Inspection on 12/05/09 for Orford House

This is the latest available inspection report for this service, carried out on 12th May 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Orford House 21/06/06

Orford House 13/02/06

Orford House 15/08/05

Orford House 15/07/04

Orford House 15/01/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Orford House Orford House Ugley Bishops Stortford Essex CM22 6HP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Louise Bushell     Date: 1 2 0 5 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 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 Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Orford House Orford House Ugley Bishops Stortford Essex CM22 6HP 01279816165 01279816858 kerry.dunne@hft.ork.uk www.hft.org.uk Home Farm Trust Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr David Bolton Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 26 persons) Date of last inspection Brief description of the care home Orford House is located in a rural location close to Stanstead Mountfitchet and is registered to provide accommodation for 18 people with varying degrees of learning disabilities. Accommodation is provided in one purpose built bungalow that provides 6 single rooms at ground floor level. While the newly furbished cottages provides 12 single rooms in 3 separate units. All of the accommodation provides en-suite bathrooms and is decorated and furnished to a high standard. The service is located in large accessible, and extensive grounds. All bedrooms in the home are highly personalised. The communal areas are domestic in nature and well Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 26 Brief description of the care home used by the residents. The service aims to provide personal, social and emotional care to the people living there while supporting their independence. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the inspections undertaken by the Care Quality Commission is based upon outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting two people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Care Quality Commission. We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection and we looked at the Annual Quality Assurance Assessment (AQAA). Care Homes for Adults (18-65 years) Page 6 of 34 During the visit information was gathered information directly from the management and staff team, any visitors and the people who used the service. The visit took place over one day. This enabled the inspector to directly and indirectly observe the care practices and the day to operations of the service. A selected tour of the building was conducted during which the inspector spoke with people who use the service, staff and visitors and the proposed Registered Manager. The range of fees to reside at Orford House are from one thousand two hundred pounds per week to one thousand seven hundred pounds per week. This excludes all personal items. The fee also includes a two hundred pund per year clothing budget. The fee includes the staffing costs for holidays. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? The AQAA tells us that assessments and risk assessments are up dated using an electronic assessment and care planning system. The people who HFT supports are able to access their individual goals. HFT have been slowly and methodically working through the support plans and updating them in accordance with care standards and the Mental Capacity Act / Deprivation of Liberty. All support plans are person centred and incorporate how to support someone to understand the daily rituals and support needs of the service user. HFT have updated menu plans to demonstrate its commitment to supporting healthy living. This includes the implementing of at least five fruit or vegetables a day and recording as to daily intake for each individual. All of the team at Dove Cottage and Pear Tree Cottage have received training in using the new computerised data base called Support Planning Assessment and Recording System (SPARS). Further improvements have been made with the service now recording individual community inclusion and recording achievements met through individual goal planning on SPARS. Health Action plans have been implemented and work is still ongoing to ensure that they are all up to date. Senior management team have received training regarding the Mental Capacity Act. Care Homes for Adults (18-65 years) Page 8 of 34 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service benefit from a well managed admission procedure. People who use the service can be assured that there is a pre-admission systems in place that ensures that the service can meet the needs of the individual. Evidence: The service understands the importance of having sufficient information when choosing a care home. It has innovative ways of helping prospective individuals to choose a home that will meet their needs and preferences. It has developed clear information to help them understand what specialist services it can provide. The service has a Charter in place which is available in a variety of formats. The team manager and the service manager stated that this document is in the process of being reviewed and re branded. The AQAA tells us that the organisation operates a nationwide vacancy service, which can allow for individuals to move closer to their families. In the last year two representatives of the people who use our service, have been working with the Quality Standards Group to develop information and processes that enhance the admissions Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: process. To date this has resulted in a vacancy outline providing initial information about any vacancy. The service provides a statement of purpose that is specific to the individual units and the individual needs of the people who use the service. It clearly sets out the objectives and philosophy of the service supported by a service users guide. The AQQA tells us that the new formats are in the process of being agreed and fully implimeneted. Admissions are not made to the service until a full needs