Care Home: Orchard House Nursing Home

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What the care home does well People are provided with current information about the home so that they can make informed decisions about whether they may like to live there. Comprehensive pre admission assessments are undertaken so that people know their needs can be met when moving into the home. People have access to a range of health and social care professionals and this ensures that health care needs are met. A choice of a wholesome and nutritious diet, which meets any dietary, cultural needs or personal preferences, is offered. Staff support people in a respectful manner and their privacy and dignity are maintained. Most of the staff have completed a qualification in care so that peoples needs can be met and quality care is delivered. People told us: "I`m very happy here, you couldn`t be better looked after" "I see the hairdresser every week" "Food is ok, you get a choice" "I would talk to the manager if I had a problem" "I have a very nice room, it has everything I need" "Its a nice atmosphere here" "I don`t have to wait long for the staff, they come when I call them" "People listen to what you say and take it on board" What has improved since the last inspection? All of the requirements made at the previous inspection have been addressed and this shows that the home is keen to make improvements in the best interests of the people living there. Care plans and risk assessments are detailed so that staff have sufficient information to assist people to meet their needs. People are offered the choice of a lockable facility and a key to their room and records are available to confirm their decision. There has been a variety of new equipment purchased, including profiling beds and a new hoist and there has been some redecoration of the home and a new carpet in the dining area. CCTV has been unobtrusively installed so that people live in a safe and homely environment. Records for people`s valuables and personal money have improved and this should mean that people are protected from harm. What the care home could do better: Staff must ensure that medication is administered at the time and on the day it is prescribed to ensure that people receive their medication safely. The recruitment procedure must be robust to ensure that people are protected from harm. CARE HOMES FOR OLDER PEOPLE Orchard House Nursing Home 126 Whitehouse Common Road Sutton Coldfield Birmingham West Midlands B75 6DS Lead Inspector Lisa Evitts Unannounced Inspection 29th February 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard House Nursing Home Address 126 Whitehouse Common Road Sutton Coldfield Birmingham West Midlands B75 6DS 0121 378 0272 0121 378 3220 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) Orchard House (Midlands) Ltd Mrs Deborah Kelly Care Home 31 Category(ies) of Dementia - over 65 years of age (31), Old age, registration, with number not falling within any other category (31) of places Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Currently under review 1. 2. 3. The Home is registered for the maximum number of 31 people. Registration category is nursing care for reasons of old age and dementia, over 65 years of age. (N), OP, DE (E). Two people who were under 65 years of age at the time of admission can be accommodated and cared for by reason of physical disability. 2PD 20th March 2007 Date of last inspection Brief Description of the Service: Orchard House is an attractive purpose built home situated within a residential area of Sutton Coldfield on the outskirts of Birmingham. The home is registered to provide personal and nursing care for up to 31 people who may suffer from dementia. There are local amenities very close to the home that include a small row of shops and a public house/restaurant is directly adjacent to the home. Another parade of shops is within a short walking distance. Local public transport is accessible including a regular bus service to the city centre. There is sufficient off road parking at the front of the premises. Communal facilities consist of a main lounge with a large conservatory, a separate dining room and a large reception area with seating. There is a large enclosed rear garden with an extensive paved area where people can sit during clement weather. Bedrooms are located on the first floor and consist of 21 single rooms (two ensuite) and five shared rooms (two ensuite). The home has a no smoking policy and people who choose to smoke would be required to go outside of the home. The home has three walk in showers and one assisted bath to meet the needs of the people who live at the home. There is a passenger lift to the first floor. There are a number of notice boards in the reception area, which provide relevant information about the home and forthcoming events, which may be of interest to people. Copies of the last inspection reports are on display so that people can read them if they choose to. The current scale of charges for the home are not included in the service users guide but can be obtained directly from the home. Additional costs include escorts to appointments, hairdressing, toiletries, dentist, optician, physiotherapist, chiropody and newspapers. Orchard House Nursing Home DS0000024875.V359399.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 stars. This means that the people who use this service experience good quality outcomes. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. One inspector undertook this fieldwork visit to the home and an additional person undertaking their induction was present during the morning. The visit took place over eight and a half hours and the provider and registered manager assisted us throughout. The home did not know that we were visiting on that day when there were 31 people living at the home. Information was gathered from speaking to and observing people who lived at the home. Four people were “case tracked” and this involves discovering their experiences of living at the home by meeting or observing them, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety files were also reviewed. Random questionnaires were sent out in order to gain peoples views about the service, however non had been returned at the time of writing this report. If we receive any information we will share this with the manager. Three people who live at the home, two visitors and one member of staff were spoken to. Previously the provider had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us some information about the home, staff and people who live there, improvements and plans for further improvements, which was taken into consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. No immediate requirements were made at the time of this visit. What the service does well: People are provided with current information about the home so that they can make informed decisions about whether they may like to live there. Comprehensive pre admission assessments are undertaken so that people know their needs can be met when moving into the home. Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 6 People have access to a range of health and social care professionals and this ensures that health care needs are met. A choice of a wholesome and nutritious diet, which meets any dietary, cultural needs or personal preferences, is offered. Staff support people in a respectful manner and their privacy and dignity are maintained. Most of the staff have completed a qualification in care so that peoples needs can be met and quality care is delivered. People told us: “I’m very happy here, you couldn’t be better looked after” “I see the hairdresser every week” “Food is ok, you get a choice” “I would talk to the manager if I had a problem” “I have a very nice room, it has everything I need” “Its a nice atmosphere here” “I don’t have to wait long for the staff, they come when I call them” “People listen to what you say and take it on board” What has improved since the last inspection? What they could do better: Staff must ensure that medication is administered at the time and on the day it is prescribed to ensure that people receive their medication safely. The recruitment procedure must be robust to ensure that people are protected from harm. Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 8 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 Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have sufficient information about the home to enable them to make an informed decision about whether they would like to live there. Pre admission assessments ensure that people know their needs can be met prior to moving in. EVIDENCE: The statement of purpose and service user guide contains sufficient information about the home so that people can make an informed decision about whether they may like to live there. These documents were available in large print format so that people with visual impairments would be able to access the information. Both of these documents were on display in the reception area of the home, which ensures that the information is available to people if they choose to read it. Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 10 The certificate of registration and public liability insurance certificate are on display and copies of previous inspection reports are displayed so that people have access to this information. Comprehensive pre admission assessments are undertaken prior to people coming to live at the home. This means that people know that their individual needs can be met when moving into the home. People told us: “I’m happy here” “I’ve lived here for 7 years” “I’m very happy here, you couldn’t be better looked after” Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans provide staff with sufficient information to assist people to meet their needs. The management of medication ensures that most people receive their medication safely and as prescribed. EVIDENCE: Following the pre admission assessments and admission into the home, staff undertake a full nursing assessment to identify any areas of actual or potential need and each person has a care plan written. This is an individualised plan about what the person is able to do independently and states what assistance is required from staff in order for the person to maintain their needs. We looked at four peoples care files. Care plans were based on a core care plan format however these provided staff with details about individual needs and choices. Examples of these needs were “wears spectacles for reading”, “requires two hourly turns throughout the night”, “shaves using an electric razor” and “likes to go to bed at 6pm”. These details should ensure that people’s individual choices are maintained. Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 12 People had care plans for specific needs, for example a care plan had been written for seizures which gave staff details about when to administer medication and when to call emergency services. Risk assessments had been written where required for example for people at risk of falls and for the use of bedrails where there is a potential for injury to occur. Moving and handling plans gave staff details about the type of equipment that they should use to assist people to move around the home. Care plans are evaluated monthly and changes made as required. There was evidence that peoples plans are changed as their condition changes for example one plan had been evaluated to show that someone now needed a hoist instead of a moving and handling belt, and another plan identified that someone’s appetite was poor following a short illness. These changes ensure that people’s needs are constantly assessed so that staff have appropriate information to follow. Turn charts and food diaries indicated that staff were following the instructions on the plan of care to meet peoples needs. This also enables staff to monitor changes in condition in order to take action as required. There was evidence of people receiving visits from external healthcare professionals including General Practitioners, opticians, dentist, chiropodist and the falls team. People are able to keep their own GP (If the GP is in agreement) or they can register with a local GP. The management of medication was reviewed and was found to be securely stored. Photographs are taken for identity purposes and copies of the prescriptions are kept so that staff can check that they have received the correct drug into the home. Two people sign medication received into the home upon receipt. Controlled medication was secure and audits