Inspection on 09/08/05 for The Orchards

This inspection was carried out on 9th August 2005.

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

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

Other inspections for this house

The Orchards 20/11/07

The Orchards 15/05/07

The Orchards 20/09/06

The Orchards 09/03/06

The Orchards 07/03/05

The Orchards 17/09/04

The Orchards 15/01/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Orchards 164 Shard End Crescent Shard End Birmingham B34 7BP Lead Inspector Amanda Lyndon Announced 9 August 2005 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 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 E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Orchards Care Centre Address 164 Shard End Crescent Shard End Birmingam B34 7BP 0121 730 2040 0121 730 1655 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Healthcare Care Home with nursing 72 Category(ies) of Old Age (OP) 72 registration, with number Dementia, over 65 years of age of places The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. 66 persons requiring nursing care and 6 persons requiring residential care. 2. The home may accommodate 5 named residents between 50 and 65 years of age. Date of last inspection 7 March 2005 Brief Description of the Service: The Orchards is a modern purpose built care home first registered in 1998 and situated in a residential area close to local shops and public transport links. The home provides 24 hour nursing, residential and respite care for a maximum of 72 older people. This includes the provision of transitional care for up to sixteen older people who are in need of short term care arranged by two Primary Care Trusts. Accommodation is available over two floors and each bedroom is for single occupancy with an en suite facility. Provision can be made for two companion bedrooms if required, subject to availability. There are two good sized lounges and one dining room on both floors. There is a pleasant enclosed courtyard with a variety of attractive features and with easy access for residents. There is limited parking space available at the front of the home however there is ample space to the rear of the building. The first floor is serviced by two passenger lifts. Security is good at the home and CCTV is unobtrusively installed. The home has a hair salon and this is open twice a week. The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection was undertaken by three Inspectors, including the Pharmacist Inspector, when there were 65 residents living there. This included 7 people receiving transitional care. Information was gathered from speaking with residents, staff and visitors, observing staff perform their duties and examining care and medication records. A full tour was undertaken. The Inspectors were assisted throughout by the Acting Manager. The Home Manager was due to commence employment in the near future. CSCI received 17 comment cards in respect of the service provided and the vast majority of these were found to be very positive in nature, including “ The care from all the staff is excellent” and “My mother is very happy living at the home”. A negative comment received was “ The call buzzer is not always within reach” What the service does well: The nursing staff monitor any treatments and care regimes and follow other Health Care Professionals’ instructions to ensure that residents’ health problems are improving and medicine management is to a very high standard. There are a wide variety of activities on offer for residents to enjoy including shopping trips, cinema afternoons and prize bingo. Residents are able to exercise choice over their daily lives and the group activities that they choose to participate in and they can personalise their bedrooms to reflect their individual tastes to ensure that they feel comfortable in their surroundings. Residents are supported in a respectful manner by the staff team and visitors are always made to feel welcome. One resident said, “ The staff are so friendly and helpful”. Another resident said, “ My family get on so well with the staff, it’s a real family atmosphere here”. Residents receive a wholesome and nutritious diet, which meets any dietary needs and preferences, and there is always a choice of meals on offer. One resident said, “ I like small portions of food and the staff always give me what I want”. Residents are provided with a homely, clean, comfortable and safe environment to live in and there are assisted baths and other special equipment available. Training and supervision is arranged for the staff team to ensure that they have the appropriate skills, knowledge and support to work competently within The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 Page 6 their job roles. One relative said, “ All staff, nurses and carers have always been most helpful and caring. I cannot fault the care here”. There is a robust system for the management of residents’ personal allowances should the resident choose for the office staff to hold this on their behalf. