Care Home: The Orchard Nursing & Residential Care Home

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What the care home does well Staff working in the home were seen to demonstrate a genuinely kind and caring attitude to the people that they support. People who live in the home described them as "kind", "great fun" and "very nice". The manager was seen to be very supportive and was bringing about positive changes. Comments from people living in the service, visitors and relatives included, "", "the new manager has worked wonders", "I can get in touch with the manager if I need to", "home is working better making sure residents and staff are cared for in a relaxed atmosphere" and "since new manager arrived staff have been included in the running of the home." The service is decorated in a manner that is in-keeping with what people would have in their own home. it is a warm and welcoming place for people to live in. People living in the home are offered the opportunity to decorate their rooms to their own taste. Menus for meals offer a choice of foods available at all sittings. The expert by experience eat a meal with people at our visited and said that it was "well cooked and nutritious". What has improved since the last inspection? Since the last visit the manager has changed and a deputy is in place, they make sure that they look at the quality of the service that they provide and strive to improve it. Over the three days of our visit they made significant changes to improve the quality including making some of the care documents much simpler, arranging for medications to be managed more safely and fixing some minor areas that needed repairing in the service. we are kept informed of changes in the service or significant events. The manager makes sure that all serious concerns are correctly addressed in order to maintain the safety of people living in the home. What the care home could do better: In general many areas of the communication systems need to be improved. These are more for the written communication systems such as care planning and management of some medications such as food supplements and creams. Admittances to the service need to be managed in a better way in order to make sure that the service can always be aware if they can meet the needs of people moving into the home. The daily activities including menus within the service need to be taken from peoples choices. The means to find out what people less able to "say" what their choices are need to be better managed in order to make sure that their personal preferences influence the support they receive. The arrangements for recruiting, training, managing staffing levels and communication between staff need to be reviewed. This needs to be dine in order to make sure that all staff are skilled and available in the correct numbers to meet the individual needs of people living in the home. Key inspection report Care homes for older people Name: Address: Orchard Nursing & Residential Care Home The St Mary`s Road Huyton With Roby Merseyside L36 5UY     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: Julie Garrity     Date: 0 5 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 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Orchard Nursing & Residential Care Home The St Mary`s Road Huyton With Roby Merseyside L36 5UY 01514492899 01512876501 admin@flightcare.co.uk www.flightcare.co.uk Flightcare Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N To people 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 The maximum number of people who can be accommodated is: 31 Date of last inspection Brief description of the care home The Orchards Nursing home provides nursing care to 31 older people. The unit has two lounges and two dining rooms with other small lounges available for people to meet with visitors in private. There is a small garden area available at the back of the home and another garden area at the front of the home. There is also a large car park at the rear or the building The Orchards Nursing and Residential Care Home is located in a residential area of Huyton. It is near to the main shopping centres of Huyton and there is rail and bus access within a 10-minute walk. The home is part of a privately owned Care Homes for Older People Page 4 of 29 Over 65 31 0 Brief description of the care home company, known as Flightcare Ltd; this organisation has a total of 7 homes located in the North West region. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Prior to the site visit taking place we (the commission) asked the manager to complete a document called an AQAA. This is a document, which gives information about the services strengths and weakness, and future plans for the service to develop. Once the AQAA was received, we sent out surveys to the people who live at the home and the staff who work there. Eight surveys were returned from the people who live at the home and six from the staff. The inspector was accompanied on the inspection by an expert by experience. Experts by experience are individuals who have personal experience of either living in or supporting a relative in a care environment. In some cases the expert by experience is an individual who has personal experience of either physical or mental ill health. The expert by experience was asked to talk to people and gather their opinions on what it feels like to live in service. There was a limited amount of time available for the expert Care Homes for Older People Page 6 of 29 by experience and as such they concentrated on the dignity and opportunity to make choices of the individuals living in the home. A pharmacist inspector also attended the visit to look at how the service managed medications. During the visit, we had discussions with people who live at the home, their visitors and staff. Their views have been included within the report. We looked at the environment and the care records in the service. This information was used to help us to make a decision about the quality of service that the Orchards provides. Feedback was given during the visit to the manager, deputy manager and the owner. The visit took place over three days and lasted a total of 12 hours. