CARE HOME ADULTS 18-65
Apple Orchard The Green Dean Road Newnham-on-severn Glos GL14 1AQ Lead Inspector
Mr Simon Massey Key Unannounced Inspection 22 & 25th June 2007 09:00
nd Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 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 Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 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. Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Apple Orchard Address The Green Dean Road Newnham-on-severn Glos GL14 1AQ 01594 516582 F/P 01594 516582 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) Mr Thomas Alfred Mills Mrs Beverley Mills Mrs Elaine Elizabeth Watkins Care Home 10 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (2), Physical disability (1), of places Sensory impairment (2) Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The LD(E) category refers to two named service users. The home will revert to the original category (LD) when these service users no longer reside at the home. 26th November 2006 Date of last inspection Brief Description of the Service: Apple Orchard is in the village of Newnham-on-Severn, Gloucestershire. It is a large detached property on three floors and provides care and accommodation for 10 adults with learning disabilities. All residents are accommodated in single rooms. The home is staffed at all times. Adjacent to the home is a two-storey building that is used for activities, training, meetings and social groups. This also incorporates a sensory room and leisure facilities. The home’s Statement of Purpose and Service User Guide provide information as to the services that the home provides. The current fee range for the home is between £307.50 and £859.34 per week. Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection was undertaken over two days. The inspector met with the Provider, Registered Manager, care staff and all of the service users. Records relating to medication, staff recruitment and training, health and safety and care planning were examined. The environment was also inspected. As part of the inspection process a number of surveys were distributed and returned to the Commission. What the service does well: What has improved since the last inspection? What they could do better:
The home should ensure that all staff undertake the Adult Protection training provided by the local area team. There is scope for the care planning system to be further developed. The home needs to ensure that it has an admission process in place that ensures full assessments are completed on any service user before they are admitted to the home. The home needs to develop its quality assurance process to ensure there is genuine evaluation of progress and that staff, service users, relatives and Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 Page 6 outside professional have an opportunity to provide feedback about the service. 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. The summary of this inspection report can be made available in other formats on request. Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 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 Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments completed prior to admission would help ensure that people’s needs and aspirations are assessed prior to moving into the home, which would help staff to better meet the needs of new admissions EVIDENCE: Records relating to the most recent admission to the home were examined and some shortfalls were identified. The service user had been provided with information about the home and had preliminary visits. They subsequently moved to the home and appear settled and positive about their new home. However, no written assessment was completed and the information provided was dated from 2005. At the time of the inspection visit the home were still completing a care plan. An assessment should have been requested or undertaken, and a basic care plan in place from the onset of the placement. This plan could then have been developed using the person centred approach that it is being implemented in the home. There was evidence that the home has supported the move in a positive manner and that staff had developed their understanding of the person’s needs but a robust admissions procedure would better ensure that people’s needs are anticipated and met during their initial period of placement. Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans ensure that the service user’s needs are documented and guidance is available to staff. The home takes action to encourage service users to make choices and supports them to take appropriate risks. EVIDENCE: The home have introduced a more person centred approach to care planning over the past twelve months and continued improvements were observed during this inspection. Attempts are made by the staff team to engage as far as possible the service users in the planning and reviewing of their care plans. Examples were seen of new interests or approaches that have been identified as a result of the improved care planning. A sample of plans were examined and these were seen to cover a wide range of needs including personal care, leisure interests and behavioural issues. Good information is provided to staff about behavioural triggers and risk-assessed activities. All plans seen were up to date with regular reviews being planned. There were examples of good regular recording being completed
Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 Page 10 The home has regular service user meetings, which provides information and feedback for the staff team. Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to pursue their interests and hobbies, and are able to access the local community independently or with support if this is required. A healthy and nutritious diet is provided but choice is respected. EVIDENCE: Service users have individual weekly routines that involve time at college, attendance at a day centre and activities in the home. The home has an outside building that is equipped as an activity centre and service users explained how they used this for social events such as parties, as well as for activities such as pool, crafts and other hobbies. There is also a sensory area that is used by some of the service users. Two service users said they thought they had enough activities provided and enough opportunities for trips out to town, or further a field. Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 Page 12 Staff explained how they encouraged and supported activities and all interviewed said that the amount of opportunities and choice provided met the needs of the service users. The home was stocked with sufficient fresh and packaged food at the times of the inspection. The menus show that a healthy diet is promoted but that choice is also respected. Service users questioned were very positive about the food. Staff also stated that they thought the food was of good quality and that sufficient choice was provided. The food was correctly stored and labelled, where appropriate, and the kitchen area was maintained to a high standard. Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 7 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to access the healthcare professional they require to ensure that physical and emotional health needs are met. Satisfactory arrangements are in place for the handling of medication, promoting service users’ wellbeing and, where appropriate, their independence. EVIDENCE: Care plans contain guidance about personal care and the records show that people are supported to visit health professionals and that the staff team are proactive in monitoring health concerns. One service user has been successfully supported by the staff team to reduce their weight and blood pressure and appeared noticeably healthier and more settled. Recording show the regular involvement of outside professionals when required and that service users are being supported to heave regular checkups. Appointments are recorded and any information correctly distributed. Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 Page 14 The system for storing and administering medication was examined and found to be in order. Medication is now audited on a regular basis and additional information has also been provided in the medication file. Staff have completed a distance learning pack in medication training, which involves an assessment of competence undertaken by the manager. The medication file contains a list of designated staff who can administer medication. Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a safe environment for service users in which they are respected and treated with dignity. Service users views are listened to and acted upon but additional training for staff in the area of Adult Protection is recommended. EVIDENCE: The staff have completed a distance learning course about Adult Protection but a recommendation is made that the home also access the training provided by the local Adult Protection Team. The home has had to recently deal with a protection issue. The Manager has liaised correctly and promptly with other agencies and the issue has so far been dealt with appropriately. The home has a complaints procedure in place and all staff questioned stated that they were aware of the procedure and that they would be confident about approaching either the manger or Provider if any issue concerned them. Service users also said that they would speak to the Manager or Provider if there was something they wished to complain about. There appeared to be confident and relaxed relationships between staff and service users. Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a home that is well maintained and decorated throughout and that provides a comfortable homely environment. Service users are supported and encouraged to personalise their living space and are involved in decisions relating to the redecoration of the home. EVIDENCE: The home has been undergoing a general renovation for the past 12 months and various improvements were seen. The kitchen is well equipped and maintained to a high standard and the staff have continued to increase the service user’s involvement this area. Improved washing facilities have been provided as well new flooring and tiles. The dining room has been decorated and the furniture replaced, greatly improving the appearance and atmosphere. Several service users said they were very pleased with their new dining area.
Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 Page 17 The refurbishment of the large hallway and stairs has now been completed and several bedrooms have also been redecorated. Some bedrooms have also been provided with new furniture and fittings. Service users spoken to were very positive about their rooms, all of which are personalised and organised according to personal preference and choice. The home provides spacious, comfortable and homely accommodation in a private location but with easy access to the local town. The large adjoining activity building has been reorganised making access to the facilities easier and ensuring greater usage by the home. The home was clean and hygienic throughout at the time of this inspection. Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by a staff team that relates well to them and has a positive approach to their care and support. Formal supervision of staff and improved care planning have helped produced a more professional service. EVIDENCE: The home has improved its induction training and process for new staff. New staff receive mentoring from an experienced staff member, supervision from the manager and have various competencies signed off as they progress. Basic statutory training is also undertaken as part of this. One staff member interviewed stated that the induction was very appropriate and that they were well supported by the staff team and the management during this period. Staffing files all contained the required information and there was evidence that all employment checks had been completed on new staff. Not all files have photographs in place but the Manager stated they were addressing this. All staff have now been receiving formal recorded supervision, which was a requirement from a previous report. The manager is also undertaking staff appraisals.
Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 Page 19 All staff are now up to date with the required training in first aid, fire safety, food handling, medication and health and safety. Examination of staff rotas and feedback from service users and care staff evidenced that sufficient staffing levels are maintained to support individual and group needs. Staff confirmed that, if requested, additional staffing can be provided to support specific trips or activities. Several staff commented that they thought they worked well as a team and that they received good levels of support and supervision from the management. Staff demonstrated an awareness of the care planning process that has been gradually introduced and how this can be used to meet the needs of service users. There is scope for further development in this area as staff become more familiar with the principles of a person centred approach to care planning. Service users interviewed spoke very positively about the staff and the Manager, and there appeared to be relaxed atmosphere within the home on both days of the inspection. Staff were observed interacting in a positive and appropriate manner with the service users, who appeared confident and relaxed in their home. Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from a home that is well managed and organised and committed to good quality care and support. However a structured and effective quality assurance system is needed to ensure that the outcomes of these standards are fully met. EVIDENCE: The Manager has developed an open and transparent approach to the running of the service. All staff spoken to were positive about the approachability of the management and the support that is provided. Service users interviewed also stated they were happy to approach the Manager or Provider on issues that concerned them. The Manager has provided leadership and direction on various improvements that have been introduced to the home, including care planning, training and staff supervision.
Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 Page 21 The manager stated that they had regular, often daily contact with the Provider, who plays an active role in the life of the home. They have now started having monthly recorded meetings, where ongoing issues and plans are discussed more formally. There is a significant shortfall still in terms of the self-monitoring, review and development of the service. Whilst some efforts have been made to incorporate the views of service users, the home is yet to develop a fully functional quality assurance system and a discussion was had with the manager about how this must be progressed. This needs to be in place to improve the quality rating of the Management standards. All fire safety testing and servicing has been completed and the home has completed a fire risk assessment. The home is maintained to a good standard but a recommendation is made that, considering the size of the accommodation, a more formal health and safety audit should be completed on a monthly basis. The home has completed all the required safety checks and staff were up to date with the required statutory training in first aid, fire safety and food handling and hygiene. Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 Page 22 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 Standard No Score 1 x 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 2 X X 3 x Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 Page 23 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 YA39 Regulation 24 Requirement The home must ensure that there are formal quality assurance systems in place. This requirement is repeated from previous inspection (previous timescale 31/12/06) Timescale for action 31/12/07 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 2 Refer to Standard YA23 YA42 Good Practice Recommendations The Manager and care staff should attend the Adult Protection training provided by the local authority. The home should introduce a more structured or formal system for the monitoring and checking of health and safety within the building. Apple Orchard DS0000016365.V334663.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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