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 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 standard(s) 1, 2, 3, 4 & 5 The assessment and admission processes are comprehensive which ensures that the prospective resident has all relevant information about The Orchards and that individual care needs can be met. EVIDENCE: The Organisation had produced a comprehensive statement of purpose that included all information as required by Regulations and this was also available on audio cassette. Pre admission assessments are undertaken for all prospective residents before coming to live at the home for both long and short stays using an assessment document which did not include all information required. Following the pre admission assessment and prior to the trial period of one month, comprehensive letters are sent to prospective residents to inform them that their care needs could be met and statements of terms and conditions of residency are issued at this time. The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9 & 10 Residents’ health and personal care needs are well met by the nursing and care staff using comprehensive care plans to ensure residents’ continuity of care. Residents’ safety is protected as individual risk assessments have been undertaken and the systems for medicine management are very good. Residents are cared for in a respectful manner by staff and this ensures that their dignity and self-esteem are maintained. EVIDENCE: Comprehensive assessments are undertaken on admission, identifying individual care needs and preferences and care plans are derived from these. Separate care plans are written for each care need and these are reviewed thoroughly at least once each month. A number of care plans required minor amendments to include more detail of the actual care to be afforded and daily reports were recorded in good detail. Personal risk assessments had been undertaken including the risks of falls, malnutrition and pressure sore development and these were updated regularly and action required to minimise risks was undertaken. Bed safety rail risk assessments had been undertaken and reasons for the use of a number of these had been agreed by either the resident or their relative in most instances. Moving and handling and continence risk assessments had been The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 Page 10 undertaken, however these required more detail to describe the actual care to be afforded. Wound care and pressure relieving care were of a good standard and appropriate pressure relieving equipment was in use. Residents and their relatives had not been involved in the agreeing and reviewing of their care plans and individual activity plans had not been developed, including for those people who are either being nursed in bed or had chosen to spend their time in their bedrooms. Current residents had a variety of complex physical and mental health care needs, including PEG feeds, wound care and continual Oxygen therapy and have access to Health and Social Care Professionals including Nurse Specialists, General Practitioners, Social Workers, Speech Therapists and Opticians. Prompt medical advice is sought from these people by the nursing staff as required. One Health Professional that visits the home said “ I find the care excellent, staff very friendly and caring and willing to adapt”. In most instances the staff follow the advice of Health Care Professionals and residents’ changing care needs are monitored by the nursing and care staff and reviews are arranged to assess whether the home can continue to meet their needs. Residents appeared to be well supported by staff to choose clothing appropriate for the time of year and apply make up and wear jewellery in keeping with individual wishes. The care staff were assisting a resident to eat their breakfast via a syringe without the advice of a Speech Therapist and this is considered to be an unsafe practice due to the risk of aspiration or choking. This matter was brought to the attention of the Operations Manager who addressed the issue immediately. A number of residents had impaired communication, cognitive and manual dexterity skills and aids to improve these were not always available. All the audits undertaken were accurate demonstrating that all the medicines had been administered as prescribed. Written protocols for occasional use medicines were seen and nursing staff interviewed had a good understanding of the service users clinical needs. Residents are risk assessed if they wish to self-administer their medicines. Hand written Medicine Administration Record charts were well prepared and evidence was available to confirm all dose changes audited. Prescription creams were not always dated when opened and in some instances numerous tubes of the same product were opened for an individual resident’s use. Residents were cared for in a respectful manner by the staff and it was apparent that a good rapport had built up between the staff team and The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 Page 11 residents and visitors. In addition to a portable pay phone, a number of people had private telephones in their bedrooms. The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14 & 15 The activities on offer meet the needs and expectations of most residents, however an exception to this would be in respect of those people who are nursed in bed. Residents are given choice and freedom to make decisions regarding their daily lives in most instances, which promotes their independence and individuality. Residents receive a wholesome and varied diet which meets any dietary needs and preferences. EVIDENCE: An activities organiser is employed and there are a wide variety of activities on offer for residents to enjoy including cinema afternoons, prize bingo, entertainers, shopping trips and meals out. Residents’ birthdays are celebrated and a hairdresser visits twice a week. Holy Communion is available each month. A comprehensive record of activities was maintained however this did not include detail of activities and social stimulation for those people who are either being nursed in bed or had chosen to spend their time in their bedrooms. There is an open visiting policy. One relative said, “ My family and I feel the home is very warm and welcoming”. One resident said, “ My family get on so well with the staff, it’s