Inspection on 14/10/05 for 1-2 Orchard Mews

This inspection was carried out on 14th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1-2 Orchard Mews 22/04/08

1-2 Orchard Mews 03/05/07

1-2 Orchard Mews 07/02/07

1-2 Orchard Mews 20/05/05

1-2 Orchard Mews 14/01/05

1-2 Orchard Mews 08/07/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 1-2 Orchard Mews Bakers Drove Rownhams Southampton SO16 8AD Lead Inspector Ms Wendy Thomas Unannounced Inspection 14th October 2005 09:10 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 1-2 Orchard Mews Address Bakers Drove Rownhams Southampton SO16 8AD 023 8073 9076 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Choice Support Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th May 2005 Brief Description of the Service: 1-2 Orchard Mews consists of two purpose built bungalows with through access via the office. Service users have learning disabiities and those living in bungalow 1 require a high level of physical support, have communication difficulties, and are wheelchair users. The occupants of bungalow 2 have greater communication skills and are more physically able. One staff team operates throughout the home, although the servuice users tend to keep their own area of the home. The home is purpose build and designed with the needs of wheelchair users in mind. Each service user has their own bedrrom and there are shared lounges and kitchen/dining areas in each bungalow. 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on Friday 14th October 2005 between 9:10 and 17:30. The inspector spent time with four of the five service users. Because of service users’ communication needs it was not always possible to ascertain their true opinions about life in the home. Information was therefore also gathered through observation of service users, their interactions with each other and the staff, discussion with members of staff and examination of three service user plans. The inspector also interviewed three support staff and spent time with the manager and deputy manager. The home has had difficulty recruiting a manager since the last manager left in November 2004 and a succession of temporary measures have been introduced to cover the vacancy. This has not been totally successful due to lack of consistency and direction from those managing the home. The current acting manager had been working in the home for two weeks and the current deputy manager for slightly less at the time of the inspection. Both had been brought in from other Choice Support homes in the area. What the service does well: What has improved since the last inspection? The continuing development of service users plans since the last inspection means that they are now of a good standard. The newly appointed acting manager and deputy manager are refining the home’s files further, and out of date information is now being removed from the files in current circulation. New “Daily Working Files” have been introduced so that the information staff need to support service users is readily at hand. Staff said that they found these very useful. The open management style and hands on approach of the newly appointed acting manager and deputy manager has lead to improved staff morale. All staff expressed their praise and appreciation of their new management team. 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 6 Since the last inspection lists of the training staff had been given had been compiled and it was easy to see the range and frequency of training. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Pre-admission assessment forms are in place. These are being developed further to ensure that the home can meet the needs of future service users. EVIDENCE: There have been no new admissions to the home for several years. The home currently has one vacancy. There are no plans to place another service user in the immediate future. The manager reported that Choice Support has an admission policy and assessment forms. He is also working to develop a localised admissions procedure and forms specifically for the homes in the Hampshire and Southampton area. 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9. Clear and detailed service user care plans and risk assessments ensure that staff are able to appropriately support the service users. EVIDENCE: The inspector sampled three service users’ files. At the previous inspection she had been informed that the poor state of service users’ plans was because new plans were being developed. This has now been completed for all service users. The plans give a good level of detail relevant to the needs of the service users. Some members of the staff team were aware of the files and said that they referred to them and found them useful, another was not aware of where they were and had not looked at them. The inspector was told that when a service user’s file had been requested by a healthcare professional visiting the home, the staff on duty were not aware where to find it. Although service users had identified goals in their service development meetings during the first quarter of the year, there were no records of progress or programmes to meet these. 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 10 The acting manager at the time of the inspection had been at the home for two weeks. He had set up “Daily Working Files” in each bungalow relating to the care needs of the service users in that bungalow, shift schedules, staff handover sheets, recording sheets for individual service users, and other useful information. These files were readily available to staff, their comments were very favourable, saying that they contained the information that they needed. The manager reported that he had identified a need to consolidate information into relevant and easily available formats. A lot of out of date and irrelevant information was being archived and the filing system simplified. 