Care Home: Orchard House

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What the care home does well The service manages admissions to the home well, they provide people with the right information so that they can make an informed choice about whether they would like to live at Orchard House. The people who live at Orchard House, or their representative are involved in the care planning process and regular reviews. The staff make sure that people receive the right care from specialists that are appropriate to their individual needs such as doctors, dentists and opticians. Although there is no formal activities programme or dedicated coordinator the service does provide a range of activities for the people who live there, these include in house activities, celebrations and outings. People who live at Orchard House are also supported to engage in light domestic activities such as dusting, should they wish to do so. People are able to exercise choice in their daily lives and to maintain links with their families and friends. Arrangements are also in place for people to maintain their faith, should they wish to do so. The service ensures that people who live there have a good choice and variety of food and that appropriate alternatives are available. The service is responsive to the views of the people who live there and manages complaints well. The Registered Manager is a Registered Nurse with experience of providing care for the elderly, she has undertaken further study in the care of people with Dementia. People told us `The home does everything well, there is nothing that needs to be improved` `The staff care for and about their clients` `The care is very good, my mother certainly gets `TLC` ` I usually receive care and attention needed ` The home cares for me well` ` I am kept clean and tidy` ` I believe that I am looked after very well by all of the staff` The expert by experience spent a lot of her time talking with the people who live at the home, they were all very enthusiastic about the home and told her that `Orchard House is Just like home` `If I was a millionairess I would not want to live anywhere else` The staff take great care of me especially when it comes to moving me or washing me I have complete choice as to how much I wish to do for myself I can go to bed whatever time I like and if I am watching a late television programme I just tell them and press my buzzer when I am ready. What has improved since the last inspection? The service has reviewed the preadmission assessment documentation and used this to ensure that the service can meet the needs of both new and existing people who live there. The format of the individual plans of care have been reviewed, these are now more person centred and provide staff with detailed information about people preferences and detailed instruction as to how their health, personal and social care needs are to be met. We also looked at the medication systems, these were found to be in good order, the service has complied with four outstanding requirements from the last inspection report. The people who live at Orchard House, their relatives and the management have combined their efforts to develop a sensory garden which was much enjoyed during the fine weather. The management ensure that the appropriate referrals are made to the local Safeguarding Teams when specific incidents occur. The service has worked to improve signage that is appropriate for the needs of people with dementia. Other improvements include replacement windows, carpets and ongoing decoration of rooms as they become vacant. A digital aerial has also been installed so that people are able to have access to digital television and additional television channels. Staffing levels are good, staff have the right pre-employment checks and training so that they can care for people properly. Arrangements are now in place for staff to receive a thorough induction programme and supervision on a regular basis, this ensures that they have the right skills to care for people properly. The management have complied with seven requirements made as a result of the last key Inspection. This shows that they work with us to achieve better outcomes for the people who use the service. What the care home could do better: The service needs to make sure that they have the right certified facilities in place for the storage of Controlled Drugs. The management are mindful of the constraints of the environment and the needs of the people who use the service as such clutter should be reduced, decorations should be appropriate and the arrangements for hair dressing should be reviewed to ensure access to appropriate facilities and privacy. Key inspection report Care homes for older people Name: Address: Orchard House 155 Barton Road Kettering Northants NN15 6RT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Stephanie Vaughan     Date: 2 5 0 1 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 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. 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 Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Orchard House 155 Barton Road Kettering Northants NN15 6RT 01536514604 01536485599 daryl.wilson@btopenworld.com rsonshomes@btopenworld.com R Sons (Homes) Limited care home 33 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: No one falling within category DE(E) maybe admitted into the home when there are 18 persons of category DE(E) already accommodated in the home. No one falling within the category of PD(E) may be admitted to the home when there are 10 persons of category PD(E) already accommodated in the home. The total number of service users must not exceed 33 Date of last inspection Brief description of the care home Orchard House is located in a quiet residential area in Barton Seagrave, on the outskirts of Kettering. It is an extended detached property offering accommodation, in 26 single bedrooms and 2 double bedrooms, on the ground and the first floor, which can be accessed via stairs or a lift. Orchard House offers 32 places for older people over the age of 65 who require personal care and support due to age. Its registration includes the capacity to care for older people with physical disabilities and some with Care Homes for Older People Page 4 of 28 Over 65 18 33 10 0 0 0 Brief description of the care home Dementia conditions. The service user guide states that the Fees charged for staying at the home range from GBP 356.99 to GBP 500.00 a week. Items not included in the fees include hairdressing, newspapers, private health cost, dry cleaning and TV concessionary licence charge. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We spent four hours in preparation prior to this inspection, this included looking at the Annual Quality Assurance Assessment which is a document sent to us by the management, the previous inspection reports, associated requirements, the service history and other documentation. We sent surveys to the some of the people who use the service and eleven people returned them to us. Their responses were all favourable and specific comments have been included in the body of the report. We have received no concerns, complaints or allegations about this service. However we were informed about one incident that has safeguarding implications. The service has shown us that it responds in the right way and ensures that incidents such as these are referred to the local authority for review. Care Homes for Older People Page 6 of 28 The Commission have a focus on Equality and Diversity and issues relating to this are included in the main body of the report. The site visit was conducted over a period of seven and a half hours during which the inspector made observations, spoke to the people who live there and the staff. A limited tour of the premises was conducted which involved reviewing the communal areas and some of the bedrooms. Case tracking is the method used during the inspection where a sample of four people were selected and aspects of their care and experiences were reviewed, including the individual plans of care and associated documentation. The service specialises in the care of people with dementia as such some of the people who live there have limited ability to recall and communicate their experiences. In these circumstances observations are used to inform the inspection activity. We were also accompanied by an Expert by Experience this is someone who has previous experience of social care services and who works with the CQC Inspectors to view the service from a users perspective. The findings of the Expert By Experience are included in the body of the report. The Acting Manager was present throughout this inspection Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? The service has reviewed the preadmission assessment documentation and used this to Care Homes for Older People Page 8 of 28 ensure that the service can meet the needs of both new and existing people who live there. The format of the individual plans of care have been reviewed, these are now more person centred and provide staff with detailed information about people preferences and detailed instruction as to how their health, personal and social care needs are to be met. We also looked at the medication systems, these were found to be in good order, the service has complied with four outstanding requirements from the last inspection report. The people who live at Orchard House, their relatives and the management have combined their efforts to develop a sensory garden which was much enjoyed during the fine weather. The management ensure that the appropriate referrals are made to the local Safeguarding Teams when specific incidents occur. The service has worked to improve signage that is appropriate for the needs of people with dementia. Other improvements include replacement windows, carpets and ongoing decoration of rooms as they become vacant. A digital aerial has also been installed so that people are able to have access to digital television and additional television channels. Staffing levels are good, staff have the right pre-employment checks and training so that they can care for people properly. Arrangements are now in place for staff to receive a thorough induction programme and supervision on a regular basis, this ensures that they have the right skills to care for people properly. The management have complied with seven requirements made as a result of the last key Inspection. This shows that they work with us to achieve better outcomes for the people who use the service. 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. Care Homes for Older People Page 9 of 28 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. Care Homes for Older People Page 10 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 people who use the service have their needs fully assessed prior to moving in to Orchard House ensuring that the service is able to meet their needs. Evidence: The service has a Statement of Purpose and Service Users Guide which are currently being updated so that people who may wish to live at Orchard House have a access to up to date information. The service also provides a welcome pack and ensures that any new arrival is supported to settle into the home by being introduced to the other people who live there and the staff. We looked at the Care Plans for one recent admission, these contained the right information including a detailed pre admission assessments conducted by senior staff before admission. This means that the service is able to meet the individuals assessed Care Homes for Older People Page 12 of 28 Evidence: needs and also forms the basis for the development of detailed individualised plans of care. All of the people who live at the home have contracts in place that set out their terms and conditions of occupancy, these are updated to accommodate any changes such as an increase in the fees charged. One resident commented The home does everything well, there is nothing that needs to be improved The expert by experience spent a lot of her time talking with the people who live at the home, they were all very enthusiastic about the home and told her that Orchard House is Just like home If I was a millionairess I would not want to live anywhere else Care Homes for Older People Page 13 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service now have a detailed plan of care which sets out their personal health and social care needs this ensures that they are treated as individuals and that their health care needs are fully met. Evidence: We case tracked four of the people who live at Orchard House. All of them had an individualised plan of care which sets out how the person needs and wishes to be cared for. The individual plans of care are detailed and cover all aspects of need including health, personal and social care need. There was some evidence the that the people who use the service are involved in the care planning process and that the care plans are reviewed on a regular basis. Each resident is assessed for the risks of falls and bathing, appropriate controls are in place to reduce the identified risks . People who use the service are also assessed for the risks associated with pressure and nutrition. Where it is identified that the individual is at significant risk the service liaises with the District Nursing services and Care Homes for Older People Page 14 of 28 Evidence: Community Dietician to ensure good outcomes for the people who live there. Comprehensive Movement and Handling plans are in place which set out how the individual needs to be supported. The service specialises in the care of people with dementia individual plans of care contained good information