Care Home: The Orchards

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What the care home does well There was a statement of purpose and people who were interested in moving into the home were given a copy. This meant that people had the information that they needed to decide whether the home was the right place for them. People could visit the home before deciding whether to move in. People`s needs were assessed in detail so that their needs would be met. Each person also had a care plan so that their needs would be met. The plans were detailed and showed what support each person needed at different times of the day. People were registered with a GP and they saw a range of healthcare professionals so that their health care needs were being met. People were generally protected by the arrangements for storage and administration of medication. People`s privacy and dignity were respected.The OrchardsDS0000050595.V378056.R01.S.docVersion 5.2People could participate in a range of activities according to their interests and wishes. There was an activities organiser and different activities were provided every day. People told us that they enjoyed the activities. Visitors were welcome at any time. Most people had regular visitors so that they kept in contact with their family and friends. People could exercise choice and control over their lives. There was a varied menu and a choice of drinks, meals and snacks was provided throughout the day. People were offered a variety of meals in pleasant surroundings and people enjoyed their food. There was a complaints procedure and any complaints were investigated. People knew how to make a complaint and their complaints would be taken seriously and acted upon. There was information for staff about protection from abuse and staff had received training about safeguarding adults from abuse. People were protected from abuse and harm. People lived in homely, clean and pleasant surroundings suited to their needs. There were several seating areas with flat screen televisions and a large conservatory which was used for activities. The accommodation was well maintained and decorated. Each person had a single bedroom and most of them had en-suite toilets. There were sufficient bathrooms to meet people`s needs. People were supported by sufficient staff, who were appropriately trained and competent to meet people`s needs. There were usually five care staff on duty in the morning, four in the afternoon and two at night. Staff received all the required training and some specialist training as well. There was a recruitment procedure and staff had all the required checks before they started work so that people were protected from being cared for by unsuitable staff. The manager was appropriately qualified and experienced. They had applied to become the registered manager but had not yet been approved as a fit person to manage the home. Here was a quality assurance process and all service developments were based upon the views of people who lived in the home. There were several health and safety checks and people were generally protected by the health and safety measures. What has improved since the last inspection? The manager was sending letters to people before they moved into the home to confirm that the home would be able to meet their needs. More detail was being recorded in the care plans. This meant that there was more specific information for staff about how to support people at different times of the day. More information had been obtained about people`s life history, likes, dislikes, hobbies and interests. Some people had memory books to help them and the staff remember things about their lives. These developments would help to make sure that people`s needs would be met.The OrchardsDS0000050595.V378056.R01.S.docVersion 5.2Each person had a photograph of their key worker in their room to help them to recognise their key worker. Keyworkers were spending more one to one time with people and taking them out so they got to know people and could support them better. A record was being kept of the medication each person took. This would help to make sure that staff knew what medication people were taking so that they had the right medication at the right time. The controlled drugs cabinet had been made more secure so that controlled drugs were being stored safely according to the regulations for storing these drugs. Staff had received training about dementia to help them to understand the needs of people with dementia and to support them. The owners had appointed a person who was appropriately qualified and experienced to run the home. The manager had made several improvements to the running of the home since they had been in post. The temperatures of the hot water delivered from the taps was being checked weekly to reduce the risk of people being scalded. What the care home could do better: The assessments should include information about needs in relation to disability, gender, age, race, ethnicity, faith and sexual orientation to ensure that these needs will be met. The daily records should contain aspects contributing to peoples’ quality of life rather than generic comments such as: ‘all personal care given’ and ‘no problems’. The registered person must ensure that all hand written entries on the medication administration record (MAR) sheets are signed and dated by two members of staff. This is to show who made the changes, to confirm that they are correct and to be able to cross reference any changes to instructions in the care records from the prescribing doctor. This will help to make sure that people have the right medication at the right time. The registered person should also make sure the home`s insurance covers staff undertaking procedures such as taking blood. Improvements could be made to the arrangements for cleaning commode pots. More training about dementia was planned so that staff would have a more in depth knowledge about the needs of people with dementia and how to support them. A risk assessment should be conducted when a person uses bedrails to make sure that they are kept safe in bed.The OrchardsDS0000050595.V378056.R01.S.doc Version 5.2 Improvements need to be made to the recording of the health and safety measures so that it is clear that the checks have taken place and people are kept safe. When staff receive fire instruction a record should be made together with the date. When the temperature of the hot water from the taps is checked a separate record should be made of the temperature from each tap. Key inspection report CARE HOMES FOR OLDER PEOPLE The Orchards The Orchards 1 Perrys Lane Wroughton Swindon Wilts SN4 9AX Lead Inspector Elaine Barber Key Unannounced Inspection 6th and 9th October 2009 10:10 DS0000050595.V378056.