Care Home: Orchard Lea

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What the care home does well Staff working at the home provide attentive and sensitive care for people living at the home treating people with dignity and respect. The managers ensure that people’s needs are assessed before new people come into the home. In this way the home is sure that they can meet people’s needs. Meals at the home are a social occasion where personal food likes and dislikes are catered for with home cooked cuisine. Activities seem to be good with a range of events offered to occupy and stimulate people’s bodies and minds. What has improved since the last inspection? The home was previously inspected during June 2009. The outcome of that inspection was that the home was providing poor quality outcomes for people living at Orchard Lea. It is credit to the home’s current management team that at this inspection the quality of overall care and management at the service has improved. We could see that a lot of effort has been put into development of person centred care planning at the home. The management of people’s medicines is now also safer. What the care home could do better: A person centred care planning system must be fully introduced to provide staff with consistently reviewed and updated written guidance on how to meet individual needs. Quality assurance processes at the home remain underdeveloped. There needs to be an overview of staff training needs so that a staff development plan can be arranged. The CQC has not been notified of all events in the home that has put people’s safety at risk from regular falling. Such safety considerations have not been properly collated nor assessed to prevent further accidents. Key inspection report CARE HOMES FOR OLDER PEOPLE Orchard Lea Orchard Way Cullompton Devon EX15 1EJ Lead Inspector 5Judith McGregor-Harper Key Unannounced Inspection 12th November 2009 09:00 DS0000039280.V378414.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard Lea Address Orchard Way Cullompton Devon EX15 1EJ 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) 01884 33375 01884 33375 carol.a.jackson@devon.gov.uk http/www.devon.gov.uk Devon County Council Vacant Care Home 26 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (26), of places Physical disability over 65 years of age (5) Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th June 2009 Brief Description of the Service: Orchard Lea is a local authority (Devon County Council) care home which is currently registered to provide accommodation together with personal care to up to 26 older people, up to five of whom may also have a physical disability and up to five of whom may also have dementia. The home was originally built with thirty-six bedrooms. Ten of them are now either used for office space, visitors’ rooms or storage. There is level access into and throughout the building. There is a shaft lift between the two floors and adapted bathrooms and toilets accessible to people with physical disabilities. Each floor has its own lounge and dining areas. The first floor has a quiet room. The weekly cost is a set fee of £570.50. Extra costs include dry cleaning, hairdressing, dentist, optician and chiropodist (unless NHS funded), private telephone lines, pet costs (if pets are agreed) and newspapers/magazines. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk . The last inspection report is on display in the main entrance hall Orchard Lea DS0000039280.V378414.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 1 star. This means the people who use this service experience adequate quality outcomes. This is the second key inspection for this home in 2009 to help us monitor standards. The inspection was unannounced and took place over seven hours and forty five minutes. Three inspectors carried out this inspection, including a Pharmacy Inspector. We were told different information by two members of staff regarding the number of people living at the home, initially we were told nineteen people and then twenty people. This included several people who were staying at the home on a respite basis. We last inspected the home on 12th June 2009 and sent out surveys, which we included in the last key inspection report. Since this inspection, the home has sent us information regarding their quality assurance systems and feedback from people living or visiting the home, which we have included in this report. We asked the home to complete an AQAA (Annual Quality Assurance Assessment) to tell us about the service and help us make a judgment about how the service is run but this was not completed in the time scale required, and has not been received by CQC. As part of our inspection, we spoke with people living at the home and observed the care they were given to help us judge the quality of the care provided. We case tracked four people; this means that where possible these people were asked about their experience of living at the home, their rooms were visited and the records linked to their care and stay were inspected. Staff members spoke about their roles and responsibilities, and their views are contained in this report. We also spoke to people visiting the home, including a health professional. During the inspection, a tour of the building took place and records including care plans, staff recruitment, training and medication were looked at. The home currently has no registered manager and is being run by a temporary management team. The responsible individual has told CQC that they hope to make this a permanent arrangement. Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.2 Page 6 What the service does well: Staff working at the home provide attentive and sensitive care for people living at the home treating people with dignity and respect. The managers ensure that people’s needs are assessed before new people come into the home. In this way the home is sure that they can meet people’s needs. Meals at the home are a social occasion where personal food likes and dislikes are catered for with home cooked cuisine. Activities seem to be good with a range of events offered to occupy and stimulate people’s bodies and minds. