Orchard Care Centre Care Home Service Adults Lychgate Road Tullibody Alloa FK10 2RQ

Transcription

1 Orchard Care Centre Care Home Service Adults Lychgate Road Tullibody Alloa FK10 2RQ Inspected by: Lesley Greig Kuldip Dhesi inspector manager Type of inspection: Unannounced Inspection completed on: 18 December 2012

2 Contents Page No Summary 3 1 About the service we inspected 5 2 How we inspected this service 7 3 The inspection 13 4 Other information 31 5 Summary of grades 32 6 Inspection and grading history 32 Service provided by: HC-One Limited Service provider number: SP Care service number: CS Contact details for the inspector who inspected this service: Lesley Greig Telephone enquiries@careinspectorate.com Orchard Care Centre, page 2 of 33

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 3 Adequate Quality of Environment 3 Adequate Quality of Staffing 3 Adequate Quality of Management and Leadership 3 Adequate What the service does well Residents and relatives/carers of people who live in Orchard Care Center spoke highly of the staff and the quality of care the service provided. Care staff communicated and interacted with residents in a respectful manner and worked very hard to provide people with the care and help they needed. What the service could do better The service should continue to roll out their staff training programme. This was well underway at this inspection. The management team should make sure that staff are given the time they need to to complete the transfer of information from the old personal planning system to HCone paperwork. At this inspection we saw that this work had started however there is a great deal still to do. This would help to make sure that important information is not lost or missed while working between two systems. Staff supervision systems should be developed and more closely linked to training and professional development and could include direct observation of care practice. Activity provision should be improved and closely linked to residents needs, choices and preferences. Orchard Care Centre, page 3 of 33

4 To support good communication between staff and residents the service should consider examining types of communication aids they can use when communicating with residents. This will support residents to give their views on all aspects of their care needs. What the service has done since the last inspection The service has made good progress in making changes and improvements to the environment for the benefit of residents. This included new carpets and redecoration of some communal and corridor areas. The lounge in Anbri House has been redesigned increasing the space available to residents. The management and staff have made some progress on making improvements as required or recommended from the previous inspection. Staff training is being rolled out and good progress is being made. This will help to make sure the staff team are provided with the knowledge, skills and support they need to care for residents. There is a new manager in the service who expresses a strong commitment to the ongoing development and improvement of the service. Some new paperwork has been put in place such as HC-One introductory pack and Cornerstone, a system for quality assurance. Conclusion Orchard Care Centre provides a service that results in positive outcomes for many residents and relatives. The management team and staff have worked hard and continue to be motivated to make improvements. Who did this inspection Lesley Greig Kuldip Dhesi inspector manager Orchard Care Centre, page 4 of 33

5 1 About the service we inspected The Care Inspectorate regulates care services in Scotland. Prior to 1 April 2011, this function was carried out by the Care Commission. Information in relation to all care services is available on our website at The Care Inspectorate will award grades for services based on findings of inspections. Grades for this service may change after this inspection if we have to take enforcement action to make the service improve, or if we uphold or partially uphold a complaint that we investigate. The history of grades which services have been awarded is available on our website. You can find the most up-to-date grades for this service by visiting our website, by calling us on or visiting one of our offices. Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. - A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. - A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reforms (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of the Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Inspectorate." This service registered with the Care Inspectorate on 31 October Orchard Care Centre is located in a quiet residential area of Tullibody. The care home is registered to provide a service to 60 older people in two separate units; Anbri House, which is a 16 bedded unit which caters for older people with dementia, and Fortune House, which is a 42 bedded unit for older people. The care home is built on one level with an enclosed and secure central garden and landscaped gardens to the exterior. The care service defines its aims and objectives as, "to provide a high standard of individualized care to all service users. It is the objective of The Orchard that all service users will enjoy a clean, smoke free safe environment in private spaces and non-communal areas within the home and be treated with care, dignity, respect and sensitivity to meet the individual needs and abilities of the service user." Orchard Care Centre, page 5 of 33