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Orchards DS0000050595.V378056.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Orchards DS0000050595.V378056.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Orchards Address The Orchards 1 Perrys Lane Wroughton Swindon Wilts SN4 9AX 01793 812242 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) orchards45@aol.com Buckland Care Ltd Susan McCarthy Care Home 35 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (32) of places The Orchards DS0000050595.V378056.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 17 service users in total with dementia (DE and DE(E)) may be accommodated. This is a temporary arrangement and subject to conditions 2 and 3 below. When the accommodation occupied by the 10 of the 16 current service users with dementia aged 65 years and over is no longer required, the maximum number of service users in the category DE(E) must be reduced to a maximum of 6. No service users with dementia to be accommodated on the second floor. 16th October 2008 3. Date of last inspection Brief Description of the Service: The Orchards is one of a number of homes owned by Buckland Care Limited. The Orchards provides accommodation and personal care to a total of 35 people. The home is located in the village of Wroughton and is close to local shops and public amenities. The home is a large three-storey building set in its own well-maintained grounds. All the bedrooms are single and some have ensuite facilities. The bedrooms are located on three floors and can be reached by either a passenger lift or a stair lift and each room has an emergency call bell installed. The home has an attractive conservatory that is appropriately furnished and allows people the benefit of extra communal space. Information about the home is available in a statement of purpose. Inspection reports are available from the home and also from our website www.cqc.org.uk. The Orchards DS0000050595.V378056.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Stars. This means the people who use this service experience good quality outcomes. We asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It also gave us information about what has happened during the last year and about their plans for the future. We sent out surveys so that these could be completed by the people who lived in the home and by the staff. We had surveys back from twelve people who lived in the home and three staff members. We also received surveys from five health care professionals. We looked at all the information that we had received about the home since the last inspection. This helped us to decide what we should focus on during our inspection. We visited the home on the 6th of October 2009 and again on the 9th October 2009. We talked to the registered manager and three members of staff. We looked at some of the homes records. We met with five people who lived in the home and asked them about their experience of living in the home. The judgments contained in this report have been made from all the evidence gathered during the inspection, including the visits. The last inspection of the home was on 16th October 2008. What the service does well: There was a statement of purpose and people who were interested in moving into the home were given a copy. This meant that people had the information that they needed to decide whether the home was the right place for them. People could visit the home before deciding whether to move in. Peoples needs were assessed in detail so that their needs would be met. Each person also had a care plan so that their needs would be met. The plans were detailed and showed what support each person needed at different times of the day. People were registered with a GP and they saw a range of healthcare professionals so that their health care needs were being met. People were generally protected by the arrangements for storage and administration of medication. Peoples privacy and dignity were respected. The Orchards DS0000050595.V378056.R01.S.doc Version 5.2 Page 6 People could participate in a range of activities according to their interests and wishes. There was an activities organiser and different activities were provided every day. People told us that they enjoyed the activities. Visitors were welcome at any time. Most people had regular visitors so that they kept in contact with their family and friends. People could exercise choice and control over their lives. There was a varied menu and a choice of drinks, meals and snacks was provided throughout the day. People were offered a variety of meals in pleasant surroundings and people enjoyed their food. There was a complaints procedure and any complaints were investigated. People knew how to make a complaint and their complaints would be taken seriously and acted upon. There was information for staff about protection from abuse and staff had received training about safeguarding adults from abuse. People were protected from abuse and harm. People lived in homely, clean and pleasant surroundings suited to their needs. There were several seating areas with flat screen televisions and a large conservatory which was used for activities. The accommodation was well maintained and decorated. Each person had a single bedroom and most of them had en-suite toilets. There were sufficient bathrooms to meet peoples needs. People were supported by sufficient staff, who were appropriately trained and competent to meet peoples needs. There were usually five care staff on duty in the morning, four in the afternoon