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: In general many areas of the communication systems need to be improved. These are more for the written communication systems such as care planning and management of some medications such as food supplements and creams. Admittances to the service need to be managed in a better way in order to make sure that the service can always be aware if they can meet the needs of people moving into the home. The daily activities including menus within the service need to be taken from peoples choices. The means to find out what people less able to say what their choices are need to be better managed in order to make sure that their personal preferences influence the support they receive. The arrangements for recruiting, training, managing staffing levels and communication between staff need to be reviewed. This needs to be dine in order to make sure that all staff are skilled and available in the correct numbers to meet the individual needs of Care Homes for Older People Page 8 of 29 people living in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service needs to improve how it admits people into the home and the information that they provide. This needs to be done in order to make sure that the service can meet peoples individual needs. Evidence: The AQAA from the service told us that they, Have a comprehensive pre-admission assessment, which includes a draft care plan agreed by client and or family. We have a statement of purpose and service user guide that is readily available. Prospective service users / family are always offered to view the home and given the opportunity to ask any questions We looked at records in the home that showed us that service had the opportunity to assess (look at needs) people before they moved in. Of the four records viewed this had been done for three people. When we looked at the records of the fourth person the person had not been assessed before they moved in. We were told by the Care Homes for Older People Page 11 of 29 Evidence: manager that the service had not had the opportunity to assess them as they had moved in as an emergency. We looked at the policy and procedure that help staff to manage an emergency admission safely and noticed that these were unclear and out of date. The records for the person showed that a full assessment had not been done before they moved in and had not been fully completed after they moved. The manager and deputy showed us how they planned to address this in the future. This included making sure that a basic assessment was completed for all people moving in, even if over the phone. They also said that they intend to review all the assessment forms which they said need to be more person centred. Once put into place this will help staff to understand peoples needs before they move in and plan their support once they start living in the home. Surveys from people told us that they are provided with information, which tells them what they can expect if they decide to move to the Orchards. When we looked at this information it had not been updated for several years and no longer explained what services the home provided. Surveys also told us that the majority of people received a copy of a contract but this was not the case for all. Without up to date information people will not be able to decide if the home can meet their needs. When we spoke to people and their relatives they told us that, my daughter looked around and the staff are very nice it was one of the reasons I came to live here. At our visit we asked or expert by experience as to their impression of the home they told us that they found the staff welcoming and if I needed to live in a care home I would consider this one. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and welfare needs of people living in the home are supported in a manner that maintains their safety. Evidence: As part of the visit a pharmacist inspector looked at how medicines were being handled. Overall we found medicines were being handled safely. Medicines stock were generally organised and records were clearly completed. Ordering and recording procedures were efficient and all medicines could be accounted for. We carried out some checks on the current stocks and records and found that regularly prescribed medicines were being given correctly. When we looked at items such as antibiotics we found some were not given before food as they should be. Records for some medicines such as creams and food supplements were not completed accurately. The manager showed us some new paperwork. This could be used to make provide a more accurate record. Records of medicines given should always be accurate and complete to help make sure medicines are used properly. We looked at how a person was supported to look after some of their own medicines Care Homes for Older People Page 13 of 29 Evidence: and found the paperwork was clear and up to date. A risk assessment and care plan had been written and this was reviewed regularly. When we spoke with this person we found they were happy to manage some of their own medicines and they were pleased with the amount of support staff gave them. When we checked care plans for instructions such as per required need medications and creams we found that these details were not available. As such staff will not always have the correct guidance they need to know when to use a cream or give a when needed medication. Other care plans were not available. Two people had been admitted to the home and neither had a care plan put into place within 4 days. We discussed this with manager and deputy who agreed that this was not good practice. On the second day of our visit the manager had written the necessary care plans and had developed arrangements to make sure that all people admitted to the service would have a basic plan in place that would be updated within 3 days. We looked at three other care records and noticed that these were often repetitive, overburdened the staff team with paperwork and were not read by staff. Information was contradictory as an example one person had an assessment in place stating that they did not use footrests on a wheelchair. Whilst another section for the same person stated that footrests were to be used at all times. Another person had conflicting information regarding the