Care Home: Orchards Residential Care Home (The)

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What the care home does well The provider filled in their AQAA, a self assessment and reported: "During induction, staff are made aware that people in care homes want to retain their individuality and be able to exercise the freedom to make choices- for example, choosing what time to go to bed, and what time to get up; choosing to participate in an arranged activity, or choosing to sit quietly, reading alone." This principle was clearly seen during the visits. Service users were encouraged to express their individuality and exercise their autonomy. One of them enjoyed laying the table and helping with drying up after residents meals. At the same time the staff at The Orchards House reacted when a service user became unwell and called her GP, as seen during the site visit. Another huge benefit to residents was the fact that staff knew service users very well and treated them as individuals. One of the entries in daily records stated: "Can we make sure that the user does not wear her pink jumper, it is very tight and she does not like it anyway." Another entry also indicated the respect and dignity shown to residents: The resident would like to see the optician to come out to see her". The tick against this entry and the staff member explanation confirmed that staff followed this request and arranged for the optician to visit the specific service user. A senior staff member was seen administering morning medication and she completed her round within 50 minutes, efficiently, patiently and correctly. The checked files contained appropriate information of the assessed needs, risks and how to best help the residents, according to their wishes. There were no complaints or abuse allegations which indicated that service users were appropriately protected. What has improved since the last inspection? The providers realised that the home environment needed some significant investment into improvements and planned this carefully prioritising appropriately. Some carpets were replaced in communal areas and in some bedrooms, although the plan included replacing the carpets throughout the home. The provider commented and explained in their self assessment, AQAA: "Carpets have been changed in lounge, landing, and a few residents rooms. More chairs, and garden facilities have been provided. Despite living in an ensuite room, some residents have been provided with commodes as per their needs and wishes." The comments also indicated: "Most staff have completed dementia course. We continued with the ongoing staff devepoment programme. We are aware of the need for an on going training programme." What the care home could do better: The unexpected cancellation of flights while the manager and the provider were away, left the home in a difficult situation, as there was no named person in charge, there was no access to certain documents and no clear responsibility dealing with potential major disaster or significant events that could affect the residents. There was a need for such a plan to be put in place. Some minor environmental issues had been addressed during the site visit, such as marking the taps with very hot water, replacing a worn washer on a tap, sorting the drainage from the sink and temporarily fixing a loose bath panel while awaiting the planned total refurbishment of the bathroom. Key inspection report Care homes for older people Name: Address: Orchards Residential Care Home (The) Mill Lane Bradwell Great Yarmouth Norfolk NR31 8HS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Dragan Cvejic     Date: 2 6 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Orchards Residential Care Home (The) Mill Lane Bradwell Great Yarmouth Norfolk NR31 8HS 01493652921 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Dev Tirbhowan,Mrs Amitah Tirbhowan Name of registered manager (if applicable) Mrs Amitah Tirbhowan Type of registration: Number of places registered: care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of people who can be accomodated is 13 The registered person may provide the following categories of service only, Care Home only, Code PC to service users of the following gender, either, whose primary care needs on admission to the home are within the following categories, Old Age, not falling within any other category, Code OP, Dementia, Code DE Date of last inspection Brief description of the care home The Orchards is a chalet style bungalow to which has been added an extension with 7 single rooms all having en suite facilities. The premises are located in a residential suburb of Great Yarmouth, close to shops and a bus route. It stands in its own grounds Care Homes for Older People Page 4 of 26 Over 65 13 13 0 0 Brief description of the care home with garden to the front and back and has a small private car park. In addition to the extension, service users are accommodated in 2 further single and 2 double rooms upstairs in the main building. The upper floor is accessed with a stair lift. The care home is registered to accommodate 13 Older People, some of whom may in addition be suffering from dementia. The fee payable is advised verbally and also included in the contract that is provided before admission to the home. All additional charges are also listed in the contract. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The home was generally informing us, the regulators of significant events that affected the quality of care and the events that affected individual service users. They sent us their self assessment, AQAA, used to inform this report. We visited the home on 14/05/2010, but due to a general European problem, volcanic ash preventing normal flying, the providers were stranded abroad and the home operated without the manager. As the manager - provider - was away, we were not able to conduct a full inspection. We re-visited the home on 26/04/2010 when two inspectors visited the home conducting an unannounced visit. One of the inspectors used a SOFI tool and explained: We spent two hours of our inspection observing the care, staff interaction and well being of a small group of people living in the home. We used a process called Short Observational Framework Inspection (SOFI) to enable Care Homes for Older People Page 6 of 26 us to experience what it is like to live in the home. Based on our observations of three people, we looked at there records, asked staff how they cared for them and looked at relevant records such as staff training, to enable us to form an opinion. The other inspector checked the evidence and the outcomes for people living in the home against the National Minimum Standards. We spoke to several service users, to two staff members and to the providers on the second visit. We checked some service users and some staff files. We checked the environment, making a tour of the home. We also checked some procedures and policies. We checked medication process and records. We combined the findings from both visits and the results from SOFI to reach our judgement. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: The unexpected cancellation of flights while the manager and the provider were away, left the home in a difficult situation, as there was no named person in charge, there was no access to certain documents and no clear responsibility dealing with potential major disaster or significant events that could affect the residents. There was a need for such a plan to be put in place. Some minor environmental issues had been addressed during the site visit, such as marking the taps with very hot water, replacing a worn washer on a tap, sorting the drainage from the sink and temporarily fixing a loose bath panel while awaiting the Care Homes for Older People Page 8 of 26 planned total refurbishment of the bathroom. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offered appropriate information to potential service users, allowing them to make an informed choice of the home. The home also offered reassurance that the assessed needs would be met for people admitted to the home. Evidence: The home provided information about the services offered in their statement of purpose and the service users guide. The AQAA stated: Prospective service users and their representatives who are seeking or considering an admission to the Orchards should be able to make informed decisions. They are provided with the service users guide and statement of purpose and its functions. They can also read the latest inspection report which is displayed at the entrance of the care home. When a referral is made to the Orchards, we ask for brief information about the potential service user to get an idea whether their needs can be met at the care home. Whether the person making the initial inquiry is a social worker or relative, they are greeted and treated with respect. Staff show respect and dignity and are Care Homes for Older People Page 11 of 26 Evidence: given as much information as staff feel adequate to enable them to formulate a good understanding of the care home before they are able to make a decision to go ahead with the placement. Three checked files demonstrated that good initial assessments were conducted prior to new admissions for individuals. Althought the home expanded their registration conditions to 13 people with dementia, only milder cases of this illness were accepted, ensuring that the home could meet the assessed needs. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users were treated with the respect and their health was appropriately monitored and actions taken when it was necessary. Evidence: Three service users files were checked. They all contained details of the initial assessments, care plans derived from these and appropriate risk assessments. These documents were regularly reviewed and updated. The SOFI, a Short Observation Framework Inspection also resulted in mainly positive findings, with some passive and very minor negative feelings and interactions. The files checked showed that appropriate healthcare was ensured in the home. The observed process of a carer calling a GP showed that staff acted when it was necessary to ensure appropriate healthcare was implemented. Although the majority of care plans and risk assessments were appropriate, one indicated the need for further action: the care plan stated: keep her mind stimulated, but the daily records showed: sleeps better since started on night sedation. These two entries indicated the need for a review to protect service users from being over-sedated. Care Homes for Older People Page 13 of 26 Evidence: Medication process was observed and three records were checked and were all correct. Privacy and dignity were respected. Staff knew users very well and formed a nice relationship maintaining a homely atmosphere, possible in a home of this size. A visitor seen during the site visit also felt welcomed and very much respected. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offered a range of afternoon activities, but remained open to the wishes of individual users to join or not, while respecting their wishes about the food, managed to gain a high five star award for food quality. Evidence: Service users visibly dictated the rhythm of daily life in the home. In a relaxed atmosphere, on the first day when we visited, the majority of residents were resting in the living room, while on the second day, they interacted more both between themselves and with staff. SOFI indicated positive outcomes generally and showed that the atmosphere suited service users aspirations and wishes. Contact with the local community was good with the small community where the home is located. Visitors, mainly relatives of service users were coming regularly, as one of them seen during the visit stated: I am coming every day. As a part of their respect for dignity the home offered users the choice to remain active or inactive as they wanted. One of the users was regularly helping in sorting the dining room and dishes after the meals. The provider reported in their AQAA: All residents are encouraged to pursue the activities of their choice within the limitation of the care home and they are also encouraged to keep the community linked activities/interest. Their views and opinions Care Homes for Older People Page 15 of 26 Evidence: are sought regarding the way in which their social life in the home. While we do approach this with a flexible attitude, we take into account that many would like to keep to their routine, hence all activities for example, daily living and hobbies and interests are geared to keep up with their routine as much as possible so that they feel and are in control of their life in a safe and motivating environment within the practice/policies and procedures of the Orchards. The home successfully presented their nutrition care and food preparation and was awarded five stars on the recent inspection. Although they did not have a dishwasher, they used this as an advantage to involve residents who wanted kitchen duties. The small negative element was that the care staff were doing cooking and food preparation, although it was seen during the second day visit that the provider stepped in and helped with food preparation, thus allowing more time to care staff to be with service users. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users were protected by clear policies and procedures and by an open and trustworthy atmosphere. Evidence: There were no major complaints or allegations of abuse since the last inspection. The AQAA reported three received complaints, but all were satisfactorily resolved, as the manager explained. The procedure was clear and a user stated: I would complain if I had anything to complain of. This is a good place, we dont have any complaints. There were no referrals to POVA register (Protection of Vulnerable Adults). The recruitment was conducted appropriately ensuring good protection of service users. Appropriate risk assessments also contributed to good protection of residents. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The size of the home allowed for a very homely atmophere and service users benefited from it and enjoyed the settings, however, the standards were not fully met due to the need for bigger investment that could be arranged gradually to improve environmental standards. Evidence: The home was taken over by the current owners in the state when it required a major investment in environment. Some initial investment was visible, the carpets in communal areas and in some bedrooms were replaced. New furniture for the garden was obtained. Service users were encouraged to choose the colours when some areas including some bedrooms were re-decorated. As the manager attended a dementia training, the idea was opened to paint the doors in different colours to help people with dementia in their orientation. However, at the time of the site visit, there were no changes yet. Two residents were seen in front of the door to the lounge, that was a push type door, with no handles on one side, wondering, as one of them said: what is this door for, I wonder. The alternative for a sluice was designed by the provider and ensured that hygiene was not jeopardised by locating the sink for the sluice just outside of the laundry area. The laundry area did not have appropriate flooring, the floor was exposed concrete. The bathroom upstairs had a few major faults: the bath panel was loose; the sink did Care Homes for Older People Page 18 of 26 Evidence: not drain properly, the handles next to the toilet seat were wrapped by the tape, the hot water tap washer was worn. The provider explained that the plumber was already called and was expected the same afternoon. However, there was a plan for a complete re-design of that bathroom and only necessary work was organised. The provider agreed to make it safe until a replacement is organised and to give us the planned dates for this major work. This is why these elements were not addressed as requirements in this report. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff that knew service users well and showed respect to them, ensured the residents safety and satisfaction, although the home did not have clear plans on how to deal with a major emergency. Evidence: On the day of the first visit, there were two care staff and one carer/cleaner that came on duty after breakfast. These two carers were helping some users to get up, to get dressed, were preparing breakfast and morning drinks and helped users with any extra needs. One of them also administered medication. The senior on duty explained that, normally it would be the manager also on duty at time of the day, but due to the manager being away, there were no other staff available. This staffing level, at the time did not seem sufficient to meet the users needs, especially as there were a few users that needed two staff to help them. On the second day, the manager and her husband (the providers) were present and there were three other staff on duty. This number was sufficient and seemed to influence a more relaxed atmosphere too, both among staff and service users. The rota did show when the manager was planned to work and her husband, also a provider, was an extra person present. They explained that normally, this would be staff complement and that they were able to meet the residents needs. The SOFI also showed that this time, users did have sufficient interaction and stimulation and that their other needs were met. Care Homes for Older People Page 20 of 26 Evidence: However, the home did not have a plan in place to delegate the managers duty to the named person in her absence. This resulted in staff files being unaccessible even for inspection, to uncertainty of the full management and staffing level, when providers were not present. Five of ten staff held NVQ qualifications. All of them had completed the induction programme for their roles. Recruitment was conducted appropriately and staff files checked on the second visit contained all required documentation. Staff training records also were checked on the second visit and confirmed what staff stated that they had sufficient and appropriate training. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home depended on the providers presence and service users were well served when the manager-provider was present. Evidence: Details about the manager were only available on the second visit and demonstrated that the manager had the skills and experience to manage the home. An extra advantage was also in fact that the manager was a qualified trainer and provided regular training to staff. Quality assurance monitoring was effective on the principle of individual contact with service users. The provider responded in their AQAA: We listen to our service users, their relatives and the commissioners re any suggestions and act promptly; this has enabled us to maintain good relationships, satisfaction among service users and to have a small number of complaints. Policies and procedures were reviewed and updated yearly, as AQAA showed, but also seen from a few checked examples during the site visit, such as generic risk assessment, financial procedure and Environmental health policy. Care Homes for Older People Page 22 of 26 Evidence: The home encouraged relatives to help service users with their finances, thus avoiding and minimising the risk that staff accessed users finances. Staff supervision was regularly conduced and well recorded both in managers records and in staff files checked. Safe working practices were in place except for the time when the manager was away. The notes on the notice board in the office area helped staff pay individual attention to each service user, but the manager must ensure that there is a plan to manage the home in her absence, as explained under staffing section of this report. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 27 38 The provider must ensure that there is a named person with delegated management duties when the providers, including the manager are absent. This would ensure better safety and safeguarding of service users at all times, including the times of the absence of the provider and the manager. 30/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 26 of 26 - 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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