6 Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 3 - Adequate Quality of Environment - Grade 3 - Adequate Quality of Staffing - Grade 3 - Adequate Quality of Management and Leadership - Grade 3 - Adequate Inspection report continued This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. Orchard Care Centre, page 6 of 33

7 2 How we inspected this service The level of inspection we carried out In this service we carried out a medium intensity inspection. We carry out these inspections where we have assessed the service may need a more intense inspection. What we did during the inspection We wrote this report following an unannounced inspection which was carried out by inspector Lesley Greig and inspector manager Kuldip Dhesi. The inspection took place over 2 days on 28 November and 13 December Feedback was given to the manager and the quality assurance manager on 18 December The main focus of this inspection was to follow up on progress made with the requirements, recommendations and areas for improvement detailed in the last inspection report dated 24 July In this inspection we gathered evidence from a range of sources, which included: Discussions with residents and families/relatives Discussions with care staff, nursing staff and the manager Observation of a breakfast and lunchtime service Observation of care practices and interactions between staff and residents Observation of the environment (examining equipment and the environment, for example, is the service clean, is it set out well, is it easy to access by people who use wheelchairs?) A review of a range of policies and procedures, records and other documentation including the following: the self assessment submitted to us by the service the action plan submitted following the last inspection a sample of 7 residents personal plans minutes of relatives and residents meetings completed survey questionnaires issued by the service the activity programme policies and procedures relevant to the Quality Themes accident and incident records staff training information a sample of 5 staff files audits carried out by management Orchard Care Centre, page 7 of 33

8 information displayed on notice boards 3 weeks of the service staffing rota Inspection report continued Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at Orchard Care Centre, page 8 of 33

9 What the service has done to meet any requirements we made at our last inspection The requirement The providers are required to ensure that quality assurance systems/audits are used effectively to assess the quality of the service being provided. Where areas for improvement are identified action plans should be developed and regularly reviewed to measure progress made. This is in order to comply with: SSI 2011/210 Regulations 3 Principles, 4 (a)(b) Welfare of users Timescale: 1 month of receipt of this report What the service did to meet the requirement Please see Quality Them 4 statement 4 The requirement is: Not Met The requirement The provider must be able to show that the quality of life of people who use services, including their interests, needs and beliefs and support service users fulfil their potential and aspirations, have been taken into account when planning and delivering support. This is to comply with SSI 210 Regulation3 - Principles and Regulation 4 (1) (a) Welfare of service users - providers shall make provision for the health and welfare of service users Timescale; within 3 months of receipt of this report What the service did to meet the requirement Please see Quality Theme 1 statement 3. The requirement is: Not Met The requirement The providers are required to demonstrate how they will ensure that all staff have received training, support and guidance to ensure good outcomes for service users. Areas such as care values, person centred approaches, dementia awareness and communication must be provided to staff in addition to mandatory training and healthcare assessment and care planning. A system of evaluation of the outcomes of training should be put in place to measure staff understanding and application of training received into practice. Orchard Care Centre, page 9 of 33

10 This is in order to comply with: SSI 2011/210 Regulation 15 Staffing (a) (b) (i)(ii) Timescale: within 1 month of receipt of this report the providers must submit a training plan to the Care Inspectorate.Within 3 months of receipt of this report the providers must ensure that all staff have attended the planned training and can apply learning into practice. What the service did to meet the requirement Please see Quality Theme 3 statement 3. The requirement is: Met Inspection report continued The requirement The provider is required to ensure that all service users have a care plan in place which sets out how their health and welfare needs will be met. This must be regularly reviewed to ensure it takes account of risk factors and reflects residents needs. This is to ensure there is clear direction and guidance on how to meet identified needs of residents and to minimise or manage known risks. This is to comply with SSI 2011/210 Regulation - 5 (2)(b)(c) - Personal plans Timescale: Within2 months of Receipt of this report. What the service did to meet the requirement Please see Quality Theme 1 statement 3. The requirement is: Met Orchard Care Centre, page 10 of 33