thickness of fluids needed. When we looked at how care plans had reviewed we noticed that this were not always updated as peoples needs changed or once a month. The manager explained that she intended to simplify the care plans and make sure that they reflected the needs of people living in the Orchards. An example was shown to us that when put into place should assist in maintaining care records that reflect peoples needs. Staff need up to date instructions in order to make sure that they can support people in the correct manner. We spoke to people living in the home and sent surveys that told us that people were able to access the medical care that they need. The service has a doctor from the options team visit twice a week. The options team is a system meant to reduce hospital admissions they visit the services in order to give advice and guidance. The doctor from the options team told us that they thought the home was very supportive and accessed medical advice as needed. Care Homes for Older People Page 14 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there are activities and choices of food available this does not meet the individual choices or provide sufficient stimulation for some of the people living in the service. Evidence: We spoke to people who live in the home and sent surveys. We also spoke to family, members and staff working that day. They told us that catering team are first class, recent entertainment in the home has been very good and likes activities outside especially in the summer. This positive view was not held by all people with comments such as entertainment could be better, they need more to do and better entertainment needed. Half of the people living in the home surveyed felt that they had appropriate activities and food, sometimes. The other half told us always and usually. Staff spoken with told us that they did not think activities were sufficient. One relative said people staying in their own rooms get little or no stimulation. We spoke to one person who told us that they never came out of their room and were often on their own with nothing to do but watch the television. The activities co-ordinator records what activities people do but this information is not used to develop individual activities. The programme showed a number of group activities in place. In the better weather there was a mini bus to take the people on Care Homes for Older People Page 15 of 29 Evidence: outings Chester Zoo, a near by park and other places of interest. A variety of activities need to be in place to help maintain peoples independence and provide them with stimulation. People spoken with said that there was a routine but they could get up and go to bed when they wanted. Staff told us that they were unable to supply service as people wanted they were very busy in the mornings and meal times so if people wanted a bath in the morning or night this was limited. On the day of our visit they said that they had only been able to offer a bath in the afternoon. As part of our visit we asked an expert by experience for their views they told us I had a meal with the residents, there were two dinning rooms, in one sat people who required support with eating. I was seated with the people who were more or less capable of eating independently. There was a choice of three courses. It was well cooked. Meal times were very busy for the four staff on duty, one of the people in the room I was using, required help to cut their meat. Another person who had finished their meal was shouting for help to be moved into the lounge. An extra member of staff at mealtimes would take the pressure of the four staff already on duty. Staff told us that they thought meals times were particularly busy. People we spoke with had differing points regarding the food some saying, very good, plenty of choice and others its okay most of the time, but could have a little more variety. We spoke to staff regarding how they provide choice for people unable to say what they wanted. They informed us that they generally choose for them, in particular for people who needed a softer diet. As there is limited information about peoples preferences staff are unable to make a full choice for the people that they support. We looked at the menus available and noticed that there was a choice of meals available at all times When we spoke to the manager about how the menu was developed they told us that it was developed between the cook and the management team. As such it was not taken from the expressed choices or needs of the people living in the service. There was no indication on the menus as to what meals were suitable for special diets such as diabetes. We looked at records in the home and found that there was little or no determination of what food people preferred. Peoples weight was monitored in order to make sure that they maintained a healthy weight as much as possible. Records showed that the majority of people maintained the weigh that they were admitted with showing that general eat an appropriate diet. Care Homes for Older People Page 16 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have the skills and knowledge to help protect vulnerable people who live in the home from any potential abuse Evidence: We sent surveys to people before we visited of those returned all but one person said that they knew who to talk to if not happy and how to raise concerns. There is a policy for complaints that is available to people who live in the service. Comments from people who live in the home were, I have every confidence that staff would address any issues and I have lost a couple of dresses in the laundry. We looked at complaint records available in the service their AQAA told us that the manager had received one complaint in the last 12 months. When we looked at that complaint it was not in relation to missing laundry. The concern had been fully investigated and an outcome that everyone was happy with achieved. However the lack of a complaint about clothing means that staff either did not pass on the concern or the person was unsure of how to raise this concern. The survey information shows that not everyone living in Orchards is aware of how to raise concerns. The AQAA from the service told us that the service has