Care Home: Orchard Blythe

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What the care home does well What has improved since the last inspection? The presentation of care files had been changed and new care plans devised. A new section entitled `All About Me` had been added to the care file. These were ready to implement. Resident and/or their representative were included in devising the care plans. There had been a great improvement in the medication system. The acting care officer responsible for medication was committed to ensuring that the home had safe practices. Ten bedrooms had been decorated to improve the comfort of the occupants of those rooms. Two the three units had been brought together in order to provide more space for health and safety reasons. Unwanted stored items had been disposed of therefore creating more storage space. Some new good quality armchairs had been provided to replace the old ones, which had become shabby. Further armchairs were on order. Advice had been sought from Environmental Health regarding the previous dishwashing and drying practice. Dishes were now going to the main kitchen to be washed in the dishwasher, and tea towels were no longer used for drying dishes. The Activity Organiser no longer carried out care tasks and was not used to cover care staff absences. This enabled the organiser to dedicate their time to activities and occupation. Care staff carried on some activities if the organiser was absent. A robust recruitment system was in place, safeguarding the residents from the employment of unsuitable people. Staff had attended training related to health and safety issues such as moving and handling, fire safety and first aid. Infection control training had also been undertaken and dementia care, Parkinson`s disease and strokes training had been arranged for the near future. Staff responsible for medication have also undertaken relevant validated training. Age related drinking glasses were provided for all residents rather than the plastic beakers previously used. Crockery had been replaced and tables looked nicely set. The staff rotas now include the designations of staff so that it is clear in what capacity each person in the home works. Recruitment practice was more robust with references validated and employment history explored. All practices related to residents` money held by the home had been reviewed and revised. There were now practices in place that protected the financial interests of these residents. The current manager had worked at the home since July 2007 and was registered with us, the Commission. she has nursing qualifications and has achieved the Registered Managers Award. Staff supervision now takes place for the number of required times a year. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. What the care home could do better: Whilst all the necessary information for care provision is contained within the care file it was not always easy to find the information we were looking for. There were no instructions to staff in the care plan regarding the loss of weight of one resident. Methods of improving the nutrition of people with weight loss should be pursued and added to the care plan. Pads for continence management were stored under a bed. A more suitable storage place with regard to safety and dignity should be found. Staff rotas did not show the actual hours that were to be worked or had been worked, with a code used for the shift. To ensure that everyone reading the rota and for the purposes of inspection a key to the code should be added to the rota, for example `E` was presumed to stand for an `early` shift but the start and end times of the shift were not recorded. CARE HOMES FOR OLDER PEOPLE Orchard Blythe Orchard Blythe HEP 3 Wingfield Road Coleshill Birmingham West Midlands B46 3LL Lead Inspector Lesley Beadsworth Unannounced Inspection 19th August 2008 1:45pm 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 Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 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. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard Blythe Address Orchard Blythe HEP 3 Wingfield Road Coleshill Birmingham West Midlands B46 3LL 01675 467027 01675 467027 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) Warwickshire County Council Mrs Susan Waugh Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th June 2007 Brief Description of the Service: Orchard Blythe is a Local Authority home for older people. It provides 25 permanent care beds, 5 beds for people on short stays, and 5 beds for assessment purposes. The home is situated very close to the town centre of Coleshill, next to a primary school. There are a few local shops within fifty yards, and Coleshill High Street is within easy walking distance for a mobile service user. There are parking spaces to the front of the home. Orchard Blythe’s accommodation is all on one level and is easily accessible for wheelchair users. It is divided into three wings, two have been joined and are for permanent service uses, and one wing used for short stay purposes. There is a very large reception area, which is used by service users to socialise and to participate in therapeutic activities. There are three staff offices, a hairdressing room, a kitchen (with its own staff room and WC) and a laundry. In addition, there is a day care lounge for ten people, which is not registered with us. All bedrooms have en-suite lavatories and wash hand basins. There are four communal bathrooms with assisted bathing facilities and WCs, and one separate WC. There is a staff room with a WC and a shower. The usual management team consists of a registered manager, assistant manager and four care officers. A part time clerical officer provides administrative support to the management team. There are care assistants, providing care during the day and night. In addition to care staff are domestic staff, cooks and assistant cooks. The home does not provide nursing care. Service users who require nursing attention receive this from the community nursing service, as they would in their own homes. The fees for this home are the social services rates. Extra charges are made for private chiropody hairdressing, newspapers, toiletries and outings. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. The inspection included a visit to Orchard Blythe. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Ten surveys were sent to service users. Eight were completed and returned to us. One survey was given to a visitor during the inspection visit and this was also completed and returned to us. Information contained within the AQAA, in surveys, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 1:45pm and 10pm. What the service does well: Pre-admission assessments were carried out that gave sufficient detail for the home to make a decision about whether the home could meet the person’s needs or not. Assessment of needs continued after admission in order to ensure that all needs were identified. All care files contained a care plan devised from the pre-admission and subsequent assessments to ensure that all required care was provided. Residents on going health care needs were being met with evidence of visits to or visits by health care professionals being identified in the care files looked at. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 6 The following responses were made in the surveys returned to us, to the question, “Do you receive the medical support you need?” Always – 6; Usually – 1; Sometimes – 0; Never – 0. One resident said that they had never needed a doctor. Records for falls, pressure areas bathing and weights were in place within the files looked at. Assessments for nutritional risk screening and a manual handling risk were also in place in order to minimise these risks. Pressure relieving and moving and handling equipment was in place. In completed surveys residents responded as follows to the question, “Do you receive the care and support you need?” Always – 6; Usually – 1; Sometimes – 0; Never – 0. Comments made in the survey with regard to this question included, “I couldn’t be in a better place.” “Many of the staff go “that extra mile” in the care that they give to my (relative)” “I love it here.” “The care and attention that I receive is excellent at Orchard Blythe. The atmosphere is lovely.” The practices and procedures for medication safeguards the health and well being of the people living at the home. The residents’ preferred names were used and had been entered on their care plans. Residents spoken to said that staff respect their privacy and confirmed that they knock before coming into their rooms, thereby maintaining dignity and self esteem. The home has a designated activity organiser to provide support to the residents in activities and occupation. There are a variety of activities offered, including trips out and entertainers visiting the home. In surveys returned to us comments included, “Activities are many and varied – (relative) enjoys all of them. Staff help her when needed.” “There is always plenty to do if I wish.” One family visiting a resident was spoken with and they made very positive comments about the home, the manager, the staff and the care provided. They added that they were always made welcome and it was seen that they had a comfortable rapport with the manager and other staff. They completed a Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 7 survey with the comments, “Very caring and kind” “Excellent communication” “We are very pleased with this care home.” There was evidence to show that people living at the home have the opportunity to make choices about their daily lives and some input in the way the service is provided. The meals provided are varied and residents spoken with or who completed surveys told us that they enjoyed the meals. The home has appropriate policies and procedures related to Protection of Vulnerable Adults (safeguarding) and complaints to safeguard residents. Staff spoken with were aware of what they needed to do if they suspected or witnessed abuse taking place and had shown that they would act appropriately in order to protect residents. All recruitment practices safeguard residents from the employment of unsuitable people. Financial policies, procedures and practices safeguard residents’ financial interests. The home offers the people living there comfortable indoor surroundings, which are clean, free of offensive odour and safe and well maintained but with some shortfalls in décor in some of the communal living areas. The gardens were attractive and well maintained. The residents benefit from smaller group living units rather than all residents living in one large area. Specific team of staff allocated to these units provide continuity and familiarity. The bedrooms viewed were comfortable, clean and free of any offensive order. Each one had been personalised by the occupant and/or their family with such items as pictures, photographs and ornaments. There were also some smaller items of furniture that the residents had brought with them. Everyone completing surveys said “Yes” in response to the question, “Is the home fresh and clean?” One person also made the comment, “No doubt about that.” There are sufficient staff available to meet the needs of the residents. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The home had a extensive quality assurance programme implemented the Local Authority and which was monitored by a representative of the organisation and records maintained at monthly unannounced visits. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? The presentation of care files had been changed and new care plans devised. A new section entitled ‘All About Me’ had been added to the care file. These were ready to implement. Resident and/or their representative were included in devising the care plans. There had been a great improvement in the medication system. The acting care officer responsible for medication was committed to ensuring that the home had safe practices. Ten bedrooms had been decorated to improve the comfort of the occupants of those rooms. Two the three units had been brought together in order to provide more space for health and safety reasons. Unwanted stored items had been disposed of therefore creating more storage space. Some new good quality armchairs had been provided to replace the old ones, which had become shabby. Further armchairs were on order. Advice had been sought from Environmental Health regarding the previous dishwashing and drying practice. Dishes were now going to the main kitchen to be washed in the dishwasher, and tea towels were no longer used for drying dishes. The Activity Organiser no longer carried out care tasks and was not used to cover care staff absences. This enabled the organiser to dedicate their time to activities and occupation. Care staff carried on some activities if the organiser was absent. A robust recruitment system was in place, safeguarding the residents from the employment of unsuitable people. Staff had attended training related to health and safety issues such as moving and handling, fire safety and first aid. Infection control training had also been undertaken and dementia care, Parkinson’s disease and strokes training had been arranged for the near future. Staff responsible for medication have also undertaken relevant validated training. Age related drinking glasses were provided for all residents rather than the plastic beakers previously used. Crockery had been replaced and tables looked nicely set. The staff rotas now include the designations of staff so that it is clear in what capacity each person in the home works. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 9 Recruitment practice was more robust with references validated and employment history explored. All practices related to residents’ money held by the home had been reviewed and revised. There were now practices in place that protected the financial interests of these residents. The current manager had worked at the home since July 2007 and was registered with us, the Commission. she has nursing qualifications and has achieved the Registered Managers Award. Staff supervision now takes place for the number of required times a year. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. 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 summary of this inspection report can be made available in other formats on request. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 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 Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care files were looked at as part of the case tracking process. Two of them had pre-admission assessments that had been carried out by senior staff in the prospective resident’s current location and using a format that included all the necessary headings. There was sufficient detail to decide if the home could meet the person’s needs or not. The assessments seen had not been signed but had been dated. The third care file contained a social work assessment and care plan, as the home did not usually carry out pre-admission assessments at the time the person was admitted. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 12 Further assessment takes place in the days following any admission to the home and is used to formulate a care plan to inform staff of the care they need to provide. A key worker is allocated at this time. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. Care instructions are included in the care plans but there are shortfalls in accessing the information. Residents have access to health care professionals and are cared for in a respectful manner. There are no concerns around the medication process and residents are safeguarded by the medication practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care files were looked at as part of the case tracking process. All three files contained a care plan that had been devised from the pre and post admission assessments. All areas of assessment needs were addressed. Progress had been made in improving the format, the local authority having revised this. The presentation of care files had been changed and new care plans devised. A new section entitled ‘All About Me’ had been added to the care file. The home had begun to implement this format. Whilst all the information to provide care was included in the care file in sufficient and up to date detail to ensure that all aspects of the health and personal health needs of residents would be met, some care information was recorded only in the risk assessments and referred to as appendices in the care plan. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 14 Some care issues were referred to in the ‘strengths, needs and concerns’ columns, for example, the wearing of glasses, hearing aid, use of a walking stick and alcohol consumption but not addressed in the care instructions columns. The health care professionals section of the care file showed that a district nurse was dressing a wound but this was not mentioned in the appropriate care plan. There was evidence that concerns about a residents losing weight had been appropriately referred to the GP. The GP felt that a referral to a dietician was not needed. However the care plan did not include how staff were to enable this person to maintain or increase their weight. Residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse being identified in the care files looked at. Visits from health care professionals are recorded separately and able to be cross referenced to changes in care needs. The following responses were made in the surveys returned to us, to the question, “Do you receive the medical support you need?” Always – 6; Usually – 1; Sometimes – 0; Never – 0. One resident said that they had never needed a doctor. Residents spoken with said that they had access to the GP but one resident commented in a survey that, “Doctor does not always come when you want them to come”. This survey was anonymous so this could not be followed up with the person completing it. Records for falls, pressure areas (an area that is at risk of an interference with the blood supply due to pressure) bathing and weights were in place within the files looked at. Completed risk assessments for nutritional risk screening and a manual handling risk assessment were also in place. These would help to minimise any risk of poor nutrition or injury to the resident to member of staff during assisted moving of a resident. These would help to minimise any risk. Preventative measures such as pressure relieving mattresses and cushions, and equipment to assist with transferring residents were in use. In completed surveys residents responded as follows to the question, “Do you receive the care and support you need?” Always – 6; Usually – 1; Sometimes – 0; Never – 0. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 15 Comments made in the survey with regard to this question included, “I couldn’t be in a better place.” “Many of the staff go “that extra mile” in the care that they give to my (relative)” “I love it here.” “The care and attention that I receive is excellent at Orchard Blythe. The atmosphere is lovely.” The home’s medication system was inspected. There had been considerable improvements and the senior member of staff responsible for medication showed a commitment to making sure that the system was safe. The medication policy was easily accessible to staff with a copy kept with each Medication Administration Record (MAR) folder and a copy in the office. The Local Authority was in the process of revising this. The Local Authority had reviewed the homely remedies policy but currently the home was still not able to have a supply of ‘over the counter’ medication to give to residents with minor ailments in a safe way. A multi dose system (MDS) was used. This is medication being dispensed, by the pharmacist in named bubble packs. Some medication and all liquids cannot be dispensed in this way and they are provided to the home in their original packages. All medication in the home was stored correctly. All creams were dated once opened and discarded after 28 days if they contained an active ingredient or 3 months if they were an emollient, such as E45 cream, as they can become unstable after this period. All eye drops were also dated on opening and discarded after 28 days as they may also become unstable after this time. The home had lockable medication fridges that are located in the locked medication cupboard and staff record the minimum, maximum and current temperatures each day to ensure that the contents are stored safely. The medication administration procedure was observed and MARs were, correctly signed. The trolley was kept in the view of the person administering the medication or locked if left unattended. The procedure safeguarded residents and the security of the medication. A random selection of MARs were checked. These were clearly printed with all handwritten entries signed by two staff to ensure the accuracy of the recording. There were no unexplained gaps in the Medication Administration Record Sheets and appropriate codes had been used when medication had not been given. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 16 A random audit of medication in original packaging was carried out. There were no errors identified. To confirm that the correction medication had been received the home retained copies of all prescriptions. The practices and procedures at the home safeguards the health and well being of the people living at the home. Terms of preferred address were on the residents care plan and heard to be used by staff. Interaction with residents was respectful and those residents spoken with confirmed that they were cared for in a respectful manner and that they knock before coming into their rooms. These practises ensured that their dignity and self-esteem were maintained. Observations of staff practices found staff responded promptly and sensitively to the needs of residents. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. Residents were occupied and stimulated. Visitors were made welcome and their needs considered. Residents had choices and control over their daily lives and enjoyed the nutritious and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a designated person who is responsible for supporting residents to be occupied and to be offered activity. Whilst previously this person had covered for absences in care staff this was no longer happening. This was reflected in the rotas. Care staff carried on some activities if the organiser was absent. Activities offered in the home included, a recent visit to Twycross Zoo, which several residents spoke about with enthusiasm, trips to the Butterfly Farm at Stratford and Garden Centres, visiting entertainers, a monthly reminiscence group, an exercise group is held two weekly, croquet and boules, bingo and quizzes. The home has also purchased a Wii Game console (interactive games equipment controlled by movement), which the manager advised had “created greatly enhanced interest, stimulation and humour”. This is a innovative way Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 18 of providing exercise as well as entertainment. Group activities take place in the day centre or in the large reception area. The AQAA informed us that quizzes that involve visitors from the community had been very successful and had raised considerable income for residents’ funds. Minutes of a residents meeting on display in the reception area discussed them getting a pet for the home. The home already has a rabbit, which lives in an enclosed garden space off one of the units. This created a great deal of interest and obvious pleasure for the people living on this unit, and they were particularly amused when one of the staff could not catch the rabbit to put it back in the hutch for the night. The residents’ meetings had become a regular event with an external observer/facilitator in order to gain feedback from residents and to give them the opportunity to give their own views and wishes for the home and themselves. A ‘mobile’ shop had been established in the home selling toiletries, healthy snacks, soft drinks and day-to-day useful items. The AQAA informed us that this had become very popular. Residents and day care service users decided what they wanted the home to sell. A notice in the reception area advised residents what was on sale and asked them if there was anything else they thought should be. This ensured that their independence and self-esteem were supported. The manager advised in the AQAA that three clergymen of three denominations visit the Home, and services were held there. Any resident wishing to go to church was enabled to do so where practicable. Arrangements had been made to enable one resident to continue to worship in their chosen faith. A new large flat screen televisions had been purchased making viewing much easier everyone sitting the lounge to see. A newsletter had been produced in July and the residents, family and staff were invited to contribute to future editions. This created interest and improved communication. In surveys returned to us and in response to the question, “Are there activities arranged by the home that you can take part in?” residents answered as follows, Always – 4; Usually – 4; Sometimes – 0; Never – 0. Comments to the question included, Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 19 “Activities are many and varied – (resident) enjoys all of them. Staff help her when needed.” “not very keen on attending but… staff always invite me to attend.” “There is always plenty to do if I wish.” Visiting was at any reasonable time. One family visiting a resident was spoken with and they made very positive comments about the home, the manager, the staff and the care provided. They added that they were always made welcome and it was seen that they had a comfortable rapport with the manager and other staff. They completed a survey with the comments, “Very caring and kind” “Excellent communication” “We are very pleased with this care home.” Observations made and discussion with residents and staff showed that people living at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. The AQAA informed us residents were involved in recent staff recruitment and there were plans for this to be repeated in the future as it was so successful. There were two dining areas as two units had been brought together. One unit lounge/diner had been turned into a dining room, with one or two armchairs for those who still wanted to sit there, and the other adjacent unit lounge/diner was a sitting room only. Both rooms had a kitchenette but the one in the sitting area was to be removed and to be replaced by a ‘quiet’ sitting area. This arrangement provided a more spacious eating environment, as the previous dining areas were becoming a health and safety issue due to lack of space for wheelchairs and other aids. It was arranged attractively and the new crockery and other tableware were attractive and appropriate. Plastic beakers previously used had been destroyed and usual glassware was in use. The teatime meal was observed in this unit and was a pleasant social event. the food looked appetising and was plentiful. Assistance and support in eating was available to residents as required. This was individual, unhurried and sensitively given. Staff were interacting with residents while they served meals or assisted them. A substantial meal was provided and included, soup with bread, quiche and salad or sandwiches and a choice of fresh fruit, yoghurt and/or ice cream. Homemade cakes were also available. All those present said that they had enjoyed the meal. Surveys returned to us responded as follows to the question, “Do you like the Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 20 meals at the home.” Always – 6; Usually – 1; Sometimes – 0; Never – 0. One person did not answer this question. The following comments were also made, “Always given a choice of menu” “Not always.” “Very much like the meals and definitely no complaint regarding the food.” “Oh I love the food.” The kitchen was visited and was clean and well managed. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. The home has appropriate policies and procedures to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints procedure that was on display in the reception area. Copies were also included in the Statement of Purpose folder that is given to each resident. A complaints log was kept and this was viewed. In response to the question, in the surveys, “Do you know who to speak to if you are not happy?” all said “always”. One person added that they would go to the manager. Residents spoken with confirmed that they also knew who to go to if they had any concerns and that they were confident that they would be listened to. The following responses were made to the question, “Do you know how to make a complaint?” Yes – 6; No – 1; One person did not answer. The following comments were also made, “I don’t like making complaints. I can’t find any anyway.” “I would come to you (manager)” Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 22 The one survey from a visitor also indicated that they knew how to make a complaint, but that they had never needed to raise any concerns. The home had appropriate policies and procedures related to Protection of Vulnerable Adults (safeguarding) including the local authority version. Staff had attended training and those spoken with were aware of what they needed to do if they suspected or witnessed abuse taking place. This was shown by an allegation made on behalf of a resident by a member of staff, which resulted in the prompt suspension of staff members pending resolution of the incident. The procedures according to the local Safeguarding Adults protocol were followed. The outcome of investigations was still pending. All recruitment practices safeguard residents from the employment of unsuitable people. Financial policies, procedures and practices safeguard residents’ financial interests. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 26 Quality in this outcome area is good. The home offers the people living there comfortable surroundings, which are clean, generally free of offensive odour, safe and well maintained but with some shortfalls in décor in some areas. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The reception is large, bright and open plan and separated by trellis screening. It had several functions. A large table was provided for group activities; a small cosy sitting area had a television, armchairs, settee and coffee table; a screened corner housed a computer and an electric organ for residents’ use; another corner was built as a bar but was now used to accommodate the ‘shop’ as it was no longer licensed. The offices, for the manager, senior staff and administrative assistant, were also sited off the reception area and a hairdressing salon for residents was nearby. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 24 There were pleasant, well maintained gardens around the home, with patio areas between the units. Residents were provided with suitable garden furniture, including two new garden swinging seats. The living areas of the home are divided into two self-contained units, creating smaller group living. Each unit has it’s own staff team providing continuity and familiarity for the people living at the home. There had previously been three units but two adjacent ones had been brought together to give more space for reasons of health and safety. They provided comfortable, odour free and clean surroundings mainly well decorated and furnished in a domestic style but some communal areas were in need of redecorating as they looked dated and/or shabby. Lighting was not domestic in nature, with office-type spotlights in the ceiling. Some new good quality armchairs had been provided as the old ones were looking shabby, and more were on order to replace the remainder. They were attractive and domestic in appearance. The manager informed us that ten bedrooms had recently been redecorated. The bedrooms of the residents that were case tracked were viewed. These were comfortable clean and free of offensive odour and with ensuite facilities. Each room had been personalised by such possessions as photographs, ornaments and some small items of furniture. Both occupants said that they were happy with their rooms. Pads for continence management were stored under a bed. this is not a safe or discreet place to store them and a more suitable place should be found. There were sufficient toilets and assisted bathrooms for the people living at the home. all those viewed were clean and free of any offensive odour. All communal hand washing areas where staff and residents were expected to wash their hands had the appropriate facilities of soap dispensers and disposable towels in order to maintain infection control. Apart from a very faint and underlying smell of urine in the reception area the home was free of offensive odour and all areas viewed were clean. Laundry facilities were inspected and found to be well organised, clean and hygienic. Disposable gloves and disposable aprons were readily available for staff in order to maintain infection control whilst providing personal care. Disposable aprons of a different colour were worn when handling food. Advice had been sought from Environmental Health regarding the previous dishwashing and drying practice. Dishes were now going to the main kitchen to be washed in the dishwasher, and tea towels were no longer used for drying dishes. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 25 Staff had undertaken Infection Control training to give them the relevant knowledge and skills. Everyone completing surveys said “Yes” in response to the question, “Is the home fresh and clean?” One person also made the comment, “No doubt about that.” The home is a no smoking home. Anyone wishing to smoke would have to go outside the home to do so. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. There are sufficient staff available to meet the needs of the residents. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The rota showed that the usual number of care staff on duty were six in the mornings from Monday to Friday, three each evening and two night care staff, and this was confirmed by the manager. In addition to care staff there are sufficient catering staff and domestic assistants, although the rotas do not identify designated laundry staff. There is always a senior member of staff on duty each shift. There were sufficient staff to meet the needs of the current residents and to maintain standards of hygiene, food and safety at the home. The rotas did not show the actual hours worked by all staff, relying on everyone understanding the code used. A key to the code should be added to ensure everyone understands and for inspection purposes. The majority of the care staff had achieved the National Vocational Qualification Level 2 showing that they were assessed as being competent in their role. Those that had not yet achieved this were in the process of undertaking the training. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 27 Three staff files were looked at and all records showed that recruitment practices safeguard residents from the employment of unsuitable people, with validated references and the required Criminal Records Bureau and Protection of Vulnerable Adults checks being evidenced. There was evidence that all new staff undertake appropriate induction training. Training records show that staff have all undertaken mandatory training including, manual handing, first aid, health and safety, food handling and fire prevention. Other recent training undertaken by all or the majority of them included Protection of Vulnerable Adults and Infection Control. Additional training had been arranged related dementia care, Parkinson’s disease, and strokes. Staff responsible for medication have also undertaken relevant validated training. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is good. A person with the appropriate qualifications and who has previous management experience manages the home. The monitoring and auditing of the service and practices ensures that all services operate in the best interests of residents. Health and safety practice protects residents and staff at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager had held the post since July 2007. She has nursing and social work qualifications, the Registered Managers Award and Assessors Award. She continues to update her training needs and attends regular training events. She is competent to run the home and it has benefited from her leadership. The manager, with her line manager, had carried out a major review of care practices in order to ensure that staff were working for the benefit of the Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 29 people living at the home. She demonstrated a good knowledge of the residents and staff and an awareness of the areas of the service that needed to improve. Staff spoken with considered her approachable and supportive, and residents and staff spoken with agreed that they would be listened to. The acting care officer present at the visit was knowledgeable and familiar with aspects of the service. There are also an assistant manager and three other care officer staff who form the rest of the senior team and at least one of them is in the home throughout both the morning and evening shifts. The home used the Local Authority’s Quality Assurance programme, which is extensive and covers all areas of the service. A representative of the Local Authority monitors this, making monthly unannounced visits to the home and provides a report for us and for the home. Some monies are held for safekeeping on behalf of residents. This is kept in a secure location and all transactions were now recorded appropriately, following a review and revision of the practices. A random sample of transactions and cash balances were audited and found to be accurate. Records and discussion with the manager showed that the staff supervision was up to date and including appraisal and reviews all staff received supervision six times a year. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and issues related to the philosophy of the home. It is also another opportunity for staff to contribute to the way that the service is delivered. Her line manager, who had been supportive through this first year, supervises the manager. Training records showed that staff had undertaken the required mandatory training related to health and safety. There was evidence from a random check of records, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date. There were no health and safety concerns identified. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 30 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP7 OP8 OP19 OP22 OP27 Good Practice Recommendations Care plans should be recorded in a manner that enables staff to extract care instructions easily. Care plans for people for whom there are concerns about weight loss should include methods of addressing this. Personal items should be stored discreetly and so that they can be accessed safely. Suitable storage space should be found for incontinence pads. The duty rotas should stipulate the times of the shifts so that it is clear what times each person works in the home. Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Orchard Blythe DS0000041996.V371919.R01.S.doc Version 5.2 Page 33 - 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. 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