11 The requirement The provider is required to put systems in place to check that the care and support being provided promotes good care outcomes for residents. This should include checks for the proper provision for the health, welfare and safety of services users in the following areas: a) help should be provided for residents who require this to maintain or improve levels of continence b) a falls prevention programme should be put in place to manage and reduce falls and fractures. c)help for residents to have adequate food and fluids. The level of support for residents should be informed by a nutritional assessment, advice from health professionals, the care plan and recording of dietary and fluid intake. d)behaviour support plans should be put in place for residents who require these. Staff should be informed of the causes, triggers, and ways of responding to residents stress and distress. This is to comply with SSI 2011/210 Regulation - 4(1)(a) - Welfare of users Timescale: This is to start immediately and be completed within 3 months. What the service did to meet the requirement Please see Quality Theme 1 statement 3. The requirement is: Not Met Inspection report continued The requirement The Providers are required to ensure that staffing levels are based upon an individual assessments of service users physical, social, psychological and recreational needs.the assessment and staffing levels must take the physical layout of the premises into account. Assessments must be carried out on a 4 weekly basis and be included in service users personal plans. SSI 210/2011 Regulation 15(a)(i) Staffing Timescale: immediately upon receipt of this report What the service did to meet the requirement Please see Quality Theme 3 statement 3. The requirement is: Not Met What the service has done to meet any recommendations we made at our last inspection The service had made progress with recommendations made in the last report. The manager gave us a strong to commitment to continue the improvements which had started to take place. Orchard Care Centre, page 11 of 33

12 The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Inspection report continued Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The service submitted their self assessment as requested before the inspection. The self assessment identified some areas where the service felt it performed well and also gave some information about how it aims to improve and develop. The service should use their self assessment to provide outcome focused information to show how the work being carried out in the service has resulted in changes and improvement for residents. The self assessment needs to reflect current practice which can be evidenced. Taking the views of people using the care service into account We spoke with 18 residents as part of this inspection. We also spent time in communal lounge and dining areas observing staff interactions with residents and their responses. Overall most of residents spoke positively about their experience of living Orchard Care Centre. People gave us positive feedback on the quality of the food, the staff and the new manager. Some people told us they would like more to do day to day and a couple of residents spoke about having to wait for help at busy times. Taking carers' views into account We spoke with 7 relatives/carers as part of the inspection. Overall relatives were happy with the care and support in the service. Relatives were pleased to see the home was in the process of being decorated. Relatives gave us positive feedback on the quality of the staff and told us they could see the positive changes taking place since the new manager had taken up his post. Orchard Care Centre, page 12 of 33

13 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths We found that the service had some methods in place to help residents and their relatives/carers give their views and opinions of the service. These included: Meetings for residents and relatives. Comments and suggestions books. Survey questionnaires issued by the service to residents and their relatives. An 'information station' in the front foyer of the home. Six monthly reviews of residents care and support taking place. In line with legislation, the service carried out six monthly reviews of residents care. Relatives confirmed that they were invited to these reviews. One relative told us that the staff went over care plans with them, giving them the opportunity to ask questions and share information. The reviews helped the service to check that care plans remained appropriate or to make changes that reflected current needs. The service was in the process of introducing 'getting to know you' paperwork. This was a tool which could contain lots of personalised life history information specific to individual residents and could be a good way of really getting to know people. This was a work in progress and we look forward to seeing how this useful information will be used to promote effective communication and interaction with residents. We will follow this up at the next inspection. We made a recommendation in the last report asking the service to consider how they could improve involvement for those residents with communication and understanding difficulties. The manager had sourced the choices toolkit and was keen Orchard Care Centre, page 13 of 33

