Care Home: Orchard House

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What has improved since the last inspection? This could not be assessed on this occasion as this is the first inspection of this newly registered pre-existing service, but for those residents previously accommodated in this home prior to the change of ownership there have been clear improvements to the standard of accommodation, frequency and type of activities offered and improvements in the range and choice of meals offered. What the care home could do better: The service has already identified shortfalls within documentation that they have inherited from the existing service and are addressing these, our inspection has highlighted these also and we have required the service to ensure records are updated and compliant with regulations. Whilst there has been improvement to the management and storage of medication we have highlighted shortfalls of which the provider was not aware and have required improvements in storage and recording of medication. Three recommendations for improved practice have also been made in respect of medication, greater clarity in the fire arrangements for the home including the availability and updating of the fire risk assessment and the routine testing of fire alarms, we have also recommended that the provider who is on site two days per week records evidence of the service monitoring undertaken and that copies of this are initially made available to the Commission. Key inspection report CARE HOMES FOR OLDER PEOPLE Orchard House St Johns Road Bexhill on Sea East Sussex TN40 2EE Lead Inspector Michele Etherton Unannounced Inspection 29th April 2009 09:30 DS0000072547.V374957.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard House Address St Johns Road Bexhill on Sea East Sussex TN40 2EE 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) 02085499951 01424 732141 Southlands Court Care Ltd Mr David Pollard Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). 2 2 The maximum number of service users to be accommodated is 32. Date of last inspection New service Brief Description of the Service: Located one mile from Bexhill town centre with it’s’ shops and access to buses and main line rail services. The telephone number for the home is 01424 211898. Bedroom accommodation is provided on three floors, with 22 bedrooms located on the ground floor of the home, a shaft lift is fitted to assist access to first and second floor rooms. Bedrooms are all en-suite apart from two. The home has two lounge areas, a dining room and a conservatory. There is ample parking to the front of the property and a large well tended garden at the rear. The home is registered to accommodate up to 32 older people and the registered owners are Southlands Court Care Ltd. Fees as stated by the provider for the current service are within the range £360-£550 per week. Extra services including chiropody and hairdressing are charged separately and details of these can be obtained from the manager. Orchard House DS0000072547.V374957.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 2* star service. This means the people who use this service experience good quality outcomes. An inspection of this newly registered service has been undertaken; this has taken account of information received from and about the service since its registration on 22nd October 2008. Although we acknowledge that up until the end of March 2009 both Southlands Court and Orchard house services remained separate, with full amalgamation taking place only from the beginning of April 2009. Surveys had been sent out but these had been completed by residents of Orchard house only owing to the delay and did not reflect their views once the service had amalgamated, we have therefore taken note of their feedback but not used it for the purpose of this inspection. An unannounced site visit of the service has been conducted on 29th April between 9:30 am and 17:30 am during which we spent time speaking with residents in groups and individually both in private and public settings, we met with the provider registered manager and deputies, in addition to undertaking interviews with four care staff and meeting members of the ancillary staff team. In arriving at our judgement of this service we have tried to be proportionate and consider the identified shortfalls and their overall impact on residents weighed with the very real positive outcomes that have been achieved to date e.g. environment, activities, choice of meals within a short timescale and the awareness and insight shown by the management team into the shortfalls and the plans already underway for addressing these. What the service does well: The new service has managed to achieve continuity in staffing for the two resident groups brought together by this move. The service is forward thinking and plans for further development are underway, finances are currently secure to progress these works. The service is enhancing the physical appearance and facilities available to residents to provide a well maintained comfortable living environment for residents. Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 6 The service prides itself on providing a good range and choice of fresh home cooked meals to residents. Residents benefit from having an activities co-ordinator available four hours each day Monday to Friday and the activities programme is evolving to take account of resident’s interests and preferences The service ensures there are adequate ancillary staffing arrangements in place to support residents and care staff. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have informed us that they had enough information to inform their decisions but the recent amalgamation of two services means this now needs to be updated. Prospective residents can be confident their needs will be assessed prior to admission. Residents are provided with terms and conditions information but this needs updating to reflect the new service. EVIDENCE: The recent purchase of Orchard house by a pre-existing provider has brought about amalgamation of both services onto the Orchard house site, combining staff and resident groups later than expected at the end of March 2009. As a result of the merger the home is now actively undertaking to merge systems and amend documentation but not all of this has yet been undertaken. Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 9 Prior to the registration of the Southlands court and orchard House services as one service both had their own documentation and resident survey information tells us that prospective residents to both homes were provided with enough information about the service including opportunities to visit prior to admission and this helped with their decision making, clearly this information is no longer relevant and the home is aware of the need to consolidate documentation to reflect the new service and should progress this. Only one new service user has been admitted to Orchard house since the reregistration of the service and we found that an assessment had been conducted for this person prior to their admission although we were able to speak to the resident during the course of our visit they were unable to remember much about their experience of admission to the service to inform us whether this had been good, discussion with the senior deputy manager indicated an awareness that the assessment tool used would benefit from additional information to aid staff in developing care plan information, and this is an area she is hoping to develop further in the near future. We looked at care files for both original Orchard house clients and those who came from Southlands court, we found that private clients are provided with terms and conditions contracts from those establishments, these now need to be reviewed and re-issued under the new provider and service, Local authority funded clients have recently had their contracts reviewed by social services and will also need to have updated terms and conditions information to inform them of their rights and responsibilities in addition to what they can expect from the service they receive. Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents’ daily routines and health care needs are generally well supported and work is underway to standardise the documentation used. Medication storage and administration practice has been developed but some further improvement is needed. EVIDENCE: At the time of our site visit the service is transferring care plans from the original Orchard house residents over to the computerised system favoured by the new provider and used in the Southlands Court service before it transferred and which staff’ from that service are familiar with. We looked at a selection of care plans from both services and found that whilst the hardcopy documentation used in the Old Orchard House service was detailed and person centred there was little evidence to indicate this was Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 11 routinely reviewed and updated with daily records not maintained. Feedback from residents of the service indicate that they felt their needs have been appropriately supported y the care staff and the new provider has identified shortfalls in documentation and is currently addressing these and ensuring that all documentation relating to residents is developed to a consistent standard and kept updated and this is being progressed as a priority. In order to ensure that staff from both staff teams familiarise themselves with residents from both resident groups care has been taken to ensure every staff member key works a mix of residents from both residents groups, staff rotas also reflect a mix of team members from both homes to ensure residents have familiar staff available. Residents are now actively involved in reviewing their support plan monthly and signing their agreement to it where they have capacity to do so. Staff confirmed that any changes to resident support plans are made known to them. We have been advised that the new management team had identified one resident without a care plan and were taking action to address this, by liaising with relevant health professionals and relatives for important information to inform the care plan, as the resident had been in the home for some months staff are familiar with daily routines and preferences as the resident is unable to contribute to care plan development it is important that staff information is recorded also. The Service has developed a service development plan which identifies the need to amalgamate the care plan records and ensure these are all updated and we are satisfied that the service is now working towards this. We spoke with fourteen residents during the course of visit some in groups and others individually in private and in public areas we tried to ensure we spoke with a mix of residents from both groups to ascertain their overall views. Feedback from residents suggested that whilst there had been initial concerns about the changes and what this might mean for them in respect to possibly moving rooms, changes in staff, and the upheaval from one home to another for many of the residents most expressed positive views of the move and are becoming increasingly settled and happy in the new service with residents more happily sharing communal space together rather than separating into their disparate groups. One resident we spoke with said he liked to sit on his own in the dining room because he got a good view of the room and could see everything that was going on. Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 12 Risk assessments are routinely undertaken in respect of residents tissue viability, nutrition and falls and moving and handling and whilst this has been updated for those residents from Southlands court work is being undertaken to ensure those in place for Original Orchard house residents are also updated. Consideration must also be given to ensuring that where residents have been enabled to take personal risks in their day to day routines assessment of risk can be clearly evidenced. Residents we spoke with confirmed attendance at hospital and routine health appointments and information relating to appointments and healthcare is retained in separate paper files, a review of those files linked to care plans we had looked at highlighted that this information is not in any particular order and specific information is difficult to find and would benefit from greater clarity in recording, we have recommended that the facility within the computer system to record all health contacts is activated to evidence clearly that routine health care is being maintained and the frequency of such appointments. Some of the residents spoken with confirmed they had kept their own dentists and opticians and made appointments with them as needed. The move to Orchard house and the upgrading of the environment has enabled the new provider to establish a medication room, staff responsible for booking medication in and out of the home spoke positively of this resource which enabled them to book medications in without distractions, The room also allowed for the storage of a medication trolley which is now used for administration of medication, a fridge is also installed for temperature sensitive medications and the home should ensure a record is kept of the temperatures of the fridge to ensure these are within the required levels. The home administers controlled drugs to a few residents currently and whilst these are stored securely within the medication room inside a locked metal cabinet, we discussed with the provider the need for this to meet the required standard for controlled drugs storage in compliance with the medicines Act 1968. The provider has therefore agreed to purchase a suitable cabinet for this purpose. Only senior staff within the management of the home now administer medication although other staff’ are trained to do so. When we looked at medication stored we noted that creams, sprays and drops prescribed are not routinely dated upon opening. We noted that recording of medication received into the home is appropriately recorded on medication records, and we found no omissions in administration and appropriate use of codes, however we found a number of handwritten entries and these were unsigned and undated by the person entering the information which was not always the person entering the receipt of medications. At the time of our visit the home was operating two medication systems as they tried to transfer one group of residents over to the preferred Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 13 MDS system. Some residents are self medicating and we spoke to one who explained how they look after their medication when it is not in use, they also sometimes refuse to take some medication and this is documented in their care plan and this has also been referred to the GP. One resident who is being supported to self medicate by staff dispensing medication into a nomad cartridge to enable the resident to take this for himself, we have asked the service to cease this practice which in effect means the home staff are double dispensing medication as this is considered poor practice, we have asked the home to discuss with the pharmacy their providing the respective client with a filled dossett box and they have agreed to do so. We have required that the home address the identified shortfalls within the timescales given at the end of the report. We have also recommended that the home develop individual resident PRN guidelines to aid consistency of administration of this type of medication, we have further recommended that the home develop medication profiles for each resident which will take account of preferences and diversity around medication administration and inform staff about possible side effects to be aware of. Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have improved opportunities for activities, exercise and trips out into the community and the home is continuing to develop this. Residents enjoy a varied and healthy home cooked diet and their individual preferences are known and accommodated. EVIDENCE: Since the amalgamation of the two homes onto the Orchard house site, outcomes particularly for former Orchard House residents in respect of stimulation and exercise have improved. In discussion with former residents and staff of the old Orchard house service it was apparent that entertainment and activities had previously been less frequent. The new service has appointed a dedicated activity co-ordinator who provides 2hours support every morning and two hours in the afternoon over Monday to Friday period. When we visited a group of residents were playing quoits in the lounge. Recent purchases for resident entertainment have also been a Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 15 Nintendo Wii and a large flat screen TV which is wall mounted and more visually accessible to a wider group of residents. Residents reported that they also have an exercise person come in every week and have also enjoyed some musical entertainment. Outings are arranged on a weekly basis in the good weather with recent trips to the Bluebell woods organised, residents who participated in this and with whom we spoke said they had enjoyed this. The activity programme is evolving and the co-ordinator is keen for resident suggestions, when we asked residents what other things they thought they might like one resident said they would like to know about computers and another said they enjoyed the trips out but would also like to have opportunities to visit local shops so they could stock up on personal items without relying on staff or relatives. The co-ordinator has indicated she will look into the possibility of utilising an old computer of the homes and also provide some sessions for those interested in computers, email etc. trips to local shops and going out for coffee will also feature