Care Home: The Orchard Nursing Home

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What the care home does well The home ensures that new service users do not move in unless the home can meet their needs. Care plans are in place which give good details regarding how to meet individual needs and preferences. Service users have appropriate access to health care professionals. Medication procedures are followed to ensure medication risks are minimised. Staff interact well with service users and spend time chatting with them when they are not undertaking care tasks. There is a variety of activities provided and service users told us they enjoy them. Visitors are welcome at the home and are known by staff. Service users have a choice of all meals and enjoy them, as do visitors, if they choose to eat there. There is a complaints procedure in place and this is used by service users and complaints are addressed within the home`s timescales. Safeguarding procedures are also followed. The environment is well decorated and maintained. Service users are supported by a trained and qualified staff team. The manager is qualified and registered with the Commission. There are quality assurance systems in place. The home is run with due regard to health and safety. What has improved since the last inspection? The management team have been working towards improving the number of one to one supervision sessions the staff receive. The rota has also been improved in terms of numbers of staff and service users did not express any concerns about staffing levels. What the care home could do better: Closer attention needs to be paid to the recording of recruitment checks to ensure the home can fully evidence that checks are in place before a person starts work. The home needs to be assured that applicants are suitable to work with service user. Key inspection report Care homes for older people Name: Address: The Orchard Nursing Home 189 Fairlee Road Newport Isle of Wight PO30 2EP     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: Beverley Rand     Date: 0 4 0 2 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 22 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 22 Information about the care home Name of care home: Address: The Orchard Nursing Home 189 Fairlee Road Newport Isle of Wight PO30 2EP 01983520022 01983528788 sue.burton@barchester.com www.barchester.com Barchester Healthcare Homes Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Mark Sims Type of registration: Number of places registered: care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The Maximum number of service users to be accommodated is 43 The registered person may provide the following category/ies of service only: Care with nursing (N) 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 (OP) Dementia (DE) Date of last inspection Brief description of the care home The Orchard Nursing Home is a care home registered with the Care Quality Commission (CQC) to provide nursing and personal care for older persons. The home is situated in a residential area within easy access to local facilities. Accommodation is provided over two floors with a shaft lift that allows access to all Care Homes for Older People Page 4 of 22 Over 65 0 43 43 0 3 1 0 3 2 0 0 9 Brief description of the care home parts of the building. All the bedrooms are single and have en suite facilities. There is a well -maintained garden to the side of the home and ample parking at the front of the building. Barchester Healthcare Homes Ltd owns the service. Care Homes for Older People Page 5 of 22 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: This was an unannounced key inspection. Before we visited the home we looked at the last inspection report as well as other information we had received about the home. During the inspection we spoke with service users, staff, the deputy manager and the registered manager. We looked around the home and looked at records such as care plans and staff recruitment files. Care Homes for Older People Page 6 of 22 What the care home does well: 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. Care Homes for Older People Page 7 of 22 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 8 of 22 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 ensures that service users do not move in unless their needs have been assessed and the home can meet their needs. Evidence: The home undertakes an assessment of need before a prospective service user moves into the home. We looked at a pre-admission assessment and found that it covered all necessary areas. Assessments are also sought from other professionals who know the person. Prospective service users can, and do, visit the home and spend some time involved in activities before they decide to move in. New service users are given a welcome pack and brochure, which includes information from the Service Users Guide and Statement of Purpose. Both of these documents are available within the home. Care Homes for Older People Page 9 of 22 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 are supported in ways they prefer and have access to health care professionals. There are robust medication procedures in place to protect service users. Service users are generally respected but the use of language needs to be considered with regard to one care practice. Evidence: Care plans contained detailed information on service users assessed needs and included individual plans showing staff how to support service users with personal care, communication, nutrition and physical nursing care. Risk assessments and preventative strategies were on file for risks such as falling, moving and handling and falling out of bed. Files contain information about specific health care issues such as Parkinsons. We saw that health care professionals visited service users when necessary. Records of visits included in-house physiotherapy, the wheel chair service, doctors and specialist nurses. Care Homes for Older People Page 10 of 22 Evidence: Medication, including controlled drugs, was stored appropriately and medication administration records were completed, with no gaps. The home has a fridge for storing some medication and records are kept to ensure the temperature is monitored. Medication is administered by trained nurses. We saw that staff worked in ways which respected service users privacy and dignity and service users told us that staff called them by the name they preferred. We saw staff sitting and talking with service users individually and there was a lot of laughter in the lounge/dining area. Staff told us that some service users liked their bedroom doors open but they closed doors when undertaking personal care. Whilst we saw a lot of evidence that service users were respected, we did become aware that some staff we spoke with used a derogatory term when referring to a particular care practice. We brought this to the attention of the manager and he agreed the term did not respect service users and assured us that he would address the issue as a matter of priority. Care Homes for Older People Page 11 of 22 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 offers a range of activities which service users enjoy. Visitors are welcome in the home and staff know them. Service users enjoy a choice at mealtimes and can make choices other than what is on the menu. Evidence: The home employs two activities co-ordinators for a total of 48 hours a week. When we arrived at the home some service users were playing a computer game on the television screen which involved some physical activity. We spoke with one of the activities co-ordinators who told us that the regular activities included gardening and potting up, computer skills, trips out, seasonal parties, cooking classes and outside garden games, such as dominoes, cards and Connect 4. Photographs of service users enjoying activities were displayed around the home. We spoke to a service user who had spent some time that morning designing an invitation for a Valentines dinner to be held in the home. They told us