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 and 16 Service users are able to determine daily routines that suit them. The manager’s plans for developing the service will improve the opportunities for service users to participate in activities inside and out of the home. Support from staff enables service users to maintain existing relationships. EVIDENCE: During the inspection, one service user was out of the home attending a day service. The other four service users began the day gently, all being in bed when the inspector arrived at 9.10am. Three did not go out at all and one went out to get their haircut. A member of staff reported that one of the service users usually accompanied them when they did the weekly supermarket shop for the home. They could not, however on this occasion, as the home’s vehicle’s road tax had expired and the member of staff had to use their own car. The manager reported that he was having difficulty identifying who, within the organisation, was responsible for the upkeep of the car and ensuring tax and insurance were maintained. 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 12 Plans to develop the weekly activity plans and methods to monitor service users’ activities inside and out of the house had not been developed. The inspector did not scrutinise service user diaries on this occasion as anecdotal evidence indicated that, with the exception of a service user who regularly attends day services, service users were not getting out of the home much. The manager acknowledged this and outlined plans to improve this. This tied in with his plans to involve service users much more in decision making in the home. He cited meals and activities as the starting point for this. A service user informed the inspector that they did not like the food in the home. Staff had not been aware of this. Two service users often see members of their family. One service user has support to maintain a long-term relationship with someone outside of the home. Another service user told the inspector of someone they would like the home to support them to see more often. Privacy and dignity were seen to be being promoted with service users having support to have their personal care needs met in private. 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Improved care plans ensure that information is available to support service users’ personal and healthcare needs effectively. Input from healthcare professionals assists in service user’s healthcare needs being met. In order to safeguard service users from medication errors, the recording of medication administration would benefit from being tightened up. EVIDENCE: The introduction of the “Daily Working Files” to each bungalow improves the accessibility of healthcare information such as diabetes and specific feeding issues. Only introduced in the last two weeks, these are proving popular with staff, who say the information they need to support service users is now close at hand. During the six weeks prior to the inspection there had been concerns about how the healthcare needs of one service user were being met. Meetings between the home, Southampton Social Services and Commission for Social Care Inspection have led to this being satisfactorily addressed in consultation with the relevant healthcare professionals. (Amanda, is this relevant?) 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 14 The inspector asked one of the service users about their care plan. This person was not aware of the document and said they had not been consulted as to what was in it. Although the care plans set out to support the person in the way that promoted their comfort and well-being, the person had not been asked if this was the case. They said that they would like this to be discussed with them and were willing to get involved. The process of administering medication was examined. The medication was being appropriately stored although it is suggested that the manager consider the guidance from the Royal Pharmaceutical Society of Great Britain regarding the storage of insulin. A staff signature sheet was now in place making it easier to trace any errors or incidents affecting a service user’s well-being. Some medications that appeared to have been given were not signed for. Following appropriate training staff within the home are able to carry out certain invasive procedures under the authority of the district nurse. There were no records detailing who was able to carryout what procedures in the service users’ files and what training they had had. A member of staff verified that the training had occurred and the manager agreed to set up the appropriate records. 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22. The lack of information about complains meant that it was not possible to ascertain if the service to service users improved after concerns were raised. EVIDENCE: The inspector viewed the complaints log. The last two entries related to complaints made 15 December 2004 and 9 February 2005. The inspector was aware that complaints had been made to the home since then. There were no details of the complaints only a reference number. The inspector was therefore unable to make a judgement as to whether complaints were being dealt with satisfactorily. 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Service users benefit from a clean and homely environment. EVIDENCE: The décor around the home is bright and cheerful. There are pictures and ornaments giving it a homely feel. The home was clean and hygienic, and although the bathroom floors in bungalow 1 and a service user’s ensuite bathroom still looked grimy, they had improved since the last inspection. The manager said that these would be cleaned professionally next time the carpets were cleaned. No new crockery had been purchased as had been suggested at the last inspection, but the new deputy manager had identified this to be a problem and was in the process of ordering new crockery. The signs of wear and tear to the kitchen units continues to progress and no timescale for their replacement has been decided as requested by the inspector. 