made four safeguarding referrals (these are serious concerns that need to be managed by social services). Three of these had been investigated and action taken to prevent then from happening again. The actions that the manager took included removing staff who were shown not to be fit to work with the people living in the home. In all four cases the Care Homes for Older People Page 17 of 29 Evidence: service had taken the correct action and the manager understood their role and responsibility. We spoke to staff about training that the had received for safeguarding all staff told us that they had, had recent training and in discussion were clear about the roles of the manager and social services. Records about staff training in safeguarding that would help the manager make sure peoples training was always up to date were incomplete and needed to reflect the training staff stated they had received. We looked at the guidance available to staff and found that the homes own policy on managing safeguarding complaints was out of date, did not follow best practice or reflect the practice in place in the service, a copy of social services policy that helps care services action any safeguarding concerns was available. The manager told us that they are able to access guidance and support from the local social services department as needed. A recent event in the service told us that the manager understood how to address safeguarding complaints and how to take appropriate action to maintain the safety of the people living in the home. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Orchards is a clean and tidy environment that is decorated in a homely manner. Evidence: Orchards has accommodation for twenty four people. At our visit twenty people were living in the home with two people having recently moved in. Many of the rooms had recently been decorated. The people living in the home told the expert by experience that they had chosen and gone shopping for their own wallpaper. Surveys sent to the people who live in the service told us that they thought the home was clean and tidy. We looked around the home looked at all the lounges and dining rooms. We also looked at all the bathrooms, toilets and the kitchen. We found that everywhere looked clean and tidy and that the home presented as a pleasant place to live. People living in the service told us, I like my room since it was recently redecorated and Id like my bedroom redecorating soon I have been told it will be in the next few months. We spoke to staff and relatives, many commented that they thought a better garden area was needed for the people living in the home. There are two dining rooms and two lounges for people to use. The main corridors were well light and had handrails in place to help people move around the service independently. There is a variety of specialised equipment in the Orchards such as Care Homes for Older People Page 19 of 29 Evidence: adjustable beds, hoists to help people get into baths and specialised bed mattresses. There was records that showed that these items were regularly checked to make sure that they were well maintained. People spoken with were happy with the environment. A number did comment that they would like a better garden area and we need a nicer outside space. There are gardens to the front of the building but these are not easily accessed from the building. The rear of the building whilst a large space is mainly car parking. The manager told is that they would like to refurbish the Victorian veranda at the front of the building to provide a covered seating area. At the first day of our visit there were a number of areas of damage that had not been corrected including exposed pipes. On the second day of our visit the majority of these had been addressed. We looked at how the service recognised and prevented the spread of infection. Staff told us that they had received training in the prevention of infection. Records available were out of date and did not reflect the training that staff stated they had received. All the bathrooms viewed contained liquid soap and disposable towels that made sure that people can clean their hands and help prevent the spread of any infection. Staff had equipment such as gloves and plastic aprons available that they wore at appropriate times such as mealtimes. Care Homes for Older People Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements are not sufficiently managed to make sure that there is enough staff who are skilled to meet the needs of people living in the service. Evidence: We received surveys from staff and people that the home supports. Two people living in the home that there were sometimes enough staff. Comments included, I would like to see the nursing staff interact more with the care staff and provide more staff, current staff appear to be jack of all trades working extended hours and filling in for absentees. Three people found this to be different with there always being enough staff. Comments included, I like the staff most of them are friendly you tend to like some more than others, staff supportive to residents and families, staff kind and caring, carers always bring a smile and laughter in with them when they come on duty. Staff commented that there was not always enough staff. Comments included need more cleaning staff, staffing levels can be awful at times, nursing staff could help out more when staff absences mean care staff are struggling, communication between nursing and carers is not good. Nurses could help out more, nurses need to communicate more with clients and staff and help more on the floor. and nurses need to involve themselves more. The owner adjusts staff as people need extra support however the comments received show that staff, people who live in the home and their relatives feel that there are occasions in which there is not enough staff available to meet peoples needs. Our expert by experience observed during their visit Care Homes for Older People Page 21 of 29 Evidence: that more staff over lunch time would be of benefit. We looked at off the duty rotas that showed how many staff were on duty in the home during the day time and the night time. This showed that recently staffing levels have been increased in the morning due