within the activity programme. There is also some thought that the home may wish to keep chickens or some other smaller animals when the gardens are developed. The home currently has two hairdressers who attend residents on different days, residents can make their own choice, a small hairdressing salon is provided where residents can have their hair done without impacting on other residents or infringing the privacy of their own bedrooms. In conversation residents spoke about visits they receive from family and friends and these would seem to be unrestricted and actively encouraged. The home has invested heavily in the in the development and provision of a commercial standard kitchen and representatives from environmental health have been actively involved in the planning and development of the kitchen and are satisfied with the finished project. Residents told us they are offered Sherry or a fruit juice before lunch if they want it. Lunch and tea time menus are recorded daily on a board in the dining area, residents are offered a lunchtime choice of two hot meals, and specialist diets are catered for. Food is home cooked. Residents seemed happy with two roasts per week and commented that whilst they had found the beef tough and had commented on they were now having more pork and lamb which was tender and easier to eat. Residents are also provided with a choice of hot evening snacks. Jugs of juice are provided for residents through out the day in addition to tea and coffee. The chef reported he is advised of individual resident likes and dislikes and develops a menu plan from this, residents can give feedback either directly or through staff, he also monitors what comes back from residents to get an idea of what they like. Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 16 A resident told us “Look I have my breakfast tray in my room I have prunes and toast and cereal, I can have a cooked breakfast if I want to go into dining room, I am safe and well cared for , if I need support with appointments its provided, we have outings what more could I ask?” Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel able to express their views and are listened to. Systems are in place that safeguards residents EVIDENCE: No complaints have been recorded as yet by the new service although the deputy confirmed that the initial transition and amalgamation of both services had caused anxiety amongst residents with some expressing this though moans and groans these had been dealt with immediately with residents and relatives, in some instances this had not been resolved and a meeting with social services had been undertaken to resolve issues. An outstanding complaint from Southlands Court which has been carried over to Orchard House following the transfer of a resident has been looked into by social services and CQC, whilst it is acknowledged that the resident concerned may not be satisfied with the outcome, we are satisfied that a compromise had been reached and this is now closed. None of the residents indicated that they had unresolved complaints and survey feedback from Orchard house residents and interview feedback from our site visit indicated that residents generally felt comfortable and confident Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 18 with approaching staff about any concerns they might have and that these would be sorted out for them. There are no adult alerts at present, staff’ have received POVA training, notifications of incidents are being appropriately notified to the commission. Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are benefiting from continued investment in the development of the service to provide better overall facilities. The home is clean well maintained with a programme of upgrading and improvement underway. EVIDENCE: The new providers have provided extensive investment in the upgrading of the property and these have and continue to be of positive benefit to residents and include: an ongoing programme of redecoration, ensuite facilities increased to 29 out of 31 bedrooms, 22 of the bedrooms are located on the ground floor, installation of a purpose built commercial kitchen, and a new parker bath has been installed, although residents benefit from a large conservatory space and neat well maintained gardens, planning permission is sought for a further Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 20 conservatory and two additional gardens have been purchased to enlarge garden space for residents. The call bell system has been updated and on the day of our visit a problem with this was being addressed by the maintenance service Residents we spoke with confirmed the problem had arisen the previous evening and a request for the system to be repaired made as soon as possible. The home has a dedicated maintenance post and we spoke to the post holder in regard to their duties, this discussion highlighted that their role includes taking account of residents preferences in regard to the layout of their rooms which he helps rearrange to suit their wishes, this often also requires the relocation of call bell cords to ensure residents can continue to reach them when their furniture has been moved around. Fire equipment and alarm systems have been serviced and the emergency lighting tests are routinely undertaken by the maintenance person, some confusion exists as to who is undertaking responsibility for testing fire alarms and it was agreed during our visit that this would also be undertaken on a weekly basis by the maintenance person and records of this are to be maintained. Staff’ receive fire training which incorporates drills, consideration should be given to ensuring night staff participate in between 2-4 drills annually. The fire risk assessment could not be found although the home was visited last year by the fire officer, we have recommended that the home ensure fire arrangements are clear and that the fire risk assessment be updated to reflect the installation of a stair gate in the main house. Door guards have been installed on many of the doors to enable these to e kept open at resident’s request. There is a separate laundry located in the basement of the home this is spacious but not ideal because of the need to carry laundry upstairs, there may be an opportunity to provide additional laundry space with proposed future building development. The Home employs a range of ancillary staff including maintenance, cleaning kitchen and laundry staff. The home is maintained to a good standard of cleanliness with no noticeable odours, plentiful supplies of liquid soap, hand sanitizer and paper towels were noted throughout the home, one shower room would benefit from the addition of a bin to ensure residents do not flush hand towels down the toilet causing blockages. Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents from the two amalgamated services benefit from continuity in the staff support they receive. Staff are being supported to develop a sense of team and to work across both former resident groups. The amalgamation of the two services has highlighted some shortfalls in the content of information relating to staff recruitment, training and supervision that the new provider and management team are taking steps to address. EVIDENCE: As the original AQAA did not reflect the staff training details of the team from Southlands court it has not been possible to judge the level of NVQ achieved within both staff teams as the records of staff training at the original orchard house service had not been well maintained. A review of all staff training achieved and identified gaps in training is being undertaken within the new service currently. All care staff’ spoken with on the day of inspection are NVQ level 2 and above qualified. The amalgamation of the two services has ensured continuity of staffing for both groups of residents and staffing levels are currently higher as the service Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 22 settles down with a registered manager three deputies, five carers on duty each shift with two waking nights, there are also a team of ancillary staff. Residents we spoke with felt well supported by staff. No new staff have been recruited for the new service with the merging of teams leading to some redundancies, staff spoken with thought this had been managed well although those who stayed with the home thought that they would have benefited from more information about their position in the new service, although this has now been made clear to them and they are happy in their new roles. No complaints have been received by the Commission from any of the displaced staff which is a testimony to the professional way in which this was conducted to the satisfaction of all parties. Review of staff recruitment files highlighted those of original Orchard House staff to be less well developed with an absence of much of the information required by legislation. Vetting and checks had been undertaken but in two out of three files viewed 2nd reference information had not been pursued and the overall content of the files was not in keeping with schedule 2 of the Care Homes Regulations 2001with lack of ID, and photographs, there is also an absence of interview records to confirm that gaps in employment and verification of reasons for leaving previous care roles have been explored, most of the staff have been in post for more than five years and we acknowledge it may be difficult to retrospectively seek references however, file content across all staff files should be standardised, and any new staff files should comply with regulations. Staff from both teams reported initial anxieties about the merger of the two homes and working with different staff but all agreed this is now working out quite well, they commented that residents are now more relaxed and staff are well accepted by both resident groups, key worker arrangements have been organised to ensure that staff have a mix of residents to support from both original services to enable staff and residents to familiarise themselves with each other. Staff said they felt confident about approaching the management team with issues or raising these within staff meetings, staff thought that only one staff meeting had been held so far. An initial appraisal of all staff has been undertaken as part of the amalgamation of the service and those management staff involved thought this had been a very useful exercise in assessing overall staff performance with some staff they would have considered as performing well scoring badly overall, they consider they may adapt this tool for more routine appraisal of staff performance. Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 23 Although staff spoken with felt well supported and confirmed they are in receipt of regular supervision we could find no documentation to support this or the content of supervision within staff records viewed, it is important that these meetings are documented to ensure the manager and senior staff can evidence staff performance is being monitored and staff are provided with opportunities to express concerns and views about work issues or those of a personal nature that impact on their work Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is generally well managed in the best interests of residents however, there are some identified shortfalls that the service has confirmed it is taking steps to address and we will monitor progress accordingly EVIDENCE: The current registered manager is experienced and is undertaking qualifications suited to the role but is not a hands on care manager leaving this to the deputies who work alongside staff on the floor. He acknowledges there may be some changes to the management structure in the near future Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 25 The manager has commented that whilst they recognise that there are shortfalls currently which they are working to address credit is due for the relatively smooth transition of one care