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs are assessed before they are admitted to the home, so that they, and the home, can identify individual needs that need to be met by staff working in the home. Lack of mental capacity assessments means that people’s rights might not be fully protected. EVIDENCE: We looked to see how the home ensured that they could meet people’s care needs before they move to Orchard Lea. We looked at the admission process for three people who had moved to the home since the last inspection and saw that an assessment had taken place. Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 9 A staff member from the temporary management team told us that they had been to visit people who plan to stay at the home on a respite basis, and we saw paperwork to reflect this. They told us that they had liaised with other health professionals involved in each person’s care to help them assess their care needs. We saw paperwork that reflected this shared information although we noticed that assessments do not yet fully consider the implications of the Mental Capacity Act in relation to decision making for people with memory loss or dementia. We asked someone who was staying at the home on a respite basis but they were unable to tell us about the process that happened to plan this admission. Since the last key inspection, further training has taken place to help ensure that staff can meet the changing needs of people living at the home. For example, we were told by one staff member that they had attended skin care training and end of life care training, both of which had been beneficial, and they said that they hoped when there was time to put together a folder with information on this area of care. Other staff told us that they had not been given this end of life training opportunity, despite not having received training in this area, and had not had any information from this course shared with them. (see Standard 30). However, three other staff members on duty told us they had received recent training via NVQ courses that covered dementia and end of life care. One person told us that they understood the acting manager was going to arrange end of life care training for the staff team. We talked to staff about the current care needs of the people living at the home, and we observed that people’s physical needs were less complex than on previous inspections, although there were several people requiring support with their mental health needs due to behaviour linked to memory loss. We were told that currently there was no one with end of life care needs, and no one needing support with complex moving and handling using equipment, such as stand aids. We observed staff interacting with people who have dementia in a manner that was attentive and respectful of people’s individual needs. The home does not provide intermediate care. Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has introduced a useful care planning system that considers individual needs but people’s care plans are not yet fully completed putting people at risk of their care needs not being fully understood or known by staff. Staff treat people well and people respond positively toward staff who offer them support. EVIDENCE: Despite repeated requirements on previous inspections, the care planning at the home still does not provide a robust system for promoting continuity of care or clear guidance to care staff. We were told by the temporary management staff that a group of staff have been given five care plans each to update using a new format. We saw that when completed this new format had the potential to provide a good foundation for care in the home. Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 11 We saw from minutes from a meeting with this staff group that the temporary manager had given clear instructions for how the care plans should be completed and the expectations for staff to complete this task. However, we were told that due to high sickness levels for staff, this task had still not been completed and that none of the care plans had been completely set up in the new format. This is despite the home being given a reasonable timescale to complete this task. As a result the four care plans we looked at were not complete, and did not provide a strong foundation to base good care practice on. For example, information was held in daily records rather than the care plan being updated so that action and outcomes could be reviewed. The home’s daily diary was also used as an aide memoir for monitoring outcomes for people through tracking healthcare professional visits to the home. One person that we spoke to told us that they had been involved in their care plan and we could see that they had signed their care plan. When we spoke to staff they were up to date with people’s care needs, and could tell us how they supported people, which we observed in practice. Staff told us that there were regular handovers before each shift and relevant information was passed to them. However, the home currently lacks an integrated care planning system that puts people at risk of potential neglect. Key workers were clear about their role, and during the inspection we observed one person liaising with a family member to overcome communication difficulties and to ensure that the person living at the home received the support they needed. The family member understood the worker’s role and confirmed that they were happy to liaise with the home to overcome any communication difficulties. As part of the home’s own quality assurance process, surveys from people either living at the home or on a