assessment has been undertaken. The assessment is conducted professionally and sensitively and involves the individual and their family or representative, where appropriate. The AQAA states that If a person is interested in an existing vacancy they are given information about the service provided Within Dove Cottages and Pear Tree Cottage. This includes information about the house, staff and how the key working system and support is provided. Individuals are encouraged to identify how they want to be supported. HFT employs a locum Social Worker who undertakes all initial assessments and also supports the individual service user through the initial three month process of living within HFT services. During the inspection process a completed assessment was used as part of case tracking. The assessment was detailed and covered all individual areas of need. The assessment focused on specific need and highlight areas of risk throughout the process. The assessment tool had some elements of pictorial images to support the individual in gaining an opportunity of understanding. It also covered a cultural needs section, enabling the individual and the assessor to detail the cultural preferences they may have. The AQAA tells us that each person is encouraged to express themselves and are supported to try new experiences, to develop their awareness and make informed choices. HFT encourages the people it supports to have holidays either within groups or on an individual basis as and when they choose. One person using the service commented that when I moved here they gave me all the information I needed, about my money, where to go and about what to do. Admissions to the service only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of the prospective individuals. Prospective individuals are given the opportunity to spend time in the service. This may be a visit for a meal, over night or a weekend. The transition process is tailored to the needs of the individual. Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: New tenants are provided with a statement of terms and conditions or a contract. This sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. The service managers stated that the contracts are in the process of being re branded. Care Homes for Adults (18-65 years) Page 13 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are cared for and supported in a manner which is tailored to meet their individual needs. The care provided is person centred and focuses on the individual however stream lining of the system is required in order to ensure consistency. Evidence: Two care plans were fully case tracked as part of this inspection process. One person identified as part of case tracking had recently moved into the service and was able to offer their personal experiences of the entire process. The organisation is currently in a transitional position with its care planning. The organisation has introduced a system called SPARS (support planning, assessment and recording system). The system is in its early stages and the aims and objectives is to move to a paperless organisation. At the time of the inspection the organisation was mid process, with some records being maintained manually and some records being recorded using the computer system. Staff have received training in the use of the Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: system and more specific training has been unidentified for individuals and is being provided. The team and service manager discussed the use of the system at great length and agreed that the system is still working progress. For the one of the individuals identified it was found that neither the manually or electronically completed care plan and risk assessment had been reviewed within the time scales set by the service. The team and service manager discussed improvements that are required to the system, this includes a process for viewing the reviewed care plan and risk assessments. Currently the allocated manager of the unit receives a formal notification via email to review the specific documents, however the manager had recently left the service and this had not been changed and therefore the new manager of the unit had not received notification and not reviewed the documents as required. Staff have access to all documents regarding any person using the electronic system. The staff also manually up date the electronic system, inputting for example, appointments attended and diary notes. If agency staff are on duty, they do not have access to the electronic system, however on both occasions there was a system in place in the separate units for information to be passed to the agency staff member in order for them to provide the correct care and support required. The team manager and the service manager stated that this is being streamlined and teething problems are being identified and resolved as quickly as possible. The other care plan case tracked was detailed manually, it contained detailed information regarding what the person needs, the care that staff are to give, and the long-term aim of the care to be given. These support plans detailed what the person could do and what tasks they needed staff to help them with. Staff are given information on how to treat people in their care and are given clear directions on what care the person would need. The care plans cover all aspects of the persons physical, mental and social care needs. The care plans contained detailed risk assessments and manual handling, Occupational Therapist and Physiotherapy assessments. The care plan did not evidence the involvement of the individual. This was brought to the attention of the team and service managers who commented that this was a process that the organisation is implementing using the new computerised system. One person using the service commented that I know about my care plan and the Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: staff write information in there, if there are any problems its all in my care plan. Care plans recorded a variety of risks including food hygiene, scolding, choking, cross