and two at night. Staff received all the required training and some specialist training as well. There was a recruitment procedure and staff had all the required checks before they started work so that people were protected from being cared for by unsuitable staff. The manager was appropriately qualified and experienced. They had applied to become the registered manager but had not yet been approved as a fit person to manage the home. Here was a quality assurance process and all service developments were based upon the views of people who lived in the home. There were several health and safety checks and people were generally protected by the health and safety measures. What has improved since the last inspection? The manager was sending letters to people before they moved into the home to confirm that the home would be able to meet their needs. More detail was being recorded in the care plans. This meant that there was more specific information for staff about how to support people at different times of the day. More information had been obtained about peoples life history, likes, dislikes, hobbies and interests. Some people had memory books to help them and the staff remember things about their lives. These developments would help to make sure that peoples needs would be met. The Orchards DS0000050595.V378056.R01.S.doc Version 5.2 Page 7 Each person had a photograph of their key worker in their room to help them to recognise their key worker. Keyworkers were spending more one to one time with people and taking them out so they got to know people and could support them better. A record was being kept of the medication each person took. This would help to make sure that staff knew what medication people were taking so that they had the right medication at the right time. The controlled drugs cabinet had been made more secure so that controlled drugs were being stored safely according to the regulations for storing these drugs. Staff had received training about dementia to help them to understand the needs of people with dementia and to support them. The owners had appointed a person who was appropriately qualified and experienced to run the home. The manager had made several improvements to the running of the home since they had been in post. The temperatures of the hot water delivered from the taps was being checked weekly to reduce the risk of people being scalded. What they could do better: The assessments should include information about needs in relation to disability, gender, age, race, ethnicity, faith and sexual orientation to ensure that these needs will be met. The daily records should contain aspects contributing to peoples’ quality of life rather than generic comments such as: ‘all personal care given’ and ‘no problems’. The registered person must ensure that all hand written entries on the medication administration record (MAR) sheets are signed and dated by two members of staff. This is to show who made the changes, to confirm that they are correct and to be able to cross reference any changes to instructions in the care records from the prescribing doctor. This will help to make sure that people have the right medication at the right time. The registered person should also make sure the homes insurance covers staff undertaking procedures such as taking blood. Improvements could be made to the arrangements for cleaning commode pots. More training about dementia was planned so that staff would have a more in depth knowledge about the needs of people with dementia and how to support them. A risk assessment should be conducted when a person uses bedrails to make sure that they are kept safe in bed. The Orchards DS0000050595.V378056.R01.S.doc Version 5.2 Page 8 Improvements need to be made to the recording of the health and safety measures so that it is clear that the checks have taken place and people are kept safe. When staff receive fire instruction a record should be made together with the date. When the temperature of the hot water from the taps is checked a separate record should be made of the temperature from each tap. 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. The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had the information that they needed to decide whether the home was the right place for them. People could visit the home before deciding whether to move in. Peoples needs were assessed so that their needs would be met. EVIDENCE: The manager told us in the Annual Quality Assurance Assessment (AQAA) that they received an assessment from social services before a person moved into the home. They said that they had a clear admittance procedure, which ensured that people were met, their needs were assessed and the home was able to meet their needs before they were offerred a placement. We looked at the statement of purpose. This contained all the required information about the service. It contained information about the admission procedure and said that people were able to visit the home before moving in, for example for afternoon tea. It also said that if people were not able to visit The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 11 then the manager would visit them to meet them and tell them about the service. All the people who completed survey forms said that they received enough information, before they moved in, to help them to decide whether the home was the right place for them. We looked at four care files. We saw that each person had detailed assessments of their needs. These covered needs in relation to continence, mobility, moving and handling, falls, sleep, nutrition and dietary preferences, communication, sociability, activities and interests, orientation and cognition, emotions and depression. All the assessments were reviewed once a month and any changes in needs were recorded. There were also assessments of family needs and their expectations of care. Each person had a deprivation of liberty form completed to assess whether any aspect of care and support was a deprivation of their liberty. They also had a form to record their capacity to consent. Three of the people had information about their personal history. The