respite stay commented that ‘staff always cheerful and helpful’ and ‘angels’. One care plan we looked at showed that the person had been consulted about their preferences and lifestyle, which they confirmed when we spoke to them, and reflected our discussion with a staff member about the person’s care needs and daily routine. A health professional visiting the home said that the home was ‘much improved’ in the last few months, and that people were looking better cared for in the last month, with care being taken over people’s appearance, which we noticed on the day of the inspection. They confirmed that staff had been able to answer their queries during their visit and that there were enough staff on duty for them to accompany them to visit people in their rooms. They told us that they were not treating any one with a pressure sore and checked the notes held in the nursing box to confirm this. But they did confirm that staff Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 12 reported appropriate and timely concerns if they found a person with a red area of skin, which helps promote good skin care practice. This was confirmed with our discussions with care staff. The health professional gave an example where staff were following instructions from the nursing team, which had prevented a pressure sore developing. When we spoke to staff, they were able to tell us about this person and what they did to reduce risks for them. We discussed an issue with the temporary management team where there had been a delay in the home receiving a suitable pressure relieving mattress for a person who was at risk of a pressure sore. We have advised the home that these delays are not acceptable. We were told that the home is liaising with the local nursing manager to address concerns regarding delays, and confirmed with them that they are aware of how to make a formal complaint if this type of delay occurs again. We saw from records that people’s weights are now recorded on a regular basis, although this would be helped by a consistent form of measurement being used e.g. pounds or kilograms so that changes are clear and easy to monitor. We asked staff if there was anyone living at the home who was having their food or fluid intake monitored but we were told that this was not the case for anyone currently at the home. We were also told that no bed rails were currently being used, which was confirmed by our tour of the building. We saw from some people’s records that they were at risk of falls (see standard 37) and that several people had been to the hospital for treatment, which one of the people confirmed. However, for those people at risk, there was no overview of how often this was happening, at what time, where and a review of actions taken. This type of information may help the home identify risks particular to the individual and ensure that staff support at those times was appropriate. A visitor confirmed that they had translated pain relief advice in their relative’s room to their first language, and told us they are happy to work with the home to resolve any language barrier. We saw that they had a good rapport with staff, and that their relative looked at ease. A staff member told us of the steps they had taken to understand when the person was in pain using gestures and appropriate phrases in the individual’s language. We looked at the arrangements for administering, storing and recording of medicines. We spoke to staff involved with medicines and spoke to someone who looks after some of their own medicines. We watched some of the morning medication round and found that medicines are given to people using a safe method. Records are kept of medicines received into the home, those given to people and any unwanted medicines returned to the pharmacy. Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 13 We found that there have been improvements to the way medicines are handled since the last inspection. New systems have been introduced and the requirements made at this previous inspection have been met. Storage arrangements have improved with the fitting of a new cupboard for controlled drugs. The temperatures in the storage room and refrigerator are now regularly monitored. Sometimes the room temperature is slightly too warm for the storage of medicines. This needs to be monitored for a longer period and if temperatures remain at these levels, or increase, then action may need to be taken to reduce the temperatures in the room. This is to make sure that medicines are safe and effective for people. New methods of recording have been introduced for external items, such as creams and lotions, with body maps to show carers where they should be applied. These help to show that these preparations are used correctly for people. There are still some further improvements that need to be made to people’s care plans, particularly around the use of medicines prescribed to be given ‘when required’. We could not find guidance in some people’s care plans to show how and when these should be given. For one person the doctor had asked that they receive the medicine ‘only when required’ but we found that it is being given every day. Without clear guidance for staff in the care plan it is not possible to confirm if the medicine is being given in accordance with the doctors orders. It is a requirement to have clear instructions for all medicines to show that people are receiving them as their doctor has prescribed for them. Sometimes people look after some or all of their own medicines. In most of the care plans we looked at there is a documented risk assessment to see if it is possible for people to do this safely. This needs to be extended to cover all people who may look after their own medicines We looked to see if people’s dignity and privacy was respected. We heard people being called by the names that they told us they preferred to be called by. When