Care Home: Orchard House

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What the care home does well There is a welcoming atmosphere at the home and it is a friendly place to visit. People have their needs checked carefully before they go to Orchard House to make sure the home will be able to give them the correct care. People are looked after in a way that meets their personal and health care needs. Medication is managed safely overall so that people receive their medicines correctly. There are enjoyable things for people to do and mealtimes are recognised as an important part of people`s lives. The food is varied with lots of choice. Relatives and friends are made welcome when they visit. People at Orchard House are protected because concerns will be dealt with openly. A visitor told us it is always easy to raise a problem with the staff and that they listen and put things right. Staff are trained to know what they should do if they have concerns about a person`s wellbeing. The building is clean and comfortable and is kept safe and well maintained. People like the small size of the groups living in each part of the home. Recruitment procedures are good so that staff are carefully selected. Many of the staff are experienced in helping people who have dementia and have been trained to understand good practice in this type of care. The home is managed by an experienced person who wants to make sure people have a good life at the home. The management team within the home are being supported by the organisation to continue to develop the quality of the specialist dementia service provided. What has improved since the last inspection? It is three years since we did our previous inspection of Orchard House. Since then the service provided at the home has changed from providing ordinary residential care and a re-ablement service to providing a specialist service for people who have care needs due to having dementia type illnesses. Because of this we did not measure the current service against the one provided three years ago. What the care home could do better: Shaw healthcare`s internal audits have identified the things that could be improved at the home. When we checked their records about this we found that they had already highlighted things we found during our inspection and are working on them. These included making the care records easier for people to use, more person centred and more detailed about how to support people. Although medication is managed safely overall, records need to be kept when staff administer prescribed creams. Some updating to the furnishings and decor would improve the surroundings. It is important that staff training is brought fully up to date as it can be hard to catch up once a large number of staff need updates. It would be helpful for people if the results of the organisations quality assurnace audits were made available to them so they could see how their views can influence improvements to the service. Key inspection report Care homes for older people Name: Address: Orchard House The Walk Withington Herefordshire HR1 3PR     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: Denise Reynolds     Date: 1 2 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 29 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 29 Information about the care home Name of care home: Address: Orchard House The Walk Withington Herefordshire HR1 3PR 01432850671 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: orchard.house@shaw.co.uk Shaw Healthcare Ltd care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 28. The registered person may provide the following category of servcie only: Care Home Only - Code 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 - Code OP 28 - Dementia - Code DE 28 Date of last inspection Brief description of the care home Purpose built as a residential home in the 1970s, Orchard House is situated in the village of Withington, approximately 5 miles from the city of Hereford. The home is just off the main A4103 Hereford to Worcester road and it is situated in large gardens. There is a good-sized car park at the front of the building. Orchard House is registered to provide personal care for up to 28 older men and women. The service changed in 2009 and now provides respite and long term care for people who have needs due to dementia type illnesses. Care Homes for Older People Page 4 of 29 Over 65 0 28 28 0 Brief description of the care home Information about the fees should be requested from senior staff at the home. Care Homes for Older People Page 5 of 29 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: One inspector spent a day at the service for this inspection. During our inspection we spent time observing day to day life, speaking to people who live there, visitors and some staff. We also looked at a range of essential records needed to support the care of people and the overall safety and management of the service. The focus of our inspection was to look at the outcomes for people who live at Orchard House and to find out what they think about their care. To help us with this we looked in detail at the care of two people. This included observing some aspects of their care, talking to staff about the care they need, looking at care records and where possible, speaking with them. Some months previously the service had sent us their Annual Quality Assurance Assessment (AQAA). This is a self assessment tool which services use to describe what they do well, what they need to do better and what their plans are for improvement in Care Homes for Older People Page 6 of 29 the coming year. At this time we also sent surveys to people using the service and their relatives. During our inspection we also looked at the records that the organisation keeps about its internal quality monitoring. We used all of this information to help us build a picture of the quality of the service people at Orchard House are receiving. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Shaw healthcares internal audits have identified the things that could be improved at the home. When we checked their records about this we found that they had already highlighted things we found during our inspection and are working on them. These included making the care records easier for people to use, more person centred and more detailed about how to support people. Although medication is managed safely overall, records need to be kept when staff administer prescribed creams. Some updating to the furnishings and decor would improve the surroundings. It is important that staff training is brought fully up to date as it can be hard to catch Care Homes for Older People Page 8 of 29 up once a large number of staff need updates. It would be helpful for people if the results of the organisations quality assurnace audits were made available to them so they could see how their views can influence improvements to the service. 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. Care Homes for Older People Page 9 of 29 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 10 of 29 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. People who may move into Orchard House have their needs checked carefully first by staff to make sure the service can provide the right care for them. Evidence: People who may be moving into Orchard House to live, or to stay for a short period have their care needs checked first. This is to make sure that the service will be able to give each person the right care for them. Whenever possible staff from the home will meet a person and their family first to find out about them and to talk about what the home can offer. Sometimes people need to go to the home at very short notice because the usual arrangements for their care are not enough or because their usual carer is unwell. This means that some people may arrive without much being known about them. The manager told us that in these situations the staff from the department of mental health for older people (DMHOP) in Hereford are very supportive and make sure information is provided as soon as possible. In normal circumstances the home insists on having a copy of the local authority assessment Care Homes for Older People Page 11 of 29 Evidence: before a person is offered a place. This is so that they are aware of the circumstances that have led to the person needing to go to Orchard House and be sure that Orchard House will be the right place for them. People are offered the chance to visit Orchard House before they go there so that they can see what it is like. In the AQAA the manager told us that they plan to provide welcome packs in future with toiletries as a welcoming gesture to people when they arrive. Work is planned with DMHOP to look at ways to enhance the admission process for people going to the home for respite care. During our inspection it was a changeover day in the respite unit with some people going home and others arriving. This is a busy day for staff due to the work involved in getting people ready to go and settling in the people arriving. For this reason we limited our contact in this unit. Care Homes for Older People Page 12 of 29 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 living at Orchard House are given attentive care which meets their personal and health care needs. Medication is managed safely overall so that people receive their medicines correctly. Evidence: During our inspection we saw that people look well cared for and had been helped by staff to look their best. The atmosphere in the two sitting rooms was relaxed and we saw and heard staff dealing with people in a calm, caring and respectful way. The family members we spoke to were very happy with how their relative is looked after and said she had settled better than they could have hoped for. They told us that they are confident that she has the medical attention she needs and that staff are very good at doing things like helping her dress nicely and put her jewellery on. They told us they are kept well informed about how she is and told if she is unwell. We spoke to a person privately in their room and they also gave us a positive picture of living at Orchard House. They told us I love it here, I am so happy and they are so Care Homes for Older People Page 13 of 29 Evidence: kind to me. The person told us that the food is good and staff are polite, I feel safe here she said. We looked at the care records for two people and saw that these contained a lot of detailed information about the care the people needed. We found some examples of things that we felt needed to be recorded in more detail (such as how people could be helped to follow their social interests and how staff should deal with aspects of a persons behaviour). Barbara Hadley (Area manager for Shaw healthcare) and Margaret Young (the registered manager of the home) told us that work is already planned to develop the care plans. They are going to put the care plans onto computer to make them easier to review and to update when someones needs change. A member of Shaw healthcares audit team did an audit of the care plans in October 2009. The findings of this will be used to enhance the content of the written care plans. For example, they intend to check that there is enough guidance in them for staff and to involve people who live at the home and their families more in what the plans say. People in Sunnyview and Dunroamin have care needs due to them having dementia type illnesses. We saw that staff showed a good understanding of peoples needs and related to them in a sensitive way showing respect for their dignity. Margaret Young spoke to us about the importance she places on valuing people and of staff doing all they can to understand the personality of the person before they became unwell. This is an aspect of care that she hopes to continue to build on at the home. We also saw that staff were discreet when helping people who needed to use the toilet and that during the day people were encouraged to have enough to