a real family atmosphere here”. The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 Page 13 Residents have choice over their daily lives, for example, they can choose where they are served their meals and what they eat each day, however, CSCI received a comment that some residents are assisted out of bed very early in the morning, from 6am and one resident stated that they did not realise that there was a choice regarding this. This matter was discussed with the Acting Manager who stated that she would address this issue with the staff immediately to ensure that residents are consulted about what time they wish to be assisted out of bed in the morning. A wide variety of wholesome and nutritionally balanced meals are served and an alternative to the main meal option of the day is always available. The menus need to be amended to reflect this and to identify the supper time menu options available. The main meals on the day of the inspection were well presented and fresh fruit and vegetables were available. It was pleasing that most of the food is home cooked using nutritious ingredients. Special dietary requirements and cultural meal preferences are catered for as required, however these are not identified on the menus and a review of meals for those people receiving a reducing diet must be undertaken. One resident said, “ The food here is really beautiful”. A daily record of food provided for each resident was kept, however the Inspectors had some concerns about the accuracy of this record at times in respect of the quantities of food actually eaten by some residents on the day of the inspection. Staff were assisting residents respectfully with their meal as required and there were relaxed and unhurried atmospheres in the dining rooms. Dining tables were laid attractively and cold drinks were served with the meal. One resident said, “ I like small portions of food and the staff always give me what I want”. One resident explained that they did not feel hungry at lunchtime, as they had enjoyed a full cooked breakfast; further consideration is required in respect of the timing of meals. CSCI received a comment that further fridge and freezer food storage would be useful. The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 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 standard(s) 16 & 18 The complaints procedure is comprehensive and accessible to the residents and their relatives. The home has robust systems in place to protect residents from abuse and staff awareness of adult protection ensures that such incidents are recognised and dealt with appropriately by the staff. EVIDENCE: The complaints procedure was on display and included in the statement of purpose and included all relevant information. There were no complaints recorded in the complaints log since the previous inspection. One relative said “In the event of any concerns there is always a prompt response, dealt with in a pleasant manner”. One resident said “I would talk to the staff if I was unhappy about anything”. There were many “thank you” letters on display from residents and their families. A comprehensive adult protection policy had been produced and this must be further developed to include the local contact details of CSCI and Social Care and Health. Staff met during the inspection were familiar with the correct adult protection procedure. The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 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 standard(s) 19, 20, 21, 22, 24, 25 & 26 Residents are provided with a homely, clean, comfortable and safe environment to live in. Aids and adaptations provided ensure that the majority of residents’ needs are met. EVIDENCE: The internal environment of The Orchards was welcoming, well maintained and a rolling programme of redecoration was in place. Minor repairs in respect of the premises were brought to the attention of the Acting Manager. Furniture and floor coverings were of a good standard. There was an attractive and secure internal courtyard garden which was enjoyed by a number of residents and their visitors on the day of the inspection and this included good quality garden furniture and shaded areas for residents’ comfort. The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 Page 16 There were two spacious lounges on each floor, however; only one of these was used on the day of the inspection. One resident stated that they found the main lounge too noisy at times. There were four assisted baths and two shower facilities available, however a review of these should be undertaken to ensure that they meet the needs of current highly dependent residents. A nurse call facility was available in each bedroom, however a few residents could not reach or use this. Appropriate transfer hoisting equipment was available. A number of specialist nursing beds suitable for meeting the needs of residents with high dependency nursing care needs were available. Bedrooms contained many personal items reflecting residents’ tastes. Each bedroom had a lockable storage facility and bedroom doors were fitted with locks appropriate to the capabilities of the residents and staff in the event of an emergency could over ride these. Water temperatures are checked each month to ensure that residents do not have access to water that exceeds safe temperature limits. There was adequate natural and domestic style artificial lighting. The temperature within the home was comfortable and the internal environment was clean and fresh. One resident said, “ My room is cleaned and vacuumed thoroughly every day” Effective and hygienic laundry and hand washing facilities were available. Contracts were in place for the disposal of clinical waste and