home into another, he understands that there were initial expressed anxieties from residents and staff but these have been worked with and resolved, and he now feels residents are benefiting not only from improved physical facilities 22 ground floor bedrooms and all but two rooms being ensuite, but from the recent purchase of additional land to increase overall garden size, the provision of a dedicated activities coordinator, weekly outings and also greater food choice particularly for residents of orchard house who had not previously had this. The provider and manager feel strongly that whilst all the details and problems have not been completely sorted yet things are improving all the time and the service is evolving and adjusting. There was nothing in the feedback we received from all the residents and staff we spoke with that would indicate a different view at this time. The Provider is currently on site 2 full days per week and is actively involved in all aspects of the care home but not in direct operational control and should therefore be completing regulation 26 visits monthly, this has now been discussed with the manager and provider and the need for the provider to evidence the monitoring he undertakes of the service each month, initially we are requesting a copy of these be submitted to the Commission each month as confirmation they are taking place and this is a recommendation. Many of the shortfalls identified are as a result of the amalgamation of systems which have not been fully implemented, and we have on this occasion issued a requirement for the home to ensure that all records which the home is required to maintain are to a consistent standard, are maintained and compliant in accordance with legislation and are kept updated. The AQAA informs us that Health and safety servicing and checks have been undertaken and the management team have confirmed any due for updating have been, we examined a random sample of these and found these to be current. The Service is developing a number of stand alone audits and checks, conducts resident meetings and is intending to reintroduce a newsletter to inform residents of happening s within the home, these have not been progressed and surveys have not been conducted as yet, in order to allow time for the move to settle and provide a more balanced view from residents’ quality assurance is still to be developed. We viewed accident reports for residents whose files we viewed and found a low level of accidents recorded generally Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 26 Whilst we recognise that the inspection has highlighted some omissions and inconsistencies in information we consider that outcomes for residents have improved and residents are generally safe, the home management team have identified shortfalls themselves and are taking steps to address some of these things. It is our view that it would be proportionate at this time bearing in mind what has already been achieved, to award a good rating to the service management who have also developed a service development plan identifying some of the areas in need of improvement some of which have already been achieved. We consider the home should be given time to consolidate the move and the service to demonstrate whether there are ongoing areas of concern which the home has failed to address to this end we will undertake a further inspection of this service within one year of this inspection to assess whether the service has in fact addressed the shortfalls as agreed. Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 27 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 2 2 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x 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 3 3 3 3 3 x 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 2 2 3 Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 28 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. 1 Standard OP9 Regulation 13(2) Requirement The provider is required to review medication arrangements to ensure that: Controlled drugs are stored in accordance with the Medicines Act 1968. Handwritten entries onto Mar sheets are signed and dated by the person entering the change Staff must not undertake double dispensing of medication on behalf of residents alternative arrangements must be sought The provider is required to ensure that shortfalls identified by this report within current records are addressed in that records are compliant with regulation in their content and are kept updated Timescale for action 29/06/09 2 OP37 17 schedule 3&4 29/06/09 Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 29 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 Refer to Standard OP8 OP9 Good Practice Recommendations Health care information should be recorded in one place and enable frequency and monitoring of health care to be easily assessed Medication administration arrangements for individual residents would benefit from the creation of individual PRN guidelines for those in receipt of this medication to ensure consistency in administration by staff. We also recommend the development of Medication profiles for residents to inform staff of preferences and diversity issues in medication administration in addition to possible side effect information and the purpose of each medication. The provider must ensure that fire equipment and alarm testing arrangements are undertaken within agreed frequencies and that these do not become overlooked in the absence of the person responsible for completing these. The fire risk assessment should be available to view and updated to reflect the recent addition of a stair gate The provider should record monthly monitoring visits of the service and a copy of each monthly visit should be sent to the commission 3 OP19 4 OP33 Orchard House DS0000072547.V374957.R01.S.doc Version 5.2 Page 30 Care Quality Commission Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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