14 to start using this in the service. This is a pictorial communication aid which can be used with people who have communication or understanding difficulties and help them to express their needs, choices and preferences. The manager planned to provide staff with guidance on how it should be used with residents. We will check to see how this is being used with residents when we return for our next inspection. In the last inspection report we made a recommendation asking the service to develop a participation strategy. This can be a good way of sharing the aims of involving people and letting them know about the range of opportunities to have their say and get involved in the assessment and improvement of all aspects of the service. The organisation had developed a participation strategy. Through discussion with the manager we identified that the service should develop the participation strategy to reflect the different ways that people living in Orchard Care Centre, and their relatives/carers, can get involved and have their say in the assessment and improvement of all aspects of the service being provided. We will follow this up at the next inspection. Areas for improvement Inspection report continued In the last report we identified that while there were some methods for helping people to have a say in their care and support, we found that opportunities to participate were limited to those residents who were more able to express themselves and make their views know. The service should improve the way it engages with those residents who are hard to reach. The service should offer staff training in participation. This will help staff understand and put into practice ways of helping residents to get involved and have a say in how they wish to be supported. The service should provide information such as minutes of resident meetings and feedback from opinion surveys in easy read and other formats, for example large print. This would make the information more accessible to some residents. Minutes should also be improved by making clear any actions which will be carried out with timescales. This would help the service to monitor and evidence how well they respond to residents and relatives suggestions and ideas. We would expect to see residents being helped to be actively involved in their six monthly reviews of care whenever possible. Some residents were not routinely involved and it was not always clear why. It was not clear how the service shared information with those residents who did not attend meetings. This is an area for improvement which could help the service gather the views of as many people as possible. Some residents were not aware of the meetings and did not know there were minutes they could read. The service should continue to develop and improve methods of participation to ensure residents and their relatives/carers have a range of opportunities to participate in the assessment and improvement of all aspects of the service provided. Orchard Care Centre, page 14 of 33

15 Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 1 Recommendations Inspection report continued 1. Residents should be helped to be as involved as possible in their reviews of care. National Care Standards 8 Care Homes for Older People - Making Choices National Care Standards 11 Care Homes for Older People - Expressing Your Views National Care Standards 14 Care Homes for Older People - Lifestyle - Keeping Well - Healthcare 3 -During your first week in the home, and at least every six months after that, you will receive a full assessment to find out all your healthcare needs, and the staff will ensure that these needs are met. Staff will record all assessments and reviews of your healthcare needs. Orchard Care Centre, page 15 of 33

16 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths From the evidence we sampled during the inspection and from our observation of practice we have graded this quality statement as adequate. We saw that the service had a range of healthcare audits in place which help to identify residents who needed help with nutrition, maintaining healthy skin, medication, keeping safe and preventing or treating infection. The home had good links with primary and secondary healthcare services, people like GPs and community nurses. We saw examples of GPs being contacted if staff were concerned about residents health. From examination of a sample of residents personal plans we saw evidence of assessments being carried out for residents who needed help with mobilising, keeping their skin healthy, nutrition, continence and oral health. We saw care plans which gave staff guidance on how the residents needs were to be met. In some cases care plans had been signed and agreed by the resident or their relative/carer. In some residents files there were certificates for medical treatment under the Adults with Incapacity (AWI) Act (Section 47). Some of these certificates showed consultation with relatives which was considered good practice. From examination of a sample of residents personal plans we saw that nutritional assessments were carried out on a monthly basis. We saw examples of residents gaining weight as a result of the measures which had been put in place to promote good nutrition. We saw that there was an activity programme lead by the activity organisers. Information was on display on notice boards and activity lists were delivered to each residents room. Some residents told us about enjoying outings and activities they had taken part in and we saw photographs of parties and events which had taken place. We observed a breakfast and a lunch service in the home. We thought that staff worked with a positive and patient attitude which helped to make mealtimes pleasant and relaxed for residents. We saw that residents were offered choices of drinks and meals. Staff provided extra help to those residents who needed it in a discrete and sensitive manner. Overall we saw an improvement in mealtimes. Areas for improvement During the inspection we observed that there were times when there was no staff presence in lounge areas in both Anbri House and Fortune House. Some of the Orchard Care Centre, page 16 of 33