infection, missing person, falls and trips, fire safety, traffic, nutrition and visual impairment. People are able to leave the home alone or are escorted by a member of staff if required. Staff understand the importance of individuals being supported to take control of their own lives. Individuals are encouraged to make their own decisions and choices. The service knows and records the preferred communication style of the individuals and uses proven methods that enable the person to lead a full life that promotes independence and choice. This includes communication aides such as photographs and symbols. The care plan also refers to equality and diversity issues and addresses any needs identified in a person centred way. Staff have skills and ability to support and encourage individuals to be involved in the ongoing development of their plan. There are procedures to ensure that people using the service are informed of their rights to confidentiality. Individuals understand when staff may have to share personal information and can access advocacy services for support. The service is aware of current policy issues and good practice developments, and tries where possible to transfer this thinking into their daily work. From discussion with staff and from observation of care practices in the service, it was evident that people are supported to make decisions and choices regarding their lives. Promoting peoples independence is key to the aim of the service. During the inspection staff were directly and indirectly observed supporting people. It was pleasing to see that one member of staff was supporting an individual to eat their lunch as per the specific details held on the care plan. The support plans provide information of how decisions had been made and by whom, and this matter was well recorded. One person using the service commented that the staff are really good, they really help us out. The service ensures that individuals are consulted regularly to gather information about their satisfaction with the service. They are involved in both the development and review of the service. During the inspection it was directly observed that records were stored appropriately maintain the confidentiality of the person. Care Homes for Adults (18-65 years) Page 16 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the service have excellent opportunities for personal development. Activities are provided that are appropriate to their needs and they are supported to build and maintain relationships with families. The people living in Orford House benefit from a well-balanced, nutritional and varied diet. Evidence: Central to the services aims and objectives is the promotion of the individuals right to live an ordinary and meaningful life, appropriate to their peer group, in both their home and the community, and to enjoy all the rights and responsibilities of citizenship. The service understands the importance of enabling younger adults to achieve their goals, follow their interests and be integrated into community life and leisure activities in a way that is directed by the person using the service. During the inspection Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: process time was spent at the garden centre on site. This offer people using the service and people external to the service to work, gain experience and employment opportunities. One person who uses the service and works at the garden centre commented that I really like working here, we grow all the plants and sell them. During the inspection a limited tour of the services occurred and included the resource centre. This is a separate building to the accommodation where people live. People are able to access the resource centre to attend groups, such as current affairs, become involved in wood work and poetry and also attend training and watch films. The service also makes commissioned work, such as bird tables and houses, pottery and mosaic designs for gardens. A recent talent show was run at the the service where people entered and completed a short dance or song or played a musical instrument. During the inspection pictures were seen of the talent show. One person commented It was great fun. A further person using the service commented I have been watering and re potting plants, it gets me out and about. The service understands and actively promotes the importance of respecting the human rights of people using the service, with fairness, equality, dignity, respect and autonomy all being seen as central to the care and support being provided. Home Farm Trust runs a forum which is facilitated by the people who use the service. The group meets on a quarterly basis an also produces a magazine called Popcorn which is published. People who use the service are encouraged to write articles and be as involved as possible. Individuals are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The AQAA states service users at Dove Cottages and Pear Tree Cottage attend various colleges; this gives people an opportunity to develop friendships external to HFT and widens their social networks. Courses attended include flower arranging, communication skills, cooking and Art and Craft sessions. HFT also offers day activities at the main resource centre on site that all service users are welcome to join. Courses include making and trading, HFT united speaking up group, IT and power point presentations, pottery, current affairs and gardening. Each person HFT supports has a schedule of programmed activities. The routines, activities and plans are person centred, individualised and reflect diverse needs including religious preferences, age related activity, non gender specific activities and cultural awareness. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: The service actively encourages and provides imaginative and varied opportunities for people using the service to develop and maintain social, emotional, communication and independent living skills where appropriate. The service has very strong and highly effective methods, which focus on involving residents in all areas of their life, and actively promotes the rights of individuals to make informed choices, providing links to specialist support when needed. This includes developing and maintaining family and personal relationships. The AQAA states that Individuals are encouraged and supported to develop and maintain relationships with family, friends and contacts within and outside of HFT. Service users are supported by their key worker to buy cards and gift for birthdays, anniversaries and special events. Key workers have regular contact with family / friends of each individual depending on the wishes of each service user and their family / friends. One person using the service commented my key worker always helps me out, and I have my own bank account so i can buy what I want to. One person using the service commented that there are difficulties in using the transport as they do not take wheelchairs currently. Following discussion with the senior on duty and the team manager it was established that they are looking into purchasing a wheelchair adapted vehicle. There is evidence of innovative methods being used, and staff actively seeking information to enable people to access education and work, including supported employment, and paid employment where they have the capacity. The service actively supports people to be independent and involved in all areas of daily living in the home. This includes where appropriate, taking responsibility for shopping, planning meals, and meal preparation dependant on skills and abilities. Meals are very well balanced and highly nutritional and cater for varying cultural and dietary needs of individuals. For those individuals who need support during mealtimes, including those who have difficulty swallowing or chewing, staff give assistance. During the inspection one member of staff was indirectly observed supporting a person in a dignifying manner. They are discrete and sensitive to the feelings of both the person they are helping and also to others present. Mealtimes are flexible and relaxed. One person who uses the service commented the food is lovely here my favourite is toad in the hole. Care Homes for Adults (18-65 years) Page 19 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that their medication and health care needs are well managed and in their best interest. Evidence: People receive personal and healthcare support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. Personal healthcare needs including specialist health and dietary requirements are recorded in each persons care plan. The AQAA states Individuals are invited to health screening, for example cervical and breast screening. Females are supported using the NHS picture books to explain the procedures. It is also possible for people to visit health staff at the facilities and look at equipment on a prior visit to try and minimise stress about procedures. However if people do not wish a certain procedure, this is immediately respected and revisited or referred to the CLDT if appropriate. Best interest meetings occur as needed and consider MCA issues. During the inspection records were observed of people attending regular health and specialist meetings. One person who uses the service commented that the staff help me and I can see my doctor when I want to. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: The new SPARS data base contains detailed daily records of the people who use the service. It was observed that entries have been made in their diary using this system when appointments have been attended. The AQAA tells us that the service has updated and implemented the Health Action Plans within the last twelve months. It states all individuals health needs are identified in a health action care plan and associated risk assessments are in place. This means that all individuals have necessary health checks at appropriate intervals. The service has local medication guidelines in place covering ordering, storage, disposal, administration of medication, including guidelines around over the counter remedies and the safe storage of staff medication. Staff receive accredited training and are tested for competency through Boots. One staff member commented all my mandatory training is up to date, I really like working here, its a nice atmosphere and quite supportive. Personal support is responsive to the varied and individual needs and preferences. The delivery of personal care is individual and is flexible, consistent, reliable, and person centred. Staff respect privacy and dignity and are sensitive to changing needs. The service listens and responds to individuals choices and decisions about who delivers their personal care. People are supported and helped to be independent and can take responsibility for their personal care needs. Staff listen and take account of what is important to them. This was indirectly observed through the care practices observed during the inspection. Direct observations was also seen on the care plan, where personal preferences had been reviewed and changes made. In addition to this individuals had goals set in the care plan.These are goals that they had set themselves and work with staff to achieve them as required. It was pleasing to see a range of different goals being set that where clearly individual to the person using the service. One member of staff commented that the Health Action Plans are in the process of being implemented in full. The AQAA stated that one of the improvements for the next twelve months includes offering training around sexual health and boundaries for staff and service users, and to offer training around death and bereavement. The service has an efficient medication policy in place. Medication records are completed, contain required entries, and are signed by appropriate staff. A random audit was completed on a number of medication records as part of case tracking. In general the medication systems are well managed. The service has a system in place Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: where by audits are completed on a daily basis to ensure people have signed, received and been administered there medication as