manager told us that they asked the families to provide this information to help staff to get to know the person and understand their needs. The manager also said that several people had memory books which they kept in their rooms. These contained information about their life history with photographs and helped them to remember about their past lives. There was information in the files about peoples age, gender and religion. However there was no information about the other aspects of equality and diversity such as race, ethnicity and disability. The manager told us that they were going to attend training about equality and diversity the following week. We made a requirement at the last inspection that the registered person must confirm in writing that the care home is able to meet the needs of the person, following assessment. The manager told us in th AQAA that a letter of acceptance is sent out with a copy of the contract, most recent inspection report and service user guide. When we looked at the files we saw examples of these letters confirming that the home was able to meet peoples needs. The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person had a care plan so that their needs would be met. Peoples health care needs were being met. People were generally protected by the arrangements for storage and administration of medication. Peoples privacy and dignity were respected. EVIDENCE: When we looked at the care records we saw that each person had a daily care plan with a summary of their daily routine. The manager told us that this provided at a glance information for staff about how to support each person throughout the day. The records showed that the care plans were reviewed every month and any changes were recorded. One persons care plan said that they had bedrails but their file did not contain a risk assessment about the use of bedrails. We saw in a health and safety The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 13 file the policy and guidance about use of hospital beds and bedrails. This said that anyone using bedrails would have a risk assessment. We made a requirement at the last inspection that the registered person must ensure that care plans fully reflect people’s needs and how they are to be supported. This is particularly important for people with dementia. When we looked at the care plans we saw that they provided detailed information about how people should be supported at different times of the day. We recommended that greater consideration should be given to obtaining information relating to people with dementia’s past interests, hobbies, skills, likes and dislikes. This could then form a ‘life book’ and a working tool for the staff team. We saw that each person had a personal history and information about their likes, dislikes, hobbies and interests was recorded in their assessment. Most people also had a memory book. We recommended that staff should be allocated one to one time with their person that they key work. The manager told us in the AQAA that all care staff were reviewing care plans for those people for whom they were key worker, to encourage more active interest in the person and to build up a friendship with the family by inviting them to review care plans. During our visit the manager told us that staff were taking people out on a one to one basis and spending more individual time with them. We stated that people using the service and relatives should be reminded who their key worker is. We saw that each person had a photograph of their key worker in their room. We recommended that the daily records should contain aspects contributing to peoples’ quality of life rather than generic comments such as: ‘all personal care given’ and ‘no problems’. When we looked at the daily records we saw that these included entries saying ‘all personal care given’ and ‘no problems’. There were some more detailed entries about the personal care given and occasional comments about mood but no information about peoples quality of life such as their activities, visits, daily routine and going out. We saw in the files that each person had a medical history including information about the medication that they took. Each person was registered with a GP. Appointments with the GP were recorded with the outcome. There was information about contacts with other healthcare professionals including a dietician, dermatologist, ophthalmologist, chiropodist and community nurse. During our visit the chiropodist was visiting several people, two community nurses visited and the GP saw several people. The healthcare professionals who completed surveys said that peoples social and healthcare needs were properly monitored, reviewed and met by the home. Eleven people who completed surveys said that the home made sure that they received the medical care that they needed. The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 14 The manager told us in the AQAA that the home provided a blood taking service so that people could have blood tests. During the inspection she told us that she had received training to do this at the hospital and she had received supervised practice and been deemed competent by the community nurse. We saw records to confirm this and a training certificate. She also said that the GP and district nurse had delegated responsibility to her for this task. She said that she had enrolled in a course to update her training. She told us that since she had become manager she had not had much time to take blood so the district nurse was doing this. She was considering training another member of staff so that the home could continue to offer this service to people. We looked at the arrangements for handling medication. We saw that there was a medication policy and a monitored dosage system with printed medication administration record (MAR) sheets. We looked at the MAR sheets and saw that a record was made when medication was received into the home. An accurate record was being kept when medication was administered to people. A record was kept when medicines were returned to the pharmacist. We made a requirement at the last inspection that the registered