we spoke to people living at the home, they indicated that they were happy with the way that staff supported them and treated them. We observed the body language of people who were not able to converse directly about the way they were supported and they generally looked relaxed with staff and in their surroundings. People told us that they had regular access to a bath, which records confirmed. We saw in one person’s daily notes that they had asked for bath in the afternoon, and that this had been provided at their requested time. A person told us that help with intimate care was given in a way, which maintained their dignity. People that we met looked well cared for and appropriately dressed, and a person told us that the laundry cared for their clothes well. Staff told us how Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 14 they ensured that any missing items of clothing were always found, and notes showed that the key worker role included labelling clothes to help prevent loss. Surveys from people either living at the home or on a respite stay confirm that laundry is well managed and provides a good service. We saw that staff offered timely and appropriate help with food, such as offering to help cut meat but also respecting people’s wishes as to how they were assisted. Since the last inspection, we have been told that some staff have attended specialist training in end if life care but other staff said that they were not aware that this was available and had not been passed information from this course by the people who had attended. There was nobody with end of life care needs when we visited so we were unable to judge how people’s needs were met. We saw from one person’s care file that information was available about what to do in event of their death but records did not reflect that discussion had taken place regarding advanced decisions or preferences. Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the home have access to a range of indoor activities and are supported with day-to-day choices. Spiritual needs are not yet consistently addressed, meaning some people’s needs might not be met. The home has developed a good relationship with people’s relatives and representatives. People benefit from a nutritious diet based on people’s likes and dislikes. EVIDENCE: We looked to see how peoples’ social and recreational interests are supported by the home. The home employs an activities organiser for 12 hours each week. We were told that care workers also provide activities at other times, which we heard them organizing. People told us that they were supported to take part in activities that interested them. For example, we saw from people’s records who had expressed an interest in playing cards or quizzes that they were able to take part in these activities. One person we spoke to confirmed that they were still Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 16 supported to visit the pub twice a week. Another person we spoke to said that they mainly enjoyed reading their chosen newspaper and completing crosswords, which we observed during the day. We saw people moving freely around the home and making choices about whom they sat with and where they sat. During the day we observed ladies taking their small personal items with them when they moved about the home. Walking aids had been adapted to carry handbags so that a person need not leave their bag behind when they moved about the home. One person said they liked using their own room to meet visitors and to complete puzzles. We saw staff providing activity sessions for small groups of people both in the morning and the afternoon. One staff member organised an ‘armchair aerobics’ session. The staff member said they had received training from Age Concern in order to offer this. Apart from the person who visited the pub, two other people told us that they did not have regular access to the local community. Their expectations were not high regarding the home’s role to support them with this and they told us that they relied on family members to assist with these types of trips. We saw that a trip to the seaside had taken place for a group of people living at the home. Records showed this was enjoyed by twelve people, and was supported by a generous donation by a former visitor to the home. Care plans that we looked at still did not clearly state whether people’s religious preferences could be met or whether this had been asked, although one person we met said that their religious beliefs were catered for by visits from a local church. Surveys from people either living at the home or on a respite stay confirm that staff are welcoming to their visitors, and are offered drinks and can be invited for meals. People told us they were happy with the standard of food and that they were provided with a choice. We saw that people’s preferences had been recorded, and staff confirmed that these were catered for. For example, one person has their taste for fresh fruit and vegetables, as well as a range of cheeses, catered for. We were unable to confirm this with the person direct. Minutes from a residents’ meeting recorded that from September 2009 there has been an improved choice of meals, and twelve people who attended the meeting said that they were happy with the food at the home. We observed that the lunchtime meal had a calm atmosphere with plenty of staff in the room to meet the needs of people living at the home. We saw people being offered choice and seconds. We were told that currently the upper dining room is not being used as it was felt that staff could provide more efficient support from the dining room next door to the kitchen. Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 17 We talked to kitchen and care staff about one person’s identified care plan need to have their food cut up for them. All were aware of how the meals should be presented. We saw fruit available and offered as one of the snack choices on the afternoon tea trolley. Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live or work at the home do not have reliable information, or are not fully aware, of how to raise concerns in the home or to outside agencies. EVIDENCE: Since the last inspection CQC have not received any complaints about the home, and a member of temporary management team told us that this was also the case for Devon County Council. Therefore, we cannot currently judge how the home handles complaints. However, we did see that on a notice board in an area near the upper lounge that people are still given the name of the former manager to contact, which is not helpful and needs to be addressed. However, people that we spoke to generally knew who the temporary manager was or who they would go to if they had a complaint or concern. We spoke with one staff member about their role in safeguarding people in Orchard Lea, although they knew their role in reporting poor practice within the home’s structure, they were not clear who they could contact outside of the home. Staff training records indicated that the last time staff received an update in safeguarding people was in 2008. Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 19 During the last inspection, the temporary management team told us that they have reminded people of their whistle-blowing responsibilities if they have concerns about practice in the home as staff have acknowledged to them that things were wrong in the home but did not report their concerns outside of the home. At the time of the last key inspection, a safeguarding alert had been made and an investigation was carried out by Devon County Council. This matter has now been closed. Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home generally provides people with a clean and homely place to live, although for some people the size of their bedroom does not meet their individual needs. EVIDENCE: Orchard Lea is a purpose built home and therefore has the advantage of level access on both floors, a large garden, a passenger lift, and a variety of communal and private spaces and several pieces of specialist equipment. There is a large and pleasant bathroom with a modern accessible bath, as well as two other bathrooms. There are several mobile hoists around the home, but Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 21 we were told by staff that currently nobody living at the home needs to use the hoist. People told us that they knew how to contact staff using a call bell, although they said they did not need to use it as the staff checked on them regularly. Most of the bedrooms are small by current standards and this affects the amount of furnishings and fittings that can be accommodated. Therefore there is not enough space to provide comfortable seating for two people, and a table to sit at. Rooms are clean and odour free. Some appeared homely and personalised but generally fittings are dated and tired in appearance. Some of the bedroom furniture is utility in style and marked, such as the fitted wardrobes and sink units. Where possible efforts have been made to brighten rooms with colourful curtains and in some rooms replacement carpets have been fitted. There are no current plans to refurbish the bedrooms. One person told us that they were very happy with their room, which is one of the larger bedrooms in the home. They have been able to bring in personal items with them and told us that their own family had decorated it for them. Another person who was in a smaller room felt that the room was ‘claustrophobic’ and did not met their needs as they had to move a chair to be able to get into a cupboard. We saw that preparations were being made to furnish a room appropriately to meet the needs of someone moving to the home. A visitor expressed concern that on the day of the inspection some people’s rooms did not have paper towels or liquid soap available, which could compromise infection control. We inspected all communal bathrooms and toilets and the sluice and we found that liquid soap and paper hand towels were available in these locations. We looked at the laundry facility in use and saw it to be suitably equipped for the home. Although the home appeared clean and tidy there was one area of malodour along one ground floor corridor. Domestic staff described this as an on-going problem. They also told us that the acting manager had arranged for a carpet to be recently replaced in another corridor, which had suffered a similar problem with malodour. Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from being cared for by a staff group who are experienced and caring. Some necessary training is required for staff to ground their hands on practice in a knowledge base. EVIDENCE: The rota showed us that generally four care staff are on duty in the morning plus an officer-in-charge, three in the afternoon and three in the evening, with two waking staff on duty at night, plus an officer-in-charge. They are supported by an assistant manager, and domestic staff overseen by the home’s temporary manager. We were told that due to staff sickness the home has been using bank staff in the office. The person we met was up to date with the needs of people living at the home. There is a stable core staff team, with many having worked at the home for a number of years. The staff we talked to clearly enjoy their work and take a pride in providing a good quality of care and services. However, people did express frustration that staff sickness levels were impacting on the home making further improvements to its service. They told us that it was important to know the individual needs of the people they care for, and this was Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 23 demonstrated in discussion and observation but was not backed up by care records. Staff recognised the importance of building