any problems with pest control. A number of residents were barrier nursed following hospitalacquired infections and staff were familiar with infection control procedures in respect of this. Suitable facilities for the hygienic cleansing of commode pots were available. It is recommended that lidded bins are provided in bathrooms for noncontaminated waste. Infection control audits were not undertaken. The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 For the majority of the time staffing is provided in adequate numbers to meet the needs of residents, however there are not always enough staff to supervise residents in the lounges and attend to residents’ cares needs promptly, which may pose a risk to residents’ safety and welfare. With one exception, the robust recruitment practice and comprehensive induction and training provided ensures that residents are supported and protected by staff. A new staff member had not received a fire safety training and this fails to afford full protection to residents and other people within the building. EVIDENCE: The staffing rotas identified that the staff were working within previously approved levels and agency staff are used to cover periods of staff sickness and annual leave. The management team provide on call support to the person in charge of the shift and details of this were identified on the staffing rotas. One relative said, “All staff, nurses and carers have always been most helpful and caring. I cannot fault the care here”. One resident said, “The staff will get you anything you want, it’s better than a hotel here”. On the day of the inspection there was a period of time when vulnerable residents were unsupervised in the lounge with the door closed behind them and CSCI received a comment that “I had to ask staff twice to help my relative and had to wait a long time”. Another comment received was “Staff have not always been available in a reasonable time to help my relative with toileting The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 Page 18 needs”. One other concern of this nature was also received from a relative of a current resident. A number of staff worked an excessive amount of hours per week by choice and action must be taken to reduce this from happening regularly. Correction fluid was used on staffing rotas and this is not considered to be good practice. The systems for staff recruitment were good and staff files sampled contained all information required. Interview notes were kept and staff are issued with a contract of terms and conditions of employment and a job description. All staff had criminal records clearance and were deemed safe to work with vulnerable people. Staff had received training relevant to their job roles including adult abuse and whistle blowing, care of the dying and bereavement, communication skills and infection control. A comprehensive staff training needs matrix had been completed. Revised induction programmes were due to be sent from the Organisation. A new staff member had not received a fire safety induction since commencing employment and this is considered to be unsafe practice. This matter was brought to the attention of the Acting Manager who addressed the issue immediately. The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 35, 36 & 38 Residents live in a home which is well managed and has a good standard of care which is regularly monitored for quality. Residents’ financial matters are safe guarded through robust accounting of personal allowances. The health, safety and welfare of residents are protected through comprehensive staff training and maintenance checks of equipment. EVIDENCE: The Acting Manager has had much experience of managing residential and residential EMI establishments and has provided good managerial support to the staff team and has ensured that the high standard of care has not been affected by the vacant position of a Home Manager. A new Home Manager is due to commence employment in the near future. The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 Page 20 Relatives meetings are held regularly and are well attended however despite having the opportunity to attend, residents’ meetings are not so popular with current residents. Staff meetings are held regularly and the minutes of these were available. The system for the management of residents’ personal allowances was good, detailed individual transaction records including receipts were kept, two signatures were obtained for all monies in and out of personal accounts, each resident’s money was stored separately and all account balances examined were found to be correct. An effective system for formal staff supervision and appraisal was in place. A number of policies and procedures were tailored to the needs of The Orchards. Health and safety checks in respect of equipment used were maintained as required including fire safety equipment, emergency lighting, gas and electrical appliances and wheelchairs. Trailing multi socket adapters were in use in residents’ bedrooms and risk assessments must be undertaken in respect of the use and safety of these. Staff had received training in health and safety issues including fire safety, moving and handling, food hygiene and COSHH and a fire drill had been undertaken recently. The most recent Environmental Health inspection identified a good standard of hygiene. Accident records were found to be fully detailed and well-maintained and regular audits of accidents were undertaken. Action taken to minimise the risk of further accidents had been undertaken. A suitable accident book was not available for accidents involving staff and members of the public. Bedroom and lounge doors on the first floor had been closed when