzanne Butts, head of care in the social care unit has the Registered Managers Award and has assessor’s qualifications D32 and 33. All staff, service users and visitors spoken to were positive about the management, felt able to raise concerns and felt that their ideas are listened to. There is a questionnaire at the entrance inviting visitors to provide feedback about the service. The rights of service users, the complaints procedure and contact details of the CSCI are also displayed by the manager’s office- all in a good-sized font. The home has a key worker system that staff understood. The care team has a good representation from established staff and all staff members spoken with regarded their team as supportive and the management as open and inclusive. Staff meetings are held regularly and the last meeting was 16/02/06. Staff supervision has continued 6 times a year and was evidenced in the social care unit but not evidenced in the nursing unit. Staff spoken to all felt that they were a good team but some staff in the nursing unit, voiced concerns over the staff shortages and the use of agency nurses. Records required for inspection were stored appropriately in both units. A tour of the premises was made and most areas were free from hazards. The inspector recommended that the downstairs kitchen of the nursing unit be re-decorated as paint was flaking of the walls. The manager was required during the previous inspection to address shortfalls in health and safety. Of those mentioned, the following had not been met *The laundry door must be kept locked to ensure that chemicals are securely stored to comply with COSHH regulations 2000. *The emergency lighting should be checked monthly. It seems that the system in the old house does not allow staff to comply with this therefore the system must be upgraded to allow for manual testing. A range of records were examined and were well maintained and demonstrated satisfactory checks were carried out. These included; *Fire equipment and systems *Staff fire and mandatory training *The homes insurance certificate The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 31 *Water temperatures, legionella checks *Hoist Servicing *Bed rails risk assessments *Staff fire training *Fridge temperatures *Call bell tests *PAT tests *Emergency lighting tests. *Wheelchair maintenance The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 32 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 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 3 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 1 3 3 1 3 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 2 3 3 The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 33 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 (1) Requirement The agreement of service users with their assessment of needs and with the plan to meet their identified needs must be documented before all future admissions A care plan of service users needs in respect of health and welfare is required to be completed for all service users on admission. Timescale for action 30/04/06 2. OP7 15 (1) 15 (2)(b) 30/04/06 3. OP12 12(4)(b) 4. OP18 (13)(7) 5. OP21 23 (2)(j) This care plan must be reviewed at least one a month to reflect the service users changing needs. It is required that physical, social 30/04/06 and psychological care plans must be developed, implemented, recorded and reviewed for those patients with dementia based on a person centred approach. It is required that no service 07/03/06 user be subject to physical restraint, to comply by the immediate requirement made on the day of inspection. The adapted bathroom that has 03/08/06 DS0000060598.V285670.R01.S.doc Version 5.1 Page 34 The Orchards 6. OP21 23(2)(j) 7. OP29 19(4)(c) 8. OP38 13 (4)(c) been out of use for most of 2005 until the present must be brought to use, to comply by the immediate requirement made on the day of inspection. Hand wash facilities are required in bedrooms were dressings are performed as recommended in previous inspection It is required that all staff recommencing employment, following a break in service, repeat the recruitment process. The laundry door must be kept locked when not in use to ensure that chemicals are securely stored. (Previous timescale not met ) 28/05/06 30/04/06 31/03/06 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 Where core care plans are used these should be reviewed to ensure that individual needs are fully recorded, that they always include protocols to minimise risks that monthly reviews identify and that all elements of the plan had been reviewed and agreed with the service user It is recommended that all service users have a nutrition assessment on admission and each service user is weighed every month. It is recommended that the ergonomic needs of a service user’s personal needs for appropriate sitting at the dining table (and also for easy armchair in living room) be assessed and that professional nutritional guidance be also sought for this person. 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. (previous timescale not met) The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 35 2. 3. OP8 OP15 4. OP26 5. 6. 7. 8. 9. OP27 OP36 OP38 OP38 OP38 It is recommended that further staff recruitment is needed to ensure that all service users needs are met. It is recommended that staff files be updated and reorganised and a record be available of all staff having received induction training. All emergency lighting should be checked monthly It is recommended that the downstairs kitchen of the nursing unit be redecorated. It is recommended that a more suitable method of recording bath temperatures is implemented to ensure safe working practices. The Orchards DS0000060598.V285670.R01.S.doc Version 5.1 Page 36 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.V285670.R01.S.doc Version 5.1 Page 37 - 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!