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 34 Service users would benefit from staff having further training relating to specific conditions affecting service users. The lack of information about staff and their recruitment process means that service users could be being put at risk due to possible unsatisfactory recruitment practices. EVIDENCE: Staff spoken with said that Choice Support was committed to offering staff training. As well as mandatory training such as moving and handling, first aid, basic food hygiene, health and safety and fire safety, some of the staff had attended such courses as epilepsy, risk around the individual, values and attitude, challenging behaviour, and protection of vulnerable adults. It is suggested that service users would benefit from more staff having training relating to the service users specific needs such as diabetes, sensory impairment, dementia, epilepsy etc. Training records indicated that a number of staff needed to update their health and safety training. No staff were recorded as having had infection control training. Staff were able to describe having had training in the administration of insulin and enemas, but this was not recorded. A member of staff informed the inspector that they and another two members of staff were currently working towards their NVQ level 2 in care. The manager, a RMNH (registered nurse – mental handicap) was hoping to do the registered managers award (NVQ 4). A member of staff who had started work in April 2005 had completed a TOPSS (Skills for Care) induction training 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 18 pack. All new staff had attended a one-week “foundation” training course at the Choice Support area office. The home will not meet the National Minimum Standard that 50 of care staff are qualified to a minimum of NVQ 2 by the end of 2005. The inspector was able to view the staff records. There were no records at all relating to the two most recently recruited members of staff. The records were reported to be held by the organisation’s personnel department. The records need to be held in the home and be available for inspection. Records were in order for a member of staff who started working at the home in April 2005. 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42. The new ethos being introduced by the new manager is impacting positively on service users as staff morale rises and systems are put in place to improve the running of the home and service user consultation. Service users are being put at potential risk by the staff disregarding fire safety procedures. EVIDENCE: For almost a year the home has not been satisfactorily managed. Staff and service users’ representatives have described a period of falling standards and low staff morale. The acting service manager and acting manager have now come to the end of their temporary deployment to Southampton. The assistant manager has also left the home. A permanent appointment has been made to the post of assistant area manager and this person has responsibility for the three Choice Support homes in the Hampshire and Southampton area and service development in the area. The manager’s post at 1-2 Orchard Mews is being covered by another secondment of a manager from one of the Choice Support homes in the area. This is initially for six months. All this 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 20 change is proving very difficult for staff, service users, and their representatives. Low staff morale is also impacting on service users. It has been suggested that one service user’s health problems are being affected. With another acting manager a lot more changes are occurring. Staff are, however, extremely positive about the current situation and everyone spoken with praised the manager and new (seconded) deputy managers’ hands-on approach, their involvement with the staff and service users, and the encouragement and support they are giving to all. All commented favourably about the new ethos the manager has brought into the home, with a much greater degree of openness, and consultation of both staff and service users. A period of stability in which workable systems and good management are developed is badly needed. On the previous inspection visit the inspector had found the fire door into the utility room in bungalow 1 wedged open. Despite a requirement that the home consult with their Hampshire Fire and Rescue Service’s fire prevention officer, they had not done so, and the fire door was once again wedged open. The requirement is therefore repeated. Records examined by the inspector showed that checks and tests of equipment and plant were being carried out at the expected frequencies, with the exception of the weekly testing of the fire detection and alarm system, which was being tested less than once a month. 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 x 12 3 13 x 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 X 2 X X CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 1-2 Orchard Mews Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 3 2 X X 2 x DS0000059159.V257367.R01.S.doc Version 5.0 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 Requirement 2 3 YA22 YA34 4 YA42 5 YA42 Records must be kept of the training and authorisation that staff have had to carry out invasive medical procedures for individual service users. 22(4) & A log of all complaints must be 17(2)Sch 4 kept in the home giving detail of timescales and action taken. 19 Schedule 2 Records as stipulated in Schedule 2 of the Care Homes Regulations 2001 are held on all staff recruited. (E.G. two references, complete employment history.) This is a repeat requirement of 14/1/05 and 20/5/05. 23 (4) Advise must be sought from the fire safety officer regarding the utility room door This is a repeat requirement of 20/5/05. 23 (4) The fire detection and alarm system must be tested weekly. Timescale for action 06/01/06 06/01/06 06/01/06 06/01/06 11/11/05 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations It is recommended that you consult the Royal Pharmaceutical Society of Great Britain publication on administering medicines in care homes regarding the storage of insulin. A timescale should be proposed for the replacement or upgrading of the kitchen units in both bungalows. Training specific to service users’ needs is recommended e.g. diabetes, sensory impairment, dementia, epilepsy etc. 2 3 YA24 YA32 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 1-2 Orchard Mews DS0000059159.V257367.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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