required. In the main office a sample signature sheet was held. The team manager stated that this was used to manage errors as they occur. Medication records were completed well, with stock being signed in following checking. On one occasion it was observed that the stock take of an individuals Valproic acid 250mg tablet was missing. The member of staff reviewing the medication with the inspector stated that this was possibly due to a previously dispensed tablet being soiled and consequently a member of staff used another tablet from the end of the pack. Some medicines were seen to detail the instructions as required. Whilst the service had introduced some guidelines for the interpretation of as required, there were some medicines with no further instructions detailed. This was brought to the attention of the senior on duty, team and service manager. No temperatures were being recorded where the medication was being stored. Care Homes for Adults (18-65 years) Page 22 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to an understandable complaint procedure that ensures that they are listened to. The service operates robust practices and procedures to protect the people who live there. Evidence: The service has a well designed pictorial complaint procedure that is placed throughout various parts of the units. People who live in the units were able to explain in great detail how they can make a complaint and who to make a complaint to. One person who uses the service stated I know how to make a complaint, I feel it would get sorted reasonably well. The AQAA tells us that eight complaints have been received in the last twelve months, none of these have been up held and one remains awaiting an outcome. The staff working in the home were able to describe what they do when a complaint is made. They spoke of the procedure that they are expected to follow, how important it is to listen to the person making the complaint, and to encourage the person to make the complaint official. The service has maintained its policy and procedures for Safeguarding Adults. All staff, apart from the most recent appointments, have been provided with training on the understanding, recognition and reporting of abuse. The service offers in house training Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: using the Essex County Council workbook and DVD. Training certificates were available on staff files. Ongoing training has been arranged. Staff comments included I have received SOVA training through the service, this is part of all the staffs mandatory training and I am attending training in the Mental Capacity Act on Monday. The AQAA provides us with further information and states that HFT (Home Farm Trust) has a clear and effective complaints policy and procedure in place. HFT have national guidelines regarding complaints and how they are to be dealt with and the timescales for dealing with all complaints. Complaints forms are accessible to all. The complaints process is discussed within house meetings. Staff support individuals to fill out complaints forms as appropriate. Care Homes for Adults (18-65 years) Page 24 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Orford House provides people with a homely, warm, comfortable and accessible place in which to live. The service has adaptations and equipment that meets the needs of the people living there. Evidence: The service has a purpose built bungalow that has accommodation for six people. The bungalow is airy, spacious, comfortable and homely. The kitchen is large and up to date and the is decorated in neutral, calm colours. Visitors are able to meet with individuals in the communal areas of the service or in their bedrooms. Other quite areas are available for them to use if they so wish to. A number of bedrooms were observed as part of the inspection process and were seen to be very personalised and reflect the personalities of the person. One person using the service commented I chose my room, everything in it was great and what I wanted. The building known as the Cottages had a major refurbishment in 2007 and this building now accommodates twelve people in three separate units. Each of the bedrooms has a large en-suite bathroom, the cottages units are decorated and furnished to a high standard but it has maintained a homely atmosphere. Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: The services laundry facilities are located away from communal areas and individual bedrooms to reduce the risk of cross infection. The equipment in the laundry is suitable for the needs of the people living there. The home has a sluice facility that is complimented by the sluice wash cycle of the washing machines. Care Homes for Adults (18-65 years) Page 26 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service benefit from a skilled and competent staff team. The recruitment procedure ensures that people are safeguarded and makes sure that appropriate staff are employed and trained. Evidence: The people spoken with and from information gathered from the service determines that they have confidence in the staff who care for them. Rotas were seen and displayed adequate staffing numbers on duty to meet the needs of the people suing the service. Specific attention was given to the busier periods of the day. The Team Manager was usually on shift in addition to the minimum requirements. This enable the service to ensure that numbers were maintained for the safety of all and that record keeping was completed and monitored as required. Staff members undertake external qualifications beyond the basic requirements. Managers encourage and enable this and recognise the benefits of a skilled, trained workforce. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. People who use the service report that staff working with them are very skilled in their role and are consistently able to meet their needs. Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. A total of four staff files were audited and were seen to contain all the required documentation. Three individual staff commented on the strong team culture of the service. Home Farm Trust is in the process of a large recruitment campaign. The Team Manager reported that this is going well and that they are awaiting clearances in order for people to start in their new roles. Staff recruited confirmed that the service was clear about what was involved at all stages and was robust in following its procedure. There are clear contingency plans for cover for vacancies and sickness and limited use of agency staff was present. One staff member commented when I started I had a CRB (Criminal Records Bureau) check and two references, one which was my last employer. I also had Hepatitis B checks and clearance from my GP (General Practitioner). Staff receive training and induction once recruited. The induction process is detailed and is a process where the staff member is trained and mentored through a complete programme. The programme is then signed at the end of each stage. Following discussions with a number of staff and the manager it was determined that this process was being reintroduced the service to ensure that all staff had fully received this and that evidence was held on their file. The AQAA tells us that HFT (Home Farm Trust) have developed a new induction pack and training programme in accordance with Skills for Care guidance. The induction work is completed within the first 12 weeks. HFT have a 6 month probationary period, within which time staff are expected to be supported to become competent in practice and knowledge of policy and procedure. Staff are also given a copy of the codes of conduct and practices set by the GSCC and these are discussed during the induction period. HFT induction process is accredited. Staff confirmed that the senior team provide supervision. Records reviewed on the day of the inspection showed that regular supervision was occurring with staff. One staff member confirmed that David Bolton provides me with supervision, I have it around once a month and its really useful. The service has scheduled specific mandatory training for each moth, conducted by qualified trainers amongst the group. A recent training needs needs analysis has been completed and identifies staff requiring training as well as the planned training. The AQAA has identified that there is a need for training in Safeguarding Adults is required. Care Homes for Adults (18-65 years) Page 28 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager of the service is suitably qualified and has clear policies and procedures are in place for the staff to adhere to ensuring that care, health, safety and welfare of the people who use the service is protected. Evidence: The proposed Registered Manager has the required qualifications and experience and is competent to run the service. The proposed Registered Manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. HFT work to continuously improve services for people. Feedback received on the day of the inspection from staff and the people who use the service determines that the management are effective and approachable. One person commented the managers are always really helpful and approachable. With the introduction of the new care planning format and training around its completion and implementation within the units, there is a focus on person centred thinking, with the people who use the service becoming increasingly more involved. Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: The Registered Manager leads and supports the staff team who have been recruited and trained to satisfactory levels. The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. The service has sound policies and procedures, which are corporately and internally reviewed and updated, in line with current thinking and practice. The manager ensures staff follow the policies and procedures of the service. The staff team are positive in translating policy into practice and showed good knowledge of care principles, health and safety and safeguarding issues. This includes the management of finances within the service, where systems are transparent and open, with records being maintained at all times. The AQAA tells us that The Registered Manager for this service, 28 years experience of working within the care sector. 10 years experience of management. The Registered Manager has NVQ 4 Care Management and the RMA NVQ 4 . There is an open, positive, inclusive atmosphere within the Cottages. Discriminatory practice towards staff or service users is not tolerated by management. Staff look to the Registered Manager for leadership and direction. The Registered Manager uses HFT complaints procedures to support people to complain. The Registered Manager has an open policy towards to the management and running of each Cottage. Staff meetings take place regularly and minutes of the meetings are available on each unit. The service works to a clear health and safety policy. Safeguarding is given high priority and the service provides a range of policies and guidance to underpin good practice. Care Homes for Adults (18-65 years) Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 Care plans must contain all the information relevant to an individual and ensure that is accurate, and up to date. To ensure that the staff are able to provide the correct care and support required to the individual at all times. 31/07/2009 2 20 13 Medication instructions on the Medication Administration Record must be clear for all staff to follow. In order to ensure that people receive there medication as prescribed. 30/06/2009 3 20 13 Temperatures must be recorded of the storage room of medication. To ensure that medication is stored in environmental conditions that are monitored and are suitable. 30/06/2009 Care Homes for Adults (18-65 years) Page 32 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 6 12 Documents should reflect the involvement and agreement of the people using the service and or their representatives. The service should purchase a vehicle that is wheelchair adapted to meet the needs of the people who use the service. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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