17 residents were at high risk of falling and others were unable to summon assistance should it be needed. On one occasion we had to use the call alarm to summon staff assistance for a resident to use the toilet. We discussed this with the manager who agreed this was not acceptable and told us he would address this issue. Some of the AWI and DNACPR (do not attempt cardio pulmonary resuscitation) certificates we saw in residents files had not been properly completed, and we were unable to see how some of these had been discussed or agreed with residents or their next of kin. The service should make sure that residents, and when appropriate their relatives, are fully informed and consulted in decision making. This is an area for improvement which we will follow up at the next inspection. We heard from some residents that they would like the home to offer more activities including outings and getting outside for fresh air. It would be beneficial for residents health and wellbeing if they are encouraged and helped to spend time outdoors. During the inspection we spoke with some residents who spent a lot of time in their rooms. People told us they didn't want to take part in the group activities and found it difficult to communicate with some of the other residents. The service should make sure that all residents have opportunities for meaningful activity. Individual activity plans should be developed, particularly We made 3 requirements under this Quality Statement in the last report. These were: 1. We directed the provider to make sure that all residents had a care plan in place which set out how their health and welfare needs would be met. At this inspection we found that all residents did have a care plan in place. The content and quality of some care plans was variable. Some were disjointed and some contained only very basic information. For example, we looked at the care plan for a resident who was at high risk of falls and found nothing specific written about any action required to mitigate against falls. Plans needed to be much more person centred, detailing the help and support staff should give to the individual. The service was in the process of rewriting all residents personal plans and this was an opportunity for the quality to be improved. We consider this requirement met however we have made a recommendation. See recommendation We directed the provider to put systems in place to check that the care and support being provided promotes good care outcomes for residents. The service had started to introduce audit systems which could be used to monitor how well different aspect of health care provision were being provided to result in good outcomes for residents. Training was in the process of being rolled out to staff which could help to improve their knowledge and understanding, and a new care planning format was being introduced in the service. We would expect that the new care planning format would detail the individualised levels of support residents needed. Audits of residents personal plans were being carried and we saw that this was helping to highlight areas of care planning which needed to be improved to reduce risks to residents and to Orchard Care Centre, page 17 of 33

18 promote person centred care. This requirement had been partially met however we have repeated it to make sure that work continues in the areas detailed and the requirement is fully met. See requirement We directed the provider to demonstrate that residents interests needs and beliefs had been taken into account when planning and delivering support. At this inspection we saw that there were some good opportunities for residents to take part in activities and outing which were relevant to them. We did however see a lot of residents spending long periods of time in lounge areas with little in the way of stimulation or activity available to them. Some of the personal plans we looked at needed to be improved to show that residents interests, needs and choices were being taken into account when planning and delivering activities. We have repeated this requirement and will follow up progress at the next inspection. See requirement 2. Orchard Care Centre, page 18 of 33

19 Grade awarded for this statement: 3 - Adequate Number of requirements: 2 Number of recommendations: 1 Requirements 1. The provider is required to put systems in place to check that the care and support being provided promotes good care outcomes for residents. This should include checks for the proper provision for the health, welfare and safety of services users in the following areas: a) help should be provided for residents who require this to maintain or improve levels of continence b) a falls prevention programme should be put in place to manage and reduce falls and fractures. c) help for residents to have adequate food and fluids. The level of support for residents should be informed by a nutritional assessment, advice from health professionals, the care plan and recording of dietary and fluid intake. d) behaviour support plans should be put in place for residents who require these. Staff should be informed of the causes, triggers, and ways of responding to residents stress and distress. This is to comply with SSI 2011/210 Regulation - 4(1)(a) - Welfare of users Timescale: This is to start immediately and be completed within 3 months 2. The provider must be able to show that the quality of life of people who use services, including their interests, needs and beliefs and support service users fulfil their potential and aspirations, have been taken into account when planning and delivering support. This is to comply with SSI 210 Regulation3 - Principles and Regulation 4 (1) (a) Welfare of service users - providers shall make provision for the health and welfare of service users Timescale: This is to start immediately and be completed within 3 months Recommendations 1. It is recommended that care plans are developed and improved to fully reflect residents needs and the actions required by staff to meet those needs. National Care Standards 6 Care Homes for Older People - Supporting Arrangements 1 You can be confident before moving in that the home will meet your support and care needs and personal preferences. Staff will develop with you a personal plan that details your needs and preferences and sets out how they will be met, in a way that you find acceptable. Orchard Care Centre, page 19 of 33