up a relationship with visitors, and this was apparent from our observations on the day of the inspection. We have not been provided with the NVQ levels of staff at the home because the home has not completed an AQAA. We looked at the staff recruitment files and found that no new staff had been employed since the last inspection; therefore we were unable to check that the home had met a previous requirement on safe recruitment procedures. Staff we spoke to said the council were good at highlighting when training needed to be refreshed, although numbers on training courses could be limited. Staff told us that their mandatory training was up to date but that they did not always have access to more specialist training i.e. end of life care. We have previously identified in this report that staff training has not taken place on the implementation of the mental Capacity Act, nor has it on the associated Deprivation of Liberty Safeguards. We saw individual staff training files but we did not have access to a record showing an overview of the staff team’s training as a whole. We could see that some staff have undertaken training in moving and handling, good hygiene, care of the dying, medicines and first aid during 2009. Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home and staff who work in the home are benefiting from management that has the direction and vision to improve quality outcomes. However, management systems are not yet able to demonstrate that people’s health, safety and welfare is robustly protected. EVIDENCE: The home has not had a registered manager for over two years despite requests from the Commission for this to be resolved to help provide suitable leadership and stability for the home. Staff told us in the past that they have Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 25 struggled because of a lack of leadership and structure but that the situation had improved with the temporary management team being in place. We spoke to staff who were positive about the temporary management arrangements, who told us that they felt this was what the home needed. One person said the temporary manager was ‘excellent’ and another said there have been ‘great improvements’. Staff told us that the manager was making improvements in the home but was hindered by a number of staff going off sick. We were told that this meant that the temporary management team have been part of the rota, rather than extra, which would enable them to have an overview of the service and address long term problems. Staff were positive that the temporary manager had recognised staff members who worked as part of the team and those who did not. Some people expressed frustration that this had not been tackled by the Council earlier and felt that different staff teams did not always work together well. There has been no written formal confirmation of how long the temporary management arrangements will be in place, and when management arrangements formalised. We looked to see how people can influence the way the home is run and how they are supported to share their views. We were told that every three months a Residents’ Meeting is held in the home, chaired by an advocate from Age Concern, and we saw minutes for these meetings, although one person we spoke to was unaware of them. Activities and outings are regularly discussed in these meetings, along with other topics relating to daily life in the home, and we could see from the minutes that suggestions have been acted upon. Since the last inspection, the home has put in place systems for people visiting, working and living at the home to share their views i.e. surveys and staff and residents’ meetings. We have been sent the outcome of these surveys that show that people are positive about the care they receive. The home is also visited on a monthly basis by a representative from the council as a quality check, which we saw reports for and provides basic information about the home. We asked for the home to submit an AQAA. This has not, to date, been supplied. We looked at the way the home looks after money and valuables handed to them for safe keeping by people who do not want to (or who are unable to) look after their own cash or valuables. We could see from records that a detailed list is now kept of people’s belongings when they move to the home or have a respite stay. We saw from minutes from a staff meeting that staff have been reminded that they must double sign during financial transactions and when we looked at records we could see this was now common practice. Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 26 Individual records have been kept for each transaction. The money is held in a bank account set up by Devon County Council specifically for people living at the home. A float is kept in the home – this provides sufficient cash for daily requirements, although larger sums would need to be requested in advance. We looked at a random selection of the records. Transactions are doublechecked by a second member of staff to ensure the balances are correct. On the last inspection, we were reassured to hear that Devon County Council regularly audits the records of cash held by the home on behalf of people living there and that these audits were likely to discover any errors in calculation. We spoke to some staff about how they were supervised. Some staff said they had received formal supervision recently, some said they had not for some months. Since the last inspection, we can see that medication records and records relating to money and valuables are kept up to date but that further work is needed for care planning. We could not use the home’s AQAA as evidence to see how safety is maintained at the home so we asked to see safety checks for the lift and hoists in the home, all which were up to date. However, due to a lack of organisation in the office, there was initially a lack of