person must ensure that all hand written entries on the medication administration record (MAR) sheet are signed and dated by two members of staff. This had not been addressed in full. We saw three handwritten additions to the MAR sheets which had been signed by two members of staff but not dated. We saw three other handwritten additions, which had been neither signed not dated. We recommended that protocols for the administration of ‘as required’ (PRN) medication should be included within the individual’s care plan. The manager had developed a form to record protocols for the administration of as required medication. They said that they planned to implement it in the next round of reviews. We also recommended that a list of current prescribed medication should be included in each persons care plan. When we looked at the care records we saw that these included a list of current medication taken. We recommended that consideration should be given to purchasing a medication cabinet for the storage of controlled medication. This should be in line with the current legislation. The manager told us that she had enquired about installing a new controlled drugs cupboard and the company representative who looked at the cupboard told her that it complied. When we looked at the cupboard we saw that it complied in most respects. It was attached to the wall with two screws and two rag bolts. By the time of our The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 15 second visit the handyman had replaced the screws with rag bolts so that it complied. Controlled drugs were being stored appropriately and a record of controlled drugs administered was made in a controlled drugs register. Each person had their own bedroom and most of these had en-suite facilities. Personal care took place in the privacy of the bedroom and bathroom. The principles of privacy and dignity were taught to staff as apart of induction. We saw that staff knocked on doors before entering. We observed that people could choose to spend time in the privacy of their bedrooms or in the communal areas. Five health care professionals who completed surveys said that the home respected peoples privacy and dignity. The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People could participate in a range of activities according to their interests and wishes. People kept in contact with their family and friends. People could exercise choice and control over their lives. People were offered a variety of meals in pleasant surroundings and people enjoyed their food. EVIDENCE: The manager told us in the AQAA that the home provided a planned activities program which reflected the wishes of the residents. They said that this had been the outcome of residents meetings and there was a monthly newsletter, which was sent to all residents, families and advocates. They told us that there were regular visits from various religious faiths, who visited individuals and held a service for all who wished to attend. The manager also told us in the AQAA about improvements they had made to the activities program. They said that they had purchased a keyboard, a fish tank and a summer house for the garden. We saw all these items during our visits. They had increased outings and walks. They told us that the conservatory was used for group activities, such as singing, dancing and music The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 17 for health. They said that there were outside entertainers who came in regulary, one of which made cakes and sweets with the residents. When we visited we saw photographs of these events on the wall in the hallway. The manager said that they provided a clothes party twice yearly to enable people to choose their own clothes. One of these events was planned shortly after our visits. We saw that there was an activities organiser and an activities programme. This showed that there were one to one activities every morning with people who stayed in their rooms. In the afternoon there were group activities such as music and movement, reminiscence, DVDs, art and craft, bingo, cards and dominos. The programme showed when entertainers came in. This included singers and a group who did activities such as art and craft and cake making with people. There was a record of activities each day which showed who had participated in which activities. This helped to make sure that each person had the opportunity to be involved in activities. Ten people who completed surveys said that there were always activities that they could take part in and two said that there usually were. On the first day of our visit the activities organiser was leading music and singing during the afternoon in the conservatory. The manager and a staff member told us that they always celebrated peoples birthdays by arranging an activitiy. On the second day of our visit a singing duo were performing in the conservatory to celebrate someones birthday and there was a birthday cake. The manager and a staff member also told us that there had been a trip to Cotswold Wildlife Park. One person told us how much they had enjoyed the trip. We asked people in their surveys what the home does well. One person said Provides regular activities for residents. Another person said Food and activities. Another said Include families in activities. The manager said in the AQAA that the home encourages families to visit at anytime. A member of staff told us that people have visits from their relatives. During our insepction we saw several relatives come to visit people in the home at different times of the day. Three people told us that they have visits from their family. Families were welcome to stay for meals. Peoples capacity to make choices and decisions was assessed when they moved into the home. We saw examples of where people were able to make choices. There was a choice of meals. We saw people choosing how to spend their time. Some people liked to spend time in their rooms while others liked to sit in the lounges. People chose whether to take part in the activities. People moved freely around the home. There was a choice of activities and activities were suited to peoples needs. People