20 Quality Theme 2: Quality of Environment Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the environment within the service. Service strengths Please refer to Quality Theme 1, Statement 1 for areas of strengths which were also relevant to this statement. We found this service was performing to a good level in the areas covered by this statement. We found the environment was clean, bright and odour free which was pleasant and beneficial for residents. There was an on-site hairdressing salon and a visiting hairdresser attended the service regularly. Some residents spoke about their appreciation of this service. We were kindly invited into 3 residents rooms and saw that they were well maintained, clean and most were personalised to suit individual choices and preferences, some people had chosen to bring small items of furniture from home. Residents spoken with told us they were very happy with their bedrooms. We saw attention had been paid to supporting residents to display pictures and photographs which could be helpful in promoting their sense of familiarity and belonging in the service. The service had a comments book which was being well used, particularly by relatives. We saw lots of positive feedback about the redecoration of the home, the new coffee and information area in the foyer and the introduction of a cinema room. Some of the residents we spoke with were very keen to try out the cinema and had made suggestions for about the movies they were keen to see on the new big screen. Areas for improvement The manager told us that he plans to display residents art work and use pictures and items of local interest on the walls in communal areas. We look forward to seeing this progressed with the involvement of residents. This kind of decoration can help with orientation and stimulate interest and discussion. Orchard Care Centre, page 20 of 33

21 The service should continue to seek out opportunities for residents and their relatives/carers to get involved in the assessment and improvement of the quality of the environment. Grade awarded for this statement: 4 - Good Number of requirements: 0 Number of recommendations: 0 Inspection report continued Orchard Care Centre, page 21 of 33

22 Statement 2 We make sure that the environment is safe and service users are protected. Service strengths The home had an entry system at the front door and a signing in and out book. This system ensures that the identity of visitors is confirmed and that people are accounted for in the event of an emergency, helping to keep residents safe. The service had processes and audits in place to help them monitor the environment and make sure it was safe for residents. Equipment checks were being carried out regularly (things like hoists, slings etc), there were regular fire drills held for staff and there were health and safety checks carried out around the home. Any accidents or incidents were recorded and these were monitored by the manager and the provider. This double check could help to make sure that appropriate action was taken to minimise any future risks. Staff training records showed that staff received a range of training which could help to keep residents and the environment safe. Training included health and safety, fire drills and emergency procedures. We saw that there was personal protective equipment (things like gloves, aprons and wipes) available in residents rooms and in toilet and bathing areas. Having this equipment readily available at the point of contact can help to minimise the risk of infection and is considered good practice. Areas for improvement At the time of the inspection the shower in Fortune House was in need of refurbishment. We saw that it needed to be re-tiled. Some of the toilet and bathrooms needed attention, woodwork and shelving was shabby and needed painted. The manager told us that he had prioritised the shower room for upgrading. Some door closures needed to be adjusted to make sure the door closed slowly. We saw that some doors were heavy and closed very quickly behind residents leaving rooms putting them at risk of being knocked over. The manager told us he would address this. The manager should review the use of the locked door between Fortune House and Anbri House. It is important that residents can move around the home freely when it is safe for them to do so. The service should refer to 'Rights Risks and Limits to Freedom', a good practice guidance document which can help the service to make sure that people are not unnecessarily restricted. Orchard Care Centre, page 22 of 33

23 The manager is currently looking at ways of improving signage to help residents orientate to their environment. The service should review the use of signage to help people move easily around the home and know where to find their own bedroom, dining rooms, lounges and toilet areas. We would expect the care home to use clear signs, large print signs and pictures. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Inspection report continued Orchard Care Centre, page 23 of 33