drink. Medication is securely stored in locked trolleys. We saw that staff administer medication safely by dealing with one person at a time and signing to show that the person has had their tablets or medicines. The records we looked at were tidy and up to date with no unexplained gaps. We found that a medication record sheet was missing for one person; the team leader dealing with the medicines at the time had already identified this and made a note that the pharmacy needed to be contacted about it. More information needed to be recorded in the care records about creams that people have prescribed for them and where these are to be used. Application of prescribed creams was not recorded on the medication administration charts. During 2009 the home had correctly notified us about some medication errors. In the AQAA they told us that this was dealt with by providing extra training and reviewing the medication policy. Further medication training was due to be provided shortly and Care Homes for Older People Page 14 of 29 Evidence: Margaret Young explained that all staff who deal with medication (including her) are assessed to make sure they are competent. Good practice is followed in respect of medication arrangements for people who are having respite care visits so that staff know people have the right medication when they arrive and when they return home. Care Homes for Older People Page 15 of 29 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 living at Orchard House are given the chance to take part in a number of activities and plans are being made to make this more individualised in future. Mealtimes are recognised as an important part of peoples lives and the food is varied with lots of choice. Relatives and friends are made welcome when they visit. Evidence: As part of the continuing development of person centred care plans staff are working with people to find out more about their lives, contacts with family and friends and things of interest to them. This will help staff give people an improved quality of life based on a more individualised approach. We saw and heard staff working with people in the home in a way that showed they know people well. We noted how relaxed people were with the staff and that staff did not rush people at all. We had a long conversation with the activity organiser who works three days a week. She told us that in the respite unit the activities she does vary according to who is staying at the time. She said she mostly concentrates on providing activities in Sunny view because it is a permanent home for the people there. We saw that the garden is well equipped with garden furniture and she told us that this was bought following joint fundraising events with the Lions Club. She said it is very well used in fine Care Homes for Older People Page 16 of 29 Evidence: weather. Shaw heathcare allocate a monthly budget of £250 for entertainment and activities. This is used to finance entertainment from musicians and singers who come to the home as well as trips out and activities in the home like quizzes and coffee mornings. Birthdays are marked with special teas to which people can invite people if they wish. In the lead up to Christmas the activity organiser took two people to a carol service at the cathedral and took photos of people to use to make Christmas cards for their families. We were told that people have their own things they like to do such as knitting, reading and doing crosswords and we saw evidence of this while we were around the home. A gardener comes to the home twice a week and works mainly with one person in the garden but other people can join in if they wish. The winter hanging baskets filled by people were pointed out to us. We saw the gardener and resident while we were at the home managing to spend some time out of doors in spite of the snow on the ground. People also have the chance to go to town and to local garden centres. We were told this is usually in small groups so people have personal attention. We had a conversation with the family of one person who were visiting. They told us they are made to feel very welcome at the home and enjoy their visits. They find the staff friendly and easy to talk to about things and are very happy with the care their mother receives. They told us that the small size of the group in the unit suits their mother and this was one of the things that they looked at when they chose the home. The home has a well equipped kitchen which is staffed by two cooks who cover the week between them. The menu provides a varied diet with at least two choices offered at every meal. We noted that as well as a substantial meal at teatime there is also a supper menu which includes options like sandwiches, cakes, toast and crumpets. This is a very positive thing which gives a focal point during the evening and reduces the gap between meals. We spoke to one of the cooks who has worked in catering for several years and has qualifications as a cook. She confirmed that the food budget is sufficient to provide a balanced, enjoyable and nutritious diet. We learned that at present the cooks have limited face to face contact with people who live in or stay at Orchard House and recommend that this is looked at. It is beneficial for cooks to get to know people, especially those who are newly arrived. This is an important opportunity to make sure food and nutrition is looked at for each person and to involve kitchen staff in making sure needs are identified and met. This may be as Care Homes for Older People Page 17 of 29 Evidence: simple as finding out about likes and dislikes or talking about more complex nutritional needs. Care Homes for Older People Page 18 of 29 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. People at Orchard House are protected by complaints and safeguarding arrangements which make sure concerns will be dealt with openly. Staff are trained to know what they should do if they have concerns about a persons wellbeing. Evidence: Staff working for Shaw healthcare