occupied and this may pose a risk to vulnerable residents’ safety and was against residents’ wishes. Magnetic releases had not been fitted to these doors that would be activated in the event of a fire and risk assessments had not been undertaken in respect of this. Other risk assessments in respect of fire safety had been undertaken. The garden contained items of potential risk to residents’ safety, for example a trailing watering hose and risk assessments must be completed in respect of these. The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 4 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 4 14 2 15 2 COMPLAINTS AND PROTECTION 2 3 3 2 x 3 3 3 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 x x 4 3 x 2 The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 Page 22 Yes 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 3 Regulation 14(1) Requirement The pre-admission assessment document must be further developed to include all required information. Care plans and personal risk assessments must be further developed to include: The actual care to be afforded to residents Details of activities enjoyed by residents and how these needs will be met, including those people who are nursed in bed or those who had chosen to spend their time in their bedrooms Residents must be encouraged to be involved in the agreeing and reviewing of their care plans Moving and handling risk 30 assessments must include detail September of the action to be taken should 2005 a resident fall. Timescale for action 09 October 2005 31 October 2005 2. 7 15 3. 7 13(5) 4. 7 (Time scale of 07 June 2005 not met) 13(4)(b)(c Consent from residents or their ) relatives must be obtained in respect of the use of bed safety E54 S24876 The Orchards V235396 090805 Stage 4.doc 31 October 2005 Page 23 The Orchards Version 1.40 rails. 5. 8 12(1) Methods and aids must be sought to assist those residents who have impairments in respect of communication, cognitive and manual dexterity skills. Prescription creams must be dated on opening and a system to improve and monitor stock control of these must be inmplemented. Activities for residents who are nursed in bed or chose to spend their time in their bedrooms must be developed and a written record of these must be maintained. Residents must always be consulted about the time that they prefer to be assisted out of bed in the morning. An accurate record of food provided for each resident must be available in sufficient detail to reflect that their diet is adequate and nutritious. (Time scale of 07 June 2005 not met) The menus must be further developed to identify: Any special diets and cultural preferences. Any alternatives to the main meal options of the day. The supper time menu options. A review of meals for those people receiving a reducing diet must be undertaken. 11. 18 13(6) The adult protection procedure Version 1.40 Page 24 31 October 2005 6. 9 13(2) 15 September 2005 7. 12 16(2)(n) 30 September 2005 8. 14 12(2)(3) 01 September 2005 01 September 2005 9. 15 12(1) 10. 15 12(2) 16(2)(i) 30 September 2005 The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc 12. 19 must be further developed to identify the local contact details of CSCI and Social Care and Health. 23(2)(b)(c Minor repairs are required in ) respect of the premises as follows: Wall tiles in a number of en suite facilities must be replaced One toilet seat must be replaced The cord of the ceiling fan in the first floor dining room must be replaced 30 September 2005 30 September 2005 13. 14. 22 27 13(4) 18(1)(a) 15. 27 18(1)(a) 13(4) 17 16. 38 17. 38 13(4) 18. 38 13(4) 23(4) Residents must have a means of summoning help from care staff at all times. The number of staff on duty must be monitored to allow for the supervision of residents in the lounges at all times and to ensure that residents care needs are attended to promptly. Action must be taken to reduce the number of staff working an excessive amount of hours each week regularly. A suitable method of recording accidents involving staff and members of the public must be available. Risk assessments must be undertaken about the use and safety of trailing multi socket adapters in residents bedrooms. In the event that bedroom and lounge doors on the first floor are to be kept open, they should be fitted with devices that are linked into the fire alarm system Risk assessments must be undertaken about this in the interim. 01 September 2005 01 September 2005 30 September 2005 30 September 2005 15 September 2005 30 September 2005 The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 Page 25 A dated action plan should be submitted to CSCI about how this is to be achieved. 19. 38 13(4) Risk assessments must be undertaken about any potential risks to residents safety found in the garden. 15 September 2005 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. 4. 5. 6. Refer to Standard 7 15 21 26 26 15 Good Practice Recommendations It is recommended that an age appropriate alternative to the term cot sides (such as bed rails) be used in care plans in order to maintain residents dignity It is recommended that further consideration is given to the timing of meals served A review of assisted bathing and shower facilities should be undertaken to ensure that they meet the needs of current highly dependent residents. It is recommended that lidded receptacles are available in bathrooms for domestic waste. Infection control audits should be undertaken It is recommended that additional food fridge and freezer storage are available. The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Orchards E54 S24876 The Orchards V235396 090805 Stage 4.doc Version 1.40 Page 27 - 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!