24 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths Please refer to Quality Theme 1 statement 1 for strengths which were also relevant to this statement. Most of the residents and relatives/carers we spoke with told us that they were happy with the staff team. Comments included: I'm well looked after and very comfortable. The staff are good to me. We were a bit nervous at first but now can't fault it. Staff are very nice to her (mother) and we would say they're excellent. They always phone to let us know whats happening. They bend over backwards to help. We observed interactions between residents and staff. Staff spoke with residents in a respectful manner and it was obvious that staff knew the personal preferences, likes and dislikes of individual residents. This is an important aspect of care that respects the individual. Areas for improvement Please refer to Quality Theme 1, Statement 1 for areas of improvement which were also relevant to this statement. We did not how feedback from residents and their relatives/carers was being used to inform the assessment and improvement of staffing. Residents should be supported to express their views and opinions about staff and this should be used in staff induction, supervision, training and development. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Orchard Care Centre, page 24 of 33

25 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths We have graded this statement as adequate. We spoke to residents, relatives and staff, viewed paperwork and observed practice. Staff we spoke to were motivated to provide the best care possible to residents and appeared to know the likes, dislikes and preferences of individual residents. The manager had introduced regular weekly meetings for staff. We sat in on one of these meetings and saw that staff were actively encouraged to share their views and ideas about the development and improvement of the service. Staff told us that they felt supported in their roles and appreciated the guidance and leadership of the new manager. We saw reference to Best Practice Statements and other practice guidance in some of the provider's policies and procedures. Most staff we spoke to were aware of best practice guidance, National Care standards and relevant Codes of practice from the Nursing and Midwifery council and Scottish Social Services Council. The provider had introduced a new on-line training system. We looked at staff training records and saw that good progress had been made in providing staff with the training they need to care for people properly and keep them safe. The manager gave us very strong assurances that the training programme would continue to be progressed. We spoke to staff about the new training system and received positive feedback. We made 2 requirements about staff training in the last report. We consider these met, however we have made a recommendation asking the service to make sure that they have a system in place to evaluate the outcome of training. This is to measure staff understanding and application of training into practice. See recommendation 1. Areas for improvement In the last report we made a requirement directing the providers to ensure that staffing levels are based upon an individual assessment of residents physical, social, psychological and recreational needs, also taking into account the physical layout of the premises. The provider did use a dependency assessment tool which defined each residents care needs and translated these into hours of care each day. The dependency assessment tool did not take into account the physical layout of the premises, and for some residents we did not feel the tool was subtle enough to accurately assess their actual needs. From examination of staffing rotas we saw that Orchard Care Centre, page 25 of 33

26 the provider had reduced staffing numbers and we had concerns about how this impacted on residents safety, particularly overnight. We discussed our concerns with the manager who very quickly increased staffing levels. We have repeated this requirement, see requirement 1. In the last report we made a recommendation asking the service to improve the frequency, quality and content of staff supervision. At this inspection we saw that all staff had received supervision from a senior member of staff. The supervision which had been carried out was in the form of a standard template with a generic agenda. We have asked the service to improve the quality of supervision to reflect more evidence of individual agendas, staff training, professional development and feedback on observation of practice. This may help to make supervision a meaningful learning process which supports the staff team to carry out their roles and responsibilities effectively. See recommendation 1. Grade awarded for this statement: 3 - Adequate Number of requirements: 1 Number of recommendations: 2 Requirements Inspection report continued 1. The Providers are required to ensure that staffing levels are based upon an individual assessments of service users physical, social, psychological and recreational needs. The assessment and staffing levels must take the physical layout of the premises into account. Assessments must be carried out on a 4 weekly basis and be included in service users personal plans. SSI 210/2011 Regulation 15(a)(i) Staffing Timescale: immediately upon receipt of this report Orchard Care Centre, page 26 of 33

27 Recommendations Inspection report continued 1. Staff should be provided with the training they need to care for residents and keep them safe from avoidable harm. A system to evaluate the outcome of training should be put in place. This is to measure staff understanding and application of training into practice. National Care Standards 5 Care Homes for Older People - Management and Staffing Arrangements You experience good quality support and care. This is provided by management and staff whose professional training and expertise allows them to meet your needs. The service operates in line with all necessary legal requirements and best-practice guidelines. 2. Supervision records for staff should show more evidence of supervisor feedback and joint discussions on performance that includes: observational monitoring, shared agendas, team and individual objectives, evaluation of training and training needs analysis. Supervision sessions should end with an action plan and a date set for the next meeting. National Care Standards 5 Care Homes for Older People - Management and Staffing Arrangements. You experience good quality support and care. This is provided by management and staff whose professional training and expertise allows them to meet your needs. The service operates in line with all necessary legal requirements and best-practice guidelines. Orchard Care Centre, page 27 of 33