have training about what to do if they have concerns about how someone is being treated, either due to neglect or abuse. This training is provided by one of the organisations own training team and is based on national guidance about safeguarding adults. The manager will be attending a safeguarding course for care service managers run by Herefordshire Council when a date is available. We spoke to a new carer who told us that the topic was covered in her induction training. The training matrix shows that a number of staff were due to have their safeguarding training updated in January and others would be due in February. There is a complaints procedure and this is available in the home and given to new people with their service user guide. The service had received two complaints during 2009. Both of these had been dealt with but the records gave limited information about the enquiries made. This meant it was not clear how the outcomes had been reached. All but one of the people who sent back surveys knew how they could make a complaint and all the relatives who replied said concerns had been dealt with appropriately. Care Homes for Older People Page 19 of 29 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. People at Orchard House have clean and comfortable surroundings which are safe and well maintained. People appreciate and benefit from the small size of the groups living in each part of the home. Some updating to the furnishings and decor would improve the surroundings. Evidence: Orchard House is a two storey 1970s building with a passenger lift to the first floor. The building is divided into three separate units of living accommodation, a day centre, office and utility areas. The three units each have bedrooms and a sitting/dining room. Only two of the units are in full use at present. Both these units provide a service for people who have needs due to a dementia type illness; one is a respite stay facility for people and one provides a long term home. The family we met told us that it was this small group arrangement that helped them choose Orchard House; they felt it would suit their mother well and this had been the case. They felt she would not have been as settled or happy somewhere with larger rooms with more people. The third unit was not in full use and there was currently only one person living in it. This was because they were one of a small group who had stayed in the unit when changes were made to the service Orchard House provides. The others who had stayed had since died or moved. This might have been isolating for the person but we Care Homes for Older People Page 20 of 29 Evidence: saw that staff made sure they spent time with the person and that there were other arrangements to make sure they did not spend all of their time on their own. All parts of the building we saw were clean, comfortable and smelled pleasant. Some of the furniture and decor would benefit from being updated. For example, we saw some bedroom furniture which was a mixture of older items which though clean and safe meant the room looked less pleasant than it could be. The corridor areas would look brighter and more homely if the dark wood bedroom doors were painted in lighter colours. More could be done to develop the decor so that it is more helpful to people with dementia to supplement things already being done such as names and pictorial bedroom signs on doors. In the AQAA the manager told us that work is planned with families to start making bedrooms more individualised. This work was in hand and discussions about putting this into action had begun. We looked at the laundry facilities and infection control arrangements. There was a good supply of gloves, aprons,and waste bins for ordinary and clinical waste. The laundry was well equipped, very clean and well organised. Although it was winter the courtyard style garden in middle of the building looked tidy and looked after. This area provides raised beds, tables and chairs, a shed and pergola style covered area. A gardener comes to the home twice a week to provide support to people who want to do some gardening. Care Homes for Older People Page 21 of 29 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. People at Orchard House are cared for by staff who have been carefully selected and receive a range of training to help them develop their knowledge and skills. Staff are able to be supportive to people who have dementia related needs because many are experienced carers and have been trained to understand good practice in this type of care. Evidence: Since the previous key inspection the purpose of the home has changed and two staff groups have been merged due to the planned closure of another service operated by the organisation. Margaret Young explained that whilst this had been challenging for everyone the newly formed staff group had worked hard to knit into one team. In the AQAA she told us that there had been some problems recruiting new staff due to the rural location of the home but that most of the vacancies were now filled or soon would be. The AQAA also told us that the organisation is looking at improving how it recruits staff to improve the quality and retention of new staff. We are aware that this is a national initiative that Shaw healthcare is working on at present. Shaw healthcare has a thorough recruitment process with responsibility for the procedure split between the registered managers and staff at head office. We sampled the records of a new member of staff who was working her first day at the home. The records showed that the correct recruitment procedures had been followed. We spoke Care Homes for Older People Page 22 of 29 Evidence: to the person who confirmed that she had to wait for their references and criminal records check before she was allowed to work in the home. She had started her induction training and the day of our inspection was the first of a number of shadow shifts she was working. The person told us that everything had been well organised and that they