of this were correct. Audits undertaken on medication were found to be correct with the exception of one drug, which had been signed as given the day before, but had not been given. The nurse on duty administered this medication on the day of the visit. This is not safe practice and staff should not sign for medication until it has been administered. Staff must also ensure that medication is given at the time it is prescribed to ensure that doses are received at the correct times. Creams and eye drops are dated when opened so that they are discarded at the appropriate times to minimise the risk of cross infection. Fridge temperatures were recorded daily to ensure that drugs were stored at the correct temperature. People appeared to be well supported by staff to choose clothing appropriate for the time of year which reflected individual cultural, gender and personal preferences. Staff interaction with people was positive and people were treated with respect. Dividing curtains were seen in shared rooms so that people’s Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 13 privacy can be maintained. People have the option of a lockable facility and a door key to maintain their privacy. Orchard House Nursing Home DS0000024875.V359399.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to choose the activities that they participate in which promotes their individuality and independence. People are offered a choice of meals to meet their dietary, cultural needs or personal preferences. EVIDENCE: The home has an in house activity programme, which includes music to movement, games, quizzes and arts and crafts. The home provides a monthly external entertainer and celebrates ‘special days’ such as Valentines Day, Mothers Day and Easter. The activity programme is displayed in the reception area so that people can choose what they would like to participate in. A priest visits once a week and will give Holy Communion to people who wish to receive this. The Church of England visits each Sunday and this means that people can continue to follow their religious beliefs if they choose to. A hairdresser visits the home so that people can have their hair attended to as they like and people can have newspapers delivered to the home if they choose so that they can keep up to date with articles that interest them. Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 15 Care plans provided information about past history and personal interests and people discussed activities at the residents meetings. There is an open visiting policy, which means that people can see their visitors as they choose. People were seen to visit at various times throughout the day. People are able to go out of the home with their relatives as they choose and the manager stated that some people make use of the public house, which is situated, next to the home. People told us: “I see the hairdresser every week” “Its mothers day and I’m going out for lunch” The home has a four-week rolling menu. The menu gave people two choices at lunchtime and teatime. Snacks and sandwiches were available at all times if someone required anything extra. There was a large menu board on display outside the main lounge so that people knew what the day’s choices were. People can choose to have wine, beer or a soft drink with their meal. The home is able to cater for special diets and was serving pureed meals for people who had difficulty swallowing. The manager confirmed that these were served as separate portions so that people could experience the different tastes and choose which portions they wanted to eat. The lunchtime meal was briefly observed and the dining area was well presented. Staff were sitting down to assist people to eat their meals and protective clothing was used for people who required this to maintain their dignity. We observed that all staff wore blue gloves when in the dining area and it is recommended that this practice is reviewed with people living at the home, as it does not promote their dignity. The inspector sampled one of the hot meals and this was well presented and appetising. People told us: “The food is lovely, you get a choice” “Food is ok, you get a choice” One person commented that there was “a lot of waiting around” prior to meals and this was discussed with the manager on the day so that this could be reviewed. Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is comprehensive and is accessible to people should they need to make a complaint. The home has policies, procedures and staff training, which should safeguard people from harm. EVIDENCE: The complaints procedure is displayed in the home and is included in the service user guide so that people know how to make a complaint if they need to. The document is available in large print so that people with visual impairments can access the information. Since our last visit to the home we have not received any complaints about the service offered by the home. The home has received only one complaint since our last visit. The complaint was recorded and it was clear that a meeting had been arranged with the complainant; however there were no records made of the outcome of this meeting. The manager was able to inform us of the outcome of the meeting however it is recommended that minutes are recorded from any meetings that take place so that people know what actions have been agreed. One person said “I would talk to the manager if I had a problem” and this suggests that people know who they can talk to if they need to. There were a number of thank you cards on display in the reception area, which indicated Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 17 people’s satisfaction of the service offered. There is also a ‘suggestions book’ in reception where people can make any comments about the service if they choose to. The home has an adult protection policy and has copies of local Multi Agency Guidelines so that staff have guidelines to follow in the event of an allegation of abuse. This should safeguard people from harm. There have not been any allegations of adult protection nature made. Staff have received training in adult protection and one staff member spoken to demonstrated a good understanding of this procedure to ensure that peoples safety would be maintained in the event of an allegation. Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with a homely, clean and comfortable environment in which to live where their privacy is maintained. EVIDENCE: Access to the home is via a doorbell and this ensures that people know who is accessing the building to ensure that people are safe. CCTV has been installed so that the outside of the building can be monitored, this does not affect peoples privacy. Access to the home and the garden area is suitable for people who need to use wheelchairs. A partial tour of the home was completed to review areas which were relevant to the people we case tracked. The home was clean and very fresh and there are hand gel dispensers available for people entering and leaving the home to minimise the risk of Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 19 cross infection. There was a friendly and welcoming atmosphere within the home. The lounge is pleasantly decorated and from this leads onto a conservatory. There were a variety of chairs to suit people’s different needs and these rooms were homely in style. People are assisted into a separate dining room for their meals if they choose to sit there and this promotes a social event. The home has three walk in showers and one assisted bath to meet the different needs of people living at the home. Toilets seats were raised and handrails were available to assist people to maintain their independence for as long as they are able. During the day incontinence aids were stored in the toilet areas unopened and it is recommended that these are kept in their packets or in lidded receptacles to minimise the potential for cross contamination. The home has purchased about ten profiling beds. These beds assist staff and people to change their position and can assist in sitting people up whilst they are eating. There are three full hoists and two hoists to assist people to stand or move their position. The home also own a number of air mattresses for people to use when their skin is at risk of breaking down and becoming sore. Bedrooms seen were personalised and reflected individual tastes, gender and cultural preferences. People are encouraged to bring in their own possessions in order to have familiar items around them to make their rooms as homely as possible. People who are in shared rooms are given the option of moving into a single room when one becomes available if they have expressed this wish. People are asked if they would like a lockable facility and or a key to their bedroom and this promotes peoples privacy. People told us: “I have a very nice room, it has everything I need” “Its a nice atmosphere here” There have been a number of improvements to the environment since our last visit including new equipment and decoration, which is under constant review. The kitchen had recently had new flooring laid and had new fridges and freezers. The Environmental Health Officers had visited the home in November 2007 and no requirements or recommendations were made. Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some improvement is needed to ensure that people are consistently supported by staff that are deemed suitable to work with vulnerable adults. EVIDENCE: There are two trained nurses and five care staff on duty throughout the morning and two trained nurses and four care staff during the afternoon/evening. During the night there is one trained nurse and two carers. The home generally maintains a core group of staff so that people know who will be assisting them to meet their needs. When the home requires staff they use one agency and try to get the same staff so that they know the needs of the people living at the home. In addition to nursing and care staff the home also employs maintenance, domestic and kitchen staff to meet all the needs of the people living at the home. A number of staff have completed a National Vocational Qualification (NVQ). Seven further staff are enrolled onto a course and are currently working towards completing this. This will bring the total to 96 of staff that hold a qualification and this should ensure that a knowledgeable and skilled workforce can meet people’s needs individually and collectively. Staff were observed to have good interactions with the people living at the home. Staff were heard explaining what they needed to do and were talking to Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 21 people about their interests. There was a relaxed and friendly atmosphere in the home. People told us: “Staff are fine” “I don’t have to wait long for the staff, they come when I call them” “They are all lovely” Three staff files were reviewed and these contained most of the information required to ensure that people were safeguarded from harm; however further improvements are required to ensure peoples safety. One file had a gap in the work history, the manager was able to state what this person had been doing during this time but it had not been recorded. This person had worked in a care home before but no reference had been sought from this employer as to why they left and this was discussed with the responsible person at the time of the visit. There were however two references on all files, including one from last employers. Staff had had POVA (Protection Of Vulnerable Adults) first checks prior to starting work at the home. A potential new member of staff was looking around the home on the day of the visit. The responsible person was informed that this member of staff was to start the next day, however it was of concern that there had been no recruitment checks completed for this person. This was discussed with the responsible individual who stated that this person was not being employed by the home, as they were self-employed. Further guidance was sought and it is required that anyone who is in regular proximity of people living in the home have the appropriate recruitment checks to ensure peoples safety. This information was confirmed to the manager via the telephone shortly after the visit. The manager had devised a training matrix, which stated what training people had received. It was recommended that the actual date of training is recorded to assist in future planning. Staff had received training in fire, Parkinson’s disease, diabetes, nutrition in dementia and some staff had attended external courses for tissue viability (prevention of skin sores) and the Mental Capacity Act. Moving and handling training was booked for all staff to attend. There was evidence that staff receive an induction into the home and that they then proceed to complete a three-month induction in line with Skills for Care guidance. Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in the best interests of the people who live there. EVIDENCE: The manager has many years experience in working in the care home. She is a Registered Nurse and has been the Registered Manager for approximately four years. People we spoke to stated that they could talk to the manager at anytime and good interactions between them and the manager were observed. The manager had a good knowledge of the people who lived in the home and their individual needs and this means that people should receive the individual care that they require. The manager is supported daily by the responsible person who is available by telephone at all times. Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 23 Relatives, residents and staff meetings are held so that people have the opportunity to voice their concerns and suggestions for improvement. Minutes of residents meetings were available in large print on the notice board so that people had the opportunity to read them if they wished. It was evident from these minutes that people who live at the home have the option to discuss how the home is run and this included meals and outings. The home sends out satisfaction questionnaires as part of their quality assurance programme twice a year and this information had been collated, stating clearly the outcomes for people at the home. There are a number of audits in place to ensure that all areas of the home are assessed and a clinical audit is completed every six months. An annual report of all the quality assurance needs to be formulated which includes any actions to be taken and timescales and this was discussed with the responsible person at the time of our visit. This report should be available for people who live at the home to read if they wish to. One visitor said, “People listen to what you say and take it on board”. The provider had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us clear information about the home, staff and people who live there, improvements and plans for further improvements, which was taken into consideration. The recording and management of personal money was robust and this means that people can keep small amounts of money at the home safely. Three peoples monies were checked and the balances were correct. Each person has an individual transaction sheet and receipts were kept to evidence any spending on the accounts. Two people complete a monthly audit so that any discrepancies would be identified early so that they could be rectified. People’s valuables were also listed so that staff knew whom they belonged to. Staff receive formal supervision and this means that staff have the opportunity to discuss any training needs or concerns they have. Some supervision is completed by observation. It was noted that one member of staff was completing supervision for a staff member, who was also a close relation. This practice should cease, as it may not give a clear reflection of the person’s ability. This was brought to the attention of the manager and the responsible person at the time of our visit. Health and safety and maintenance checks had been undertaken in the home to ensure that the equipment was in safe and full working order. Water temperature checks are recorded each month and this assists in the prevention of people accidentally scalding themselves. Maintenance checks are completed on the fire system and equipment and staff receive fire training and drills so that people should be safe in the event of a fire occurring. Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 24 Accident records are audited each week so that any trends are acted upon, for example someone who had had a number of falls was referred to a falls clinic for further investigation and advice. The GP is informed of all injuries and this means that peoples care needs are monitored so that appropriate action can be taken to try and reduce any risks. Staff have access to data sheets for COSHH (Control Of Substances Hazardous to Health) and risk assessments have been undertaken so that staff know what to do in the event of any accidents with these products. The home has a number of policies and procedures and these are reviewed to ensure that the information within them is current. Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 25 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 3 X 3 X X N/A 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X 3 3 X 3 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 X 3 Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 26 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 Medication must be given at the time prescribed and records must be accurate to ensure people receive their medication safely. Recruitment procedures must be robust to protect people from harm. Timescale for action 11/04/08 2. OP29 19(4) 25/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP15 OP16 OP26 OP30 OP33 Good Practice Recommendations People should be asked if they want staff to wear gloves when they are assisting them with food so that their dignity is maintained. Minutes should be recorded following meetings held so that people know what actions have been agreed. Incontinence aids should be stored in packets or lidded receptacles to minimize the potential for cross infection. Dates of actual training should be recorded on the training matrix so that the manager can plan future training needs. An annual development plan based on quality assurance DS0000024875.V359399.R01.S.doc Version 5.2 Page 27 Orchard House Nursing Home 6. OP36 findings should be written and accessible to people living at the home and their representatives. Staff should not complete formal supervision for members of their family, as this may not be an accurate reflection of their abilities. Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Orchard House Nursing Home DS0000024875.V359399.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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