they were enjoying learning computer skills. We also saw that service users could carry on with their individual hobbies, such as making cards. Another service user told us that activities were always happening and that the activities co-ordinator did, wonders. We saw that visitors were welcome at the home and that some had their lunch there Care Homes for Older People Page 12 of 22 Evidence: before relaxing for a while. We saw a visitor arrive and all the staff said hello and one staff member sat down with the visitor and service user and spent time chatting with them. The conversation was not task based and appeared to be unhurried. There is a menu displayed in the hall and outside the dining room. Service users can make their choice of meal when they sit at the table. The dining tables were set with glasses and serviettes. There is a kitchenette in the dining area which is safe for service users to use. Drinks are available for visitors to help themselves to, or service users if they are able. We heard staff asking what a service user had ordered for lunch and they said a dish that was not on the menu. We heard staff asking, would you like a drink, ladies and gentlemen? and asking individuals specifically if they would like some juice. Similarly, soup was offered to individuals. We heard the chef offering a choice of main course as it was being served and there was a choice of vegetables. There was also a choice of pudding and we heard the chef offering a choice or, some of both. We heard a nurse asking a visitor if they enjoyed their lunch and they replied, very nice. Lunch was unhurried and we saw staff feeding service users at their pace. One service user told us how the chef had made an individual pie for them and their visitor because they did not like the pie on the menu. Another service user told us that the food was, better than you would expect in a care home and that the pureed food was, pureed well and nicely presented. Care Homes for Older People Page 13 of 22 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 feel able to complain and there are safeguarding procedures in place. Evidence: The home has a complaints procedure in place and has received five complaints since the last inspection. We saw that these had all been addressed within the timescales of the homes policy. We spoke with two service users who both said they would feel able to complain if they needed to. The home has safeguarding adults procedures in place and the manager has made referrals to the local Adult Services Safeguarding Team in response to various concerns raised by service users and staff. The manager has addressed allegations and has dealt with the issues on an individual basis. We spoke with staff about safeguarding procedures and they knew who to report any allegations or suspicions of abuse to. Care Homes for Older People Page 14 of 22 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a well decorated and clean home. Evidence: The home is decorated to a good standard. It has a sitting and dining rooms with comfortable good quality furniture, domestic in style. It was neat, clean and free from offensive odours. The specialist equipment required to meet the needs of people who use the service is in place. There are sufficient wheelchairs, hoists and assisted baths and there are grab rails. There are specialist beds to maintain the safety and comfort of those nursed in bed and there is pressure relieving equipment available. Bedrooms are comfortable with comfortable furnishings and all are en suite. The bedrooms are personalised according to the wishes of people who use the service. Radiators are covered and people can lock their bedroom doors. There are suitable laundry facilities sited away from areas of food storage and preparation. Washing machines have the required programmes. Care Homes for Older People Page 15 of 22 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by trained and qualified staff. Recruitment procedures are in place but more attention is needed with regard to the record keeping. Evidence: The manager told us that the rota currently includes one nurse and four carers or two nurses and three carers. At night there is one nurse and two carers. These staff are supported by three housekeepers, three maintenance staff, two chefs, two hostesses (who serve meals and drinks), two activities co-ordinators, an administrator, a physiotherapist, the deputy manager and the registered manager. The home is undergoing building work and currently has seventeen beds closed. There is a training programme in place includes fire training, food safety, health and safety, infection control, moving and handling and safeguarding of vulnerable adults. We spoke with staff who confirmed they had undertaken various training courses and we saw certificates on individual files. We were told that other training included mental capacity, hand washing techniques, how to use bed rails and diabetes awareness. The manager told us he was trying to find dementia training and that he was in discussion with a training company to find a course which could be tailored for his staff. The organisation supports staff to attain National Vocational Qualification Level 2 in Care Homes for Older People Page 16 of 22 Evidence: Care. We looked at recruitment files for three new staff. One file was complete with clear records of the checks which had been completed before the person started work. Another file had a checklist which showed that both references had been received before the person started work but one of the references had a different date which appeared to show it could not have been received earlier. However, it was also possible that the numbers had been transposed and that an administration error had occurred. The third file showed that one reference was received after the person started work but we were told that a telephone reference had been taken before the person was employed. This practice is not acceptable and the manager acknowledged that a written record of the conversation should have been made. The manager told us that he was in the process of recruiting new staff but was waiting for the necessary checks to be completed. Care Homes for Older People Page 17 of 22 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. Service users benefit from living in a home which is well managed. Evidence: The manager has been registered since the last inspection and has the necessary qualifications to manage the home. There is a quality assurance system in place which includes monthly visits from a representative of the organisation. The manager undertakes a variety of monthly checks and audits and takes any necessary action. Surveys are undertaken and an independent company analyses the data and sends the home a report. The manager told us that the home does not look after any money on behalf of service users. We looked at staff supervision dates and found that those we looked at had completed a supervision session in January. The manager told us they had tried a particular way Care Homes for Older People Page 18 of 22 Evidence: of undertaking supervision, but that this method had not worked and so another method had recently been put in place. The manager told us that supervision included one to one sessions as well as attending team meetings. The manager was able to demonstrate that the home is managed well with regard to health and safety and we saw certificates which confirmed that equipment was tested and maintained. Care Homes for Older People Page 19 of 22 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 20 of 22 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 29 19 The registered person must 09/04/2010 ensure that pre-employment checks are completed and recorded before staff begin working at the home. The home must be assured that applicants are suitable to work with vulnerable service users. 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 21 of 22 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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