felt supported and made welcome by everyone at the home. Shaw provide a good range of training opportunities for staff. A colour coded training matrix is used to monitor staff training dates and when updates are due. The matrix given to us at the inspection showed that some staff were overdue for updates in some topics and a lot of people were shortly due for updates. The change of service provided from ordinary residential care and re-ablement to a specialist dementia service had been supported by training in dementia care for staff. This training had been provided by experienced nurses from the Department of Mental Health for Older People in Hereford. We were told that all but a small number of recently appointed staff had been on this training and more dates were planned. Additional training about working with people who show challenging behaviour was also planned. Many of the staff team have worked in specialist dementia care for several years in other homes they have worked in. The staff we saw and met during the day were smart and professional in their appearance. We observed how staff helped people and heard how they spoke to them. Without exception the contacts we saw were polite, friendly and caring. We noted also that staff were discreet when encouraging people to go with them when they needed help to go to the toilet. We heard them speak to people in a calm but adult way that was clear and reassuring. This indicated that staff have a good understanding of the importance of good communication with people who have dementia. Visitors we spoke to told us the staff are always easy to speak to and very good with the people in the home. In a survey a relative told us Friendly and helpful staff. On the day of our inspection staffing levels appeared adequate and the two staff working in each of the units were supported by a team leader and the manager. We spoke to one professional who has contact with the home who told us that they find the care good. They said they might have concerns if a person needed help from two people for their care. This was because if two staff were in a bedroom, other people would not be attended for periods of time. The professional said that it is the extent of close contact with staff during the day that is one of the strengths of the service. Care Homes for Older People Page 23 of 29 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. Orchard House is managed by an experienced and suitably qualified manager who is committed to providing a service that meets peoples needs. There has been a period of significant change at the home and the service provided has changed. The management team within the home are being supported by the organisation to continue to develop the quality of the specialist dementia service provided. Evidence: Margaret Young the registered manager has had a long career in care for older people and has been a senior member of staff and a manager for 15 years. We found her open and eager to build on the good practice already in place. In recent months the organisation has changed its regional management team and we met the new area manager while we were at the home. We also looked at the recent monitoring reports done by regional staff. This showed that most of the issues we raised during our inspection had been identified by the organisation and plans were in hand to develop and improve things where needed. Care Homes for Older People Page 24 of 29 Evidence: We saw some questionnaires filled in by people at the home and/or their families and noted that some numerical information about satisfaction levels was recorded. There was no report to tell people how the service would use the results of the questionnaires to change or improve things at the home. We noted that most of the ticks were in the good and very good columns indicating that people are happy with the service they get. Only one person has spending money kept safe for them at the home. We looked at the records for this and found that they were detailed and accurate; the balance of cash held for them in the safe was correct. Other people have their money dealt with for them by family or others who then make any purchases needed. If someone does need a small amount of cash at any time a petty cash float is kept for this and then the persons family are invoiced for payment. The building is well maintained and important safety checks on things like fire equipment, water temperatures and electrical safety are carried out routinely. Staff are trained in health and safety related topics although as stated in the staffing section of the report some updates are needs for a number of staff to prevent this falling too far behind. Care Homes for Older People Page 25 of 29 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 29 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 13(2) External prescribed medications such as creams must be recorded in the medication records when they are applied. To ensure that people receive their prescribed treatments. 28/02/2010 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 15 It would be beneficial for catering staff to have more direct involvment in speaking with people about menus, the food they like and any special dieatary needs they may have. The records of complaints could be improved to provide a clearer account of how matters have been dealt with and what, if any, lessons have been learned. It would be good practice to make the results of internal audits and surveys available to people in a clear report. This would tell them that their views can influence improvements to the service. It is important to update the staff training in health and 2 16 3 33 4 38 Care Homes for Older People Page 27 of 29 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 safety topics so that this does not become a major task to get back up to date. Care Homes for Older People Page 28 of 29 Helpline: 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). 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