28 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 3 - Adequate Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths Please refer to Quality Theme 1, Statement 1 for areas of strengths which were also relevant to this statement. We could see from information produced by the service such as the newsletter, noticeboards which included 'you said, we did' information and minutes of meetings, that the management team kept residents and relatives informed on a regular basis about all aspects of the service. Relatives that we spoke to found the meetings useful and appreciated getting a copy of the minutes posted out to them if they were not able to attend. Areas for improvement Please refer to Quality Theme 1, Statement 1 for areas of improvement which were also relevant to this statement. The management team are in the process of introducing new paperwork and policies and procedures. We saw evidence of this in some residents care plans and in the policy manual. We could not see ways in which the management team have involved residents in this process. The service could put opportunities in place for residents to take part in policy development. When reviewing and updating their participation strategy, the service should identify how they intend to help residents, their relatives/carers and any other stakeholders to get involved and have a say in the assessment and improvement of the quality of management and leadership. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 0 Orchard Care Centre, page 28 of 33

29 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide. Service strengths We graded this statement as adequate after discussion with the management team and examination of records held by the service. A range of audits were reported to the manager. These included areas such as residents personal plans, healthcare needs, accidents/incidents, catering, and the environment. The audit system should give a clear reflection on how the care home is operating. The manager has worked hard to provide staff with clear leadership since he took up his post approximately 4 months ago. The manager had recently appointed a deputy manager and charge nurse team has recently been extended to included a Deputy manager. The development of leadership roles in the service should help to make sure that the staff team are being supported and led to provide good quality outcomes for the people in residence. We saw evidence of regular communication between the management team, staff, residents and relatives. For example, there are daily Heads of Department meetings when there is an opportunity to identify any areas of concern and agree actions on how to address these. This regular communication may help the management team to have an overview on what is happening in the service and to address any areas that could lead to poor outcomes for residents. Areas for improvement From records examined we saw that there was a system in place to audit residents personal plans. It was not always clear that improvements identified as needed through the audit system had been carried out. This meant that the information detailed in personal plans was not as accurate or up to date as it should be which had the potential to put residents at risk. See recommendation 1. Some of the personal plans we examined lacked detail about how needs and risks would be managed or minimised. For example, we looked at the personal plan for a resident who was at high risk of falls and found no information documented to show how the service would work with the person to reduce these risks. We looked at the audit of residents nutritional status which gave the management an overview of those people who were at nutritional risk. The audit tool identified those residents who had lost 1.5kgs or more weight in the previous 4 weeks. We thought that the nutritional audit could be improved as it did not include those people who had been losing weight over a period of time but at less than 1.5kgs. Orchard Care Centre, page 29 of 33

30 As detailed in Quality Theme 1 the service should make sure that whenever possible residents are involved in their six monthly reviews of care. We thought that supervision and monitoring of staff could be improved as detailed under Quality Theme 3 statement 3. We made a requirement under this statement in the last report. We directed the providers to make sure that there were effective quality assurance systems in place to promote quality outcomes for residents. At this inspection we found that the management team had improved the way they monitored the quality of the service. We consider the requirement met. Grade awarded for this statement: 3 - Adequate Number of requirements: 0 Number of recommendations: 1 Recommendations 1. It is recommended that the management team review how audits of residents care files are carried out to ensure areas of concern are identified and improvement actions are followed through. National Care Standards 5 Care Homes for Older People - Management and Staffing Arrangements 4 You are confident that all the staff use methods that reflect up-to-date knowledge and best-practice guidance, and that the management are continuously striving to improve practice. Orchard Care Centre, page 30 of 33