to more people moving into the home, which meant that people needed more support. Staffing files were reviewed to determine how staff were recruited. Records in all files were incomplete, not all the files had a application form, two references or evidence of a full induction. As an example one persons file had a references from a previous employer and a letter that started to whom it may concern. Letters that start in this manner are not considered references but a testimonial as the letter can not be confirmed as being written by a previous employer. The head office for Orchards keeps all records that show police checks and another check known as POVA. The head office had not completed this information for the home to be sure that all checks had been done. We spoke with the owner of the home who told us that the manager would have this information available to them in the future. We had also noted that there was little evidence that the nurses employed in the service had the correct information as an example checks on their registration known as PINs had not been updated. The owner addressed this before or visit was completed. The manager needs to be assured that all staff working in the service are fit to do so. We spoke to staff about training and all confirmed that they had received a variety of different training over the last year. Staff surveys also confirmed that staff were offered training as needed. The manager stated the company the owners the Orchards employs their own trainer and that they had delivered lots of training to staff recently. When we looked at the records held by the head office we noticed that there was no records of training since late 2008. The owner told us that head office would update this information and send a copy to the manager in order that she can monitor that staff training remains up to date. Care Homes for Older People Page 22 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed safely and is a safe place for people to live. Evidence: At the time of our visit the manager was not yet registered with the commission to manage the service. The owner of the service has already checked that the manager is suitable to work in the Orchards. The manager informed us that she has completed an application form and sent it to us. The deputy manager previously worked in the home as the manager. Surveys from people who live in the home and staff told us, you can speak to management and you are listened to and helped where possible, support and peace of mind, the new manager has worked wonders, I can get in touch with the manager if I need to, home is working better making sure residents and staff are cared for in a relaxed atmosphere, since new manager arrived staff have been included in the running of the home, new manager is gradually improving things and new management is benefiting the home, manager very understanding. We Care Homes for Older People Page 23 of 29 Evidence: know that the manager informs us of any events that affect the health and welfare of any of the people who live in the home. The manager also provides details of what action she has taken to investigate and rectify any concerns. The service sends out surveys once a year to the people who live at the home as another way of monitoring standards and gaining their opinion. The last surveys were done in 2009 and needed some actions putting into place. The manager discussed that she addressed any issues from the surveys. The manager had also recently had a meeting for relatives to attend to discuss the care and support of the people living in the home. The provider visits the home twice a month to make sure quality is maintained. The service has audited (checked) on medications not done audits on other areas such as care plans, staff training, staff recruitment, accidents and environment as examples. Senior staff at the home support some people to manage their money. We saw records, which were clear and easy to track who spent what money on which day and for what purpose. Care Homes for Older People Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The arrangements for 05/04/2010 emergency admissions (in particular) and assessments for people wishing to move into the home need to be reviewed. The service needs to confirm in writing that the service can meet the needs of the person wishing to move in, keep assessment under review and revise as changes occur. A copy of any assessments need to be availiable. The service needs to be satisfied that it can meet the needs of people they support before they move in. 2 7 15 Care plans need to be kept under review and updated as peoples needs change. 05/06/2010 Care Homes for Older People Page 26 of 29 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 Clear instructions need to be available to staff in order for them to support people appropriately. 3 29 18 Review all staffing files to 05/03/2010 make they include evidence of application (with gaps in history explained), 2 verified working references, CRB, POVA and induction. To make sure that staff are suitable to work in the care home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 Statement of purpose and service users guide need to be updated to reflect the practice in place in the service. The information needs to be in formates that meet the needs of people wishing to move into the home in order to help support them decide in the service is for them. The times medicines are given to people should be reviewed to make sure they are all given at the right and best time. The recording of external medicines and nutritional supplements should be improved to help make sure accurate records are always made. Arrangments need to be in place to make sure that staff are aware of how to give as needed medications. 2 9 3 27 Review the staffing levels including the nursing staff in line with the individual needs of people living in the service. Care Homes for Older People Page 27 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 30 Update all training and make arrangements that support the manager to check that staff are receiving the correct training including induction and mandatory training. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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