clarity as to where these might be stored. Staff said that there were not clear systems for organising paperwork. We asked two people on duty, who held senior positions, how many people were living at the home, one told us nineteen and the other twenty. This has the potential to put people at risk if there was a fire at the home. A person told us about a fall and the fall of another person living at the home both of which resulted in hospital treatment. CQC has not been notified of these events, which they must do, as made clear in the requirement made on the last inspection. When we looked around the home, we spot checked upper floor bedroom windows and found that these were restricted and that radiators are protected, these practices help keep people safe. We saw that chemicals are stored safely and that there are generally good infection control practices in the home. Since the key inspection, we have received a full and detailed notification for someone whose care needs had increased as a result of falls and a deteriorating condition. This details the good practice steps that the home has taken to meet their changing needs. The temporary manager has also told us about a new form that has been brought in since the inspection to monitor falls and the actions taken. Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X 3 X X 2 X 2 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X 3 2 X 2 Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 OP4 Regulation Requirement Timescale for action 28/02/10 18 (1) (c ) People’s needs must be met by (i) staff who have received training appropriate to the work they are to perform. (Previous timescale of 31/08/09 not met). Each person must have a current care plan. Each person’s care plan must describe in detail the person’s needs, personal preferences and provide clear guidance as to how these changing needs are to be met. This is so that staff and people using the service know how each person’s changing needs will be met. (Previous timescale of the 31/08/09 not met). Arrangements must be put in place to promote and provide for the health and welfare of people using the service. This refers to falls management. This is so that people safe and any risks can be identified rapidly and appropriate action taken in a timely way. DS0000039280.V378414.R01.S.doc 2. OP7 15 28/02/10 3. OP8 12 28/02/10 Orchard Lea Version 5.3 Page 29 4. OP9 13(2) 5. OP29 19 (1) (a) (b)Schedu le 2 6. OP33 24 (2 - 5) 7. OP36 18 (2) Arrangements must be made to ensure that controlled drugs are signed out of the home when people who have received respite care return to their own home. This is to ensure a clear audit trail of controlled substances. Staff must have a full employment history, two written references, including one from their last care position, proof of identity and POVA/CRB checks before working at Orchard Lea to help protect the people living there. (Previous timescales of 31/05/07, 31/12/07 and 31/07/09 not met). This requirement could not be inspected as staff told us that no new staff had been recruited. The home must submit an Annual Quality Assurance Assessment (AQAA) when requested by the Care Quality Commission. This provides us with information to how the service monitors quality issues. Staff working at the home must be appropriately supervised to ensure that standards are maintained and people are cared for appropriately. (Previous timescale of the 31/08/09 not fully met). The Registered Person must ensure that events adverse to the welfare of people using the service are reported to the Commission in accordance with regulation and guidance. This is to enable monitoring of any patterns of adverse events or how the home is managed. DS0000039280.V378414.R01.S.doc 28/02/10 28/02/10 28/02/10 28/02/10 8. OP38 37 28/02/10 Orchard Lea Version 5.3 Page 30 (Previous timescale of the 12/07/09 not met). 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. OP3 OP7 OP9 OP9 OP11 Refer to Standard Good Practice Recommendations Mental Capacity assessments should form part of initial placement assessments. Care plans should show how people and/or their representatives have been involved and be kept under review. Where applicable there should be a plan of care for a person that integrates non-medicinal and medicinal approaches to behaviour management. It is recommended that the temperature of the medicines room be monitored so that appropriate action can be taken if it is found to be high. Staff should be provided with clear guidance to meet the needs of people reaching the end of their life. Care plans should reflect people’s advanced decisions and preferences. Care plans should describe how people’s identified spiritual needs will be met. Staff should be provided with appropriate training to help safeguard the people in their care. Bedrooms should contain comfortable seating for two people; at least two accessible double electric sockets and a table to sit at to make them a more comfortable place to spend time. To effectively manage the risk of cross infection liquid soap and paper hand towels should be consistently available in bedrooms where people have hand basins installed. There should be a recorded improvement plan to ensure that that all staff are competent to carry out their individual role to protect the people living at the home. The home should have a manager registered with CQC to help ensure they are competent for this role and to provide clear leadership for the home. At each handover there should be agreement as to how DS0000039280.V378414.R01.S.doc Version 5.3 Page 31 6. 7. 8. OP12 OP18 OP24 9. OP26 10. 11. 12. OP30 OP31 OP38 Orchard Lea many people are living at the home and a clear way of recording this. Orchard Lea DS0000039280.V378414.R01.S.doc Version 5.3 Page 32 Care Quality Commission Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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