were able to shop for their own clothes at the clothes parties and sometimes staff took them shopping. The manager said in the AQAA that meals were available from 7am and a choice of drinks and snacks were available throughout the day and night. They The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 18 also said that fresh fruit was available in all the lounges for people to help themselves. During our visit the manager told us that the chef had a good knowledge of peoples likes and dislikes and monitored whether people were eating enough. We saw in the files that peoples weight was monitored and advice was sought from a dietician if needed. We looked at the menus which were very varied. The chef told us that he knew everyones likes and dislikes and he set the menus from these. The menu showed that there was a set meal for lunch. The chef said that there was a choice of alernatives if someone did not like the set meal. We looked at a record of meals that peole had chosen. These showed that a range of meals were provided. The manager said that special diets were catered for. We saw a carer asking people whether they wanted the meal planned for tea and offering alternatives if they did not. There was information in the dining room about the meals provided throughout the day. There was a choice at breakfast including a range of cereals, toast and cooked breakfast. A drink and biscuits were provided at 10:30 am. Lunch was provided according to the menu. Tea and biscuits were provided in the afternoon. On the second day of our visits there were scones, jam and cream and a cake because it was someones birthday. There was a choice of meals at tea including a cooked meal or sandwiches. In the evening there was a supper trolley with drinks and a choice of snacks. We saw that juice and water were available throughout the day and there was fresh fruit in the lounges. People told us that the food was very good. When we asked people in their surveys what the home does well one person said The chef is superb. Six people told us in the surveys that they always liked the meals and six said that they usually did. During our visits some people told us that that they always liked the meals provided by the full time chef but not always when he had a day off. The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People knew how to make a complaint and their complaints would be taken seriously and acted upon. People were protected from abuse and harm. EVIDENCE: The manager told us in the AQAA that the home has a clear complaints procedure which is available to all. They said that it was in clear view for residents, families and staff to see. They also said that all complaints are documented and acted upon in the agreed timescale. We saw that there was information about the complaints procedure in the statement of purpose and there was a copy of the complaints procedure on the notice board in the hallway. People told us in their surveys that they knew how to make a complaint. We saw that there was a complaints book. There had been no complaints to record. However, forms were available to record complaints including details of the complaint and the action taken. There was also a record of complements. There had been one complaint to the Care Quality Commission since the last inspection. This had been sent to the manager to investigate and they had done so appropriately. The manager also said in the AQAA that all staff have been trained about the Department of Health guidelines No Secrets. They said that incidents were reported and all staff had a Criminal Records Bureau (CRB) check. They also told us that staff had Safeguarding of Vulnerable Adults (SOVA) training, The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 20 dementia awareness and challenging behaviour training. We saw that there was information for staff in the office about how to make a safeguarding referral. When we looked at the training records we saw that all staff received training about safeguarding vulnerable adults. The manager said that this was updated annually. They told us that staff receive this training as part of induction and then they have the full training. Three staff told us in their surveys that they knew what to do if someone had a concern about the home. The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lived in homely, clean and pleasant surroundings suited to their needs. Improvements could be made to the arrangements for cleaning commode pots. EVIDENCE: We looked around the home. We saw that the accommodation was spacious with a selection of shared areas. There were two seating areas downstairs where people were watching television. These had photographs of bygone Hollywood film stars on the walls. The manager said that these were the stars whom the people who lived there would remember. There was another television room, a large conservatory and a separate dining room. There was another small seating area on the top floor with a dining table and chairs, comfortable chairs and a television. The accommodation looked clean, well maintained and decorated. The manager told us in the AQAA that the home The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 22 had a continuous improvement plan for decoration and refurbishment which is reviewed monthly. They also said that a new business manager had been employed by Buckland Care to ensure that maintenance was completed to a high standard. We met the maintenance person who was employed to complete maintenance tasks and keep the accommodation in order. We noted that they cleaned the dining room carpet straight after lunch when there had been some spills. Each person has a single bedroom. Twenty two of these had an ensuite toilet. The other rooms had toilets nearby. The bedrooms were individually decorated and furnished. Some people had brought small items of furniture, pictures and ornaments to personalise their rooms. Most people had televisions in their rooms. The bedrooms were on three floors with a lift to the first and second floors. There was a separate laundry room with industrial type washing machines and a tumble drier. The tumble drier was