about how staff were to interact with the people living there and also how episodes of challenging behaviour are to be addressed. The service also works with the Community Psychiatric Services. People appeared well presented and were dressed appropriate to their age and gender. We received comments from the people who live there they told us that The staff care for and about their clients The care is very good, my mother certainly gets TLC I usually receive care and attention needed The home cares for me well I am kept clean and tidy I believe that I am looked after very well by all of the staff The Expert by Experience spent time talking with the people who live at Orchard House, they told herThe staff take great care of me especially when it comes to moving me or washing me I have complete choice as to how much I wish to do for myself I can go to bed whatever time I like and if I am watching a late television programme I just tell them and press my buzzer when I am ready. The staff observed were always very respectful when talking to the residents. They always knocked on the door of the residents room when they wished to enter. When I was in a room and staff entered they always said hello and had a quick chat with the resident. We also looked at the medication systems, these were found to be in good order, the service had complied with four outstanding requirements from the last inspection report. However the service needs to make sure that they have the right certified facilities in place for the storage of Controlled Drugs. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Orchard House have control over their lives so that they are able to enjoy a lifestyle that promotes their independence. Evidence: We case tracked four people who live at Orchard House, their individual plans of care set out their preferences regarding their daily routines. There was evidence that people are able to make choices in their daily lives about their appearance, personal routines and how and where to spend their time. Although there is no dedicated activity coordinator or formal activities programme there is evidence that people have access to a range of in house activities such as ball games, sing a long sessions and quizzes. People also told us that they go on outings with staff members and that the service arranges festive celebrations and parties, such as the opening of the recently completed sensory garden. People told us that these events were appreciated and enjoyed. There was also evidence that the people who live at Orchard House are supported to engage in light domestic activities such as dusting should they wish to do so. People are supported to maintain links with the local community through access to Care Homes for Older People Page 16 of 28 Evidence: local churches and visiting clergy specific to their religious and cultural needs. The service also arranges various outings and events to enable the people who live there to entertain visitors to the home for events such as the opening of the sensory garden. Arrangements are also in place to enable people to maintain links with family and friends through flexible visiting arrangements. Lunch time service is generally at 12:30 however there is some flexibility to this for individual needs. We observed the arrangements for lunch in the main dining room, however food is served wherever individuals wish. People using the main dining room engaged in conversations between them selves which indicated that they were well stimulated within their daily lives and this promoted a pleasant atmosphere. We noted that people were able to reject the food that they had ordered earlier in the day and that a suitable alternative was provided. The service has a seasonal menu which offers a choice of nutritional food at all of the four meals served within the day. All of the existing people who live at Orchard House are white British and as such the menu reflects their age and cultural preferences. Breakfast is served at times according to the residents preferred times of rising. Drinks and snacks are also available throughout the day. The expert spent time talking to the people who live at Orchard House, they told her that I can go to bed whatever time I like and if I am watching a late television programme I just tell them and press my buzzer when I am ready I am very happy here The staff said this is my home and I can do as I like Orchard House is a home from home Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a robust complaints procedure and good staff awareness and attitudes regarding their responsibilities in safeguarding adults so that the people who live at Orchard House feel safe and are protected. Evidence: The service has a complaints procedure which is included in the service users guide and welcome pack which is supplied on admission. All of the people that we spoke to were able to indicate that they knew how to complain. The service acts on the feedback for the people who live there and their representatives to put things right before they become formal complaints. The homes complaints records show that they have had no formal complaints since 2003. The service ensure that the people who live at Orchard House are protected from abuse by the use of robust recruitment systems and appropriate checks before people start working in the home. Staff are also encouraged to undertake training in NVQ qualifications, training in the Safeguarding of Adults and other training appropriate to the needs of the individuals who live there such as training in Dementia Awareness and the management of challenging behaviour. Staff spoken to were able to demonstrate a good understanding of the roles and responsibilities in the safeguarding of adults. Care Homes for Older People Page 18 of 28 Evidence: The people who we spoke to told us that they felt safe living at Orchard House and that the staff were nice to them. The Expert by Experience commented The residents and visitors were very happy to talk to me and all told me that they could not be in a better place. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ongoing improvements to the environment mean that the home is well maintained which ensures that people live in a comfortable and safe environment. Evidence: Orchard House is a large extended period property situated in its own extensive grounds. Although much has been done to ensure accessibility for people with disabilities the premises does still present the people who live there and the staff with some challenges. For example the door ways and corridors are narrow and therefore not always easily accessible to people in wheelchairs. The office although located off the dining room to allow good observation is very small and items of equipment do encroach into the public areas. In addition there appears to be some clutter around the home one example being a large Father Christmas which had been left out in one of the communal areas. Arrangements were made for this to be removed during the inspection. The service specialises in the care of people with dementia and the manager is mindful of the need to ensure that the environment is conducive to the needs of people who live there. The environment was discussed with the Registered Manager who informed us that the management are aware of the limitations of the building and that they are working toward the development of the service with the design of a purpose built unit to be Care Homes for Older People Page 20 of 28 Evidence: located within the grounds. The timescale of this development is within the next three years. Recent improvements have been the colour coding of toilet doors and pictorial signage to assist those with dementia. In addition management, relatives and people worked together to enable the development of a sensory garden which was well utilised during the fine weather. A digital aerial has been installed so that more modern televisions can be used and people can have freeview services if they wish. The service has appointed a maintenance person who is able to respond to the needs of the environment, recent improvements have been replacement windows and carpeting in some areas. Rooms are refurbished as they become available and care is taken to ensure that people have choice but that the decor also meets the needs of people with dementia. There are several areas where people can spend their time including a quiet area that has been set out at the end of one of the corridors and also a conservatory, both these areas are used for hairdressing purposes and yet do not make arrangements for the supply of water and privacy. All of the people who we spoke to told us that they liked their rooms and they were able to personalise them with their own possessions and memorabilia. They also told us that they felt safe and comfortable living at Orchard House. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the training and supervision of staff means that the people who use the service are in safe hands at all times Evidence: Staffing levels are calculated according to the needs of the people who live there. This means that the management ensure that there are the right number of staff, who have the right skills on duty on each shift. Care staff are supported by the Registered Manager and a deputy manager. In addition there is a cook, a kitchen assistant, laundry person and maintenance person during the normal working hours. We looked at a selection of staff files, these demonstrated that the recruitment of staff is managed well. The files contained evidence that the right checks are done before new staff start working in the home. Staff files also showed that staff now receive a good induction training before they are able to work without supervision. Staff are encouraged to undertake training in National Vocational Qualifications, all of the mandatory training such as Infection Control, Safe Administration of Medication, Movement and Handling, First Aid, Health and Safety, Fire Safety and Food Safety training. Staff have also received training in the Mental Capacity Act and Deprivation of Liberty Standards. Staff also have access to a good range of training specific to the needs of the people who live there such as Dementia Awareness, Falls Prevention, Activities, Client Handling and Leadership. Care Homes for Older People Page 22 of 28 Evidence: The expert spent time talking to the people who live at orchard House they told her that the staff were always courteous and kind and since there were now more staff with English as their first language communication was better. The people who live at Orchard House told us I believe that I am looked after very well by all of the staff I am very happy at Orchard House The manager and staff are helpful. The home does everything well, there is nothing that needs to be improved The staff care for and about their clients The home cares for me well Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate leadership and guidance means that the service is managed in the best interests of the people who live there. Evidence: The Registered Manager is a Registered Nurse who has many years experience of providing care to the elderly. She has a specific interest in the care of people with dementia and is currently nearing completion of an honours degree in Dementia. Following the last inspection seven requirements were made, we reviewed compliance with these during this current inspection and found that the management had complied with these. This shows that the service works with us to improve outcomes for the people who live at Orchard House. Quality assurance activities are in place, as a result the management have redesigned the individual plans of care and have been supporting staff in the use of these. Audits of medication systems have resulted in new systems for the use and recording of Care Homes for Older People Page 24 of 28 Evidence: administration if topical products. The service holds regular meetings with the people who live at Orchard House and their Representatives. People are involved in fund raising activities and also in running the home through planning of menus and activities. Feedback from the people who use the service and their representatives is that the service provided at Orchard House is good and that it is responsive to their views and their needs. The service holds small amounts of money we looked at the way that this was being managed and we found that this was being done properly. The management ensure safe working practices by ensuring that staff recruitment systems are robust and that staff have the right training and skills. Staff supervision has been introduced to make sure that staff have the formal support and development to fulfil their responsibilities. No hazards were identified, the service is fitted with appropriate window restrictors and radiator guards. Risk assessemnst are in place to reduce the risks of falls and other hazards. Accidents and incidents are recorded and reported, these are monitored by the management to identify any trends in order to reduce and eliminate risks. The people who live at Orchard House told us I regularly see the manager and she listens to what I say The manager is helpful. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The storage of Controlled 01/03/2010 Drugs must be reviewed to ensure that it is certified as compliant with the Misuse of Drugs Act (Safe Custody) To ensure compliance with the Misuse of Drugs Act (Safe Custody) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 19 The arrangements for hairdressing should be reviewed to ensure access to appropriate facilities including the protection of privacy. 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