being repaired. It had been replaced temporarily by a domestic style tumble drier. Each person had a basket in the laundry room to contain clean items of clothing and help to make sure that clothes were returned to the right people. Despite this some people commented in their surveys that some items went missing. A member of staff told us that the clothes were usually labelled but occasionally if a relative brought something new for someone and it was washed before it was labelled then staff would not recognise who it belonged to and it might go astray. We saw that there were designated domestic staff. When we looked around the home we saw that it was clean and odour free. Seven people who completed surveys said that the home is usually fresh and clean. Five people said that it is always fresh and clean. One of the health professionals told us in their survey that there was no dedicated sluice and commode pots were cleaned in a bath. When we looked around the home we found that the commode pots were soaking in a small bath upstairs. The senior carer who showed us round said that this bathroom was kept locked and was only used for cleaning commode pots. There were other assisted bathrooms, for people to use, with full sized baths. The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported by sufficient staff, who were appropriately trained and competent to meet peoples needs. People were protected by the homes recruitment practices. EVIDENCE: The manager told us in the AQAA that the home has a full staff team with four full time senior staff, twelve full time care staff, three part time care staff, one chef, one cook, three kitchen assistants, one housekeeper, two part time domestics, one activities coordinator, one administrator and the manager. During our visit the manager told us that there were five care staff on duty in the morning four in the afternoon and two at night. She also said that there were additional staff to help at busy times for example early in the morning and at meal times. We looked at the rota which confirmed this staffing arrangement. The manager said that the kitchen staff took the tea and supper trolleys round so that care staff could concentrate on care tasks. We asked people in their surveys if staff were available when they needed them One person said that they were sometimes available. When we asked this person what the service could do better they said, More staff. We received no other comments about insufficient staff. Three people said in their surveys that there were always staff available when they needed them. Eight people said that staff were usually available when they needed them. The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 24 The manager told us about staff qualifications in the AQAA. They said that three senior staff had a National Vocational Qualification (NVQ) at level 3 and one was working towards NVQ3. They said that all care staff either have their NVQ2 or are working towards it. When we looked at the training records we saw that three staff had NVQ level 3, one was working towards level 3, three staff had NVQ level 2 and eleven were working towards level 2. This meant that less than 50 of the care staff had an NVQ at level 2 or above. However, when the staff have completed their NVQs more than 50 will have an NVQ. We made a requirement at the last inspection that the registered person must ensure that they can demonstrate a sound underpinning knowledge of current good practice guidelines for working with people with dementia. The manager told us that they had received training about dementia and most of the care staff had also received training about dementia. She also said that she was planning further specialist training about dementia for all care staff. When we looked at the training records we saw that staff received training about fire safety, manual handling, health and safety, food hygiene, infection control, safeguarding vulnerable adults, promoting continence, safe handling of medicines, nutrition and health, palliative care, managing challenging behaviour and risk assessment. Other staff also received training relevant to their roles and training about health and safety, fire safety, safeguarding vulnerable adults and dementia. The manager told us in the AQAA that night staff undertake the same training as the day staff. She also said that most of the night staff have completed their medication course and those that have not will do it once they have completed their NVQ 2. Three staff told us in their surveys that they received training that was relevant to their role, helped them to understand and meet peoples individual needs and kept them up to date with new ways of working. We looked at the recruitment records of two members of staff who had started work since our last inspection. We found that each of them had completed an application form that had a declaration that they had no convictions. They had also completed a curriculum vitae (CV) which contained written information about gaps in employment. Copies of their birth certificates and passports were kept as proof of identity. They had each completed a medical questionnaire. The date when they started work was recorded in their letter confirming their employment. The records were orderly so that it was clear that each member of staff had had two written references and a Criminal Records Bureau (CRB) check before they started work. The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager was appropriately qualified and experienced. They had applied to become the registered manager but had not yet been approved as a fit person to manage the home. Here was a quality assurance process and all service developments were based upon the views of people who lived in the home. People were generally protected by the health and safety measures. EVIDENCE: We made a requirement at the last inspection that the registered provider must nominate a person who has the relevant skills to manage the service. This had been addressed. There was a new manager who had completed the Registered Managers Award and had an NVQ level 4 in care. She had several The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 26 years experience of working in care and had previously been the deputy. She told us that she had just applied to become the registered manager. We made another requirement that the registered person must ensure that CSCI are notified of any event or incident, which may affect the people using the service. This had been addressed and since the last inspection the home had been notifying CSCI and the Care Quality Commission of significant events under Regulation 37 of the Care Homes Regulations. We looked at the arrangements for keeping peoples money. The administrator kept small amounts of money for people in the safe. A record was kept of all transactions and the person and a member of staff signed the record when money was withdrawn. If a person was unable to sign then two members of staff signed the record. The administrator told us that a questionnaire was sent to each person who used the service once a year. She also told us that in previous years a report had been written about the findings but this years report had not yet been produced. We saw the reports for the last two years. These showed that there was a high level of satisfaction with the service. The manager had completed the AQAA when we requested it. It was clear and provided all the information that we asked for. They told us what they do well, how they had improved in the last twelve months and their plans for improvement in the next year. The manager told us in the AQAA about other ways they collected peoples views. These included monthly resident meetings, monthly reviews of care plans to which family are invited and residents where appropriate, e-mail responses invited to the monthly newsletter, one to one personal chats with residents and families and occassional evening events to promote informal discussion. They also told us about changes they had made as a result of listening to people. These included introducing more regular outings and walks to the local shops etc, and obtaining taxi vouchers to facilitate this. Three staff members had business insurance on their cars to escort residents to appointments, such as the dentist and hospital visits when necessary. Additional staff had been put on duty at key times of the day, for example, 7am and meal times. A new nurse call system had been put in to replace the old one, which had become unreliable. They had increased the maintenance persons hours to full time to keep the home well maintained. There was a policy about health and safety. We saw that there were several health and safety checks and measures. There were risk assessments for the environment and individual risk assessments. As stated earlier one persons care plan said that they had bedrails but their file did not contain a risk assessment about the use of bedrails. The policy and guidance about the use of hospital beds and bedrails said that anyone using bedrails would have a risk assessment. This needs to be a put in place. We saw certificates of servicing The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 27 of equipment including the lifts, hoists, flue cleaning, emergency lighting, the fire alarm system, electrical wiring and portable appliance testing. The radiators were covered and there were restrictors on windows. There were detailed fire risk assessments of the bedrooms, a general fire risk assessment of the whole building and a monthly fire risk assessment. There were checks of the fire prevention measures. Staff received fire training once a year. There were no records of fire instruction for staff for the current year. However, a member of staff said that the maintenance person had taken staff round the building two at a time to give them their fire instruction. After the inspection the manager sent us a copy of the record of fire instruction to staff. She confirmed the maintenance person was giving the fire instruction to all staff. However, the records showed that only some staff had received instruction. We recommended at the last inspection that all hot water outlets should have regular checks of the water temperatures, which should be recorded. The manager told us that the maintenance person checked the temperatures weekly. We saw weekly records of these checks. These showed a temperature range of 36 to 40 degrees with the date of the check. They did not record the temperature of the water at each tap. The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement The registered person must ensure that all hand written entries on the medication administration record (MAR) sheet are signed and dated by two members of staff. This is to show who made the changes, to confirm that they are correct and to be able to cross reference any changes to instructions from the prescribing doctor in the care records. Timescale for action 30/10/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The assessments should include information about needs in relation to disability, gender, age, race, ethnicity, faith and sexual orientation to ensure that these needs will be met. DS0000050595.V378056.R01.S.doc Version 5.3 Page 30 The Orchards 2. OP7 The daily records should contain aspects contributing to peoples’ quality of life rather than generic comments such as: ‘all personal care given’ and ‘no problems’. The registered person should check that the homes insurance covers staff for procedures such as taking blood. The arrangements for cleaning commode pots should be reviewed. Consideration should be given to installing a sluice and commode pot steriliser. A risk assessment should be conducted when a person uses bedrails to make sure that they are kept safe in bed. This should follow the guidance issued by the Health and Safety Executive. When staff receive fire instruction a record should be made together with the date. When the temperature of the hot water from the taps is checked a separate record should be made of the temperature from each tap. 3. 4. 5. OP8 OP19 OP37 6. 7. OP37 OP37 The Orchards DS0000050595.V378056.R01.S.doc Version 5.3 Page 31 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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